Stacy Sims Thriving Through Menopause

Stacy Sims
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Juliet: [0:03:19] We are very excited to welcome Dr. Stacy Sims back to The Ready State Podcast. She is a forward thinking international exercise physiologist and nutrition scientist who aims to revolutionize exercise nutrition and performance for women.

Kelly: [0:03:34] We ran into Stacy over a decade ago working alongside solving some of the problems in the Tour de France and immediately recognized that she was onto something. And this was early talking about sex differences between men and women in sport. And she ended up going on to become the preeminent researcher and even wrote an incredible book about it called ROAR.

Juliet: [0:03:56] ROAR is one of those books that we have and give away. It’s one of our most gifted-

Kelly: [0:04:00] R-o-a-r.

Juliet: [0:04:01] R-o-a-r. It’s one of the most gifted books that we give as a family and recommend it to every coach and friend we know who works with any women athletes of any kind. She also did an amazing TEDx talk that you can find online called Women Are Not Small Men. I’m a huge fan of that.

Kelly: [0:04:18] Of a lot of the coaches in our world, Stacy has impacted Juliet and I massively on our personal behaviors in terms of how we hydrate, separating our nutrition from our hydration, to some of the behaviors that we do afterwards, even some of the ways that we try to supplement our sleep. Her new project is trying to take on the no space. And what I mean no space, the vacuum, the dearth of information out there about women transitioning from youth to post menopause.

Juliet: [0:04:47] Yeah. She’s talking all about perimenopause and menopause, which is like a desert when it comes to helpful and actual information out there for women.

Kelly: [0:04:56] We think you’re going to think that this conversation is probably one of the most important ones you’ve ever heard because there is a woman in your life, whether you like it or not, whether you believe it or not. And more importantly, for men, if you’re listening, if you are a coach, you need to listen to this because you’re going to run into coaching women in their 40s and their 50s and this is vital information, not only for your family but also for your practice.

Juliet: [0:05:18] This is really one of the most useful podcasts I think we’ve ever recorded. Please enjoy Stacy Sims.

Kelly: [0:05:23] Enjoy. 

Juliet: [0:05:25] Stacy Sims, welcome back to The Ready State Podcast. We think you are our first repeat guest so we’re so excited to have you. 

Stacy Sims: [0:05:32] Thanks for having me. It’s so good to see you. I miss you guys so much and I’m excited to actually just be able to chat.

Kelly: [0:05:40] Dear listener, let me just start by saying that there’s this concept from that World War Z movie with Brad Pitt where it’s the 10th person, where 10 people say the same thing, and then it’s the 10th person that’s obligated to go against and look at the hard data and say, “We’re missing something.” Their 10th person, it’s their job to be the contrarian. And in the movie, that’s why the Israelis were like, oh, they were ready for the zombies, because it was the 10th person who was like, oh, it’s zombies, it’s not something else. For me, you are one of the 10th person thinkers and one of the most influential people in my life.

Juliet: [0:06:15] I was like where are you going with this. I was like zombies and 10th person.

Kelly: [0:06:17] I know. I’m going to land this plane. Because you really have continued to influence the way I think about 50 percent of the people I interact with and in a way that no one else has. And for people listening, I’m talking about 50 percent of the world is women.

Stacy Sims: [0:06:31] Awesome. 

Kelly: [0:06:32] It’s probably more than that.

Juliet: [0:06:32] So I mean there are like 1,000 questions we have for you. And obviously, you’re writing a new book which we have 10,000 more questions about. But I just want to ask a few questions about things that are always on my mind, especially things that I talk with my neighborhood friends about related to pieces of advice that you’ve given me and things that I bandy about in my own life and attribute to you. But the first thing is I know people are obsessed with intermittent fasting. It may not be as hot as it was; maybe it was super 2020 hot and maybe now it’s like warm. But it’s definitely a question I get from a lot of people, like should I be intermittent fasting, should I be intermittent fasting. And honestly, my response is, well, if you are a woman, there is literally zero research to show that it’s helpful or good. You’re probably not going to lose weight, since that’s probably your goal. And chances are it’s going to mess you up. So I just wonder if you could share whether I’m still sharing the right information there and whether this is still a view you hold. But what’s your current thinking, your 2022 thinking, on intermittent fasting, especially for women?

Stacy Sims: [0:07:39] It hasn’t changed; you’re saying exactly the right thing. And I think what happens with the messaging is people think intermittent fasting is like the be all, end all for longevity. And if you look at the exercise data versus the intermittent fasting data that’s on general pop, the exercise data gives you the same longevity benefits that the intermittent fasting data does but it’s a stronger stress and your body adapts to that. So anyone who exercises regardless if they’re men or women should really think about not intermittent fasting, especially if they’re going to be training within that fasting window. But it’s super, super important for women not to do that because women need more carbohydrate in order to be able to get anabolic signaling from lean mass development and to get the fitness adaptations that they’re after.

Kelly: [0:08:30] We’re going to just call this whole podcast, #askingforafriend. I think that’s really… Okay, number two, second most influential aspect of Stacy Sims, I originally started working and becoming Stacy Sims aware way back in 2010 around some of the Tour de France stuff. And you really changed how we thought and how I thought about not drinking my calories if I could avoid it and treating my hydration separately than my nutrition. Do you still feel that way, that we should whenever we can, not drink our calories?

Stacy Sims: [0:09:06] Absolutely. Yeah. Especially in sporting environment, right, because we only have a small amount of carrying capacity for fluid and fluid is so super important to keep thermoregulation going, keep muscle metabolism going, and a lot of the times when people are drinking their calories, that stuff just sits in the gut and it doesn’t get absorbed and then the carbohydrate comes in but the fluid doesn’t. We end up dehydrating because we have the fluid that comes into the gut to help reduce the pressure that those carbohydrates give. So it’s like that effective dehydration and you don’t have the ability to come back from dehydration as fast as you can coming back from low blood sugar.

Kelly: [0:09:48] I do feel that in my sauna sometimes. I get a little behind and I’m like holy moly, there’s a little bit of a lag before I can replenish those fluids that I’ve sweated out.

Stacy Sims: [0:09:56] Yes.

Juliet: [0:09:57] Are you still asking for a friend because I have something?

Kelly: [0:09:58] We’ll get there in a second. So this is the perfect place to say the last time we touched base with you, you were working in a research capacity at the University of New Zealand, doing other things too. You’re here in San Francisco currently on an advisory panel kind of summit. But can you talk about what your day job is when you’re not having TV shows about nutrition or getting people to go really fast in the world of athletics like biking? Are you still at that same university?

Stacy Sims: [0:10:29] I have PhD students at that university but I’m not actively teaching or researching for that university. But I have .2 with Auckland University of Technology, which is a really strong research university in sport and exercise science. 

Kelly: [0:10:43] And you were specializing in heat stress?

Stacy Sims: [0:10:47] Yeah, heat stress and sex differences, all that kind of stuff. Still doing it but just at a different university.

Kelly: [0:10:54] I just wanted to bring it back to everyone that where your day job is, is talking about exactly what we’re talking about. That was my point in that.

Juliet: [0:11:00] Oh, okay, I was like where are you going. Okay, so I still have another asking for a friend. The other habit that I learned from you which I have been pretty darn religious about since I learned it from you-

Kelly: [0:11:11] True.

Juliet: [0:11:11] Which is I drink some—and we just talked about not drinking your calories—but I drink a scoop of protein powder within 30 minutes of exercise. Honestly, I think maybe for me because I really hate drinking water and I am probably dehydrated all the time-

Kelly: [0:11:27] Hypohydrated.

Juliet: [0:11:27] It’s possible that one of the best benefits I get from it is that right after I work out I get a bottle full of water with some protein in it. So I mean it’s possible that that has this sort of extra benefit. But is that still a thing because that’s another piece of advice that I’m out there bandying about in the world.

Kelly: [0:11:44] Especially for women.

Juliet: [0:11:45] And just saying, well, not only this is what I do, but I do this because Stacy Sims told me to do this. Am I still 2022 on the right track there?

Stacy Sims: [0:11:52] You are. You are. And the protein also helps rehydrate you because protein and amino acids help rehydrate all body spaces, where sodium is just really plasma space. And women have more anabolic resistance, especially as they get older. So if you’re really in the habit of getting that protein dose in really soon after exercise, then one, you’re enhancing your body’s ability for lean mass development, but two, you’re stopping that burnt down state, that catabolic state. If we stay in a catabolic state then our body perceives us as being in a low energy state. And if we have that low energy availability or low energy state, then we can see thyroid dysfunction, endocrine dysfunction, putting on belly fat. And as we get older, that’s something that can come on easily anyway, so we don’t want to encourage it.

Kelly: [0:12:40] So say we all.

Juliet: [0:12:41] Sorry, and can I add too, is there any specific benefit for men doing this as well or should everybody do this? Is this best practice is drink some protein?

Kelly: [0:12:52] And would it-

Juliet: [0:12:54] Drink or eat some protein within 30 minutes or is it specifically the timing beneficial for women?

Kelly: [0:12:59] Timing’s more important for women. Men, if you’re doing something that’s completely fuel depleting, like mountain biking or something, you totally burn through everything, then it’s really beneficial. But if it’s just resistance training or a short CrossFit type stuff, then if you’ve eaten before, your window’s about two or so hours, so you can delay eating until your next meal. That’s for men. But for women, different story because we clear blood sugar and we don’t rely very much on liver and muscle glycogen so we rely on blood sugar and we rely on fatty acids and so that’s another stress on the body that brings cortisol up. So it’s more important for women to time that nutrition than it is for men.

Kelly: [0:13:40] We have run into through the pandemic lots of eating disorders and lots of disordered eating, especially among young people and particularly in a lot of women in our lives. You were one of the first people who, we had heard of the old school way of the triad, but you really had kind of refocused my brain around thinking of this around I think you call it relative energy deficiency. Is that what it is?

Stacy Sims: [0:14:06] RED-S. Yeah, relative energy deficiency in sport.

Kelly: [0:14:09] In sport. Can you explain what that is and is that only about young women or does that work its way up the chain even to women in their 30s and 40s and 50s?

Stacy Sims: [0:14:20] It works its way up the chain and it also affects men. So the thing about relative energy deficiency, and we say in sport because it’s really prevalent in sport, is you get into this aspect of not timing your nutrition well, so you end up in that breakdown state I was just talking about. Or you’re not bringing in enough calories to fuel your training, to fuel your daily stress, and to fuel everything that your body needs to get through. And if you do that, then every system in the body becomes affected. So initially it starts with endocrine dysfunction that we see with women, menstrual cycle dysfunction. For men, it’s low testosterone. We see GI distress, we see increased blood lipids, a lot of LDL increases, cholesterol increases. We see a lot of vascular intolerance. So blood pressure issues. A lot of psychological disorders. So it becomes this big myriad that a lot of people go, “Oh, you’re over drained or you’re highly stressed.” But then it comes back down to you’re not fueling your body appropriately and if you don’t have nutrition, you can’t really be resilient to any kind of stress.

Juliet: [0:15:29] So I just want to add to this, Kelly kind of alluded to it, but one of the populations, partly because I’ve got two teenage girls that I’m seeing this in spades, especially because we have two teenage girls who are athletic and playing sports, is sort of people not, parents really struggling with how to feed their kids, how to advise their kids around sport, how much to feed them. In some sports like kids’ soccer, the pendulum really swung the wrong way because people were like feeding their kids 600 calories at halftime and then donuts and Doritos afterwards, right? So there was that pendulum swing that went that direction. But now it’s interesting now that I have teenage girls, what I’m seeing is the opposite direction. I go to all these water polo tournaments, I see a lot of really weirdly timed eating. Like kids not eating before a game and then definitely eating too much in between two games. And then overall a lot of girls in particular just plain not eating enough and I think having a lot of downstream impacts from that but not being able to make that connection, right? Teenage girls really struggle to make that low energy availability connection and sport performance. I mean what would be your top few pieces of advice to parents who are trying to… Because I know parents are struggling in navigating this. I have a friend whose daughter is… Neither one of them really feel like eating ever, but then they bonk in games, right?

Kelly: [0:16:51] Cramp and bonk.

Juliet: [0:16:51] Yeah. Cramp and bonk. So she’s going crazy because she knows their kids need to eat. But I realize that’s super broad because it’s obviously specific to certain kids and sports and whatever. But what’s sort of the broad advice takeaway to parents? Like how do we navigate this and specifically girls in sports because it’s I think exacerbated there.

Stacy Sims: [0:17:11] Yeah. I see it as young as nine. My daughter’s now nine. I can’t believe it. But I see a lot of these things happening. “I don’t want to eat. I don’t want to eat in front of people. I have issues around eating.” So I mean it’s endemic even at an early age. So what we found is using different language. So instead of parents saying, “Oh, you have to do this, you need to eat, you need to do that,” we skew it and say, “Well, we want to fuel for performance, we want to fuel to have energy, we want to fuel so that this second half of the game you’re able to kick it and really nail,” so we’re bringing it all back in a positive scope to the performance. And if we just focus on that, then the mentality becomes instead of calories, it becomes fuel for performance. And the kids grab onto that. And then you can worry about the rest of nutrition the day after they’ve nailed that concept because then they become so focused on the positive benefits they feel when they’re playing or when they’re training and they can connect it back to, oh, I’m fueled for it. And parents get really confused. It’s like, “Oh, you’ve got to eat breakfast, you’ve got to take all this with you, you’ve got to make sure you eat before a game, you’ve got to make sure you eat after a game, at practice, and you get home late.” And they’re kind of micromanaging the nutrition around it. But if we just take that one conversation and change the language to a positive scope of performance and how you feel, then that becomes the big rock and the one stepping stone that really opens up the conversation for kids to become aware of what it means to have that nutrition on board to perform well. 

Kelly: [0:18:47] And parents never bring their own nutritional baggage into sports with their kids or body image at all; it’s never happened. 

Juliet: [0:18:52] Oh no, no, none of that at all.

Stacy Sims: [0:18:53] Never, never.

Kelly: [0:18:54] I want to tell you, I want to give you an update. Stacy and I were at Naval Special Warfare doing a little talk there and Stacy was in front of… there were some generals there and some colonels and a lot of very smart people. And Stacy said, “If you can’t say the word period with your athletes or soldiers or people you’re working with, the problem is you. You are the problem in the room.” And everyone really was they give their downturned face. 

Stacy Sims: [0:19:17] And blushing.

Kelly: [0:19:19] And like she said the word period. It was such a great moment.

Stacy Sims: [0:19:20] So awkward.

Kelly: [0:19:21] One of the highlights. I turned to stop watching Stacy and just watched the room. It was great. 

Stacy Sims: [0:19:26] Awesome.

Kelly: [0:19:27] You then, one of the things you put on my radar was FitrWoman App, which I think you are a consultant on. Women’s National Soccer Team. A way of women communicating and tracking where they are on their cycles with coaches, with parents without having to have an overt conversation. But I want to tell you about a young generation of kids where in my life, so I won’t say their names, my daughter and one of her best friends, driving in the car and just talking overtly about their periods and their cramps and where they were and how they were managing it with soccer and sport and it’s no big deal. And I was just like, wow.

Stacy Sims: [0:20:04] That is awesome.

Juliet: [0:20:05] Evolution.

Kelly: [0:20:08] Because I have asked, I always ask my daughters’ friends about where they are. I just try to destigmatize it.

Stacy Sims: [0:20:15] Awesome.

Kelly: [0:20:16] And to see that thing where they brought it up and I was like, okay, I’m just going to be really quiet and really small in this car and just listen to these women talking about this aspect of their physiology and just completely owning it. I was like, Stacy Sims is winning the race slowly.

Stacy Sims: [0:20:30] Slowly. But winning. This is awesome.

Kelly: [0:20:32] Winning. Okay, so you do a ton of consulting, TV shows. Your last book blew our minds and has become a resource that we’ve handed out a thousand times. ROAR. And I don’t know if that was one of your first books or just your last book that I was highly aware of. You’re just about or in process of a new project. What is that project?

Stacy Sims: [0:20:59] So yes, ROAR was the first one. So when we released it, didn’t get a lot of traction until about a year after. But then the largest and loudest voice in that was the perimenopausal, menopausal set. So the 40 onwards women that were like, “Hey, you only have one chapter but there’s so much more I want to know and I still don’t know what’s going on with me.” Because of that and I kind of rolled with it because of what I was doing at Stanford, working with Women’s Health Initiative and working with that population, to me, I was like, why don’t you know this. I don’t understand why you don’t know what’s going on. And realized that it’s worse to talk about menopause than it is to talk about your period. So the basis of this new book, Next Level, is all about the menopause transition, what’s happening to the body, what’s happening with the hormones. We have a big chapter on alternatives to menopause hormone therapy or using menopause hormone therapy. So it really encompasses all of those questions. And then it dials down into training, how do you train, what is heavy lifting, why should you do heavy lifting and polarized training, what does polarized training look like. So it goes after all of those questions that started circulating after ROAR in this really rapidly rising, active population.

Juliet: [0:22:15] So I guess I am going to have a lot of questions about this and continuing on with my asking for a friend, I am 100 percent self-diagnosed perimenopausal at almost 49 years old in three weeks. But why is there such a dearth of information on this subject? Because I mean there really isn’t anything. And on top of that, it seems like OBGYNs and physicians are totally useless. I mean I have multiple close friends who went through really early menopause and literally thought they were dying and weren’t sure what was wrong with them, thought they had a terminal illness, only to learn that they had gone through menopause and were done with it by age 45 and not a single physician was able to identify that that was what their problem was. I mean this isn’t just one person I know. This is a lot of women are going through these struggles and some of them at a way earlier age than you’d expect. And their physicians aren’t picking up on it. And then there’s no information out there. I mean I will just, quick subtext, I wrote a really not very awesome article on our blog about how I’m preparing for menopause, and it’s one of the most visited articles on The Ready State, and it’s not our area of expertise. It is not really what we do. And for some reason, it struck a chord because there’s so little info out there. Anyway, that was a really long way of asking why isn’t there, I mean 50 percent of the population will go through this, and it’s a thing, and they’ll experience a lot of things, so why is there so little info?

Kelly: [0:23:40] And men would talk about it nonstop.

Juliet: [0:23:41] Yeah, and also, it’s like men have to live with the women going through these things.

Kelly: [0:23:44] I’m not saying that. I’m just saying if this happened to men, we’d be like, hey.

Juliet: [0:23:47] Yeah. There’d be like a thousand books on it.

Kelly: [0:23:48] That’s what I meant. So let me clarify: We would wah our way right to the top of-

Juliet: [0:23:53] Well, and there’d be a cure. You guys would already have a cure. There’d be a cure for menopause if it were men. But anyway, sorry.

Kelly: [0:23:58] Take it away.

Stacy Sims: [0:24:00] So that’s the first reason right there, the whole patriarchal upbringing of the medical community. So everything’s viewed through the male lens. And if we talk about having hard enough time getting research done properly in premenopausal women because of the menstrual cycle and hormone fluctuation, the research stops at 40. The age cutoff for research for women is 40 evidently, because then it becomes really too difficult with all the hormone fluctuations that are going on, estrogen dominance, no progesterone, short cycles, long cycles, and people are afraid to dive into that because the male lens of research and the way that research studies are set up through that male lens of let’s be as short and tidy as possible instead of really trying to accommodate a woman in her life. We know that there’s a lot of research post menopause because this is where we see a drain on the healthcare system, right? All of a sudden, we have that uptick of obesity, we have an uptick of cardiovascular disease, metabolic syndrome, diabetes. And people are like, okay, what’s going on. And that’s why we have all of this post-menopausal research in a sick population. But in the perimenopause, people are like, “Shh, don’t talk about it. Shh.” And we looked at some of the research that does come out in that in active women, resistance trained women, and start to see what’s happening from metabolic standpoint, what’s happening from a muscle standpoint, and it’s really compelling. So Amanda Gould and Abbie Smith-Ryan of UNC Chapel Hill published a study maybe three weeks ago that specifically looked at what happens from a metabolic and a body comp standpoint and found that there’s decreased metabolic flexibility. So women in perimenopause, they tend to rely primarily on carbohydrate throughout all intensities of exercise, whereas pre and post-menopausal, they have that flexibility to go from carbohydrate and fat and amino acids. And there’s a really strong signaling for putting on visceral fat and there’s less of an anabolic signaling post exercise unless it’s resistance training and unless it’s high intensity. So we see this conversation that physicians will say, “Oh, do 150 minutes of moderate intensity activity or go on the ketogenic diet.” Why the ketogenic diet? Because there was one, maybe two, papers that came out in a relatively sick, obese, postmenopausal population that showed that the ketogenic diet worked. But now it makes the rounds through the medicine community or medical community saying this is the be all, end all for every woman that’s experiencing the menopause transition or post menopause. Physicians are not aware because it’s out of their wheelhouse. Again, they have a hard enough time dealing with people who have menstrual cycle irregularities. What’s their answer? Let’s put you on an oral contraceptive pill. If you are perimenopausal and talking about heavy bleeds or light bleeds, your change in menstrual cycle, they’re like, “Maybe you should go on an IUD because you’re not young enough, we don’t want to put you on an OC, but let’s put you on an IUD. That’ll help fix you.” It’s all about the hormonal fix instead of actually investigating what’s going on. And when we really start to dig into the different sections, like fertility research and seeing what’s happening there for women who want to have kids at an older age and really investigating what’s happening with the hormones, and we’re looking at cell research and the mechanisms and what happens with estrogen and progesterone deficiency, and then we have whole body research that’s slowly starting to come out, we get a really good picture. But it’s not translated to the medical community because they’re taught in classes that women might have some OBGYN issues, but that’s for that specialty, it’s not for GPs. So I’m really not surprised that your friends went through it and had no information and no help whatsoever. 

Kelly: [0:27:50] Who’s doing the best in all the aspects of research, developing a more cogent model to support especially performance through this. And when I say performance, lean muscle mass is about performance, body composition is about performance, VO2 max, all the markers of longevity and durability are also markers of performance. Who’s doing a good job right now? Is this coming out of sport? 

Stacy Sims: [0:28:17] Yours truly.

Kelly: [0:28:18] Name three menopause researchers, Kelly, go. Uh, Stacy Sims and uh-

Juliet: [0:28:22] Stacy Sims, Stacy Sims.

Kelly [0:28:24] There’s some women in University of North Carolina I found out just about like one minute ago.

Stacy Sims: [0:28:26] Yeah. Yeah. Abbie Smith-Ryan is a really interesting woman, in a good way. She does a lot of the supplement research that we know. So all the creatine stuff that’s come out and the benefit for women, she’s done that. She’s around our age and so she’s really interested in the perimenopause, so we keep pushing for it. We’re writing review papers on it. And so she’s done some research on it, I’m doing research. But anyone else? They’re all focused on the premenopause because of the conversations that come up in that, which is great. I love it. But there’s this huge population where I’m like, hey, there’s only two of us that are doing the research here on the active population; why don’t we get more people involved?

Juliet: [0:29:07] So I want to turn a little bit because you mentioned it but I want to talk broadly about the exercise piece here for perimenopausal, menopausal women or active women. How is that different than… What should women really be thinking about that’s different than say how they would train in their 30s? And then one sidepiece: What I see a lot of women doing that are my age is a ton of cardio and nothing else. And I think the pandemic really exacerbated that because everybody got a Peloton and there were a lot of… I mean I’m a huge fan of Pelotons and I think it really helped people survive the pandemic. But sometimes I see that’s the only thing. People are able to say, I can relate to, and get in a little bit of cardio. But that’s the sum total. So anyway, what should women who are in this age range and want to be active and sort of combat this process as much as they can, what should they be doing?

Stacy Sims: [0:30:02] Staying out of that moderate intensity zone, so that gray zone that everyone falls into. They really need to learn how to polarize the training. So if you’re doing cardio, it’s that sprint interval or it’s really true high intensity interval training. It’s dropping the volume and focusing on intensity. And the reason for that is women are already really endurant. We’re born with more slow twitch fibers. We can recover from submaximal stuff faster than men. And we have more protein in the mitochondria for burning free fatty acids. So our bodies are built to go long and slow. So we look at what are we doing when those hormones flat line; we need to find an external stress that’s going to take the place of those hormones in a positive manner. So we need to polarize the training. If we’re talking about resistance training, and I’m now notorious for saying, “Lift heavy shit,” because we need that power behind the resistance training to stimulate the way estrogen used to stimulate the actin part of the actin myosin chain. Women also do way better with strength and power resistance training regardless of age. But really critical when these hormones start to fluctuate to focus on strength and power development because we need to maintain fast twitch, we need to maintain that neuromuscular connectivity for that strong muscle contraction, otherwise we are predisposed to sarcopenia because of the ways that our bodies are deteriorating.

Kelly: [0:31:29] And sarcopenia is loss of lean muscle.

Stacy Sims: [0:31:32] Muscle mass. Yeah. And putting more fat in where the muscle used to be. So that cardiovascular stuff, that moderate intensity, it doesn’t have the right kind of stress to be able to support what our bodies need.

Kelly: [0:31:044] So when you’re saying polarization, let me just clarify it for everyone, one is making sure that if you’re in this category of person right now, one is saying higher intensity and some loading. What’s the other side? What’s the polarization? What’s the other side of that then?

Stacy Sims: [0:31:58] Super low, low, embarrassingly slow recovery type stuff. So if you really enjoy your Peloton and you’re doing your sit training on the Peloton, then the next day maybe you’re doing 50 percent of what you normally do with regards to RPE or intensity. So super, duper, duper slow. If you’re a runner, it’s like embarrassingly slow where power walkers could pass you. And it’s all about the recovery aspect. It’s not about how long you’re out there. It’s about enjoying that really low-end recovery. And when we’re looking at resistance training, if you’re doing the high intensity resistance training, so it’s low volume, heavy weight. Then on the low end of stuff, you’re looking at mobility functional stuff, how is your technique under the bar. So it’s really looking at the two different days and how are you stacking those. So we do two high intensity days and then we really drop it down and do super, super easy, then maybe a moderate, and then another super easy. So we have two hard days and then super easy, moderate, really two hard days. So it’s really looking at the week to have that high intensity work, the body adapts a response to it and recovers from it and then we get that stimulus again.

Kelly: [0:33:20] Thank you.

Juliet: [0:33:20] So I still, obviously I live partly in the CrossFit world where people are not afraid to lift heavy shit and interact with barbells and lift stuff. But I also, I’m a mom and have lots of friends who like to Peloton and whatever. But I think sometimes there’s this like, okay, well, I went to my spinning class and I did some one-pound weight curls while I was at my spinning class. Would that kind of work/qualify? And also, I would add yoga to that question. Would yoga qualify as the strength training of choice and/or lifting one-pound weights at a cardio class?

Stacy Sims: [0:34:00] No.

Kelly: [0:34:01] Asking for a friend.

Juliet: [0:34:01] Asking for a friend.

Kelly: [0:34:02] And not me.

Stacy Sims: [0:34:04] Yeah. Not you. Absolutely not. We had this conversation about one of the influencers that is always about don’t lift more than one pound, pick the pink dumbbell. It’s like no, that’s absolutely not what we’re talking about. If you are new to resistance training, then yeah, maybe one pound is heavy to you. But that is not heavy enough to get the stress that we need when our hormones start to fluctuate. And there is this huge lack of confidence in this age group because we grew up with Jane Fonda, we grew up with Kate Moss and the supermodels and no muscle tone and calories in, calories out. And so that’s the undercurrent in that mentality that a lot of women have in this age group. And if you go to a gym, you get the intake form, right, and it says what are your goals, and most women say to lose weight. And that’s the automatic signal to show you to the cardiovascular area, right, the cardio equipment, the elliptical. But it’s not any bells to say, “Here’s the resistance training. Let’s move you to the squat rack and move the guys out of the way.” Or if you go in, right, and it’s very squat rack, weight room, and very much the very back corner of the gym, and all the cardiovascular machine in the front, so it’s perpetuating those images that women need to be doing cardiovascular work. So it’s a big push for us in the field of fitness to push women beyond their comfort zone, to pick up a barbell, and maybe a 15-kilo barbell is heavy for them and you can lift it five times with really good form. Sweet. That’s heavy lifting at this moment in time. But we need to give the idea away that doing heavy gear work on the bike is going to be resistance training or lifting up a one-pound dumbbell is resistance training.

Juliet: [0:35:51] And sorry, could I just have you comment on the yoga question, which by the way, I’m a fan of yoga so I’m not trying to down on yoga. But are people getting… Is yoga the resistance training that people need-

Kelly: [0:36:01] That could be the zone one, zone two recovery.

Juliet: [0:36:04] Please speak to that because I will say I know a lot of people who will say, “I did my workout, I did my strength building, I went to yoga.” And I’m always like side head.

Kelly: [0:36:14] Hey, your elitism is showing.

Juliet: [0:36:16] Sorry.

Stacy Sims: [0:36:17] No, that’s all right. I agree. No, yoga is good for that zone one recovery stuff. It’s really good for balance and coordination, which we need to work on. But again, it’s not the stimulus that we’re looking for to promote lean mass development and reduce that visceral or that deep abdominal fat gain. The other aspect of that heavy resistance training is it causes what we call an epigenetic change in the muscle so that you don’t have to rely as much on insulin to pull sugar in because women become more insulin resistant when they are going through perimenopause. So there’s a whole cascade of things that happen when you are looking at heavy dumbbells, heavy barbells, and it’s really super important that we break down that barrier and make people, especially women in this age group comfortable to lift heavy and push into what it means to do true resistance training.

Kelly: [0:37:08] This is going to be the most important podcast. I’m going to have to go back and listen to this over and over and over again. As men age, there’s something called HRT, hormone replacement therapy, or TRT, testosterone replacement therapy. But I heard you say something different. You said menopause hormone therapy. 

Stacy Sims: [0:37:22] Yeah.

Kelly: [0:37:23] I think that is the first time I’ve ever heard that phrase. And I am not a dullard and I am sort of in the world deeply obsessed with all of this. Why is that not a phrase that we’ve ever heard before or talked about before?

Stacy Sims: [0:37:36] That’s a good question. I learned it waaaaay back when I was working with Marcia Stefanick at Stanford. And it stems from the fact that we’re not replacing hormones because the exogenous hormones through menopause hormone therapy do not do the same things as natural hormones. Their molecular structure is different. They’re not something that you gravitate towards for improving body composition. They might slow the rate of lean mass loss but it does not perpetuate the same thing that estrogen does with regards to muscle development and changing body composition. So people have in their head that if I take hormone replacement therapy or HRT then I’m good to go and I’m not going to have all these changes, and that’s absolutely not true. There’s a time and a place for menopause hormone therapy. It is a therapeutic agent to help you get through vasomotor symptoms, night sweats, vaginal dryness, all of the issues that you have that impact quality of life, but it’s not replacing your natural hormones. 

Juliet: [0:38:37] I think that’s really helpful to know and I think maybe you said, although I think a lot of women I know, their chief complaint around menopause is weight gain. And I think it’s partly because there is so much misinformation and noninformation in this category that there’s sort of an idea that if you take hormone therapy, then you’re like, sweet, I’ll be good and that’ll fix my weight gain problems and I’ll be good. And it sounds like you’re saying not really; it might help in the short term solve some other issues.

Kelly: [0:39:02] And you can see that women step on this rake of conditioning where your chief complaint is my body composition is changing as I go through menopause or perimenopause and then I fall right back into the traps of calorie restriction, disordered eating.

Juliet: [0:39:17] Yep. Don’t eat a carb. 

Kelly: [0:39:18] Right. Because carbs are bad. And then add in the fact that people are not sleeping, which I want to talk more about, and then we go reach for the cardio. And it’s like a hot mess, isn’t it?

Stacy Sims: [0:39:30] I know. It’s totally. I mean I have in my head the typical woman who’s not informed, right, she’s freaking out about body composition, she’s having vasomotor symptoms. She goes to her doctor who knows a little bit, and the doctor’s like, “Let’s put you on hormone therapy because that’s going to help. It’s going to help with everything. It’s going to settle your anxiety. It’s going to help you sleep. It’s going to help with night sweats. It’s going to help with body composition.” And so she gets put on it and it helps with the night sweats so then she sleeps better. If she sleeps better, then she has more motivation. If she has more motivation, then she can actually think about what kind of training she’s doing. So if we think about hormone therapy in that perspective, then yes, great. But she things automatically that that hormone therapy is what helps with the body composition because she doesn’t put the steps together; no one tells her those steps that go together. So this is why we say menopause hormone therapy is good if your quality of life is affected by things like night sweats and vasomotor symptoms because that interferes with quality of sleep. 

Kelly: [0:40:31] Will you define vasomotor symptoms for folks?

Stacy Sims: [0:40:32] That’s daily hot flashes. So it’s that heat rising and sudden sweat and then you’re freezing and you’re shivering right after.

Kelly: [0:40:41] I’ve never seen any women in my life do that.

Stacy Sims: [0:40:43] Yeah, right.

Kelly: [0:40:43] I’m not looking at you, J, I’m just looking at all the women in my life.

Juliet: [0:40:47] Lisa. She’s like I’ve never had a hot flash in my life.

Kelly: [0:40:50] I’m like are there women who have teenagers, I’m like, okay. We go to our local hangout group parties and people are talking massively about thermoregulation. And it’s really disruptive. You were one of the first people I talked with… We were on the sleep program I think, I was, because in a high performance especially male dominated society, but also children, if there’s no sleep, we can’t even tell what’s going on.

Stacy Sims: [0:41:17] Exactly. 

Kelly: [0:41:17] And I started to realize if you aren’t sleeping, I can’t even begin to understand your pain or your chronic pain or your persistent pain. There’s just too much signal noise to understand, get good data. You started talking about that there were supplements women could take—tart cherry was something you talked about literally a million years ago, Stacy Sims level one was tart cherry.

Juliet: [0:41:38] Stacy Sims 1.0.

Kelly: [0:41:39] Are there some things or how should women begin to untangle this performance because you just really put all of it together that it’s a system. No system works by itself; no aspect of the body works by itself. Changing the ecosystem influences the whole person. So the sleep piece is something that people really struggle with. Have you changed the way you think about how you’re helping people in transition or all athletes sleep? Or do you feel like there are different needs for people who are menopausal and perimenopausal?

Stacy Sims: [0:42:09] I’m a huge fan of adaptogens. I started studying them with a colleague at Stanford who was studying black cohosh for menopausal symptoms. And we were doing some research into vasomotor symptoms. And I started using them when I was doing all the Tour de France travel but I never really thought about, oh, how beneficial it could be for anyone else. But we look at adaptogens like ashwagandha and matcha are massively helpful with this whole perimenopausal transition and using things like DIM, which is the key ingredient in all your broccoli-

Juliet: [0:42:42] Greens like broccoli and stuff. Yeah.

Stacy Sims: [0:42:44] And in cauliflower, right, because it helps with estrogen metabolism. So if you’re thinking that I’m highly stressed and I have this fluctuation of hormones and high cortisol, well, we put you on ashwagandha because ashwagandha is an herb that directly interrelates with your HPA, so your cortisol, you might still produce as much cortisol, but your body doesn’t respond to it in the same way because the ashwagandha attaches to some of those receptor sites so your body isn’t as stimulated by it. So it helps you with parasympathetic response, helps you relax, helps with anxiety. And it also helps with balancing out estrogen, progesterone. Matcha has some really good peer review data. If you’re using matcha on a regular basis, it does pretty much the same thing as menopause hormone therapy with regards to vasomotor symptoms and night sweats and the inability to sleep and having that anxiety. So these are some of the things that we really try to get people to use first before they be all, end all go to hormone therapy.

Kelly: [0:43:45] And don’t worry, everyone, all of this is in this brand-new book by Stacy Sims. You’re taking frantic notes. Everyone over here, we’ve all got pages of notes going on. But it’s all written down for you.

Stacy Sims: [0:43:55] Yep. And my husband’s favorite one is holy basil because he comes from… His favorite uncle was a priest. He’s like, “Holy basil.” So if anyone remembers it, it’s tulsi, holy basil. And this one is really fantastic for the whole encompassing aspect of brain fog, of fluctuations of estrogen dominance, inability to sleep, the lack of mojo. So it’s like let’s start with ashwagandha, let’s start with matcha, let’s start with holy basil, and then we’ll see how you go. It takes about three weeks for everything to come up and work well because it’s not something that is a drug. It doesn’t directly go in and interfere. It actually works with your body’s system so it upregulates and downregulates the way your body responds to hormones. So if you don’t have enough estrogen, then it makes your estrogen receptors more sensitive to the estrogen that you do have. So that’s how it moderates some of these aspects that we have in this menopause transition.

Kelly: [0:44:52] Amazing.

Juliet: [0:44:53] So I just want to go back to the food thing as sort of a tale on the intermittent fasting because I know you have an entire chapter in your book called “Eat Enough.” And I’m assuming eating carbohydrates is part of that recommendation. But I’d love for you to talk about that because I will say that having been an early CrossFit person, I still am sort of like, I intellectually know that I should eat carbohydrates, but I definitely am always like, ah, carbs. So asking for a friend. I don’t know. I just get stuck in that mental rut of carbohydrates bad. But do you… I guess the question is, again, because I think for so many women the chief complaint is weight gain and not having the body composition they want. And my guess is a lot of women are trying to solve that by calorie restriction or carb restriction or restriction restriction or juice cleansing or intermittent fasting or whatever. And it sounds like maybe that’s sort of akin to banging your head against the wall. Is that often just going to be counterproductive for women? Would you just talk a little bit about am I on the right track there at all?

Stacy Sims [0:45:51] Yeah. Absolutely. Carbohydrate’s super essential. As we get into this transition, again, it’s the timing of nutrition and carbohydrate. So the types of carbohydrate we need to be a bit mindful of and we want to go for fruit, veg, whole grains for two reasons: One, women are more insulin resistant, so those types of carbohydrates are better for insulin resistance. But other’s gut microbiome. So we have sleep disturbances, we have high stress, and we have other things that actually change gut microbiome. So if we’re eating carbohydrate from fruit and veg and whole grains then we actually have the prebiotic type fibers that feed the gut, which encourages the growth of the Bacteroides type fila that encourages lean mass development and keeping you lean. So it’s a one, two hit. Don’t be afraid of carbohydrate because we need it; our bodies need it. Especially in this time where we have a higher sympathetic drive, we’re under a lot of stress, and our body is like we need carbohydrate to help attenuate that. And then the other is we really need to take care of our gut microbiome because of that additional stress, the gut is undergoing a lot of changes and if that isn’t taken care of, then it perpetuates the poor sleep, it perpetuates the anxiety, it perpetuates that sympathetic drive. 

Kelly: [0:47:07] Did you see the study that just came out, I think Galpin put it up, where they took some of the strains of gut microbiome from an Olympic gold medalist and it turned out to be very useful as a transplant. I was like, ooh, here comes the fecal transplant, that transplant train, let’s go.

Stacy Sims: [0:47:26] Yeah, I know. I read that too and I was like, yeah, interesting because it could also go the other way.

Kelly: [0:47:32] Yeah. I think it was done on mice, just so we’re clear. Don’t-

Juliet: [0:47:38] Don’t get too excited.

Kelly: [0:47:38] Don’t knock on the door of our Olympic gold medalist.

Juliet: [0:47:38] Okay, so can I ask another-

Kelly: [0:47:40] Oh yeah, go. I’m just on this train.

Juliet: [0:47:43] I’m kind of on this tip only because I just got a DEXA scan. And I’m giving myself a high 10 because apparently to be-

Kelly: [0:47:50] Off the chart.

Juliet: [0:47:52] You had to have the high for my age was 2.5 and I was a 3.5. Yeah. And so but I know that is entirely because I have been lifting a weight for my entire life. But can you talk a little, because we all went through the early 2000s phase of let’s eat 5,000 calcium chocolates.

Kelly: [0:48:13] Vivactin.

Juliet: [0:48:18] Yeah, Vivactin and we had the supplement thing. And if I’m not mistaken, taking calcium and other supplements for protecting your skeleton has been 100 percent debunked and the only way to protect your skeleton is to lift a weight. I mean I don’t know if I’m oversimplifying. Please elaborate.

Kelly: [0:48:31] So we’re talking about bone density here.

Juliet: [0:48:33] Yeah. Bone density.

Stacy Sims: [0:48:33] Yeah, bone density. So yeah, taking supplemental calcium doesn’t do anything. And you need estrogen, natural estrogen, calcium from food and Vitamin D to really interact. And again, when you start losing estrogen, it’s like, okay, what do I do. Jump training. So it’s lifting heavy, but plyometric jump training. There’s some really fantastic new research that shows 10 minutes of jumping three times a week is such a massive stimulus for bone turnover and maintaining and building bone density that it should be prescribed. Physicians should be prescribing this. And it doesn’t mean you have to go do 30-inch box jumps. It can be jumping off a stair. It can be doing star jumps in your living room. But that multidirectional stress of jumping is really super important because the different impact forces create the stimulus for bone mineral density. Running, no, doesn’t do it, it’s not multidirectional. Trail running, no. People are like, “But I trail run and it’s multidirectional.” No, it’s not the right kind of stress. You need the impact force to the ground from jumping to stimulate that as well as heavy resistance training.

Juliet: [0:49:45] What about jump roping?

Stacy Sims: [0:49:46] Yeah, you can do that too.

Juliet: [0:49:49] We’re just huge fans of jump roping so I was looking for a seal of approval there.

Kelly: [0:49:53] It’s in our new book. We just turned in the manuscript. It’s too late.

Juliet: [0:49:55] Yeah, I was like we just turned in the manuscript saying people should jump rope so-

Kelly: [0:49:58] People are jump roping. Yeah, there is an old saying, I think there is this group of people, they’re former Soviet sports research, they say, “When you stop jumping, you start dying.” 

Stacy Sims: [0:50:08] Oh. I like that. 

Juliet: [0:50:10] It’s funny that there’s always a Russian saying. There’s almost a Russian saying for everything in your life.

Kelly: [0:50:15] This wise calf that nurses two mothers. All right. Okay, here’s something: The preeminent expert in sex differences in sport, period. As you have gone down this rabbit hole of trying to simplify this really complex changes in human physiology, which is the most complex system in the known universe, the brain is the most complex structure, attached to really complex physiology, what surprised you about trying to come up with a blueprint or things that we were getting right or wrong? And writing this book, were there any surprises for you?

Stacy Sims: [0:50:55] That’s a good question. I don’t know. I would say more of the research that’s been done on menopause hormone therapy because I come from the whole bind of women’s health initiative where it was a big scare. But as we started looking at the newer research and understanding what’s going on and the earlier you started, there is no risk. But the other thing that was surprising and really interesting is resistance training on prevention of dementia. So if you have family history of dementia and women start becoming very concerned because they start getting brain fog and they’re like, oh gosh, my grandmother has dementia and Alzheimer’s, what am I going to do for my brain health. So you hear about aerobic exercise really helping because it helps with the frontal lobe growth. But resistance training is a really unique cascade pathway that encourages nerve growth and neural growth. And it’s really super beneficial for prevention of Alzheimer’s and dementia. So we start that early, right? And when people get into the menopause transition and I start talking about heavy lifting, it’s not just for muscles, but it’s also for brain health, for having that quality of life and remembering where you put your keys when you’re 95 years old. 

Juliet: [0:52:07] And can I just for emphasis say resistance training equals lifting heavy weights.

Stacy Sims: [0:52:16] Yes. Thank you. 

Juliet: [0:52:18] Just for emphasis. Asterisk.

Kelly: [0:52:18] Before we started chatting, you were like, “I wish I had taken this supplement earlier in life.” Could you talk about what that was? And then back into as people are, let’s just say that you’re in your 20s and 30s, how can we set ourselves up for success for aging? It’s so difficult to put bone mass back on, especially if you tinkered with your endocrine system as an earlier person, you’ve had an eating problem, or your sport watching your weight, or any of the thousand other reasons you can roll into your 20s and 30s not well prepared for these changes. What are some of the things that we should be doing as we’re prepping because I mean is really aging, does it begin, or if I’m going to be in my 40s and 50s as a woman, should I be thinking about that in my 20s and 30s, and can I? And then were there some things that you were going to take that you wished you had taken earlier?

Stacy Sims: [0:53:14] Yeah. So the thing about aging is that men age in a linear fashion. So everything we know from aging research is based on that linear projection that a lot of, well, most men have. But women, we age definitively at this menopausal transition. So we start seeing this whole cascade of events. If we are in our 30s, we have to have our eye towards what’s happening in our 40s; it’s going to be completely different. But not to be fearful of it. But to start putting into play some of the steps that we would do in our 40s. So it’s putting the emphasis on intensity and resistance training, less on volume. Of course, there are people like, “But my soul food is to go for a long ride or a long run or a long hike.” Yeah, sweet, that’s good. But don’t make that your everyday mainstay. Like you have to really think about polarizing. You have to think about what is high intensity and learning what that high intensity is. So then when you get into your 40s it’s easier to navigate because you’re not going to have as many changes to your body because you’ve already put those steps into play. We talk about supplementation and what we should do to supplement, we know that after the age of 30, you really start to have a decline in your collagen. And we see this apparently in the menopause transition because we have stiffer tissues, which I’m sure you guys are more aware of, and sore joints, and a lot of systemic inflammation. So if we start loading up on collagen early, early, then we can attenuate the decline that we see in collagen. And we can still support our tissues and maintain joint health. But it’s also looking at taking native and peptide together because they act differently in the body. So if we look at native, it doesn’t get digested, it causes an immune response that automatically stops the degeneration of cartilage and stops the degeneration-

Kelly: [0:55:02] So when you say native, you’re like bone broth, bone marrow, [inaudible 0:55:05] connective tissue, cooking your meet on a stick, is that what you’re talking about? And by stick, I mean bones. Is that what you mean?

Stacy Sims: [0:55:11] Yeah, so you’re looking at collagen that hasn’t been broken down. So if it is in bone broth or if you are eating bones in fish, then you’re not really going to digest the whole collagen that’s in there, but your body’s going to respond with an immune response to stop breaking down your own cartilage and stop breaking down your collagen. But then you have peptides which is the broken-down part of collagen that you get as supplements, and that’s digested in as a target tissue response where it will directly go to, like if you have the type twos, they go to cartilage and they start signaling the body to start rebuilding and start rebuilding the collagen associated with that. So we have to think about what kinds of collagen that we’re ingesting. Yeah.

Kelly: [0:55:55] I feel like as I get older, it is all about connective tissue health for me. Like that is the game. Everything else, I’m like, that’s nice. Cute, I have some quads. Can I talk about the tissues connecting my quads to everything else? I mean I feel like that is going to be the money play.

Stacy Sims: [0:56:10] Totally. Yeah.

Kelly: [0:56:11] Check out the connective tissue on that person. 

Juliet: [0:56:15] Sexy. And I think you also said something earlier about creatine.

Stacy Sims: [0:56:20] Yes. Yes. For sure. So women have about 70, 80 percent less creatine storage and availability than men. And we start losing it. And it’s also menstrual cycle effect. So we know that in the low hormone phase, follicular phase, we use a lot of creatine. There’s a high or actually a low response with CK. But in the high hormone phase, our body is using it not for muscle and brain energetics but to build that endometrial lining. So if we’re looking at supplementing with creatine to help with fast energetics and brain health, we want to supplement in the high hormone phase so that our body will actually be able to put it to use rather than trying to use it in the low hormone phase where it’s like, yeah, we might store it. But if that’s too complicated, just take three to five grams every day, not loading up, just that really small dose because it goes and helps every tissue of the body that has fast energetics. You’re thinking brain, gut, heart, muscle, all that kind of stuff.

Kelly: [0:57:25] Wouldn’t it be more fun to go back to the ’90s and take it with all that sugar? We had to load creatine with just massive amount of carbohydrate.

Juliet: [0:57:32] Drink it through a Red Vine straw.

Kelly: [0:57:33] Yeah, it was EA Athletics, remember? You had to drink, it was like thousands of grams of carbohydrate to load your creatine.

Juliet: [0:57:41] Get a little bit of creatine. So I’ve got a question here which I probably should’ve asked at the beginning of this podcast so 50 percent of people didn’t turn it off and decide it wasn’t for them. But of course, many men will have a partner who’s a woman who goes through all of these changes. And I mean I don’t know if this is a chapter in your book, probably not your target audience, but what should men know about this?

Kelly: [0:58:04] Everything. 

Juliet: [0:58:04] Right. I mean other than everything we said. But what should they know about it in terms of how to be a partner to a person like this?

Kelly: [0:58:10] And let me dovetail on that, if you’re a coach-

Juliet: [0:58:14] Yeah, or coaches.

Kelly: [0:58:14] If you’re a coach at all, you should read ROAR because if you’re not thinking about the sex differences, you’re a shitty coach. I just said the word. So we’re even. Second, is if you’re working with a woman over 45… You said the word once before. But if you’re working with a woman over 45 or perimenopausal, whenever that happens, and you don’t understand, you are part of the problem also. So I mean this affects a lot of people, to your question. 

Stacy Sims: [0:58:43] Yeah. Yeah. I’m really surprised at how many men take my courses or come into the Facebook Lives or Instagram Lives and listen to some podcasts because they’re really interested in helping their wives and partners and their daughters. And at the summit, there was a guy who was in tears. He’s like, “Every time I hear you speak, I get tears in my eyes because I think of my daughter and my wife and now, I know how to help them.” And it’s that conversation and that push. It’s like don’t tune out if you’re a guy because you have a mother, at some point you had a mother, you probably had some partner or a sister or a daughter or a best friend or a best friend’s wife that is going to have questions and go through this. So it isn’t put your head in the sand; it’s understand what’s going on to be supportive. And it’s not a massive amount of literature. It’s just understand the fact that she is going to go through this and don’t put her in the early 1900s insane asylum because you don’t know what you’re doing.

Kelly: [0:59:40] No, no, seriously, that womb just wanders around the body. I find it underneath the bed sometimes.

Juliet: [0:59:47] So I mean speaking of an insane asylum, there is an area that I would love you to cover a little bit, and this is anecdotal from, again, people I know. Asking for a friend. But I do think a lot of women actually feel crazy during this time.

Stacy Sims: [01:00:00] Oh absolutely. Yeah.

Juliet: [1:00:01] And again, often aren’t getting the right support that they need from the medical community who are like, “There’s nothing wrong with you. We’ve done your bloodwork and you’re fine.” And yet they’re like, “Wow, I feel crazy. What’s going on there?” And is that like a short-term passing thing and once they’ve passed to the other side of menopause, they’re going to wake back up and be like, hello, I’m back. Or how do people frame this and who do they reach out to for support? What do people do who go crazy?

Stacy Sims: [1:00:29] Yeah. I brought up the insane asylum because women actually were put there because of all of the craziness that happens in menopause.

Juliet: [1:00:36] Probably by the Sacklers. 

Stacy Sims: [1:00:38] Yeah.

Juliet: [1:00:40] Sorry. I just finished that book, so.

Stacy Sims: [1:00:43] Oh okay. Yeah. Good popular reference. But when you’re having fluctuations of estrogen and progesterone, they cross blood brain barrier. So they cross the BBB and they interfere with your neurotransmitters. So if you have a huge upsurgence of estrogen because of estrogen dominance, it crosses the BBB and you end up with a lot of hyperactivity of serotonin. And then you have a huge serotonin dump after estrogen starts to go down so that causes a lot of depression and anxiety. And you also have downregulation of dopamine so you’re not going to get that feel good feeling because you don’t have as much dopamine. So when you’re starting to feel crazy and anxious and really this intense rage that you didn’t know that you ever had in your life and you just flick of a switch you feel like you’re going crazy, it’s because of the way that the hormones are interfering with the neurotransmitters. And again, you can work with brain specialists, you can really look to adaptogens because they are really fantastic at mitigating those neurotransmitter changes. And if you’re really struggling with all of these brain symptoms, the brain fog, severe mood changes, feeling crazy, the first step is looking at using an SSRI. So serotonin reuptake inhibitor. Not necessarily for anxiety and depression but they also help with all the other symptoms. They help with vasomotor symptoms, night sweats, as well as all the crazy mood swings. If that still doesn’t help, then you talk to the endocrinologist who can specifically look at what kind of hormone therapy to use. But after you get through the transition, you’ve found yourself again. You’re like, hey, I’m back.

Kelly: [1:02:20] Amazing. Okay. When does this book come out, what’s it called?

Juliet: [1:02:25] Can people order it yesterday?

Kelly: [1:02:27] Can I buy just five copies for-

Juliet: [1:02:29] Can you buy a box?

Kelly: [1:02:30] To hand them out. Really, I’m just like wow, I know all of these women who they’ve been waiting for this.

Juliet: [1:02:33] Oh, I mean I have like 50 people I could pass it out to today.

Stacy Sims: [1:02:37] It comes out on the 17th of May and yes, you can preorder it. And yeah. It’s called Next Level: The Guide to Kicking Ass Through Menopause Transition and Beyond

Kelly: [1:02:48] Amazing. You hinted at and I get all your emails so I know what’s going on but you do a lot of teaching. You have some courses, you have support. Can you talk just direct people in those directions? Both of your books are going to be-

Juliet: [1:03:04] Yeah, they’re must reads. Must reads.

Kelly: [1:03:04] Gold standard resources. They’re must reads. Can you also direct people to where we can find you in the digital course space?

Juliet: [1:03:11] The internetosphere.

Kelly: [1:03:11] Because people I don’t think want to wait. And I also think they want to… You have uncovered just gold. So where can people learn more about the gold?

Stacy Sims: [1:03:20] Haha. On the old digi platforms of Facebook and Instagram, it’s Dr. Stacy Sims. And we post stuff every day about it. Not necessarily menopause, but all the stuff. And then you can see all the different courses, everything that’s coming up, podcasts besides this one, but yours is always at the top because I love talking to you guys. literature that I’m publishing. All the stuff. All the stuff that my fingers are into are on the website.

Kelly: [1:03:51] And there’s a lot of stuff. You have an amazing partner, you’re a busy working mother, you are one of the sharpest knives I know. So it is always a pleasure to get caught up with you. And now that they’ve let New Zealand open a little bit, maybe we can finally come down and hang out with you a bit.

Stacy Sims: [1:04:10] Yes. 

Juliet: [1:04:11] Stacy, we are such gigantic, huge fans of yours. And I’m serious when I say I’m cruising around all the time saying, “Stacy Sims said to do this and Stacy Sims said not to do that.” And so even people who don’t know you, know you. Thank you so much. And we are, I really cannot emphasize how excited we are about this book. It is way overdue and so many people are going to benefit from it massively.

Kelly: [1:04:36] And as a coach who works with a lot of women sometimes, I’m like, “Oh, one of my friends has solved this problem for me. So go check out Stacy Sims and then call me after.” 

Juliet: [1:04:47] Read her entire book and then call me.

Kelly: [1:04:49] Stacy, thank you so much. Safe travels. And thanks for being the first repeat guest on The Ready State.

Stacy Sims: [1:04:55] Oh, thanks for having me. It’s great to chat and share information. 

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