Why Women Gain Weight on the Same Diet as Men: Fueling, Fasting, and Biology with Dr. Stacy Sims

Because there was so much to cover with Dr. Stacey Sims, we have broken this episode into two parts. This is part one and we will publish part two later this week. You've not touched once on calories and calories out in our entire conversation so far and for so many of our listeners That is all they've been told that was all I was taught in medical school Yeah, that's what we were taught earlier too But when you start looking at that the human body is not an algorithm And we see the brain uses a more fuel than some of the adipose tissue and if we start thinking about calories in Calories out it doesn't quite work because calories is also a rough idea of how much energy a food has Mm-hmm, and it also comes down to quality because we're now in ultra-process global ultra-process food and people are like oh I had 2,000 calories and if you look at the 2,000 calories is someone I hate to say this But I'm going to in the US diet is the typical American diet. Yeah, standard American diet It's different from other countries who don't have access to all the ultra-process foods So that's where I'm like I don't want to talk about calories in calories out I want to talk about the timing of your food the quality of your food and a focus on protein and fiber for you Got microbiome and we need protein for station not just lean mastabella The views and opinions expressed on on pause are those of the talent and guests alone and are provided for informational and entertainment purposes only No part of this podcast or any related materials are intended to be a substitute for professional medical advice diagnosis or treatment Today's guest wrote a book that made me go back and look at advice I've been giving for years and realize Some of it was wrong. I found her the way I find most people who end up changing how I practice medicine I saw a video of hers I looked her up and two hours later. I was still reading about Dr. Stacey Sims Then I read her book next level and I started rethinking things Not just for my patients, but for myself the way I was training the way I was eating around training The way I had been telling women in my clinic to push through eat less Do more cardio and wondering why their bodies were not cooperating. I was giving advice Built on research that was never designed with women's bodies in mind Not bad advice by the standards. I was trained to believe just incomplete and incomplete in parimenopause in menopause is costly Dr. Stacey Sims is an exercise physiologist and nutrition scientist who has spent her career Studying how women's bodies actually work across the menstrual cycle across parimenopause and menopause and across every stage of athletic performance She has worked with elite Olympic athletes and everyday women trying to figure out why their bodies stopped responding She has taught and coached at Stanford author two influential books, Roar and next level that have reshaped the conversation around women and exercise A few years later I was invited to the Dary of the CEO round table on women's health Seven hours some of the sharpest people in this field and I spent half of it watching Dr. Stacey Sims be more certain More precise and more right than I had even expected that doesn't happen often Women are not small men. That's not a rallying cry That is a biological fact with specific clinical consequences that we are only now beginning to properly address This episode is going to inform how you move how you eat and how you think about what your body actually needs Not what works for everyone what works for you. I'm Dr. Mary Claire Haver a board certified obstetrician and gynecologist and certified menopause practitioner I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch Welcome to unpost the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life Summer is the time of year when most of us want less less makeup fewer steps lighter products less time standing in front of the mirror Because when it's hot outside you want products that are easy Make your skin look healthy and help you feel put together in minutes That's why I want to tell you about primarily pure They're a female founded company creating clean formulas without synthetic fragrances or harsh fillers and these new launches honestly feel made for summer Their son serum tinted SPF gives you that fresh even look while also giving mineral SPF 30 protection It's lightweight blends beautifully and gives your skin a natural glow without looking heavy or overdone Then there are the lip and cheek tints which I'm convinced are going to live in everyone's bag this summer You tap a little on your cheeks swipe some on your lips and suddenly you look awake Refreshed and pull together in seconds Honestly, it's perfect for anyone spending the summer outside all day Like my daughter who basically lives in the sun this time of year and needs something quick Easy and protective that still looks natural It's skin care, sun protection and a beautiful wash of color wrapped up into two really simple products Use code unpaused to get 15% off your primarily pure purchase That's www.primalypuri.com And use code unpaused at checkout for 15% off your order Why does blow drying your hair always feel like it takes way longer than it should For most people it's time consuming a little tiring and honestly not always worth the effort But the right tools can completely change that Introducing launch hair an easier more effective way to elevate your everyday routine Their Axia Haleu ring hair dryer is built to be lightweight so it feels comfortable to use from the start to finish And it is designed to dry hair quickly helping streamline busy mornings without sacrificing results Pair that with the gloss shock anti-frizz hair repair treatment And the difference becomes even more noticeable Apply to damp hair before drying it helps smooth, soften and enhance shine leaving hair looking polished What makes this routine stand out is just how simple it is Just two steps that work together to create a sleek, glossy look without extra products or extra time Because getting ready should feel easy not like a tour Go to launchhair.com and use the code unpaused to get 20% off your first order That's l-a-n-g-e-h-a-i-r.com and use the code unpaused for 20% off at checkout Dr. Stacey Sims welcome to unpaused Well, thanks for having me. I'm so happy to be here You are one of the most requested guests so we are so so so excited to have you here So you are a former professional athlete by grazing, yes And you've worked with Olympians but you've also worked with like normal people like me So most of our listeners are just mere mortals and humans But I like to caveat that and say anyone who exercises on purpose is an athlete Okay, because I like people to get into the mentality that they are an athlete So they actually start to respect their body and take care of their body Awesome What made you really kind of lean into women's health and and how female physiology is different than men's physiology Primarily experiences I think from growing up Being in a military household, I grew up down the road from where we are now Which is San Francisco San Francisco, yes And I remember not really having any kind of conscious liking that there's a difference between boys and girls We just had friends who were boys and we had friends that were girls and we were all doing the same stuff But then as I got older and got to a point where it's like Well, what do you want to do with your life? And I told my dad I was like, I want to be an army ranger or a seal And he's like, well, you can't And I was like, well, I can't tell, I said, because you're a girl And that's the first time There had ever been a hold on anything that I wanted to do because I was a girl And that kind of planted a seed and then when I went to university And I was seeing all this stuff coming out and exercise physiology classes Where the reference was reference man And all the positive aspects of sport was always through male lens And if it was talking about a female athlete, it was always about the pathological aspects of Anemia, bone problems, lack of menstrual psych Stress fractures, all of those things There was never any positive Accument of being a female athlete So the combination of what my dad said with the presence of you can't do this because you're a girl Plus seeing all this stuff coming up that wasn't represented to be a female athlete Exactly, these bad things will happen. This is not right because there's so many female athletes who are successful So let's go to your what what I think is your to me your most famous quote and the one that makes the most sense Is women are not small men. Yeah, and I've repeated that and I try to give you credit every time I say it What made you make that so you're such a flag bearer for that statement I mean you go into any shop right on the external touch points everything's divided by gender You have deodorant from end, deodorant for women You have clothes everything right but when it comes to the inherent aspect of how we live our lives healthily, there is no representation of gender or biological sex really until recently. And when I was teaching Stanford, I'd have a class that was about training principles and practice and I was really fully into the female body versus the male body and I would open up the class with women or not small men and today we are talking about the cardiovascular system. And I would skew it instead of coming through the male ends that everyone is used to, I would start through the female ends and then say these are all the things that women experience. These are biological differences. These are hormonal differences and this is how men compare to women instead of how women compare to men. So just really trying to flip it to get people to understand that there's a different viewpoint and a different lens to look through. Then when I started a support nutrition company that was our tagline for the women's line, women are not small men trying to make a stamp in a very aggressive, leash area where it was very male-nominated. Did you get pushback when you tried to disc solute me? Absolutely. You're talking 12, 15 years ago and you're starting to release a women or different. We have different nutritional needs, we have different training needs and people are like no, no, there's no difference. Kind of have that now sometimes, but it's new. I see it. I see it on social media. Oh yes. But it's usually in the form of just by my product and you'll be okay. Yeah. You don't need something special for women. So let's talk about women in general and what are the most common mistakes you see that women are being led to make in training? Oh my gosh. There's so many things, right? If we look at the training scope and coaching in the fitness world, it's still very much driven through the male lens. We're looking at a male body and then generalizing two female body. And if we look at how men age, they age in a very linear fashion. So what we do when we're 18, we could probably still do more in our 30s. But what we do when we're 18 is a woman is different than what we could do when we're 15 because of puberty changes and it's definitely different than what we can do in our 30s. So when we start looking at how we're training, it's we have to look at where we are in our hormonal profile, where we are in our life phase and understanding what is our goal? Is our goal to build muscle and bone? Yeah, sure. Is that a definitive aspect that people really focus on when they're in their 20s? Probably not. It's more aesthetics. But for Dan, sure, it's what people are focusing on when they get into their 40s. But when we're looking at men, it doesn't really happen the same way. They don't really start to get concerned about their lean mass and power until they're in their late 50s, early 60s, where they start feeling a little bit of demise. So when we're training women, we have to look at where they are, the focus of what they want to do and really understand that the female body responds differently. We need to be fed before we do a training session. We need a little bit more recovery. How are we hitting intensities? Why is intensity a little bit more important than long slow distance stuff? And unless we're training for a long slow distance race. And none of those questions really get asked until after the fact that someone's over trained or injured or hurt. And I read a stat recently because my daughter plays soccer. And there is a huge uprise of girls aged 11 to 12 with ACL tears. Right? I had Jocelyn Whitstein on orthopedic surgeon and women are seven times more likely to tear their ACL under the same stress as a man. And I look at it and I had a conversation with Jocelyn because she was down on New Zealand. And we were just rifting about this stuff. And it comes down to this puberty changes. When girls are 11 and 12, their biomechanics are completely changing. Their hips are getting wider. Their shoulder girdles widening. They're becoming more quad dominant. They're not retort how to run, how to jump, how to land, how to change position. So if we were to take a warmup that's really activating post-year chain and lateral movement, then that helps prevent ACL injury. The fee for warmup isn't quite right for girls who are going through puberty. It's okay for our listeners. Feef, soccer. Yeah. So they've taken an active stance of trying to prevent ACL. But for our young girls, it's not enough. And if you are predisposed to ACL injury at the get go because of all your biomechanical changes, then your risk is increasing the further you get into sport. So Jocelyn and I are talking about let's try to do something at this end to prevent it now so that we can have a reduction in the ACL injuries along the way. Amazing. A lot of women are very, very focused on weight loss, especially my audience, which is perimenopause, menopause. So pretty much 35 plus. And we were socialized. And even in medicine, I was taught thin as healthy. If you're patient as thin, that's one less thing to worry about. Focus on the other things never, never about her body composition, muscle mass, bone density until late 60s. So women were coming to me and saying, you know, I'm eating like my husband. I'm working out like my husband. And he's, you know, we're on this diet together and we're running or doing whatever exercise. And he's losing weight. Yep. And I am not. Yep. And he just rolls over and bed and lose this 10 pounds. You know, and I've been at this for months. You know, why is she? Why is this happening? So there's a biological theory behind it where women can serve when they're in a calorie deficit. And that's primarily for survival of the species. So we look at when and what are you eating? And when we're bringing it right back down to chronobiology or, you know, working with your circadian rhythm, we see that women's rhythms are different. And it's really important to pay attention to that rhythm because of our hormone pulses throughout the day, including cortisol, how are appetite hormones are regulated because it's different than men. So for women who are looking to lose weight and they're trying to follow the same diet and exercise program as her male partner, it doesn't work necessarily with what her body needs. So the example that I always like to give is when the fasting intermittent fasting stuff is really huge, right? So we see men can hold a fast till 12 or so and they'll go do their training and they'll lean up and they'll get fitter and they'll lose weight, but women, they get tired in fat. And they're like, what is going on? I'm doing the same thing. I'm putting the effort into exercise because when we look, women's cortisol, awakening response is similar to men, but their peak is higher. And with that is a correlation with appetite hormone. So if we don't eat something within the first hour of waking up, we have a dysregulation of our appetite hormones that last our entire circadian 24 hours. So what that really drives is we might not feel hungry until noon or so because there's so many women are like, oh, I'm not ever hungry until 12 or so. And then in the afternoon, incredibly hungry, tired and they get what I call the walling where they're not incidentally moving enough. Like we always are kind of moving when we have enough energy, but people who don't have enough and tighten their eating window to like late afternoon or noon to six, they get that walling where they're not moving incidentally. And their appetite hormones are dysregulated. And then they eat more in the afternoon, which then interrupt sleep. And if we're not getting really good sleep, we don't get metabolic control. So it's just a compounded variable that's pretty much like phase shifting, like here. If you are a shift worker and we know there's so many metabolic problems with shift workers, that's what's happening to women when fasting and exercising and trying to follow a male protocol because their initial chronological aspect of their cells and cell function is different from men. And does that change across the menopause transition? We see in the menopause transition. And I think you even post an article about this, all systems downregulate. So we have a decrease in our sleep metabolism and our muscle metabolism. All of those things kind of downregulate. So we have less of a calorie need and it's more of a survival system, right? The body is trying to conserve because it doesn't really know what's going on or highly stressed, but there are ways to counter it. Right? So this is where we look at building lean mass, both muscle and bone. We look at stimulating our systems with high intensity exercise and epigenetic change for glucose control. We also end up having our listeners. What is an epigenetic change? So if we look at genetics and we have a genetic code, it's like a locking key. You have a genetic blueprint that you're born with and epigenetics is a key that will unlock certain characteristics or lock up characteristics. If we're doing high intensity exercise, then it's the key that unlocks the body's ability to use glucose a little bit more efficiently. So it's able to translocate some proteins, which means create more proteins within the cell that open up without insulin. So we're able to use more glucose and regulate it better without insulin, which counters that insulin resistance. So you know, you've not touched once on calories and calories out in our entire conversation so far. And for so many of our listeners, that is all they've been told. That was all I was taught in medical school. Yeah. That's what we were taught earlier too. But when you start looking at that, the human body is not an algorithm. And we see the brain uses a more fuel than some of the adipose tissue. And if we start thinking about calories in, calories out, it doesn't quite work because calories is also a rough idea of how much energy a food has. And it also comes down to quality because we're now in ultra-process global ultra-process food. And people are like, Oh, I had 2000 calories. And if you look at the 2000 calories as someone, I hate to say this, but I'm going to in the US diet is the typical American diet. Yeah. Standard American diet. It's different from other countries who don't have access to all the ultra-process foods. So that's where I'm like, I don't want to talk about calories in calories out. I want to talk about the timing of your food, the quality of your food, and a focus on protein and fiber for your gut microbiome. And we need protein for satiation, not just lean mass development. to walk me through. this circadian rhythm puzzle. I think a lot of people don't understand it and the differences between males and females and how this affects women so differently. - So we talk about a circadian rhythm as 24 hours, but it's different for men and women. Men have a little bit longer, women have a little bit shorter. We talk about a cellular circadian rhythm and a whole body system. - Okay, I think most people are familiar with the whole body, but not cellular. So like I'm very interested in that. - Yeah, so we can get into the weeds of that, but things like people talk about mTOR. So that's your mammalian transfer of rabomisin. That's what the tour is. And it's a way of turning the cell on to grow. So we have different signals in the liver than we do in the muscle. And they're on different timing and it depends on what kind of exercise or food stress they have. So every cell responds differently depending on the tissue and the system around it. So that's a circadian rhythm and a cellular level is that it has its own little clock to work within its system. All those system work together as a whole body circadian rhythm. Okay. So if we talk about whole body circadian rhythm, within that we have our different hormone pulses. So we'll see, you know, you have quarters all that rises that allows you to wake up and then it comes down and then it pulses throughout the day depending on different stresses. It starts to go down and we have kind of a lull time about four and then might start to come up and then it platyms and goes down a little bit more so we can go to sleep. Melatonin we see starts to peak around nine o'clock or starts rising about five, starts to peak about nine. There's another peak at 11 for women. For men it's a different, it's about 10 and about one. So we see that there's differences in our sleep in the way that the sleep onset is. So if we're talking about circadian rhythm and we want to make sure that all of our systems are working well, then we have to look at light and dark and food intake because that's how we shift our circadian rhythm. So we know that when you wake up, yes, you want to see light to signal to the whole body, it's time to wake up, which then jump starts appetite, appetite hormones. It starts our pulse of our cortisol, testosterone, estradiol, all of our other hormones that have an effect on all the cells. They have pulses throughout the day. If we phase shift it, then it interrupts the cellular responses and it interrupts the whole body's systems of understanding what's going on. So this is where chronobiology is so important when we're looking at circadian rhythm because that's one of the biggest mistakes I think that women and men too, but women failed to understand is that I'm not sleeping well, what's going on? Well, let's back it up and see what are you doing in the day that's gonna interrupt your sleep. You're fasting, you've interrupted your appetite hormones. Okay, then that's gonna interrupt sleep. You held your food and your food intake until later in the day or before bed, then that's also gonna interrupt your sleep. You're hanging out on the couch with your male partner at nine o'clock, you've missed that first melatonin peak and then you try to go to bed and you can't fall asleep. It's because you've missed that first peak. So there's lots of things that happen in that 24-hour cycle that women should be educated on in order to maximize how their bodies responding to improve their overall health. This podcast is sponsored by MittyHealth. Have you noticed the conversation around menopause is suddenly everywhere? It's trending on social media, celebrities are opening up about their symptoms and conversations that used to happen in whispers are finally out in the open. 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And the best part is how effortless it feels. The pieces are lightweight and easy to wear all day long. Whether you're running errands, going out to dinner, or just getting ready at home, it's that perfect balance of simple and statement, which honestly makes getting dressed so much more fun and a lot less stressful. They also make the perfect gift, whether it's a birthday or an anniversary. You really can't go wrong with jewelry, especially when it's Jenny Bird. Get a free gift with your first Jenny Bird order when you shop at jenny-bird.com. (upbeat music) Talk to me about light, you mentioned it briefly. How important is light, what kind of light, how do you get it? I've heard don't go in a window, go outside, bright natural light is the best thing. If you can get outside, if not, you're looking at really, really bright light inside. And it's to stimulate the penal land to say, hey, wait, I'm awake, it's time to go. For those of us who live in the extremes of the hemisphere, so Iceland and Scandinavia or down Alaska. Yeah, all those places are down, Australia, New Zealand. In the winter when it doesn't get light, 'til 830 or 9, you're not going outside when you first wake up. So you do have to have a sunlight or something like that to wake up. And it's important so that your body knows, okay, time to wake up, let's go, let's do what we need to do in the day. And then when you have dark at night, then that's when your body starts to wind down and have more parasympathetic response, starts to kickstart the melatonin responses so that you can get into deep, repurgative sleep. Talk to me about timing of food. Do you do with the circadian rhythm? Yes, so we know that women really do need to eat within an hour of getting up. And I do. Why? So we have that cortisol awakening response that's how we naturally wake up. If we wake up to an alarm, we have a greater peak of cortisol. Now cortisol is not a bad thing, but it's tightly tied to what we call acylated garylene, which is part of an appetite hormone control. When it's elevated, it is a hunger hormone. It's also countered by peptide yy, right? So in order for those to work synergistically and together, we need to eat so that the hypothalamus understands there's nutrition coming in. Yes, we can have garylene drop down, peptide yy comes up so that we feel satiated. And then all of our cortisol levels drop and can pulse at a normal rate throughout the day. Disleptin, which is also a satiety hormone part of it. Yeah, but it's not as important as the other two. Pyy. Yeah, good. So what about eating before movement? I was under the impression, probably based on male data, that, you know, fasting workouts were fine. Yeah, no, not so much for women. And I mean, those of us who might be in the 5am club, the idea of getting up and having a full breakfast right before is just like, oh, no, let's not do that. How much do you have to eat then? It's just enough to bring your blood sugar levels up and to signal to your brain that, yes, there's fuel on board. We can do this exercise. And I will back it up with, when we are exercising, we are creating a breakdown stress on the body. We want that to be a very strong stress that is targeted, meaning that we have a specific plan for each exercise session that we are doing. Then the reparation comes afterwards. If we go into a session fasted, we already have an elevation of our breakdown hormones. And we can't quite hit intensities that we need to, OK? Because we're not giving our body the fuel that it needs to hit intensities. And for people who get up and say, yeah, I'm just going to go for an easy walk. It's not as easy as you think, because your body's already jumped out. It's like, whoa, it's time to get up. Let's go. Cortisol is elevated. If you're not eating, then it feeds forward into the appetite hormone and cortisol distress that we just talked about. So something small, if you're going to go for 30 or 40 minute walk, maybe you're just having half a banana. OK, piece of toast. People who can't do that, maybe they're having perching coffee. What is perching coffee? Profi-- so this all started from the social media side from me, because people asked me what I would have first thing in the morning. I love coffee. It's one of my only real vices besides-- and maybe-- that was Diet Coke. Yeah, people are going to kill me for that. So it's just a cold, double espresso with some-- [BLANK_AUDIO] and milk and a scuba protein. So it gives me some carbohydrate from the sweet and almond milk, a boost of caffeine and it tastes like a latte but you also get a good 20 or 30 gram hit a protein depending on how much you put in. And so that allows my body to get nutrition. I drink it because I'm like, yeah, great sits well and away we go. And then I have a real breakfast after training. Okay. So yeah, it's it's just something small. Abby Smith Ryan's lab showed that for women who just doing strength training in the morning, 10 to 15 grams of protein. That's so cool. Yeah, get that in based on her research. Yeah. And then if you're doing cardio aspect to add 30 grams of carbohydrate. Okay. So it's not that much at all. Why does getting breakfast help you sleep better at night? So this falls into the whole circadian rhythm, right? So if we're eating breakfast, then our whole body is in its right rhythm throughout the day so that you can hit that parasympathetic, get that initial melatonin peak and then your body is primed and ready to fall asleep naturally. I tell people you want a fuel during the day, you don't want to fuel for your afternoon wind down because a lot of people are like, I'm hungry, I'm gonna hold it and then I'll have lunch and then I'll eat throughout the day and then I'll have a big dinner, might have a snack after dinner and then they try to sleep. Mike, you're just fueling for your afternoon wind down and we don't want that because you've missed the whole part of the day where your body really needs fuel and needs to be fueled well for brain movement, cognitive focus, all of those things and then we also want good sleep because that's where we make change. So you can't have any body composition change if you have disrupted and intermittent sleep. That is a frustration a lot of women have. I see on social media, I'm eating the protein, I'm lifting the weights and I'm not seeing the body composition changes. I see how would you address that. So I see this so much as well and I wish I could take each person individually, right? Because that would just be very helpful. So I tried to get people to really look at what they're doing throughout the day. When do you first eat? What are you eating? How much? Where are you stacking your calories? Because we know that you want to front load your calories to have more of your food in the front part of the day. You want to have protein fiber at every meal because it's helping gut microbiome, gut microbiome when it's healthy and diverse, increases serotonin production, helps with melatonin production, all of those things. It also helps with circadian rhythm and then we get to sleep. So if we have interrupted sleep, then your body composition isn't going to change even if you're doing all the right things. It's about metabolic control and how your body is understanding glucose, what it's doing with protein. A lot of women unfortunately will try to stack protein in the middle of the day or maybe they'll have a big hit first thing in the morning and then they kind of forget about it. But protein is really important for satiation. It's also important for a lot of functions that happen including hormone production and things like melatonin and serotonin are not transplants. How do we build muscle? Like what is what how does that work? So this is this is the complex. So we're looking at muscle. It is a push pull, right? We want to increase the resistance of all of our push pull motions. If we are looking at a young person who's in their late teens up to their mid-30s, then they have the availability of push pull and some protein intake and that's going to really help. What we call a turn on the M-tore include signals for building that lean mass and it's going to get stronger against the resistance. When we start getting older, our body has what we call an anabolic resistance to both protein and exercise. We have to be very specific in how we're building muscle because it's incredibly difficult to build muscle when we get older. I know that every time I travel I come home like three kilos lighter and I'm always like, "Oh, it's lean mass even though I'm going to the gym." It's because I'm highly stressed and I might not be eating enough or eating properly. And then it takes a year to put it back on. We're looking at strength and power and lean mass and older women. We have to have a regular consistent doses of that strength training. We want to be on the lower end of reps and weights as we develop the capability of getting there so that we can preserve our fast twitch fiber. We can preserve our proprioception. We can improve our prefrontal cortex connectivity. We have, so explain to our listeners, so what is a fast twitch fiber? Fast twitch is all of our really quick energetics. So you go to reach for something and you accidentally hit something that's hot and you jerk your hand away. That's a fast twitch reaction. All of our ability to jump, to skip all the power-based movements. There's our fast twitch. We lose them rapidly, especially as we age. Women lose them faster than men. And we lose our ability to produce power, which is really important much faster than men. Men lose lean mass as they age. Women lose power and strength first. And then they'll start to have cell death or lose lean mass. So when we start to get it into our forties, it's the focus on how are we building that power and strength? Because that's going to not only preserve that end of the spectrum, but also help build lean mass because it's a stronger push pull. Okay. We'll come back to that. But and then you also talked about proprioception. Yep. And so I know what that is. But so proprioception is your body and time and space. So it's your balance. Balance. Yeah. And so if you step off a curb, you still have the ability to catch yourself and not fall over. And people are amazed at how fast it goes, even in their forties. So like, "Whoa, I can't run down that trail. I'm too afraid. I might roll my ankle or something." It's because they've lost a proprioception. So it's not when we're thinking about when we're in our sixties and seventies, we start to lose it. We start losing it in our forties. How do we build that back specifically proprioception? proprioception. A lot of balance and one-legged stuff. We can do our one-legged closed eye balance test. We do a lot of functional stuff with our feet looking at toe grabs and widen our toes and balancing our feet on on different platforms. One of the other things that people might forget is that as we're losing power and strength as we get older and lean mass, we're losing it from our feet, from our calf muscles, all our stabilizers. So we have to work those well too. And you also said frontal cortex. Yes. Our prefrontal cortex. So it's the front part of the brain that's responsible for cognition, reaction. And we want to have a lot of neurons that are connecting and connecting well in order to preserve our cognitive focus and reduce our risk factor for dementia and Alzheimer's. Okay. You say we need to eat more. Yeah, to lose fat and build bustle. That is a paradigm shift. I know. From what I was taught in medical school, but now having worked with thousands and thousands of patients this time of life, I completely agree with you. Yeah. But quality is right in there with quantity. Explain to the listener why this works. You know, why she's been fasting and fasting and fasting or just colorically restricting. And she is on the struggle bus. So I'm going to come back to the quality because one of the questions I had in a seminar a few weeks ago was so I can eat as much as I want whenever I want. And I was like, no, no, calories are important. Not quite, but you cannot build muscle and bone without abundance. And people will go, well, what do you mean by that? And I was like, well, if you're in a calorie deficit or you're stressed under fasting conditions, then your body thinks that there isn't enough food to maintain or build tissue. It's going to cause conserve fat. It's going to increase visceral fat. And you are not going to be able to build lean mass. If you were in a severe calorie deficit and you are also not having a higher protein intake, then you're going to lose lean mass first and conserve you in more fat. So when we talk about we want you to eat more. We want you to eat that wide variety of colorful fruit and veg, good protein sources, high quality food. And this is where I lean and say, I'm not worried about calories per se. I'm worried about the quality of your food because if you're eating appropriately throughout the day, you don't get overly hungry. You don't crave the sugar. And your body has more of a relaxed aspect where it's saying, oh, okay, I can get rid of this extra fat and I have the capability because I have the nutrition to build muscle. And it is a paradigm shift because we all grew up in the calories and calories out fat burning workout. Let's work out for 90 minutes. Let's have that cardio sweat suggestion. Yeah. Yeah. Yeah. And it's like that is counterproductive. It doesn't create the exercise stress that we want because it kind of puts you in this moderate intensity, highly cortisol sympathetic driven stress, which is more of a fight or flight scenario, not a let's change body composition scenario. So what should a woman do exercise wise to change that body composition? Meaning in a positive way, get rid of this real fat and gain muscle and bum. Yeah. So all movement is good. And I'll start with that because I have had pushback when I've been absolute because there's, you know, and I 100% agree with Dr. Sims, you know, if you are sedentary, a 30 minute walk a day will decrease your risk of diabetes by 50%. Like all movement is good. Yeah. So say you're already walking. What's the next step? The next step is add some intensity to that walking because I like to look if you're already in the consistency habit of doing some aerobic type work like walking. Let's add some intensity to that. How would you do that? Yeah. Exactly. But we pick up the pace for a minute or two. We might try to walk upstairs at a faster pace. We might go in onto a hill. So we're just increasing the intensity and we're doing two to three minutes of an increase in density, right? And then we come back down and we have a couple of sets of higher intensity during our walk. If we are looking at, I'm already walking, I'm already doing hills, then the next step is, okay, well now we really want to add in some super high intensity work. Okay. How do we do that? Right. Well, let's look at some kettlebells. Let's do some kettlebell swings or maybe if we don't want to go down the route of kettlebell and into the gym environment yet, let's look at doing some squat jumps. So let's do a body weight circuit within that session. So you walk to warm up, maybe you're going up your hill and then at the top of the hill, let's do five to six burpees and 15 air squats or squat jumps. Walk down the hill for recovery, run back up or walk back up the hill, do it again and there we have a higher intensity, total body and we're getting more of what we need. And this is all about the exercise stress because we want to look at what kind of external stress can we put on the body that's going to invoke change. This summer, Colorado was home based for me. 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Most people will hold a fast-tell noon, maybe 11, and then they'll have an eating window from 11 to 5, or maybe 11 to 6. Then they're holding a 12 to 16 hour fast. If we're looking at time restricted eating, this is where we eat according to our circadian rhythm, where we eat within an hour waking up. We eat periodically throughout the day. To fuel our body well, then we have dinner, and then we don't have anything after dinner. Then you still end up with a 12 to 13 hour overnight fast, but you're not interrupting your circadian rhythm, and you're not phase shifting any of the important hormone pulses and appetite control and sleep metrics that happen with intermittent fasting. This just seems to get way more important across the menopause transition, because our hormones are in chaos and disrupting our sleep and just adding on to all of this. You're going to get away with it in your 30s. Then all of a sudden, when the hormones start swinging, it becomes a critical mass. Exactly. I'm pretty sure that someone who's in parimenopause isn't going to go out to the pub, come home at two o'clock in the morning, have a big feed, go to bed, wake up, and say, "I feel fantastic." Okay. In one study, people ate the same meals and the same calories, but those eating bulk before 3 p.m. had better metabolic outcomes and lost more weight with no calorie restriction. Just timing. Just timing. Amazing. Yeah. There's more and more of the public health research coming out who's talking about early fast versus late fast and breaking fast early, which means 8 to about 3. You get all of the metabolic controls that you find with full day fasting and super calorie restriction in rats. In humans, we don't get that when we're having extreme fasting. Again, it's because we're working with our circadian rhythm and then we are allowing our body to have that rest and digest process and get into that repetitive sleep. We're not exactly sure why we need to sleep. We just know so many functions happen while we are sleeping that is important for total body health. If you eat so close to that time, why is this disrupting so many women's sleep? Your body is spinning all this energy trying to digest and it's actively working instead of resting. If you are trying to digest, then you're having lots of metabolic processes that are happening and your body thinks it should be awake and your brain is like, "I should be awake," but yet I'm sleeping. How do you talk to shift workers? I was a shift worker. Yeah, it's hard. It's really hard. Looking at how their shift plays out and looking at when they get off work and what they need to do, can we exercise when we get up before we go to our job or do we have to do it afterwards preferably before so we're not doing it? We're working a little bit with some chronobiologists looking at micro-dosing melatonin and knowing that with shift workers, you don't want to take it right before you go to sleep because it's too late. It's the same as women with ADHD. We see that if you are using melatonin three or four hours before you should go to sleep, wow, it helps reset the brain to be able to get into the sleep that it needs to. So when we look at ADHD, it's effectively a phase shift of the circadian rhythm as well. So if we look at micro-dosing, our shift workers with melatonin. With my everyone, here's micro-dose now and they think, "Do you want to know?" We'll talk about that in a little bit. We'll talk about that in a little bit. Micro-dosing melatonin because what you buy over the counter is way too much. Right. So what is micro-dosing melatonin? So we're looking at 0.5 milligram, not 5 milliliters. milligrams. So you can get a 1 milligram tablet and crush it if you really need to, but you can also get a prescription for 0.5 milligram. And that's your microdose. And you take that three to four hours before you need to be asleep. And then it kicks in and allows your melatonin to work properly while you're sleeping and allows your body to reset. And what is the mistake people are making? I know when I first tried it, you know, I read it, heard about it, didn't read anything. And went to the drugstore and bought a 10 milligram tablet, thinking more is better. Right. Like it's a sleeping pill. I had no idea how it worked. Yeah. I thought it would put me asleep. And like a sedative and had crazy dreams and completely drugged the next day. Yes. Yeah. And part of it also is because you're woman. Right. And the doses are primarily for men. That's just why we've had issues with Ambien. But it over stimulates the brain to be in its kind of sleepy, fatigued state. Mm-hmm. So you wake up feeling hungover and drugged. Yeah. If you're using very, very small doses, then actually works with our GAVA system in the brain. It helps parasympathetic activity. So it does the things that melatonin is supposed to do. But a big whack, which is how all Western ideas are the more the better is way too much in your brain is like I can handle this. Okay. What is your eating window? Do you mind sharing? This is not prescriptive. No, it's not prescriptive. So full disclosure when I'm highly stressed, I forget to eat. So my husband's always tapping my shoulder. Yeah. But I get up and I have some food maybe half an hour ish after waking up. Then I'll do some training. I'll come home. I'll have real breakfast, which might be 8, 8, 30 in the morning. Then because I live in a commonwealth country, we have morning and afternoon tea. So about 11 o'clock have some more protein fiber. Then I have lunch about one. And then we have afternoon tea, which is more protein fiber stuff about three. My daughter gets home from school. Our afternoon snack is also how we have our afternoon tea. And then dinners between 630 and 730. Mm-hmm. And then I go to bed about 10. All right. Let me walk you through mine and tell me if I'm making any mistakes. Okay. So I wake up and I have coffee black and I have a view of a beautiful view of the water from my bedroom, which I'm super fortunate. So I sit with my laptop and I get I answer a few emails. I drink my coffee. I do my meditation, my journaling, my lake, you know. And then I get up and I make my shake usually when I'm at home. And so that is a giant, enormous God bless myself. But I have I've seen it my protein a little bit of collagen. I have my Greek yogurt, usually frozen berries. And I have my Zoe 30 seed mix in there. So I can get my 30 plants. Yeah. And a little extra scoop of fiber. It's like eight more grams of fiber in there. And so I sit on that I try to get like a quarter of it down before I head down to the gym. So I have a gym in my home. And so I go down there and I do usually my lifting and sprints or whatever my high interval stuff. And then I get on the treadmill and take all my calls. And so I have a walking desk. Okay. And it's not super intensive, but it's better than sitting. And so I do that. And while I'm sipping on my shake for the rest of the morning. Okay. So are you sipping on your shake while you're on your treadmill? Well, walking and working. Yeah. Perfect. So yeah. And then I finish that up by like 11 new news. And then I'll go have lunch. Okay. So and that's my biggest meal is lunch. Yeah. And then what are you doing the afternoon? So I'll probably like have apple and cheese or some kind of snacky thing or some fiber crackers, you know, mid afternoon, I'll get hungry. And then my husband, I eat really are empty nested now, which is super fun. And we'll have some kind of a lean protein, some veggies, a salad, whatever for dinner. And we go to bet I stop eating by six usually. Yeah. Great. But some macronutrient profile of your Massachusetts. So typically when I look at it, I usually don't pay that close to attention. But I'm trying to get like 100 to 120 yards of protein a day. And I get 50 and that shake. So that kind of helps space that out, you know, get that kick in there. And I'll note that the 50 is not just protein powder. It's from your nuts and your seeds that all of it like I count it all now. Because people think that when you say 50 grams of protein, you're just scooping in the protein. No, no, it's not too scoops of protein. Yeah. No, no, no. I get it from multiple sources. Yes. And then I really only count really protein and fiber and try to get 30 plants in a day. And I get at least 35 grams of fiber a day. Yeah. From multiple sources. Exactly. That's how I think about it to you. I'm like completely different than what I'm doing 10 years. Right. Which was eat as little as possible, more cat as much as possible. Drink lots of coffee. Yeah. All day when I was working as a doctor like full time and taking call. The only liquids in my body were coffee, diet, doctor pepper and an occasional sip of water. That was it. Yeah. Sounds yeah. And then when you're really down for the count, mountain do. Okay. So I'm doing okay. And again, this is not prescriptive to our listeners. This is just what Mary Claire does. And literally completely different than what I did 10 years ago. Yeah. Because I'm thinking about me at 80. Yeah. Instead of me in a bikini. Right. Exactly. But you'll still be rocking hot at 80 in a bikini. I think I'll look great at 80 no matter what. Yeah. And I will wear a bikini and hopefully be chasing my grandchildren if they absolutely never appear. Yeah. All right. You said something that was a revelation. All those diets, keto, carnivore, plant-based intermittent fasting are designed to create health outcomes through eating. But if you just exercise, you get all those outcomes. Yeah. I know. Funny. Huh. We chased this whole diet culture, right? We're bombarded by that culture. Right. I was part of the problem. And I followed that hookline and sinker for years. Yeah. I think we all did. And it was either personally or when we're working with clients or telling you something. I remember looking back at some of my old files from maybe 15, 20 years ago. And I had some female triathletes doing some fasted workouts because that was the research that we had at the time. And now I'm like, oh my gosh, I'm so sorry. Yeah. But when we're looking at things like keto and the goal of keto is to lose body fat. Right. Well, you talked to any epidemiologist and then like the outcomes for a healthy person using keto is just dire on lipids. It's really specific for people with traumatic brain injury epilepsy. It's good for brain health. The problem with a lot of these diets is they've come from a clinical scope and then pulled over into the health and fitness world and got attraction. So everyone's after the aesthetics when they're looking at it, none of these are really promoted for health span. If we look at exercise, exercise in itself is a really strong stress that your body is like, yep, okay, physical activity. We have to do something about it. So it has so many different feedback mechanisms that allow your body to look at that stress, encounter that stress, overcome it and repair itself better. So if it has that stress again, it can have less of an impact on the whole system. So when we look at etopha. And everyone's like, oh, what is etopha. So this is very misunderstood. And you might say auto phage in your head because I did that until I heard someone pronounce it. Yeah, I did say. Yeah. So we look at cells and recycling dead cells in some of the parts and we want to have the body recycle some of the parts of the cells. Otherwise, we have a whole bunch of different cell parts and free radicals and things like that aren't so great for the body. So it's off of you's your body's way of cleaning up garbage and recycling it, not just throwing it away. And we see people want to do long fast because it triggers etopha and it also helps with telomere length. So this is increasing the health of our DNA. So if we look at exercise, exercise in itself is an etopha. Because it's breaking down fuel is breaking down muscle tissue with every contraction impact will load the bone. It also breaks down the bone. And after exercise that has a clean it all up. And that's part of the reparation process. And so we're going to have a strong stimulus for cell repair and cell regeneration and cell recycling. It's exercise because the post exercise response of that stress is to clean everything up. If we're looking at increasing our fat metabolism, which people want with the ketogenic diet to lose abdominal fat and overall body fat and this is where we look at the intensity of exercise and strength training. Right. And those in conjunction are going to create a metabolic shift to reduce body fat in the actual moment of exercise stress. If we're doing high intensity, no, we're not burning fat. We're using our fast glucose because we need it for fast energy. So for using a lot of glucose, then at rest our bodies relying on fat. And so we're using our fast energy to reduce the body fat and we're using our fast energy to reduce the body fat. And when we're looking at the research world, there's physical activity researchers and their nutrition researchers and rarely do they come together. When you find those people come together, you're like, it makes sense. We have exercise that's to stress all of these feedback and signolings happen for the reparation. And then we need nutrition for those signaling and feedback to actually make a difference. So that's why I said, you know, all of these diets will do something. But if we are specific in the exercise and what we do, we get better outcomes because we are controlling that stress and actually putting a proper stress on the body to get the outcomes that we want. Welcome back to another MIDI POS. I'm Dr. Mary Claire Haver, host of Unpost. Today, let's talk about something that often flies under the radar until it becomes a serious problem. Bone health during menopause and why dexascans matter more than you. you think. Osteoporosis isn't just a bone issue. It's a major women's health crisis hiding in plain sight. It's the most common bone disorder, yet many women don't think about it until a fracture happens. And the statistics are hard to ignore. Half of all women will break a bone due to osteoporosis. A hip fracture, in particular, isn't just an injury. It can be life altering. One in five people will die within a year of surgically repaired hip fracture, and that number rises to 70% when surgery isn't an option. So why does this happen? As estrogen levels drop during parimenopause and menopause, bone turnover increases. We begin losing more bone than we build, and the process is silent. You won't feel it happening, which is why osteoporosis is often called silent disease. For many women, the first sign is a fracture. In fact, women can lose up to 20% of their bone density in the first few years after menopause without even realizing it. That's why this stage of life is such a critical window to start paying attention. This is where dexascans come in. A dexascan is a simple, non-invasive test that measures your bone mineral density. Typically in the hips and spine, the area is most vulnerable to fractures. Think of it as your baseline. It tells you where your bone health stands now, so you can make informed decisions moving forward. And while many women are told to think about bone health later in life, the reality is that earlier awareness leads to better outcomes. Don't wait until there's a problem to get your first scan. The good news is that there are clear evidence-based steps you can take starting as early as your 30s and 40s to protect your bones. But it starts with having the right information. That's where platforms like Midi Health can make a real difference. Midi takes a more comprehensive approach to midlife care, including bone health. Their clinicians can help you determine if and when a dexascan makes sense based on your personal risk factors, walk you through your results, and help you build a plan that is tailored for you. Just as importantly, their virtual model gives you access to care that understands menopause. Without feeling rushed, dismissed, or left to figure it out on your own. Because the truth is, you deserve more than a quick dismissal. You deserve data, context, and a plan. Bone health isn't something to think about after a fracture. It's something to be proactive about now. So ask about the scan. Know your baseline and make sure you have the right support to protect your long-term health. Go to joinmitty.com. Join midi.com and connect with one of their clinicians today. That's so exciting. So when I'm in the gym, I stopped thinking about aesthetics for the first time. I look at aesthetics like that now, not like, oh, the bikini vision I used to have in my 30s. But I'm also thinking about what's happening on a cellular basis, and how it's lowering my risk of depression and my risk of dementia. And I literally am like one day less in the nursing home. Yeah, you know, that's my thought process when I'm down there. And it just motivates me so much more than me trying to look like a 14 year old. Yeah. My mind shift changed when, well, I had a hard pregnancy and all the things that I planned after pregnancy didn't happen. So I had to find ways around of going from rehab, from surgery to surgery to rehab, to putting weight on a whole bunch of things. But in the back and keeping a human alive and keeping a human alive, yeah. And in the back of my head, I was like, I have an extreme risk factor for dementia in my family. So I was really starting going down that route going, what are these things that we can do to prevent dementia and Alzheimer's? And you're reading the research, like there isn't anything, especially for women. Why is this? We see that women are the ones that are getting all this cognitive decline. So then because of my education and ability to be in a human performance and looking at neuromuscular changes that we see with athletes and motor patterns. And going, okay, if we're looking at increasing motor patterns and getting faster athletes when they're in their 20s, what's going on neuroplasticity? So then we come down to research coming out now within the past four or five years. And looking at motor patterns is a driver for neuroplasticity, which means that we're increasing connections of our neurons. We're not developing tal plaques like all of these things, as well as lactate production. So this is where the high intensity work comes in and we're looking at why it's through that. Like why that isn't right. Yeah. So there's a lot of drama online with the gym bros about who should be doing hit training or not. I know. I hear this. Don't worry. We're looking at the gym bros and they're relying on the male data, right? They're like, oh, yeah, we don't want necessarily want women to do high intensity work. It's bad for their metabolism and increases cortisol. It's like, no, no. And apparently there's a sex difference between women and men and muscle fibers. We know that women have more endurance fibers than men, which also means we have more of the proteins in our mitochondria, which are a powerhouse of ourselves, to be able to use free fatty acids or fat than men do. So when we're talking about the zone two work and all the low intensity work, that's all for male data. Because men need to do that to become more like women. They need to do that in order to have more endurance, right? But women, we look, we can go long and slow forever. My daughter can run a full marathon. Without too much training. No, no. Good mechanics, but also metabolically women can go along as low. This is why we're seeing ultra runners and ultra-cyclists. They're all women, dominating the ultra fields because our bodies are designed for that. We look at what's happening in parimenopause, in across, in depotmentopause. We have a significant change in brain metabolism, meaning that our brains become less capable of using glucose. And this is where we start to see a misstep in our bodies metabolic rates across the board. We also see this is where we have an increase in cognitive decline. Some of my friends talk about that specifically in like how we consolidate memory. But also when she looked at glucose uptake across the transition and how much it changes, based on estradiol levels. Right. So lactate is preferred fuel by the brain and the heart. It's not a byproduct for our listeners. We, how do we make lactate? So lactate is when we do higher intensity work. And this could be one to four minutes where we're just at a threshold where it's really uncomfortable. And people used to say it was the burn because it is an acid that's produced at the byproduct of glucose metabolism. It's not a waste product that people used to think, oh, you know, you got to flush out the lactate. While you're producing lactate, your brain and your heart are like, gray, yay, a better fuel. So if we produce lactate on a regular basis, one, we are able to keep fast switch fibers because those are the ones that generate the power that then produces the lactate. We also increase our body's ability to use lactate both in the muscle and the heart, but also in the brain. So if we're able to increase the lactate levels that get pulled into the brain to be used as a fuel, we're improving our brain metabolism. If we're improving our brain metabolism, again, that reduces dementia risk. We see it reduces the towel plaque and the amyloid development. So lactate is super important. And this is why I get so frustrated with people like you shouldn't do high intensity work of your pariamet and pausal woman because they're not looking at the full picture. Right. They're looking at male data. And if we're looking at strength and conditioning, they're very much in the what are we doing for muscle? What are we doing for muscle? They're not looking at bone. They're not looking at brain health. They're not looking at metabolism as we get older again, because men age differently than women. Even in that 40 to 60 range where I get a lot of pushback because I keep telling women you need to lift heavy and the barosets like, no, you just need to do resistance training. I'm like to optimize women for health span. We look at the changes that are because let me be clear what we're doing right now is not working. We have an epidemic of osteoporosis and frailty and dementia in this country in our in our older women over 65. Right. Exactly. And I'm right here and right now. I'm not okay with it. I am not either. And I mean, my grandmother lived to be 106. So I know there's longevity facing. I'm only halfway through my life. And she was independently living and she did all the things, right? And so I'm like, I want to be like her. Yeah. Whereas my grandmother and my dad's side was the one with dementia and wheelchair. And I don't want to be like her. So I see these two in my future. I'm like, I'm going towards the hundred and six year old who is living by herself. So when we look at aging between 40 and 60, there's a definitive change in both men and women. We see that there's a definitive aging aspect. How do we tease out parimenopause, menopause from aging? Well, I'm not so concerned about the hormonal profile. I'm concerned about what's happening on a cellular level of the muscle and also how that affects bone. If we look specifically at women and this is not hormone driven, we look at specifically at women from an aging factor, we lose our ability to produce power. Why? Because we have two contractile proteins in the muscle. One is myocin and one is actin. Myocin is tightly tied to neuromuscular, like the way that our body contracts the muscle and how fast it contracts the muscle. There's a dysfunction in that in women when we start to age. When we have estrogen that flexuates, It's even worse. It exacerbates it. So a lot of people like, oh, it's just estrogen if we use MHT, it'll get better. - Right, it doesn't look that way. Target tissues and all the things that happen with an exogenous hormone versus, so that's a whole another podcast. But for women when we're looking at the basic molecular changes that are happening for muscle protein, we have to be down on the heavier end of strength training so that we keep that neuromuscular connection, so that we keep targeting myosin to do its job, so that we change what we call the isoform into one that actually works and not a dysfunctional one. For men, they don't have that same problem. Men over the course of 40 to 60 want to focus on building mass because they lose lean mass. We lose that power in strength end and then we start to see cell death or the loss of lean mass. But if we're preserving that in the power in strength or also preserving lean mass, what percent of the population do we think is actually doing these things in the gym? - I don't know. I think it's very little. - I'm sure it is. I think it's getting better. The message is getting out, but there's still so much misunderstanding, misinformation. So I'm genetics and the generation right above me are the boomers. I think the boomers are still concerned with being slim. - Absolutely. - You know? - Yes. - Slim, slim, slim. I get DMs from the 60 to 70s and they're just concerned about their waistline. - Exactly. - What would you say to them? - Yeah. I mean, I see this with my mom's friend group and they're out walking and they think that's enough and I'm watching frailty increase and one of my mom's good friends has early onset dementia and I just need to just strengthen training. I don't like the gym. I don't want to go to the gym. I don't need to lift weights. I want to be thin. I don't want to be bulky. Michael, one, you're not going to because you are at an age now where it's incredibly difficult to put any kind of lean mass on. You actually have to work on it. But their response is I only gave weight in my middle. I don't want to necessarily want to eat more and try to put weight on. And I'm like, okay, you're here at this point right now and we see over the past year how frail you have gotten. Next year, how do you want to be? Walking is not going to do it. We have to put in some resistance training and I'm not saying go to the gym. I'm saying let's do a circuit of air squats and some pushups against the wall. Let's do stuff that's a push pole to increase the neuromuscular connection. The question is, what's neuromuscular connection on my brain health? You don't want to have your early onset dementia accelerate and your other women do not want to get that. So if we are doing more to increase that neuromuscular connection, you are maintaining your brain, but you are also maintaining your health. So if you are out on a walk and there's black ice 'cause you live on the East Coast and you slip, you won't necessarily fall and break your hip because if you fall and break your hip, we know that's one of the leading factors of why women end up in hospice and very fastemized. Yeah. So I bring it all back to what are the main things that is going on right now? It's not about being slim. It's about let's protect your brain. How do we protect your brain? We have to get those neurons firing with motor patterns. So Lisa Moscone talked about not everyone with plaques and neurofibularity tangles will have the symptoms of dementia. Right. Some of them will never, you know, they'll have the biological process, but they'll still be cognitively intact. And I wonder listening to you, is it the neuromuscular connection where they're just working around, you know, those genetics. Yeah, most likely. And they're never gonna lose their cognitive abilities, even though they've got plaques and tangles. Let's hope. Yeah. I really hope so. You can connect with Dr. Sims through her website and her newsletter at DrStacySims.com. You can find her on Instagram, Facebook, and YouTube at Dr. Stacy Sims. She's also on LinkedIn at StacyT Sims PhD. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepozlife.com. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaws dis-presented by Odyssey in conjunction with pod people. I'm your host, Dr. Mary Claire Haver.