Season 5, Episode 2: Female Fitness and Nutrition During Menstruation and Menopause with Dr. Stacy Sims

Evelyne: I am so excited to talk to you today. I was first introduced to you in the spring of 2020 when I was doing my master’s at the University of Western States, and our professor, Tim Sharp, in our sports nutrition class brought you in as a guest lecturer. And dare I say, you were one of the favorite parts of that class, not just mine, but everybody always talked about, “Oh my gosh, have you heard Stacy Sims part?”

Dr. Stacy Sims: Oh, awesome.

Evelyne: Yeah. I’m just so excited that I feel like you wrote your first book a while ago and then you wrote another book, and I feel you were on Huberman earlier this summer and I feel like, okay, everybody knows about you now. It’s amazing. And at the IFM conference, I was so thrilled that you and Dr. Gabrielle Lyon were the stars of the show. So I actually really mainly went because I wasn’t working it, but I mainly went to ask you guys to be on the podcast. Oh, thanks.

Dr. Stacy Sims: Yeah, Gabrielle is awesome. I think that was the first time we met in person-person, and it’s like meeting your long-lost sister, like yes, we have so much in common. So that was awesome.

Evelyne: I loved it. And I’m sure you heard that everybody who was there couldn’t stop talking about your presentations. So I think it’s amazing there’s really a shift happening with women’s health. So before I read your bio, what is lighting you up this week?

Dr. Stacy Sims: Spring in New Zealand.

Evelyne: Ooh, that’s right.

Dr. Stacy Sims: Finally got here. Summer’s on the way, although today you wouldn’t really be able to tell it, but yeah, it’s a small winds when the cold, icy wind disappears and all of a sudden you have warmth in the air. So that’s great.

Evelyne: Nice. Well, sending you some warmth from San Diego. We did just transition to fall, but today’s another day of summer here.

Dr. Stacy Sims: Oh, nice.

Evelyne: Yeah. So Stacy Sims is a forward-thinking international exercise physiologist and nutrition scientist who aims to revolutionize exercise, nutrition and performance for women. She has directed research programs at Stanford and at Auckland University of Technology, focusing on female athlete health and performance and pushing the dogma to improve research on all women. She’s the author of the book, Roar, written to explain sex differences in training and nutrition across the lifespan, and she published an updated version earlier this year in January 2024. This book challenged the existing dogma for women in exercise, nutrition and health. And this paradigm shift is the focus of her famous women are not small men TEDx Talk. Her latest book is called Next Level and is focused on crushing goals through menopause and beyond. She has published over a hundred peer-reviewed papers and is a regularly featured speaker at professional and academic conferences, and she resides at the beach in Mount Maunganui, New Zealand with her husband and daughter. Did I say it right?

Dr. Stacy Sims: You did. You got it right. Nice.

Evelyne: So Stacy, why has there been so little research on women in the medical field and then specifically in nutrition and exercise physiology, and how did you get into this?

Dr. Stacy Sims: It’s more of a historical, I guess, look back at why women have been excluded. Because when we look at how medicine and science all started, it really originated with who was in the room and women have been pushed out. So who was in the room? It was men that were in the room. So men were the ones who were designing the studies and asking the questions. And there was this, I guess, real mental challenge where they thought women weren’t strong enough to participate in some of the research or we were too delicate. We had menstrual cycles, we were just a smaller version of themselves, so why bother?

So it just came forward and just kept pushing and pushing and pushing, and no one really questioned it. So now that we are at an age where oh, my gosh, it’s 2024, almost 2025, and we still have this massive gender data gap, and we’re really trying to push forward and understand, well, why is there this discrepancy and how important is it to really investigate what’s happening from a sex difference and a hormonal shift difference between men and women? And it’s finally catching on. So we’re starting to get traction, but we have to look from, okay, we know this is what happened historically, and this is how we’re moving forward. So that’s why I think in the past four or five years, we’ve really started to see this increase in this uptake in research specific for women, especially across the lifespan.

Evelyne: Yeah, I also wonder with the Olympics this past summer and the American women just dominating, if that has maybe led to a surge in interest, I’m not sure.

Dr. Stacy Sims: I think it’s led to a surge of interest in funding in women’s sport, which is fantastic.

Evelyne: That’s great. Yeah.

Dr. Stacy Sims: So Michelle Kang, she is the majority owner of the Washington Spirit soccer team, and she is majority owner of quite a few other soccer teams. She announced a $50 million funding guest platform for women’s sport, and she also donated $4 mil to USA Women’s Rugby after they won the medal. So that was really inspiring to see that people are now outside of academia, outside of industry, stepping up and saying, “Yeah, we need to really focus on women’s health. We need to focus on keeping girls in sport.” We know that there’s this huge feed forward from girls who are in sport into leadership positions. So it’s really exciting landscape at the moment. And so yeah, the Olympics did have a big play in it, so I’m hoping it keeps moving forward.

Evelyne: Yeah, that’s awesome. So what are some of the implications of the lack of research in women specifically when it comes to performance and nutrition?

Dr. Stacy Sims: We could pretty much rewrite all the guidelines if we were to redo all the studies. And people are like, “Well, what do you mean? We all need carbohydrates?” Like, well, yeah, we need carbohydrate, but women’s bodies respond differently. We know that women are more metabolically flexible and that we go through blood sugar and then tap into free fatty acids more so than go through blood sugar and our liver and muscle glycogen. We see that there’s a difference in gastric emptying rate, so that impacts on how much carbohydrate and fuel you need per hour. And then when we look at body composition, body recomposition, we look at dietary protein intake and how that’s been skewed to be so much lower in women than it is for men. But when we look at things like the recommended daily allowance, we have to realize that that is the minimal amount to prevent malnutrition.

And when we start exercising and we start looking at recreational female athletes, we see that it’s close to that one gram per pound that is recommended for the more elite athletes. So there’s so many things in there that if we really want to maximize women’s health and performance, we do have to do this deep dive and say, okay, what is appropriate for women? What is appropriate for women who are in their reproductive years? What’s appropriate for women who are in their peri and postmenopausal years? Because those are significant milestones in a women’s trajectory for life, whereas men age in this linear fashion.

Evelyne: So interesting. So let’s get into some of the differences. Can you talk about some of the sex differences as it relates to performance? And I’m interested in just estrogen, progesterone, but some of the other things that those hormones, and they’re not the only ones, ’cause we have testosterone as well, but how those impact women differently?

Dr. Stacy Sims: So there’s two ways of looking at this. We see that there are sex differences from birth and things that are applicable in that regard is women who are XX, so we’re talking cis women because we don’t have enough research on outside of that typical biological binary type view. Women are born with more of the proteins responsible for better mitochondrial respiration and density and recovery. We have more of MCT1’s. We don’t have a lot of the MCT4’s. So if we’re looking at things like lactate production, women don’t have as many of the type II fibers as men do. They’re born morphologically more endurance. We have more oxidative fibers and how all of that feeds forward to things like metabolism and fueling during exercise, which will impact performance is things training for metabolic flexibility or training for aerobic capacity is almost a moot point for women to a point because from a physiological and a sex difference standpoint, we’re already there.

Then when you add things like estrogen into the fold, which increases free fatty acid utilization, again, we are really, really, really good at being endurance and fat burners. So we don’t have to spend as much time in that endurance space, even if we are training for an endurance race when we look at things like oxidative fibers and the morphological aspect of what happens with our type II’s versus our oxidatives. So we see that the more we spend in this long slow stuff, the more our type II’s will lean that way. But for women, we are not born with as many type II fibers, so we don’t have as much of that glycolytic capacity. So if we want to be a power-based athlete and we want to really perform at high intensity, we have to skew our training more towards that. We also have to look at how lactate production is really important for cognitive and brain health and proprioception.

So we see that lactate production is really, really important for brain metabolism, and if we aren’t training that for women, when we start to lose more of those fast switch fibers, we’re also compromising some of that brain capacity and the brain fueling. So when we disseminate it right down to performance, we have these sex differences from birth, and we also have more epigenetic changes that occur around puberty. So we start to see a widening of the hips, the change in center of gravity. We start to see a discrepancy in strength, men versus women with regards to upper body, lower body strength. All of these can feed forward to impacting performance if we’re not accounting for those sex differences. And the best way I can really explain it in easy fashion, as we look at the onset of puberty and we see all these changes occurring in girls with the change in our biomechanics, and then all of a sudden you get a period and we have this huge dropout of girls in sport, it’s because they feel ungangly.

They don’t feel like they can participate ’cause no one’s teaching them how to jump, how to run, how to throw, how to swim in their new bodies. And if we were to disseminate and say, okay, yep, okay, we see these girls, we need to re-teach the fundamentals, it improves their confidence and they can stay in sport, which then feeds forward to better performance down the line. So there’s a whole lot of things to unpack in that whole sex differences, hormone influences that if we really were to bring it right back down, like I said before, we should really look at redoing a lot of the research that has been done to see what is specific for women who are in their reproductive years, early career versus late career in sport, and how do we modify training to match that physiology.

Evelyne: Super interesting, Stacy. One of the questions I was actually going to ask you at the end, but it’s sort of along what you’re talking about now, is if you could design a research study with unlimited resources, what would it look like?

Dr. Stacy Sims: Oh, I know. This is hard because there’s so many factors because we can’t separate it down. There’s this big conversation right now in sports science research where we have a lot of lab-based people who are saying, “This is the gold standard of methodology.” And then you have a lot of us who are applied, we’re like, “You can’t take away the allosteric load. You can’t really separate the sociocultural aspects of how that affects training and performance and how we are feeling and how we are approaching women.” We have to understand where they come from from a cultural standpoint to perhaps get messages across and accommodate for that. Not in a bad way, but in a good way. So if we’re looking at designing a study, it has to be really transdisciplinary where we’re looking at a sociologist who understands the physiologist and where the physiologist is coming from, and the physiologist has to understand what the sociologist is wanting to do.

So you’re having all of these experts who understand each other’s, I guess, really disciplined expertise to design a perfect study that’s accommodating for a follicular phase, all luteal phase, an anovulatory phase, a shortened luteal phase for all the different perturbations that are happening across the menstrual cycle as a case point. And then we have to look at how we accommodate for all the different contraceptive methods. So it would be this huge, massive study, and that would just be to get basic information about maybe testing, how do we test women for VO2 lactate, and is it important to test for that? We don’t know if it is that important for women to know what VO2 is and what their lactate threshold is. We know for men it is because there’s manipulations we can do to improve that aspect of metabolism. But for women, we don’t know if it’s all that important when we’re talking about absolute performance.

Evelyne: Interesting. Well, I hope you get to do that study.

Dr. Stacy Sims: Yeah, I think I have to pull together a really big team.

Evelyne: It does sound super interesting, and I think it’s lacking across a lot of research, because usually in research you’re trying to just test one single thing, and that’s not how humans work. There’s so many other influences, so it’s so hard.

Dr. Stacy Sims: It is, absolutely. And from a nutrition standpoint, we look at the reductionist nutrient science that’s so endemic and never really looking at the whole person and the cultural value around food and what that means and how that influences the positive or negative feelings in associations we have with food for it to actually work in a certain way. And I felt that a lot with how nutrition science has gone, but we’re seeing some inroads more with lots of different teams coming in and understanding how we have to look at that in a different way than just that reductionist into a nutrient.

Evelyne: Yeah. So let’s talk a little bit more about the cycle because you brought it up in your answer. So you, in your TED talk, you call your period an ergogenic aid. Tell me more about that. How can we use our cycle to our advantage?

Dr. Stacy Sims: Well, first and foremost, if a woman is getting a regular cycle, then we know that she has a very robust immune and endocrine system. So that means that they’re very resilient to stress. When I first started talking about a period being an ergogenic aid, it was in the eye of really trying to get people to understand that amenorrhea is not beneficial. That is the rhetoric that has been ingrained in sport for so long that if you lose your period, then you’re more like a man. You’re training hard enough, you’re ready to perform, and we know that’s absolutely not true. So when we pull it back down and say, “If you are regularly cycling, then this means that you are robust enough to handle hard training stress.” When we start looking at the differences between the luteal and follicular phase from a molecular standpoint, we know that you have a greater ability for building lean mass and taking on stress from an immune standpoint as well as a tissue standpoint when you’re in that low hormone phase.

Ovulation is the question mark, because we know that there are so many women who have regular and ovulatory cycles, and you might still have a bleed with an anovulatory cycle. So can’t really, really test and say, “Are you absolutely in the luteal phase?” If someone is regularly cycling and they know that they’ve ovulated and they’re in the luteal phase, and we see that this is a time where we have the shift with progesterone being more catabolic, we see an increase in our metabolism, we see an increase in our protein needs by about 12%. So we start accommodating that, and then we look at really deloading about the week before our period starts, as we see that there’s greater inflammation, greater cytokine responses, and overall greater stress on the autonomic nervous system, then we start to see better training stress scores across the board.

But it’s that ovulation that’s that sticky point. But we’re seeing new fintech come out. There’s a company called Prove. I don’t have anything to do with them, but I’m very excited that it’s come out because it is from their fertility angle looking at all the metrics that can indicate ovulation, including testing for progesterone metabolites in the urine a few days after the predicted ovulation. So as an applied scientist and knowing that that’s been validated, it’s reliable, it’s FDA approved, we’re like, great. Now we have a really easy way of monitoring if there is ovulation or not. And if there is, then we can dial things in. But because it’s a little bit more, I guess, advanced in what a general person would want to do, we bring it back down to tracking your own menstrual cycle and understanding how you feel across your own cycle and finding your own patterns.

Because then you can dial in your training and say, “You know what? On day 18, I always feel fantastic. I can put in a harder session on that day. On day 25, I always feel super flat, so I know that I’m not going to put an interval session or really hard day in.” So there’s ways of finding your own patterns, and that’s how you can really dial in and understand how you can use your menstrual cycle. And don’t be afraid to work out hard when you are in menses or bleeding because that again is a misnomer that you are a delicate flower while you are bleeding. If you have a really severe period cramps, then yeah, take it easy. But for the most part, there isn’t anything from a physiological and a molecular line of thought that says that you can’t go hard and do intensity.

Evelyne: So putting this in, I don’t know simple terms is the right word, because I’m just trying to conceptualize, and I know you talk about this in your book, but if we’re talking about the first 14 days, so the follicular phase, what are the recommendations that you make in terms of performance, in terms of nutrition, and maybe also in terms of supplements and recovery during that time. Can you review those and then we’ll do the luteal phase?

Dr. Stacy Sims: Sure, sure. So in the follicular phase, I guess the way to say is we’re more like men in the fact that we can access carbohydrate, well, our heart rate variability is elevated, so our autonomic nervous system is really, really robust in taking on stress. So from a training and performance metric, we look and say, yeah, we can do really super high-intensity work. We can do really heavy resistance training, and we can monitor that from a stress standpoint and recover well from it. From a supplement standpoint, we’re looking at increasing creatine across the board because women have lower levels of creatine than men, especially important if you’re following more plant-based. And then we also look at using things like Omega-3 fatty acids for cellular integrity. It’s when we are approaching that ovulatory surge and we see that women have more propensity for soft tissue injury because of the way estrogen affects soft tissues.

The idea is that if you’re pushing too hard around ovulation, you might be predisposed to injury, but again, it’s finding how you feel and how your body’s responding to that training. After ovulation. When we get into luteal phase, this is where we see more of the changes, and this is where it becomes really important to understand that with progesterone, we start to see a decrease in our insulin sensitivity. We see more carbohydrates that’s being shuttled to help build this beautiful endometrial lining. There’s a greater amount of glycogen that’s stored in the endometrial lining because it’s becoming the place for this beautiful fertilized egg. And in that progesterone is responsible for breaking down so many different things. So we have an increase in our lean mass breakdown. Progesterone is shuttling all those amino acids to build this tissue. So when we take it into a whole person, what do we do?

We want to increase carbohydrate intake, especially in and around training to have more blood glucose available for training because again, like I said, we are seeing this compromised ability to access carbohydrate because of the shuttling into the uterine lining. We also want to increase our protein intake across the board by about 12% because we have this increased catabolism from progesterone. We have an immune shift, so we have more of a pro-inflammatory response with greater cytokine responses. So we want to make sure we’re eating more anti-inflammatory foods across the way. If you are prone to inflammatory issues, then looking at using turmeric, also increasing that Omega-3 intake, all of those things are really beneficial for supporting the body in order to take on the training load and the training stress, because it’s all about how are we mitigating increased stress the body can accept exercise stress and adapt to it.

Evelyne: So while I know several practitioners who work with professional athletes, I mean, most practitioners are just working with weekend warriors or just the general public, do you have the same recommendations whether you are an athlete? Obviously you’re not going to be training as much if you’re not an athlete, but are the recommendations generally about the same? Do you see everybody as an athlete?

Dr. Stacy Sims: When we look at a professional or an elite athlete, they’re pretty much wrapped with health professionals and they have a support network that can look after them. We’re looking at someone who’s like a recreational athlete who is wanting to compete in age group and do really well, but they have all the stress of family and work and all of the things that come with life. The biggest misstep that they have is they don’t eat enough. So the very first thing I try to get people to understand is if you are exercising on purpose, then we will qualify you as an athlete. So we have to get you into that athletic mentality. As an athlete, you eat to fuel for your training because you don’t get fitter from reducing calorie and reducing fuel when you’re trying to hit and maintain certain intensities. If you are looking to recomp your body, compromising in around training from a fuel standpoint is not when you do that.

So trying to get people to understand that you want to eat for the training that you are doing, recover from that training, and then we look at how we modify other things in the day to either create a slight calorie restriction or how do we increase total protein intake ’cause we see that the best way of reducing injury, recomping the body, feeding forward to better sleep, which is improved recovery, is higher protein, resistance training and making sure you’re not in a low energy state. So it is different when we’re talking about the elite and professional athlete versus someone who’s training hard, either for life or for a particular event, because they don’t necessarily have that athletic mentality. So trying to shift them into that to understand that food is what you need to be resilient to stress and how do we approach that? We fuel for what you are doing, recover from that, and then we modify outside of that training scope.

Evelyne: Gotcha. And bringing it back to the protein, and we’ll talk more about shifting into perimenopause and menopause, but I want to ask it now, for women who are still cycling, when it comes to protein needs, do you have general recommendations around that?

Dr. Stacy Sims: Yeah, we say between one and 1.1 grams per pound of body weight per day, and I always get pushed back, “Oh my gosh, that’s so much protein.” But when we think about it’s not really right. We’ve heard so much in the nutrition space about carbohydrate and fat and manipulating that, and protein’s been the quiet in the background. But as we’re getting more and more research around protein, it’s so important to boost that protein intake not only for your reproductive years in maintaining lean mass, but as we’re looking for all of our cellular processes, brain health, neural, and I guess our neurotransmitters and other aspects that we’re having for brain health, we need that protein.

So if you start exercising, that increases your protein needs. So this is why we’re starting to see the baseline intake for a recreational female athlete is 1.6 to 1.7 grams per kilo, which sits about that 0.8, which is still on the low side because the more we see this elevation in protein up to 2.5 grams per kilo, which is that 1.1 to 1.2 grams per pound, much better outcomes with regards to recovery, lean mass development, strength development, power development, soft tissue quality, so it feeds forward to that protein.

Evelyne: And then did you say, well, during the luteal phase, we’re increasing carbs but also protein, right? Where did you say it was like by 12% and about? What does that look like if you’re eating 1.1 grams per pound, then is it just a little extra protein snack? What does it look like practically?

Dr. Stacy Sims: Yeah. The research and everything talks about 12%, but really it’s getting an extra around 20 grams or an extra protein serving per day.

Evelyne: So one protein shake extra, maybe. Something like that?

Dr. Stacy Sims: Or adding a little bit more protein at every meal, and it doesn’t have to be animal-based protein. You can look at adding some extra edinome and some pumpkin seeds ’cause then you’re getting not only more protein, but you’re also getting all the phytonutrients that come with that as well.

Evelyne: And would you say that’s all 14 days of your cycle or the first few days of the luteal phase or-

Dr. Stacy Sims: No, across the board because your body is building tissue and then it has a signal to slough it off, which is very highly stressful and creates a lot of catabolism. So your body’s like, not only do I need protein to support what’s going on from a growth and a release standpoint, but I also need it for the immune system. And if we’re compromising on protein, this is where we start to see things like the period flu where you have the undercurrent of respiratory tract infection or stomach problems or other things that make you feel really ill. It’s a compromise of your immune system. So if we’re increasing our protein intake, we’re also making sure that we keep a really robust immune system. That’s super important when we’re looking at the stress of daily life training and this compromisation and change in our immune system when we’re in that luteal phase.

Evelyne: Yeah, thank you for explaining that. In your research, what did you find when it comes to women who are on oral contraceptives versus not, as it relates to performance?

Dr. Stacy Sims: Yeah, so I got an email this morning actually about a young girl who was put on an oral contraceptive pill because she was amenorrheic, and they’re like, “You’re going to get your period back with an OC.” That is such old school. No, that’s not the right thing. So the first thing is you don’t have a true bleed, you don’t have a true period on any kind of oral contraceptive pill. It down regulates your natural endocrine system and creates a different hormonal profile for you. And it also depends on the progestin component and how much estrogen is involved or estradiol is involved in that oral contraceptive pill. We see regardless of that, there’s a greater oxidative and inflammatory stress. Those exogenous hormones create this in the body. So there can be a little bit of a compromisation with regards to total recovery. So we have to pay a little bit more attention to increasing our antioxidative foods and our anti-inflammatory foods to counter that.

We look at overall performance. In elite athletes, this counts more than our sub elites, but that top 2%, what I call the 2%, that anaerobic capacity, the sprint capacity, is reduced. We also see that for every extra week that you’re on an OC, you have a decrease in your heart rate variability. So that’s an indication that you are not as robust distress, and this is why we talk about that placebo week or the sugar pill week. From a health standpoint, you don’t necessarily have to come off your pill. You could keep rolling those pill packs. The oral contraceptive pill was funded by women, designed by women, but actually done in the lab by men who decided that we should put in that sugar pill week. So women get a bleed and feel like they have their period, but it’s not necessary from a health standpoint.

But when we’re looking from a performance standpoint, we want that bleed phase or that withdrawal week because we see a shift again where your body rebounds and has a greater ability to withstand stress. So we see an increase in our heart rate variability. We see increase in our capacity to do higher intensity work. So we have to really look at what are we using an OC for? Are we using it for health reasons to control things like endometriosis, PCOS, heavy menstrual bleeding? Are we using it for contraception or are we using it because at some point in our life, we’re told we should probably go on it and we haven’t really rethought why we are on it. So there are lots of things to consider when we’re on an OC and when we’re looking at things that strength training. We know that the higher estradiol component of an oral contraceptive pill will create hypertrophy or increase the amygdalin mass, but there’s no strength component that comes with that.

So if you are a power-based sport or in a weight category sport, you might want to revisit that. If you can go to a 20 microgram dose instead of 30 microgram dose, we see that that helps with body comp and strength. So there are different things that we have to consider when we’re thinking about the performance world, but it first comes down to asking why we are on it and what are the reasons why we should stay on it. Is there an alternative like an IUD or progestin only mini pill that we can go to instead because that has the least systemic effects and we start to see an increase in our own natural ovarian function.

Evelyne: Super interesting. So let’s talk a little bit about perimenopause and postmenopause, which you cover in your second book called Next Level. By the way, one of the practitioners I work with, she’s a nurse practitioner, Leslie. She told me she read your book or listened to it over and over and over till she could repeat it.

Dr. Stacy Sims: Oh, my gosh.

Evelyne: She said and it made a huge impact on her health and her patient’s health.

Dr. Stacy Sims: Oh, awesome. Great.

Evelyne: Yeah. So before we talk about some of the hormonal changes of peri and postmenopause and how they impact performance, I want to set the stage a little bit more with why is it so important for women to train? What are the changes that we’re looking for more so than just aesthetically? What are we looking for?

Dr. Stacy Sims: So there’s so much confusion and conversation out there about peri and postmenopause because women have been gaslit around it for so long, and when we start hearing all the information about all the things that we should do, as a physiologist, I look and go, sex hormones affect every system of the body. So we know that affects everything from brain health, bone, gut microbiome, everything that makes us, I guess, women for the most part. So if we start to have fluctuations in our sex hormones and we are experiencing the effects of that through gut distress or loss of bone, changes in body comp, anxiety, rage, poor sleep, then again, as a physiologist, I’m like, okay, what kind of external positive stress can we put on the body that is going to create an adaptive response that these hormones used to? So this is where we look at really being specific about the kind of exercise that we are doing and the duration of the exercises that we are doing.

Because if we think about the 150 minutes of moderate intensity activity with a couple of days of resistance training of eight to 12 reps, that has been put forth by things like the American College of Sports Medicine, that’s based on male data. It’s also based on women who are just having to move. But if we’re looking at women who are already active, that’s the worst advice possible because when we think about moderate intensity, it is not a hard enough stress to invoke the type of change that we want, and yet it is too hard to invoke a positive response to reduce sympathetic drive. When we’re looking at things like estrogen and the lack of estrogen or the perturbation and changes of estrogen, we see how that directly affects our lean mass and our brain. So if we look first at lean mass, we know that estrogen is responsible for signaling just the basal cell of the satellite cell development.

We also see that is responsible for how strong myosin bonds to actin for our muscle contractions and the strength of that contraction. We also see that estrogen is responsible for how much acetylcholine is held in the vesicles at that neural gap junction. So how the nerve comes down and stimulates the muscle fibers for contraction. So we start to have changes in the ratio of estrogen, we have to look at a different stress. This is where heavy resistance training comes in. So we’re not looking at our eight to 15 or 30 reps. We’re looking at the really heavy loads and low rep, and we call it I guess, more power-based training. And there’s more and more research coming out showing that peri and post-menopausal do so much better with the heavier weight and lower rep.

One, it creates essential nervous system response that invokes lean mass development, strength and power, which are the first things that go, but it also feeds forward to better brain health because if we are doing heavy resistance training and it’s essential nervous system response, then we start to affect both white and gray matter. White matter, because it’s the peripheral nerve that is the connection there. And then the gray matter, because it’s the neurons and the dendrites that are around that are communicating for this lift and load. So we hear all this rhetoric about estrogen and brain health, and when we start to see the demise, okay, well what’s something really positive that we can bring in? And that’s that heavy resistance training.

Evelyne: Sorry, when you say low reps, you’re talking three to five reps or so?

Dr. Stacy Sims: We say between zero and six and the way that-

Evelyne: Zero. Oh, wow.

Dr. Stacy Sims: Yeah, and a really easy way to understand if you’re lifting heavy enough is if you have a rack of barbells or sorry, dumbbells, and you go up and you pick the one that you usually use. If you can do seven to eight reps pretty easily and you aren’t losing form, you don’t feel fatigue, it’s not heavy enough, so go up another weight or two weights, do the same thing. You should be able to do six to seven reps with really, really fantastic form, but just barely able to eke out the last two. If you can do that, then that’s where you want to start. That’s heavy enough to start. If you have been lifting for a long time, then that’s still a little bit light but for women who are trying to understand what is heavy enough. We want them to feel that beginning of fatigue by that sixth rep and really going, “I don’t know if I can make another one or two.”

And that’s how we’re trying to get women to understand what heavy lifting is. It’s not five pounds, it’s not 10 pounds. In general, if you’re just starting, that’s still light. We’re not looking at walking with weights. We’re looking at specifically going and lifting these heavy loads. It’s really important not only for moderating and modulating what’s happening as a perimenopausal woman to our body comp and our brain, but also we want to be able to live life the way we want to when we’re 80, 90 years old, independent, free, capable of thinking for ourselves. So this is the beginning of that journey. When we look at the way progesterone and estrogen work together, especially with insulin, insulin sensitivity, and bone health, we see that when we add in high-intensity interval training or sprint interval training, which is different from your F45s, your Orangetheory’s, your other gym classes that call high-intensity training or boot camp, we talk about true high-intensity training.

If we do sprint interval training, which is 30 seconds or less, as hard as you possibly can go with two to three minutes recovery in between, we’re invoking more of an epigenetic response within the skeletal muscle to create more translocation of what we call the GLUT-4 proteins. So that means that we have more of these GLUT-4 proteins that come up to the cell membrane, open up, allow carbohydrate or glucose to come in without insulin, so it increases our insulin sensitivity. We also see that it creates a change within the mitochondria that really encourages the mitochondria to use free fatty acids efficiently, because one of the reasons we see this increase in that deep, visceral fat that is part of menopause is there’s a misstep between mitochondria pulling and using fat and the esterified fats that are circulating because of a reduction in the anti-inflammatory responses of estrogen and the liver.

So the liver will tell the esterified fats to be stored as the serial fat, but if we’re doing that interval training, we have a different conversation that occurs so that the serial fat is not being made and is not being stored. We’re using more of those free fatty acids to be used for fuel and be stored within the muscle for fuel. When we look at true high intensity interval training, so this is a little bit of a lower intensity between 80 and 90% of your max, and the intervals are one to four minutes, and the recovery is variable between one to four minutes, this is a metabolic stress, and this is where we’re seeing more of the extra kind conversation of, let’s use more free fatty acids. Let’s reduce the amount of circulating free fatty acids. Let’s improve our ability for muscle contraction. Let’s also improve our bone health because we have this multi-directional high intensity stress.

So they’re slightly different in their conversations that are happening in the body, but they’re both equally important for maintaining and improving body composition, cognition, bone health, cardiovascular health, and of course mood because we see so many issues with mood and depression and anxiety. So these types of modalities of training really do pinpoint issues that are happening across menopause transition to help women get control of it. And yes, of course, menopause hormone therapy comes into conversation for women who need it, but I don’t fall into the line where every woman needs to be on it, which is the current rhetoric that’s going around. That’s so frustrating.

Evelyne: That’s interesting because that is like what I am thinking right now. So I want to talk a little more about that, and also with perimenopause versus menopause. So in perimenopause we have those fluctuating hormone levels, and then in menopause, like the estrogen just drops. So how do your recommendations in terms of training, nutrition, supplementation change in the perimenopause to menopause stage or perimenopause and menopause stage?

Dr. Stacy Sims: Yeah, so when we’re talking about what’s happening in perimenopause and the change in hormones, we’re really looking at trying to get control of what’s going on through these external stressors. We also see a decrease in our responses to protein and exercise. We have more anabolic resistance. So this is where protein intake is really, really important. This is where we’re seeing the higher end of our protein recommendations super important, and it’s distributed evenly throughout the day. So those guidelines not only hold for perimenopause, but also go into postmenopause. Because when we’re looking at what’s happened in Postmenopause, our hormones are flat lined. So again, we still have to have an external stress that is going to create adaptive changes and adaptive responses in a positive way. So we’re preparing women in perimenopause for postmenopause, but the benefit of doing all of this in perimenopause, it’s attenuating a lot of the symptoms that is occurring or that are occurring with the fluctuation in change in the ratios of our hormones.

So when we look at late postmenopause, so this is eight to 10 years after menopause, so that one point in time of 12 months of no period, we see we need more frequent doses and less volume. So this means instead of going, I’m going to do high-intensity and resistance training, two days of resistance training and two days of high-intensity, we look at extending that and going, we’re going to have shorter sessions, but more often because we’ve lost some of the, I guess, the subsequent estrogen receptors that are still down-regulating, even in menopause, we get to late postmenopause. Those are completely gone. So we need more of those doses responses of that high-intensity and resistance training.

Evelyne: How can a practitioner best help their patient or their client get into this with, I’m thinking of people in their even fifties, sixties, seventies who were never athletes and who don’t feel comfortable in a gym. How can their doctor get them to start that? I think that’s very hard when you haven’t done it and you do feel uncomfortable, right?

Dr. Stacy Sims: Yeah. I always bring it down to we look at four main, I mean people call them pillars, whatever, four main areas that we can really invoke change. First is sleep. If we are not dialing in sleep, then we cannot have any kind of body composition change, because if we have a misstep in our sleep, we have a misstep in our metabolism, our ability to withstand stress. So then if we’re trying to change body composition through exercise or nutrition, it’s not going to happen. And sleep is very fleeting in perimenopause. So we have to look at what are the things from a sleep hygiene standpoint, maybe looking at using some L-theanine to really help get that parasympathetic response. We also look at that mind-body, maybe using some yoga nidra or guided meditation to help bring on that parasympathetic response to be able to sleep. When we’ve nailed sleep down, this is where we can start introducing the physical.

So many women are afraid to lift weights. They’re afraid they might get bulky, which is almost impossible, unless you are really mesomorphic and young and eat a lot and don’t do any cardiovascular work, and they’re also afraid of getting hurt. So the way that we navigate that is we start with just body weight or we start with mobility. We do a 10-minute circuit of body weight, trying to get people to understand how they move, what their restrictions are. If you want to work with a physio to see where some of those sticky points are, then that’s fine because you’re going to understand how you move and get some guidance. If you’re not comfortable going down that route, then there are lots of programs online that you can start, like the Betty Rocker, she’s really fantastic with small little programs to help women understand how to move and start in your house with body weight.

You can gravitate onto someone like Hailey Babcock with Haley Happens Fitness, where she has learned to lift program that’s really basic for when you want to go to the gym. Maybe go to Planet Fitness. That’s really open and encouraging for all levels, and it’s a really safe environment to learn to lift because it’s all machine-based, and there are gradual steps up in different programming from working with a personal trainer to going to a CrossFit type class the more confident you get. But the very first thing we need people to understand is resistance training is the bedrock, and how do we get people to move? If we get people to move for 10 minutes or so a day, understanding how their body moves, using resistance training from body weight, maybe adding some load into a backpack. We see really rapid strength gains, which is positive affirmation for people to keep going.

Once we get that buy-in, then we can start really manipulating nutrition, but we can’t do it all at once because then it doesn’t work. So it’s just those small steps and it’s easy in working with someone, and this is why it’s really important to understand from that cultural standpoint how people feel about exercise, how comfortable they are. Because here in New Zealand, they make all the elementary school kids run cross-country, and at the very start when they’re young, they don’t care. But as they start to get to fifth, sixth grade and they might start coming last, this is the impetus for so many people to hate running and not ever do it as an adult.

So if you’re a practitioner, let’s start with 10 minutes of running and someone’s like, “I hate running,” you’re not ever going to get buy-in. But if you’re like, “Let’s start with 10 minutes of the circuit. Let’s do some 30 seconds of air squats and maybe some wall push-ups, let’s start our morning with that, and then we’re going to do some meditation,” and that’s going to set them up for a much better way of handling stress through the day, and they can tie that back in. So it’s a really good progression to start small and be very positive in the encouragement of what we’re doing before we really start adding load and intensity ’cause it is a journey. It’s not a training block. It’s a journey for the rest of our life.

Evelyne: Absolutely. And Stacy, I actually was a personal trainer, starting at I think 19-

Dr. Stacy Sims: Wow.

Evelyne: Yeah, for eight years. I studied kinesiology, like you, and I worked with women almost exclusively, and I so wish I had known all of this information because I could have been so much more effective. And even though I was already into nutrition at the time, I could have been so much more specific. I hope that everything that you’re teaching and talking about that personal trainers learn about that and that it gets incorporated into kinesiology programs.

Dr. Stacy Sims: I hope so too.

Evelyne: That would be fun. Yeah. Let’s talk about supplements a bit. You already brought up creatine, and I have some more questions about that. First of all, why do women have less creatine than men? Is there some advantage or it’s just a disadvantage?

Dr. Stacy Sims: Well, again, it brings it down to the morphological sex differences. If we’re looking at where creatine is primarily used, it’s all the fast energetics. Men have more of those oxidative fibers or the type two fibers. Women have more of the endurance type fibers, and we end up with less muscle mass comparatively to men because of the fact that we have body composition differences, just sex differences in body composition. So we have around that 70 to 80% versus men’s 100% if we’re looking at the ratios of women to men in creatine storage, but that doesn’t mean we don’t use it as much as men with regards to our gut, our brain, our muscle performance, and women often don’t eat as much creatine-containing foods because of the diet culture.

So when we take all of the things into account, we see that women are relatively lower in their creatine stores and intake than men. So we also lose the storage capacity as we get older because we’re losing muscle quality and the amount of lean mass that we have. So we look and say, yeah, creatine really important for women to take, men take it, sure, it’s going to help you too. But for women, it’s really important, especially in peri and postmenopause when we’re looking at brain energetics and brain metabolism, because creatine is used heavily there as well.

Evelyne: So it seems like a dose of three to five grams a day like maintenance is beneficial for most. I think I got that from your book, but then if you want it to be more specific around it, if somebody is working out, do you take it before? Do you take it after? Does it not matter? What are your thoughts on that?

Dr. Stacy Sims: Yeah, it doesn’t really matter. With creatine, it takes about three to four weeks to completely saturate the body. So as long as you’re getting it in on a regular, consistent basis, you’re going to increase total saturation. That’s the important part. If you are someone who’s like, “No, I need to take it the same time of day every day,” sweet. But if you’re someone who’s hit or miss, then you should say, “I need to take it every morning with my coffee.”

Evelyne: Gotcha. That’s helpful. Thank you. I also thought this was so interesting. I was looking at the presentation that you did at IFM regarding iron, and it’s interesting to me because we just recorded an episode on hemochromatosis.

Dr. Stacy Sims: Oh, yeah.

Evelyne: So we also talked about iron deficiency, but I thought it was so interesting that exercise induced inflammation increases hepcidin for three to six hours post-exercise in premenopausal women, up to 24 hours post-exercise in post-menopausal women, which causes decreased iron absorption, iron recycling from the gut. On this episode that we recorded, we didn’t actually even get to the part about iron and estrogen and testosterone, but can you share more about that ’cause I found this so fascinating.

Dr. Stacy Sims: Yeah. Estrogen is also involved in the, I guess we say hepcidin responses because it’s anti-inflammatory. So when we’re looking at post-exercise in women who are naturally cycling or still have robust estrogen, then the circulating estrogen helps decrease that hepcidin response. So this is why we see that three to five hour mark post-exercise in women who are still cycling. In post menopause, because we don’t have the anti-inflammatory capacity of estrogen, it doesn’t have the same post-exercise decrease. We need some kind of impetus for that. There’s a slower decrease of the hepcidin. So when we talk about iron supplementation, we don’t see a lot of low ferritin or iron deficiency in postmenopausal women ’cause we’re also not losing as much. So it’s more important when we’re looking at perimenopausal women who might have heavy bleeds, or they might have times when they’re not absorbing ’cause they have greater systemic inflammation that we keep a track of ferritin. So this is where the whole discussion of how do we do iron supplementation when we’re looking at peri versus postmenopausal women, and that hepcidin response.

Evelyne: Interesting. I want to talk a little bit more about some other supplements that you like, and then intermittent fasting really quick, even though that could be a really long segment, and then we’ll wrap up. So in regards to supplementation, I know you’re a big fan of adaptogens. Tell me a little bit more about what are some of your favorites, and I keep asking for your opinion, but I know you’re very science-based, so what does the research say?

Dr. Stacy Sims: Yeah, so there is some really robust research on our medicinal mushrooms, like reishi and cordyceps. We look at some of the other adaptogens like Ashwagandha, Schisandra, holy basil, Rhodiola. Those are really well studied as well. I prefer for my own self rhodiola because it helps moderate my stress and helps me sleep. I don’t like Ashwagandha so much for myself because I find that as it accumulates, I get very lethargic. But when we’re looking at what’s happening from the scientific standpoint, Ashwagandha is really good at modulating cortisol. It also can somewhat work as a SERM. So if you have any kind of estrogen issues with breast cancer, Ashwagandha is not the way to go.

We also see that it can have an effect on thyroid and increase thyroid function. So if you are having issues with thyroid and you start using Ashwagandha, you might have to adjust medications. So just be aware that there is some research in and around that. We look at Rhodiola, there are relatively few side effects, but it is one that either is stimulating so people wake up and feel really energized by it. Other people get more of a calming effect. I’m fortunate enough to have the calming effect from it, so it does help me sleep.

Evelyne: Interesting with the Rhodiola.

Dr. Stacy Sims: I know.

Evelyne: Because I feel like some people, I’ve recommended Rhodiola too, and I love Rhodiola. I take it myself, but some people actually get more anxious if they’re that type. And then I know so many people who absolutely love Ashwagandha, and I do too. I actually like to use them both. I love Aluthermo too. I don’t know if you mentioned it.

Dr. Stacy Sims: I haven’t tried that one yet.

Evelyne: It’s great. I remember learning in my herbal medicine course, it’s great for those who work hard and play hard and hardly sleep. I think David Winston said that, but I learned it from Dr. Low Dog, yeah, work hard, play hard, and hardly sleep, but it’s a very neutral adaptogen.

Dr. Stacy Sims: Oh, cool. I’ll have to look into that one too.

Evelyne: Anyway, tell us more about Schisandra.

Dr. Stacy Sims: Yeah. So it’s the tired but wired, right? So a lot of women experience brain fog. They’re tired, but wired. And when we look at using Schisandra, it helps with that mental focus. I’ve had some people say it’s like Adderall, and it’s like, yeah, I get that incredible focus, but I don’t have that caffeine jitters or the ups and downs that caffeine does. So it’s really good for mental focus and clarity and using it earlier in the day because it can be that mental focus and clarity that’s stimulating, so you can’t sleep that well. So those would be the ones that I would really, they’re pretty generic, but there’s a lot of research around it and how beneficial it is.

Evelyne: Absolutely. Okay. The last topic I want to cover is intermittent fasting. I feel like it’s so controversial. People just love it or hate it, and I think, if I’m not mistaken, a lot of the research has been done on men. So tell me about intermittent fasting in women. Yes or no?

Dr. Stacy Sims: Yeah. So no. If we talk about the normal intermittent fasting. We know women do better in a fed state regardless of age, and that has to do with metabolism and the fact that we use blood glucose and more so than men do, and the fact that our hypothalamus is pretty sensitive to nutrient density, even after we stop cycling just because of sex differences in our appetite control and nutrient density sensitivity. When we look at things like time-restricted eating, the fancy word for just normal eating, it’s pretty beneficial. So you get up, you have breakfast or some fuel within a half an hour to counter that cortisol peak, and then you’re eating regular intervals throughout the day, and then you have dinner and you don’t eat after dinner. Some people call that time-restricted. It really works with our chronobiology, and we see that when we have more calories in the day, particularly earlier in the day, then it helps with our overall stress, our overall metabolism, our glucose sensitivity, our insulin sensitivity to glucose and sleep.

When we look at intermittent fasting and we have large windows of time when we are not eating, especially for the most part, I guess it’s kind of stereotypical to say this, but most women will try to hold their fast till noon and then break it with lunch and that whole time period in the morning, they might be doing training. They’re heavier stress. We see a cortisol increase and it is pretty much a signal to just be catabolic. So the first thing that goes is lean mass. We know regardless of age, we want to keep lean mass. We also see from population research that both in men and women, when you hold a fast till noon or after and your eating window is 12 to 6:00, 7:00, 8:00 P.M. you don’t really garner any of the benefits that people talk about with regards to fasting. There’s no metabolic control, there’s no improvement in sympathetic versus parasympathetic drive.

There’s no real change in autophagy or telomere length. The fasting benefit comes really from not eating after dinner and having that time window when your body’s able to do what it needs to do while it’s sleeping without digesting. Last week in Chicago was the International Menopause Association meeting, and they also put forth guidelines saying that intermittent fasting and ketogenic diet are not appropriate for women who are peri and post menopause.

Evelyne: Interesting, wow.

Dr. Stacy Sims: Because it causes undue stress from the fasting, causes a lot of gut microbiome disturbance, and that’s the key thing. We need to have diversity in our gut microbiome, which takes a huge hit when we start losing our sex hormones and we have less and less diversity, and we’re seeing that there’s this incredible link between lack of diversity of the gut microbiome and negative changes in body composition. So when we’re talking about intermittent fasting and fasting windows, slight calorie restriction, high protein, good amount of fiber, resistance training is the best way to modulate body composition in perimenopausal and postmenopausal women.

With ketogenic, which is starting to have another surge in popularity, again, it affects the gut microbiome. If you’re existing on a high fat, low fiber, which is ketogenic diet, you’re reducing the diversity in the gut microbiome, so much so that you’re having a negative health effects. So I was really, really happy to see that the science finally caught up to the big societies that are putting out guidelines.

Evelyne: Very interesting that they actually made a stance on that.

Dr. Stacy Sims: I know. I was like, “Yay.”

Evelyne: We’re going to go into just our rapid fire questions for each guest, what are your top three favorite supplements that you take every day?

Dr. Stacy Sims: Creatine, vitamin D, and Omega-3.

Evelyne: Love it. What are your favorite or top health practices that keep you resilient and balanced?

Dr. Stacy Sims: I wake up before everyone else to have at least 10 to 20 minutes of absolute quietness so I can recenter and just not be bombarded by sound and noise and all of the things that create that stress response. And I’m very, very particular in sleep and owning at least one hour a day to myself for physical. Those are my top things.

Evelyne: Awesome. And what is something that you’ve changed your mind about through all of your years in this field?

Dr. Stacy Sims: I’m going to have to say menopause hormone therapy because I-

Evelyne: Yes. Tell me more.

Dr. Stacy Sims: Yeah. So I did my postdoc with Marcia Stefanick at Stanford, and she was one of the PIs for the Women’s Health Initiative. And I have been in the data sets, I’ve done research on the data sets. I’ve published papers from the Women’s Health Initiative, and I didn’t really realize what the rhetoric was outside of that bubble of Women’s Health Initiative. And when I got out, everyone was afraid of using it, and I was like, but when we’re looking at the research, the research studies were designed for women who were 60 or older, and they’re at least 10 years post menopause. So when they were put on menopause hormone therapy, they’ve already had the down regulation of all of their receptors. So it would make sense from a research standpoint that you would have negative impacts.

And so that’s what the Women’s Health Initiative was finding that for older women, this formulation of menopause hormone therapy was not appropriate. But then when you look at the UK and we have the UK Million Women Study that was looking at menopause hormone therapy for peri and early postmenopausal women, and they had lots of positive outcomes, there was this big clash. So coming out and trying to describe and discuss that, now we have new formulations. It’s like, okay, yes, we look at it as a tool in the toolbox, and there shouldn’t be an age stamp on it. You shouldn’t say you should start using it early and stop using it midway through, because there can be women who have menopausal symptoms all the way through, all the way up to 80. So I don’t agree with everyone should be on it. I don’t agree with no one should be on it.

I agree with the fact that it is a tool in the toolbox, and it is very beneficial for some women, but there’s also other things that we can pull in. Whereas before I really started investigating the differences between it, I was just in this box with the Women’s Health Initiative thinking, yeah, it’s not that appropriate at all. So it has been a mind shift. The more information you get and the more science evolves and the more the formulations change, and you see that, yes, it is beneficial, especially as we’re having these down regulation of our receptors of these hormones to slow the rate of change and reduce the severity of things, but it does not replace the work that needs to be done through diet, exercise, and lifestyle.

Evelyne: Yeah, I thought that one of the reasons why some of the results were negative of the Women’s Health Initiative was more due to the fact that they used Premarin. And now in the integrative and functional medicine communities, everyone prescribes bioidentical hormones.

Dr. Stacy Sims: Yep. That’s part of it too, because now we’re seeing an upsurgence in the micronized progesterone, micronized estradiol, and those are more like what your body naturally produces as opposed to the conjugated and the Premarin, which also had their negative side effects. So it was the age factor of the women’s health initiative and the older formulations. I bring it also back to the oral contraceptive formulations. We’ve gone through four generations now, five generations of progestins, because the more signs rolls out, the more we understand it and the more we should be changing and looking at how it influences the body. Whereas people are just like, “Well, there’s one formulation. We shouldn’t use it.” But the formulations have evolved the more sciences come out and said, “Hey, we have to start looking at these factors as well.”

Evelyne: I do have one more question just for you. Since you are the mom of a daughter and how old is she?

Dr. Stacy Sims: She just turned 12.

Evelyne: So what do you wish most for her in this world, with all of the knowledge that you have and everything that you do?

Dr. Stacy Sims: I don’t want her or her friends to experience a lot of the stuff that we did growing up, the pushback, the language use of things like sissy girl pushups, ladies bar, you’re not good enough for sport, you’re too slow. All of these things that we just assimilated as being okay and the body shaming and all of those things. I want them to understand that they are empowered. They need to take up space, that having a period is a good thing. They shouldn’t be afraid of it. They should be able to talk about it, and that they can continue to do whatever they want in sport and physical activity because they are strong, inherently from an internal and external standpoint. So with all of this information, I’m hoping that it inspires and empowers the other moms to be able to disseminate it down to their daughters, to keep pushing forward this generation, to keep invoking change so that we have more equality across the board, and that’s my big dream.

Evelyne: I love that. That’s beautiful.

Dr. Stacy Sims: Thanks.

Evelyne: Thank you for sharing.

Dr. Stacy Sims: Yeah.

Evelyne: Stacy, thank you so much. This was really, really awesome. You shared so much amazing detailed scientific information. I highly encourage practitioners to pick up your books, Roar and Next Level, and where can practitioners read more about you?

Dr. Stacy Sims: If you come to our website, the Dr. Stacy Sims website, that has pretty much a list of everything and all the stuff that we’re doing, but if you don’t want to invest that extra click over and you’re scrolling through Instagram, then you can go to Dr. Stacy Sims, and we post scientific transparent dissemination of the science as much as we possibly can.

Evelyne: Amazing. Well, thank you again. Thank you so much, and thank you for everything you do in this field. It’s truly, whenever I meet people like you, I’m like, “gosh, how lucky I am to be alive at the same time as you when you’re doing all this research.

Dr. Stacy Sims: Thanks so much. I appreciate it.

Evelyne: Yeah. Thank you for tuning into Conversations for Health today. Check out the show notes for resources from today’s episode. Please share this podcast with your colleagues, follow, rate or leave review wherever you listen or watch. And thank you for designing a Well World with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting-edge research and practical tips.