In this episode of Tales From The Midpack I talk with Dr Stacy Sims, MSc, PhD, an exercise physiologist and nutrition scientist who aims to help everyone understand how women can work with their unique physiology to have optimal athletic health and performance. Check out the episode here.
I've been looking at audio to text translations, and was able to get half an hour transcribed for free on one app, so I've put that below. I had a quick look over it, but be warned there will likely be errors due to it being done by AI.
I hope you enjoy, Beck.
Keywords: perimenopause, menopause, plyo, heavy lifting, fatigue, GI distress, sprint, training, progesterone, estrogen, running
Hi, and welcome to Tales From The Midpack. I'm your host, Rebecca hunt. I'll be bringing you stories from everyday runners, experts, and some race recaps. Today is an expert episode. We have exercise physiologist and nutrition scientists Stacy Sims joining us. Welcome.
Hi, thanks for having me. Excited to be here.
Yeah, it's very coo to have you. So your book Roar, which I did do a little bit of a book club episode about that one while ago, has changed the landscape of people talking about menstruation, shifting it or helping shift it from being this icky topic no one talks about, to being integral to conversations when you're talking about females and exercise, which is brilliant. And your latest book Next Level is having a similar impact in regards to menopause. As someone who's just turned 45 it was exciting when the book came out. And I have people in my community who are reading it or have it on their reading list. So I'm going to work through some of the questions that popped up while I was reading it, which probably means we'll jump around topics a little bit. And obviously, we'll only get time to scratch the surface. Now, from looking at your media page. This is at least the 37th podcasts that you've done this year.
Oh, really? I haven't, I haven't kept track.
You’ve also done articles and interviews. So anything that doesn't get covered in this episode, if you want to learn more, I'll put a link in the show notes to her media page, where there's just such a wealth of resources; you're very giving of your time. And we all really appreciate it.
Well, it's about trying to get science out to the real world, right. And I mean, I'm right there with you, like mid 40s, love to be adventurous and active, and I want to keep progressing. And then I have a 10 year old daughter, and I want her not to run into all the road blocks that we have as we were growing up. So it's all it's really just selfish and to help everybody else and level the playing field, I guess is the best way to put it.
Yeah, that's funny. It's like, I do this podcast to help other people. But you know, obviously, I'm asking you the questions. I'm interested. So hopefully our self interest helps other people.
Yeah, exactly. Exactly.
So a few things is about obviously menstruation, menopause. In this phase of life, it feels like it's a bit tricky. So in Roar, you talked about working with menstrual cycles. We actually have to have a consistent way of tracking it, and I discovered that the Garmin app is actually got a decent calendar in there, but when you get perimenopause, and you have such inconsistent cycles, how do we work with our cycles if we don't have predictable cycles?
Right now that is the question, right? And people who aren't quite aware that they're in perimenopause, either. So the progression really is we start to see changes in bladder. And then we start to see your regular cycle lights, there are some women who won't have irregular cycle lengths, they'll just have a shortening of the lead in phase. So for you know, in our pre menopausal years and our reproductive years, and we're used to having a couple of heavy days of bleeding and then maybe lighter days and then spotting, and then that starts to change and it shortens and gets heavier initially and then it starts to lighten up, then you know that you're in perimenopause. With regards to cycle length, what's happening is it's the follicular phase that's extending. So if you're really wanting to still have the eye to training because you're like, Oh, my bleed phase is changing a bit and my cycle’s lengthening, but I'm still regularly regular, then you can put it as Oh, I'm primarily in the follicular phase because it's hormones are low. If you're training for something and want to really optimise then what we try to do is work on a two week on one week off or active recovery with the idea that as we get into late period, menopause and post menopause, we will need more recovery because our recovery metrics change or HRV changes and decreases and bottoms out, and respiratory rate goes up. So lots of different metrics that we're used to using that change. So with a two week on, we can have micro periodisation blocks. So say you want to do a VO2 session to improve the top end, then use this two weeks to really work on the quality. And then that one week offer deload. This is for perimenopause and menopause. One week deload is just really looking at active recovery drills and maybe one long, slow, easy run, walk. And then you can hit it again for the next two week block and be like, Okay, well, I really need to work on running economy speed. So then I'm going to start doing more track sessions and your intensity work is attractive. So there's a there's a method to the madness, especially when your cycles start going a little bit arrived.
Yeah. As you said, you don't know at first and I guess one of my questions is, how do you tell the difference between when you're going into relative energy deficiency in sport, and you're going into perimenopause? Because when I first skipped a period, I just kind of panicked, going, oh, it's RED-S, and then I was eating for England. And I think I was wrong about what it was. So is there a way to tell the difference if you're going into RED-S versus perimenopause?
Yeah, if you're really concerned, and you're like, Okay, wait, I have been really fueling for what I'm doing. And I'm pretty sure it's not low energy availability, because the key point with RED-S and low energy availability, is making sure you're getting enough food before and after every training session. And then you can afford to be a little bit lower, and not so much on to when you're far away from training. But when people are in their mid 40s, and they're like, Hey, I'm becoming irregular, is it RED-S or low energy availability? Or is it actually the menopause transition on perimenopause performance, we say to get a blood test. So you want to look at your progesterone, your 21 day progesterone, or you look at estrogen progesterone ratios. Because if estrogen is completely bottomed out, and progesterone is okay, then we know that that's more Lea. But if you're looking at progesterone is bottoming out and estrogen tends to be dominant, then this is where we're like, Yep, it's perimenopause. Because with ovulatory cycles, no, you're not going to produce progesterone. But you're, you're still going to be producing estrogen.
Yeah. Because obviously, if it's right, so the consequences can be dire. Losing a period acts as like that canary in the cage. Are there any other warning signs that go along with RED-S? or is it really just that one and then, you know, go get a blood test, as you just suggested?
Yeah. A lot of the signs and symptoms are similar to perimenopause. So I'll walk you through it. First is low energy availability. So we start to see this with a flatline performance, really disrupted sleep, not getting into an elevated HRV. You are finding like really sore muscles the day afterwards, you go to do an easy run and your legs just feel bad and your heart rate skyrockets. So that's early signs, that's low energy availability. When we get into full RED, it's more than just your period’s missing. It is gastrointestinal issues. So you start going off, I have some, I feel like I have runner's trots every time I go for a run, and this is new, your blood lipids might come back abnormal. So in your normal blood check, all of a sudden your doctor is like, well, your cholesterol is really high, what's going on here. You have that dead end fatigue, you get sick more easily. So upper respiratory tract infections, super easy to get like a kid sneezes on you, and all of a sudden you're out the week. It's a combination when we get into the full RED-S. But the thing with low energy availability and perimenopause is they're very similar in their signs. With the fatigue, with the increased belly fat, with the dead legs, the skyrocketing heart rate and the poor recovery metrics. So if we're really trying to figure it out, we do steps to pull you out of low energy availability first, so we back the volume right down. We fuel for what we're doing. And we make sure we have a really good recovery and we watch sleep metrics and HRV. If that starts to come up and get better than we know, hey, yes, we there was low energy availability. But if it doesn't, there, we know that's paramount. Yeah.
Excellent. Oh, one of the things about menopause itself and you're very clear on, menopause is when you haven't had a period for 12 months. It's like one day in the calendar going, Oh, that hasn't happened. I’m in menopause now. So perimenopause really is the big feisty section. So when people hit menopause, you talked about it in Next Level, how media portrayal of women is very much, ‘Okay, bye bye, you know, fade into the background.’ And it was the same week I was reading that in your book when I saw the article about how Kelly McGillis wasn't even asked to be in Top Gun. Jennifer Connelly, 12 years younger than Kelly McGillis, was positioned as the romantic interest. And the quote from Kelly about why she wasn't even asked, “ I look age appropriate for what my age is.” So what are some of the perceptions of it really need to be changed?
Oh, my gosh, everything I think? Well, I mean, when you think about media portrayal back in the 80s, with 80s, early 90s, with the Golden Girls, right? They were all supposed to postmenopausal women, but they were in their late 40s, early 50s. So that portrayal of the really dowdy clothes and the short hair and hot flashes and all that kind of stuff. It's just mad. It's just magnetising and really putting an emphasis on the negativities of menopause. And when you think, you know, what are the images we see of menopausal women, and it is extra fat and not very fit looking and tired and putting a drain on the public health system because all of a sudden there's metabolic disease, just cardiovascular issues. So it's all the negativity. It's the same as before we really started talking about menstrual cycles. The only thing you heard about female athletes in the media was the pathophysiology. So now we're seeing that with menopause, and now people are like, Well, how do I approach it in the workplace? If I'm having hot flashes and brain fog, I can't really tell anybody, but people are like, Oh, maybe we need to open up that for discussion. So there's a little bit of a rule change. But it's still such a taboo. And there's still all these negative images where you look at someone. Let's see who's a good example. Minnie Driver, right? She's in her 50s. She's postmenopausal, but she doesn't have any of the attributes of someone that would be postmenopausal within the media eyes. So she still keeps getting roles. She has a few wrinkles. But then that's also an offshoot of what Hollywood wants to look like. So it's really just that image and how women are so portrayed as being aged and old and fat and dowdy, as soon as they hit 50. I'm like, No, that's not reality.
No, it's not reality, though. I saw the latest Jurassic World recently, and I'm trying to remember the name of that actress, but they cast her, but yeah, she's still dyed hair very thin, and she was a good 20 years younger than the person she shared in a romantic relationship with. It's frustrating, it's all such a slow u-turn. So switching to training a bit, you're an advocate for turning up the intensity at this point in life and turning down the volume. Now, coming from a trail running community, where Ultras are a big thing, immediately, we have this little panic of hang on, I've got to, you know, get the time on feet I need for this event. But how does that apply to ultra runners?
Right? Well, I come from ultra endurance as well, like, like racing gravel, all that kind of stuff, and Ironman and I did Ultras before they were cool. And then I stopped. But yeah, so this is the thing. There was an article that came out on Outside Magazine talking about this new study in postmenopausal women didn't adapt to endurance until they gave blood and then all of a sudden they're able to adapt. As I know, that's a misconception of what you're trying to push out. What happens when we are late Peri menopause, and post menopause, because we fall into our natural sex differences of exercise metabolism, our running economy, and we're ready really, really well adapted for going along and slow. Which is why we see this uptick in female participation in the older age set in ultra distance stuff. If we want to support our bodies the way our hormones used to, then we need to look for an external stress in order to maintain speed, strength, power to keep progressing forward. So this is where that high intensity part concept or sprint interval training is your heavy resistance. It's training, you plyometric work. Because those all stimulate the body with a stress that causes adaptations, where progesterone and estrogen use to support it. If we're looking at time on the feet, the other thing is coaching and coaching protocols have not caught up with science yet. So we look at coaching protocols, and they could be 20 to 25 years old. So you're saying like time on the feet to be able to go along? Yes. And now, when we start looking at what do we need to be successful in the back half of an ultra, we need to have endurance, we need to have strength, and we need to be able to have balance and coordination. You start getting fatigued, right, time on the feet isn't gonna give you that. You need to have explosiveness, you need to have pure strength and that neuromuscular connection. So when we start breaking it down. Again, if we go back to the two weeks on one week off, the way I work with my ultra endurance athletes, especially all my ultra runners, like during the week, we're going to do a lot of high quality work, that's going to work on the strength, the balance, the coordination and the stamina. So if we push you hard, and mentally, you have to get in there to be able to push yourself at that pace. If we're doing heavy lifting, and then we're doing some running economy drills right after, it's going to teach your body to run very efficiently when you're tired. We want to do some of that top and sprint work because if we have a boost in her anaerobic capacity, as we start to fatigue and get cardiac drift, we can still push the pace, we don't drop off as much. And then we'll have a couple of days where one day, maybe the Saturday is no more than three or four hours of Walk Run with a rating of perceived exertion of two to three. And then the next day is maybe an hour to an hour and a half doing the same thing. So you're backing the days up with time on the feet, but not to the point where you're so fatigued, you can't train well in the subsequent weeks. So we have that two week block of kind of doing that. And then that one week deload, it's full recovery, looking at tissue modalities, mobility, and then one long, slow, usually on a Wednesday evening, where it's two to three hours of on the trail, walk, run, low rating and perceived exertion again, to get some of that time on the feet. It's not about giving up what you love, I get a lot of pushback, I don't want to give up my marathon and my long slow stuff. It's my soul food, I’m right there with you. Because I love going out for hours and hours and being outside. It's about not making that the bread and butter, but really complementing it with time efficient, specially in our busy lives of during the week. It's quality. And then we have soul food, but it's really specific to being really low intensity not going in trying to hammer yourself at this modern in Spain. And when we start doing that we see so much more stamina, less injury, better, cognitive, better skill instability, especially on really muddy, yucky trails, right? And people are like, I can't believe I've done this, I've had quite a few adventure racers have like God zone who've done through this entire era, ultra runners, I've had a group of women who've done that too. And like I can't believe that I did a third of the volume that I normally should do. And I finished faster without injury. So it takes a little bit of a faith. But when you start looking at the physiological demands of a race and what you need to work on and how your body has changed, that makes sense. So we go back to that outside magazine article that talking about Oh, give blood and then you can adapt to endurance is like no, it's the same thing as doing anaerobic work, where your body's like, hey, there's not enough oxygen, I better learn how to use it, and deliver more. So that's what I meant. It's like the misstep and the misinterpretation of people who don't understand what's happening in transition, or in post menopause. And then they try to make a conclusion it gets written up in media.
I'll show it as some of those like the sprint interval trainings, like by the time you've warmed up, cooled down and done it like what kind of length of the quality work you're looking at?
Yeah, so if we're doing something like a sprint interval workout, so sprint interval training might be done and dusted in 25 minutes. Now I can see and hear all the Ultra runners - 25 minutes I'm just warmed up if that. Yeah. And it's like a really slow warmup, and then you're doing 20 or 30 seconds, full gas as hard as you can go and then you're recovering. And initially, you might only be able to do two or three of them and then you call it, but you get a parasympathetic response you get more growth hormone, more anti inflammatory responses, and you get a really good neuromuscular connection for maintaining muscle integrity and leg turnover. If we're doing something more, that's high intensity interval training, not sprint stuff. This is where we go to the track, or we're doing Hill reps and bounds on the trail. So you might be up to a minute, a minute and a half of really working on the strength and the foot placement and bounding group. But again, with recovery, it's usually a one to three. So it's one and a half minutes on, and then three minutes off. So that's really one to two, but three to five minutes off, so that when you go to do the next interval, your central nervous system has recovered so that you can hit it hard where you want to, instead of falling into that moderate intensity zone that so many people fall into. And you know, it's too hard to be easy, because you feel like you trashed yourself, but it's too easy to get the adaptations that you want.
Yeah. Yeah. Which used to be the bulk of what I did. Yeah. The bulk of, like, so many people do. You mentioned plyo. And you talk in Next Level about jumping, hopping, bounding, aiming for at least 10 minutes three times a week, ideally, and multi directional force in your job training. And I remember in Roar, you talking about Q angle issues. So when you're doing all that plyowork, what should we be mindful of as women?
Yeah, so first, I don't want people to just to start off jumping, like you want to phase yourself in like some mobility work doing some jumping lunges first. So not trying to jump up onto a plyo box or do countermovement jump or anything like that, even skipping as a warm up, you can do jump rope as well. And then if you're really like, you're like, okay, my joints can handle this, then you can get into a couple of real plyo moves. So maybe that is jumping down off a box or up onto a stair. So this box jump box down, could be the old fashioned around the grapevine aerobics thing where you're jump lunging around the grapevine, right? So you're making it a bit of fun, but all that counts. If you have great, but if you have a tendency to have hip and knee issues, and your body is not quite ready for the jumping, you can do upper body plyo work. So you can do med ball slams med ball tosses against the wall plyo push ups, all of that explosive movement, because the lower body benefits from it as well. Awesome.
Cheeky question. So running is a very one dimensional stress. Can trail runners kind of argue a little bit like, as our paths are so different, do we kind of get a little bit of multi directional jumping in our runs, and it's not as important? Or is that faulty thinking on our behalf?
It's faulty thinking. You have better agility and balance because of the rocks and the roots and trying to rotate around. But it's not true jumping, it doesn't give you the reactive forces within the phone to really get good bone density and maintain bone density. Yeah.
And one of the core features of the book and I think, has become the most popular just because it's so catchy is the lift heavy shit. Really memorable phrase. And so I guess, I mean, I've read all about it. But I want to make sure listeners know why is lift heavy lifting heavy stuff vital?
Yeah, so again, it comes down to as we're losing our hormones, we want to have that external stress. Estrogen is women's testosterone. Because when we're looking at muscle fibre and muscle contraction, we have actin and myosin, which are two contractile proteins. Estrogen is directly linked to myosin. So when estrogen starts to fluctuate, then we start losing the integrity of our myosin contractile protein. So that means our contractions are slower, we aren't getting the signalling to regenerate it. And if we're not getting the signal to regenerate it, and we're having slower contractions, we also lose overall lean mass. So when we're talking about lifting heavy, we're not talking about a cardiovascular workout. We're talking about that neuromuscular connection, because when we go to lift a heavy load, the nerve tries to contract as many muscle fibres as possible to overcome that load in order to move it. So if we are lifting heavy, then the nervous stimulating as many of those myosin filaments to create a very strong contraction to be able to lift that load. So this way, we are maintaining myosin integrity, or keeping the signaling to keep it and regenerate it. And we're also getting the signaling for muscle protein synthesis. So it's the way to preserve and build the quality of early math and get that neuromuscular connection, which also helps when you're out running and you're getting fatigued because that neural A connection to the muscle is really good with appropriate section as well. So it helps prevent injury and ankle roll and other hip and knee issues that are so endemic and alternative.
And when is it best to put lifting heavy around your intensity days around your long runs?
So when we're looking at phasing into a block of training leading up to an ultra, we want to have minimum two, preferably three days of heavy lifting. And if we're trying to maximise what we're doing, on those heavy lift days, you're lifting, maybe 30 minutes. So you're picking to most three exercises, you're doing three to five reps with three to five minutes in between. So this is where you go to the gym. And you see people sitting around because you're trying to regenerate the central nervous system. Right after you finish your lifts, you head to the treadmill, and you can do some sprint interval stuff, you can work on running economy. So you're doing some higher intensity interval work right after that heavy lifting. You might do that twice a week, and one day of just heavy lifting and mobility work. And then your long run. Like I said, if we're doing the long run properly, you might do heavy lifting, Monday, Wednesday, Friday, and then you're planning your time on the field days on Saturday and Sunday. But because it's such a low intensity, low RPE, then that fatigue from the lift isn't going to interfere with your long focus. Yeah, it's when people try to do race pace all the time. And they get into that moderate intensity zone, that the heavy lifting really interferes and gives that dead fatigue and poor recovery. Yeah, yeah.
All the jelly legs.
Yes, the jelly legs.
I'm going to shift into some nutrition questions about having at least 25 grams of fibre from plant food every day. And I thought to myself, Oh, is cooking method really important because I have a good load of veggies every morning. But I fry them up. And sometimes like, you know, I'll make things and then put them in freezer in bulk and then they get defrosted too. Does that kind of degrade from the quality? Or is that? Okay? Because you know, we're all busy in bulk prep and quick cooking methods.
Yeah, no, that's fine. And the other aspect about it is a lot of people think oh, if I'm just eating raw veggies, that's the best way to do it. But it's not. When you're lightly cooking them. Everything's more absorbable. If you're lightly cooking them with oil, everything is even more absorbable. So it's good. Yeah.
Okay, great. A surprising contributor to a healthy gut. microbiome was coffee. Yeah. Does the benefit of that lie within the caffeine? So you're not going to get it from decaf? Is that correct?
No, it's not necessarily the caffeine. It's all the alkaloids that are in it as well. The tannins and the all the phytonutrients that are within the whole coffee bean and compound. They all help so yeah, if you can just work to
Okay, great. So yeah, quick coffee. And I know there's a lot of people who have decaf, so that's good. Now simple sugars are always, you know, when you're going in long events, it's always a big thing. So gels, chews, stuff like that. And so you're saying simple sugars can make Firmicutes grow, like exponentially. But then in events, if you're eating more complex carbs, you risking GI distress, obviously, there's always that question of, what do we what do we eat in ultras? And I know you're a massive advocate of real food. So how do we kind of get the real food that's not going to be kind of destroying our gut, but GI distress? It's always a fight, isn't it between the two.
So the thing about concentrated carbs, like gels and sports drinks, is they actually are the contributors to GI distress, because they increase the pressure within the small intestines and your body has to take water from other spaces to dilute it. So you end up with bloating and GI distress. Now, when we're talking about an ultra, you're going at a slow enough intensity that you have more blood flow that goes to the gut, so you're not significantly compromising digestion, if you're running properly, or running at the right pace, right. And so when we're looking at it, we want that base of real food but it's not like a full salad meal or like that. We're looking at nutrient dense stuff, right? So you can look at Bliss balls, you can look at white bread sandwiches that might have Marmite and or sorry, Vegemite, or whatever it is. Or if you're more inclined to nut butter or something like that, but putting some salt in it as well and small little bites here and there. I'm a big fan of taking like, trail mix and putting it in the food processor and having little bites there. small potatoes, small white potatoes, new potatoes that are roasted and salted and cooled, it reduces the impact of the fibre because you have more insoluble fibre that comes with it. So it becomes a really good go to bland food. And then there are going to be times in places where you're like I absolutely can't eat, my stomach is so full and I can't eat, but I need some blood sugar. So what do I do, this is where you're looking at using glucose tablets, or small bites of like jet planes or something. Because then it gets absorbed in your mouth. And it's a quick hit of sugar to bring your blood sugar up. So it gives you a bit of breathing space to maintain pace without interfering with digestion.
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