Maximizing the Physiology and Performance of the Female Athlete – with Dr. Stacy Sims

"Women are not small men" is a phrase synonymous with Stacy Sims—and in this show, we find out exactly what that means. Tune in to learn just how important it is for coaches and female athletes to adapt training so that women’s physiology can be used to harness their strengths—not hinder them—throughout their athletic lives.

Dr. Stacy Sims coach and sport scientist

Exercise science has historically focused on male athlete physiology. As a result, many well-established training, fueling, and recovery recommendations have not only been less than optimal for female athletes, but in many cases have actually been counterproductive. Yet that’s all changing—and leading the charge in this wave of change is Dr. Stacy Sims. With a background in sports nutrition and exercise physiology—and a deep passion and focus for gender equality—Dr. Sims has already made great in-roads into raising the awareness around many of the factors affecting women and girls as they train, compete and strive for peak performance.

In today’s show, Dr. Sims shares a wealth of insights and research that will prove helpful for female athletes of all ages as well as their coaches. From menstruation to pregnancy, amenorrhea to menopause, there are no stones left unturned in this full and frank discussion. “Make your period your superpower” and “Women are not small men” are just some of the powerful lines you’ll hear in this episode, as well as advice on how the menstrual cycle can affect carbohydrate intake, effective ways to train during pregnancy, and the best ways athletic women can combat the effects of menopause.

Joining Dr. Sims, we have a host of experienced coaches and athletes, including multi-time world champion cyclist Rebecca Rusch, coach Daniel Methaney, author and yoga specialist Sage Roundtree, and top cyclist Kristin Legan.

So, get ready to learn a lot—and let’s make you fast!

Episode Transcript

Rob Pickels  00:04

Hello and Welcome to Fast Talk, your source for the science of endurance performance. I’m your host Rob Pickels here with Trevor Connor and Dr. Stacy Sims.

Rob Pickels  00:13

For decades exercise science research has focused on male physiology. As a result, many well established recommendations have not only been less than optimal for female athletes, but in many cases have actually been counterproductive. Leading the charge and calling specifically for research on female athletes is Dr. Stacy Sims, she’s made it her goal to help female athletes optimize their performance today, Dr. Sims talked with us about her recommendations for athletes through the various stages of life from addressing the menstruation cycle in athletes, teens and 20s to the impact of pregnancy on training and racing, and finally to perimenopause and menopause for athletes in their 40s and 50s. The recommendations provided by Dr. Sims will help any athlete addressing these questions, but are just as important for coaches who can’t simply ignore these considerations anymore. Joining Dr. Sims we have a host of experienced coaches and athletes including multi time world champion cyclist Rebecca rush, Coach Daniel mfine, author and yoga specialist sage Rountree, and finally, top cyclist Kristin leagan. So get ready to learn because this is a fascinating episode. Now let’s make you fast.

Trevor Connor  01:30

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Rob Pickels  02:02

Well, I think that we’re in for a really great conversation today, because we have with us, you know, Stacey Sims and the Stasi, I was doing a little bit of online stalking of you the other day, and you describe yourself on Instagram as a researcher and author and an expert. But in my opinion, I think that you’re you’re a heck of a lot more than that, right? Um, you’re a mom, you’re an inspiration, you’re sort of all of these things. And so I’m so glad that you’re here to bring all of your different knowledge that you have on women, and how us as coaches can work with them, how you can bring that knowledge to all of our listeners.

Dr. Stacy Sims  02:40

Thanks for having me, but also like, Wow, thanks.

Trevor Connor  02:44

Great to have you on the show again, and this time we have you here in person, because we’ve had you on before, but we were talking to you from New Zealand. Yeah,

Dr. Stacy Sims  02:51

I’m in the in the real world of the US now.

Trevor Connor  02:54

Well, it’s nice to have you here.

Rob Pickels  02:55

You know, Stacy, when I was when I was doing that Instagram stalking of you, I came across a post that you had, that women are not small men. And that is certainly something that I’ve heard in the past. But I think that it resonates with me, and it might resonate with a lot of other people. And so I would love to begin our conversation there. What are just sort of the fundamental physiological differences, sort of between men and women that in some regard make women special, you know, because there are definitely areas where they’re more advanced, so to say, than their male counterpart.

Dr. Stacy Sims  03:28

Yeah, well, when we look at sex differences from birth, right, we know that there are inherent morphological differences that come out. So we know that women have smaller hearts, smaller lungs, they have lower oxygen carrying capacity, because they have less hemoglobin, they have differences in their hip and shoulder angles, they also have a difference in their center of gravity. And even metabolically, they’re different in the fact that women are born with more protein in the mitochondria to be able to use free fatty acids. And then when we get into puberty, and we have the exposure, the epigenetic changes that come with the exposure to estrogen, progesterone. This is where a lot of people think, oh, there’s differences between men and women, because now women have a menstrual cycle, or have estrogen and progesterone and men have testosterone. And that’s where the divergence takes place. But there’s actually two separate aspects, we have the sex differences that come from being xx, x versus x, y. And then we have the overlay of hormones. So even when those hormones disappear, we still have inherent sex differences. So this is, again, the morphological and then we look at metabolic aspects where women will clear through blood sugar a lot faster, and then tap into fatty acid and not so much muscle glycogen usage. So this is where we look at carbohydrate usage during exercise, why women tend to have more GI distress when they’re trying to find general guidelines. So there are small little inherent factors that can impede women’s performance, because we have the sex differences that haven’t really been addressed when we’re looking at protocols or Can’t guidelines.

Rob Pickels  05:01

And so I think that that’s a really interesting point that you sort of ended on where there might be lacking the depth of research for females and for female athletes in particular, as compared to men. You know, one, why is that and what can we do to change it? And then all the things that we talked about today? Is this knowledge research based or is it anecdotal?

Dr. Stacy Sims  05:25

So what we’ll talk about today is a research based the depth of research in sports science is not as much as we would like it to be, there’s been a big push in about past four ish years to really go after a female athlete looking at proper methodology accounting for hormone perturbations. So there’s been some really good recent research that’s come out that has not yet been implemented into protocols and guidelines. But I’ll talk about that as we go. When we look at why this happens, we have to look at the cultural aspects of what it means to be a woman versus a man in our culture. So if you’re looking all the way back to like the early religious days, where women were told they couldn’t be in the community when they had their period, or they had to go hide, and that women were taken from the rib of Adam. So there’s all these discrepancies that come through the cultural and historical ideas of what it means to be a woman, then we get to more modern times. And there wasn’t until after World War Two, when women were entering the workforce that now they’re like, Okay, we can be a force. But in the same breath of that we have someone like JFK who is saying, We want women to contribute to society, yet, we don’t want them to be taken away from their primary responsibility, which is in the home. So although he was trying to push women out into the workforce, there was still this backlash that women are not equal to men, then when you take it into the sporting concept, we think about what it means to be successful in sport, you attribute a lot of the male qualities of aggression of power of speed of strength, but no fallibilities So when a woman comes into the sporting world, or comes into the research world that is still male oriented, and we have the male lens of research that can’t show fallibility. So this is where menstrual cycle is not accounted for hormone perturbations are not accounted for. There is language misuse around the recruitment of women where it’s very masculinized, and a little bit off putting for women to participate. So they feel like they shouldn’t participate, because they won’t contribute enough. Or their data is just washed out with men where their data is a little bit of an anomaly. So that gets thrown out, or it just gets incorporated when they are in a low hormone phase the same as men. So you’re not really teasing out sex differences. You’re not really teasing out what happens to a woman when she has an elevation in estrogen progesterone.

Trevor Connor  07:48

Rebecca Rush is one of the top cyclists around and she’s a tough as they come having completed the I did a ride on a bike. It even she has felt the impact of the masculinization of sports. Here’s what she did to help women feel welcome.

Rebecca Rusch  08:02

Well, I did launch early in my cycling career, I launched what I call the Strahm Gold Rush tour. And this launched off of one of my first years at sea otter as a pro athlete with Stram. As a sponsor, I was too intimidated to go into the Stram booth and ask them for some maintenance on my bike, because I didn’t really understand everything about my bike. And I was kind of, you know, I was too intimidated to go in there wasn’t like a huge line of guys, all male mechanics. And I sort of was like, man, if I’m a pro athlete sponsored by them, and I’m intimidated to go into the booth, something’s wrong, and I’m not putting any shade on scram. That’s just how the industry was. And so I went to the founders of CERAM and said, This is how I feel. And they just basically said, Well, what do you want to do about it? And I said, I don’t know. We need to make it less intimidating for women. And so that’s where they actually got behind me and funded. And let me design what I did for eight years was the SAM Golders tour. And it was just a series of free rides education. I mean, it started at sea otter, where we’d have a ladies lounge and women could just come in and ask questions of all the pros and talk to us and go on a bike ride. And that was, you know, the first foray into just opening the door, you know, women just weren’t seeing, having a place to gather. And now, you know, many years later, you see women’s groups all over the place, which is awesome. And what happened in those gatherings, you know, went around the country and just had free basically did a bunch of free clinics around Golders tour. And what happened is he’s wouldn’t be like, Ah, I wish there was something like that in my town. I wish, you know, can you come to Albuquerque? And it’d be like, well, I can’t come to Albuquerque, but you should start something. And I had women come back years later, and they’re like, I started a group with my local bike club. And so really, I was just this little bit of a catalyst for women and girls who were ready to do their own thing. And that was pretty cool. So that was one thing I Did that I was I’m pretty proud of because it definitely made a difference. When I did some local events here with young girls, you know, that was sort of a precursor to the Idaho Nika league. And now those girls, you know, one of them’s a pro rider, and, you know, a pro downhiller and I remember teaching her to ride and so just kind of share it, it all goes around with sharing the knowledge that you have, but making something welcoming and accessible. So it doesn’t feel intimidating, I think is key for any group, whether whether it’s women or people of color, or it doesn’t matter, people just want to feel like they’re not going to be laughed at and they’re going to be welcomed. And you know, that they can ask questions, even if they seem like stupid questions.

Dr. Stacy Sims  10:43

So when we’re looking at the guidelines and protocols and testing protocols, everything from FTP, VO to max lactate threshold ventilatory threshold, and we look at guidelines of carbohydrate and protein intake. All of this is based on male data that’s then been generalized to women. So now we have this pushback, and we’re saying, Hey, wait, we look at this research and for example, the guidelines and carbohydrate intake for women. In that specific position, Stan, there’s over 160 articles that are cited in scientific articles that are cited, but of those 160. There’s only 16 that reference women, and none of them have to do with carbohydrate intake has to do with iron deficiency, it has to do with low energy availability, but nothing Gods what should women have to be successful in endurance sport with regards to carbohydrate intake. So these are the things that are now starting to be addressed. And these are the things that women are like, wait a second, I’m not doing well on the 90 grams of carbohydrate per hour. Why not? Well, because your system isn’t designed to absorb that. And so now with this up surgeons and push for female research everywhere from cell culture models have to include female cells all the way up to whole systems have to include women and account for menstrual cycle or other hormone profiles. We’re starting to see some really good robust research coming out to show that the protocols and the guidelines should be different for women. So I’m

Trevor Connor  12:03

really interested in this because you look at sports nutrition right now it is all about carbohydrates, like you look at the work of Dr. You can droop and it’s we got to figure out how to cram more into you than your body can normally handle because the more carbohydrates you can get, the better but you’re saying that’s not necessarily what’s best for women. So what would be your recommendation? You know, for example, this is great. We’re now seeing Grand Tours for women. Tour de France is going on right now the men are cramming in as much carbohydrates as they can at the raise. What would their strategy be?

Dr. Stacy Sims  12:35

So for women, it depends on the hormone profile. So if we’re looking at things like carbo loading, we know it doesn’t work for women, primarily because in the high hormone phase after ovulation, the menstrual cycle, estrogen and progesterone whose job is to take carbohydrate and protein and shove it into the endometrial lining. So when women are like, Oh, I’m carbo loading, in fact, that carbohydrate is going to create glycogen stores in the endometrial lining not in the liver and the muscle. And we look at fueling that how the body fuels during endurance exercise in that high hormone state. This is where women clear blood sugar quickly and then go into more free fatty acid and amino acid utilization. So if you’re looking at high intakes of carbohydrate during that phase, it sits in the gut, because the body’s like, I can’t handle this much. I have a slower gastric emptying rate, I’m more sensitive to carbohydrate, I can’t absorb as much, especially if it’s fructose based. So when you’re seeing girls and women who are trying to put in a lot of carbohydrate in the moment, this is where they start hitting the wall, they start getting a lot of GI distress. So we look specifically at let’s increase total carbohydrate intake in the meals, because this is how your body is going to have more carbohydrate availability. And this is how we can tap into it. So then during exercise, you’re not going on necessarily grams of carbohydrate per hour, we’re looking more calories per day, how many calories and it depends on workload and and again, the hormonal factor. So if we’re in the high hormone phase, and the calories per hour, there’s more coming from carbohydrate, if we’re in the low hormone phase, the body does tap into more liver and muscle glycogen. So you have a little bit more carbohydrate available for keeping blood glucose elevated. But we know that you go through that more rapidly. So in that particular phase, the low hormone phase, we want more carbohydrate with protein, because the default when we start getting too low in carbohydrate is to burn through amino acids, and then get into free fatty acid use. So we have to understand where the woman is in her hormone profile to be able to be more prescriptive in what they need. When we’re talking about the elite level. In the more age group level, it’s more of a fitness dependent. So if your body is used to using more carbohydrate, then you’re going to be okay. If you’re using that as long as you’re attenuating GI distress. But the fitter you get the more we need to be in tune with where you are. Are you on an oral contraceptive pill? Are you using an IUD? Are you naturally cycling? Are you a Minarik? So all of these things can actually factor into what you need to use during your race or how you’re recovering. What is your fueling strategy. And we also know that nutrient timing for women is so much more important than men. And this comes from the hypothalamus reading the nutrition density and nutrition availability and women versus men,

Rob Pickels  15:19

Stacey, I would love to keep going along that age group thread that you started to bring out there, and work through different stages of life and sort of the various considerations that coaches both male or female should have while they’re working with female athletes. So we started off a little bit with this elite sort of cyclist. And to me, that brings to mind maybe more of a younger age group. So when a female athlete is in her 20s, what what major considerations do we have for that athlete to make sure that same menstrual cycle health is good, you know, contraceptive use other factors, things like that, what are we thinking about?

Dr. Stacy Sims  15:57

Yeah, so if I lay or if we look at someone who’s in their 20s to 30s, we call that the reproductive or the pre menopausal years, the biggest thing that women don’t do is they don’t eat enough, because they’re following trendy diets, or they’re so stressed, they forget to eat, and they fall into low energy availability. And that’s been coming out a lot in the news, with a lot of athletes, this particular Olympic cycle, who couldn’t hold on for that last year, because of the five year instead of the four year. And when we look at low energy availability, it is the fact that they’re not timing their food appropriately around training and racing. Or they’re purposely trying to lose weight. So I’ll work with elite athletes, and they’re like, Oh, my recovery day, I’m having 1100 or 1200 calories a day. And that’s not even enough to subsist lying on the couch watching Netflix, let alone recover. Right. So the big rock there is really making sure that people are eating enough to support their training. And the other thing is in their early 20s, body’s still growing and developing, depending on what’s happened in their teens. So there’s still an increase in the amount of of nutrition they need. And if we are taking care of those baseline needs, then we don’t have an interference in endocrine health. But when we’re in a low energy state, we start to see missteps in the menstrual cycle. So the reason why the menstrual cycle is so important to have and to track is you can start seeing when there’s a misstep of energy intake in the bleed pattern. So initially, people are like, Oh, I lost my period, and I haven’t had it for three years. And then they’re clinically diagnosed with a Maria and falling into a relative energy deficiency in sport, but you can back it up earlier. So if you’re looking at a woman who’s naturally cycling, and her cycle length might be anywhere from 25 to 40 days, that length might stay. But instead of leading for seven days, now all of a sudden, she’s spotting and bleeding for maybe three or four days, and it starts dropping off even more. So that’s the first sign that there’s too much stress, there’s not enough nutrition to support what she’s doing from a health standpoint. And then the hypothalamus is stepping in and going, Wait a second, we don’t have enough nutrition coming in. So we need to down regulate everything, we need to conserve thyroid, so I’m down regulating thyroid function, I’m down regulating resting metabolic rate, I’m increasing fat stores, I’m decreasing energy expenditure from resting muscle. So there are all these nuances that start to downregulate. So we’ll see this and women who kind of flatline in their performance, they might start putting on some belly fat. And unfortunately, the automatic response for that is I’m going to eat less than train more. So when we’re talking to coaches, it’s really important to understand that women shouldn’t be doing fasted training, they do better in a Fed state. Again, it has to do with the hypothalamus having two areas instead of one or two areas for women have kisspeptin neurons instead of one for men. And the fact that when we eat before we train, we are encouraging the body to maintain lean mass, as well as recover. But if we go in as a fasted state and trying to do metabolic flexibility, or increased fatty acid use, women are already there. So it becomes a very big stress on the body. And we have this backlash. So for those reproductive years, that’s the big rock. There’s so many women who don’t eat enough, and they don’t eat in around their training, and we aren’t algorithms. So it’s not like you have to eat the same amount every day. It fluctuates, because you might race really hard on Saturday, you’re not that hungry on Sunday, and it’s kind of a recovery day, and then Monday comes in, you’re ravenous, but you’re like Wait, I didn’t do a big Training Day. It’s not my recovery day. So they cut back. And that’s not the thing to do.

Trevor Connor  19:23

So I remember when I was back up in Canada training at the center, several of the women that were there who were racing, professionally, raising at the top level, it was just assumed that they would have amenorrhea. They just kind of went yeah, of course, I’m going to lose my period. Yeah, I’m getting the sense that you don’t think that’s the way they should be thinking

Dr. Stacy Sims  19:42

not at all. And again, that comes back to the cultural idea that you don’t talk about your menstrual cycle. And if you don’t have it, then you’re exhibiting the fact that you’re quote, not fallible, so that you are exhibiting more of the masculine qualities, but from a health standpoint, which then comes into performance standpoint, you’re right on On the edge of braking, and we see this when you’re a Minarik. For a bit of time, you’re having more soft tissue injuries, you’re having cardiovascular issues with rushing heart rates, you’re not able to fuel for the top end efforts because your body just can’t get there. And again, it has to do with all the downregulation aspect. I was in a conference and one of the elite running coaches stood up and said, but we know our athletes are ready to peak and perform when they’re aiming to react. And we’re like, what are you kidding? And it just is because it’s so ingrained in the sport culture that it’s normal. But we’re seeing now with more education around low energy availability, and menstrual cycle dysfunction that people are like, I’m going to use my menstrual cycle. And if there’s dysfunction, then there’s time to fix it. So that I can stepwise increase my performance because it means it’s less time out from injury from illness from other things that add up to people not being able to train or perform.

Trevor Connor  20:55

So you brought up the timing is much more important for women than for men. So what would be if we had a woman in her 20s or 30s, what would be your suggestions for timing of food a fueling?

Dr. Stacy Sims  21:08

Yeah, so making sure that you’re eating something before you go out. And if you’re someone who has to get up early and train, you’re like, I can’t eat, I’m not hungry, I’m not saying a full meal, that could be a piece of toast to half a banana approaching fortified cold brew, so something to bring blood sugar up. And then you have your real meal within 30 to 45 minutes, because we know women returned to baseline blood glucose levels within an hour, or men have three to 18 hours. So within that hour, you know, there’s a lot of things that we need to do to ensure recover or repair. Because if you don’t you stay in a catabolic state or break down state. And the first thing to go is lean mass. So if you’re looking to maintain power and speed, you need to make sure that you’re eating within that 30 or 45 minute point. And it’s protein with carbohydrate. So before looking at why protein is a priority, because we need a met amino acids circulating having a higher level of amino acids circulating in the female body, for many of the feedback mechanisms for muscle protein synthesis, and for equating metabolic equivalency, so bringing your metabolism back down to baseline without signal to put on body fat. So we look at that two to one ratio of carbohydrate to protein and making sure that the protein is high quality, it doesn’t matter if it’s plant based doesn’t matter if it’s animal base, just making sure you have really good high quality leucine with essential amino acids around it. And if you’re taking care of that timing window, and you’re someone who’s like, oh, I still need to budge body composition, I need to lose a little weight still, you can afford then to take away a slight amount of calories in the afternoon, preferably in the evening away from bed, because you’ve taken care of the stress in the moment of exercise and training. So your body’s like there’s still adequate nutrition coming in. So I can adapt to this, I can keep metabolism up, I can have endocrine function. And then when you have that slight calorie deficit in the evening, preferably before bed, you end up in a better sleep pattern. So there’s ways of manipulating diet and composition without actually impacting negatively on the body, the endocrine system, and performance. So it’s tightening up and saying, Hey, I’m very stressed from exercise, because exercise is a stress itself. It is a fasted state. So I need to fuel for what I’m doing. So the body knows that I don’t need to stay in the stress state, it can actually overcome that stress. And that’s how we get fitter.

Trevor Connor  23:32

So that’s really interesting, because I actually just had a conversation yesterday with a gentleman on our forum, talking about that window, that one hour window after exercise. And he was asking how critical it is. And the fact that there’s a lot of research saying, yeah, if you have an event later that day, it’s critical that 24 hours later doesn’t make a difference. But you’re saying that’s not the case with women that that hour afterwards is really important to prevent going into a catabolic state.

Dr. Stacy Sims  23:59

Yes, exactly. And it’s holding that catabolic state after training that your body will perceive as low energy availability, even if you’re eating adequate calories. Because women tend to book in calories, you know, and so they’ll like, eat something in the morning, they might do the noon ride, and then they might have a snack, and then they have a lot for dinner. So they’re booking their calories at either end of the day. But their body’s like I need fuel in the day around training. So their body’s in that breakdown state. And that signals to the brain that there isn’t enough nutrition and you get in the chute, this cascade of low energy availability. We’ve done some research on recreational female athletes, we know that over 60% of them are in a low energy state. And it’s not necessarily intentional. It’s the MIS timing of food so their body is in this low energy state and doesn’t adapt well.

Trevor Connor  24:47

So it’s not changing the amount of calories are eaten for the day. It’s just timing, timing. Exactly. And a lot of I know a lot of endurance athletes that finish a hard workout and go I’m not going to eat because I’m trying to drop weight

Dr. Stacy Sims  24:59

or I’m going Have coffee to increase the burn? Yes. And it’s like, no, you’re increasing cortisol and you’re signaling your body to break down your lean mass,

Trevor Connor  25:08

which is the exact opposite of what you want. Exactly. So

Dr. Stacy Sims  25:11

if we look at trendy diets, like most of them out there, you have the Keto, the low carb, high fat, intermittent fasting. So what’s really important to understand is that the data from these diets have come from initially a clinical population of obese sedentary men trying to lose weight for surgery, or metabolic control. And then they crossed over into the fitness world and it became this thing, oh, yeah, if I do keto, or I do low carb, high fat, or, you know I’m doing intermittent fasting and do my training in the in the fasted window, it’s going to increase my body’s metabolic efficiency is going to increase my ability to burn fat and use fatty acids can male data. So when you look at the outcome for women, it’s not the same, we see there’s an increase in sympathetic drive instead of parasympathetic drive. So women tend to get tired but wired when they’re following these diets, there is an increase in insulin resistance instead of better blood glucose control. We also see things like a difference in telomere length, but not in a positive way for women. Exercise in itself has better longevity data for women with regards to how it stresses the body to improve overall health and stimulus. And when we’re looking at what these trendy diets do is it puts those women smack dab in where we don’t want them in that low energy state or the body perceiving it to be in a low energy state. And again, as I said earlier, we know from hard good research that women do better in a Fed state, even resistance training days, if women are having around 90 calories of protein before their resistance training, they end up with a greater amount of post exercise energy expenditure and raised metabolic rate than if they were to just do nothing, or have a carbohydrate bolus, which is not the same for men. Because men like I said earlier, they go through liver muscle glycogen, and they don’t tap so much into fatty acid use until they are really, really low. And that’s why fasted training or ketogenic or low carb high fat type diets work for men. But for women we’re already at or a maximum ability to burn fatty acids, we don’t need to learn that from those sex differences at birth. So women need carbohydrate, they need to look at fueling for what they are doing. And the timing, super important. When we bring oral contraceptive or contraceptives into it, it’s a little bit different yet again, as compared to the natural menstrual cycle, because now we have a downregulation of our natural hormones. And the exogenous hormones or the hormones from the pill is a word is creating that metabolic control and stimulating the hypothalamus. And it’s not the same, because the estrogen receptor sites are not being stimulated the same. We don’t know from a stress standpoint if the body’s adapting or not, because we don’t have a real bleed on an oral contraceptive pill. Or if you’re an IUD, you might not have a bleed at all. So it’s really hard to keep track. If you are in a low energy state or not. We’re looking at training practices around the oral contraceptive pill, we know the first five days of the active pill, women are really robust to stress, and they can take on high loads. But for the middle two weeks of the active pill for each subsequent day they’re on it, their recovery suffers more and more, because you’re having this stepwise increase of these hormones and, and they’re kind of saturating, then when you get to the second week of the sugar pill week, or the withdrawal bleed, which is not a true period is the withdrawal bleed from those pills. The body is more resilient, but it takes two days of the sugar pills for everything to wash out. So we’re looking at training stress, it’s book ending the active pills with high load. And in the middle, being very cognizant that you can overstretch your athlete, and nutrition is the same thing. It’s like you’re really good with carbohydrate on either side of the active pill, but you need more protein, and more overall calories in that high stress, high hormone phase.

Trevor Connor  29:09

So in the past, you’ve talked to us about the two phases of the menstrual cycle and how your body is in very different states in those two phases. How does the oral contraceptive pill impact those two phases?

Dr. Stacy Sims  29:22

Well, they don’t like you have three weeks of an active pill and that’s a high hormone state. And then the sugar pill week where people have a withdrawal bleed, it’s still not a low hormone phase, because your body rebounds after day two of those pills to bring estrogen up almost the same level as the first trimester of pregnancy. So your body’s never really in a low state. It does reset and its baseline changes. So your responses are a bit different. But when we’re looking at adaptation, one of the first things I asked my athletes if they’re on an oral contraceptive pill, can they get off it or are they on it for health reasons like PCOS or Indonesia? Rio says, because if they’re not on it for health reasons, I want them to come off it. So we can see how their body responds and how much more they can adapt to training and training stress.

Trevor Connor  30:10

So before we move on from 20, and 30 year olds, let’s talk to the coach now. So we have a coach that’s working with a woman in those in that age range. What should that coach be focusing on? What should that coach be talking to their athlete about?

Dr. Stacy Sims  30:26

So we’re looking at the actual training loads, you can do some undulating periodization, just the same as you would with a man. But the big rock for the coach to be able to talk to their athlete about in these reproductive years is minstrel cycle status. Having them track it using an app or putting it in training peaks, to understand not only the bleed pattern and how long the cycle is, but starting to understand the nuances of maybe on day 23 of every cycle, my athlete feels really flat. So I’m not going to put in a test day, I’m not going to put in intervals, it’s just something that happens, we know this, so you’re able to individualize and personalize the training within the major undulation program to really work with the female physiology. The one thing I want everyone to know is there a difference between training and performance. So there is no actual difference between menstrual cycle phase and performance, you can go and nail your PR your best race on any day of the menstrual cycle, because again, it’s the psychological, that supersedes the physiological and the training that gets you there. But when we’re looking at training, we can use the perturbations of those hormones to our advantage knowing that the body is really resilient to stress in the low hormone phase, and then the high hormone phase is a bit more steady state. And then about the five days before the period starts. We have a really low resilient to stress, we see huge changes in the immune system in motivation neurotransmitters. So if you’re understanding that general pattern, and then you can see where your athlete does really well in training days, and see that patterning, you can really hone in on those ergonomic aspects of the menstrual cycle. If your athlete is on an IUD, you can still do the same thing because after six months of insertion of using a progestin like the Mirena, your athlete to start to ovulate again. So you can use basal body temperature to dial in this this phases. But again, when you’re on the oral contraceptive pill, it’s completely different. You can still have some tracks you can see mood, but it’s not as cyclical or as obvious a patterning because of the way the perturbations of the OSI works with regards to daily pulse, and how the woman responds to recovery. Because for each week that she’s on the pill, you get worse and worse in your recovery. So it’s something to understand that the OSI is a different type of cycle than naturally cycling. And for you to understand how that is with your athlete, then you can start really dialing in things to improve the hard days and really allow them to recover on the days they their bodies like I need to recover.

Trevor Connor  32:58

It is important for coaches, particularly male coaches to understand the unique needs of their female athletes. Let’s hear from experienced coach Daniel Metheny. And what he’s made sure to focus on.

Daniel Matheny  33:10

I have coached women, both Junior and I guess, masters or senior women. And in the past, I didn’t approach them that much differently. Besides trying to at least be aware of their, their cycles and be cognizant of that, I can’t say that I’ve put in the valid amount of background research to understand it even though you know, listening to Stacey Sims and I have her you know, roar book behind me and a plethora of notes from the continue education that I’ve been to, that I’ve tried to apply basically, to know when to apply intensity, when it’s better to go low intensity based on their cycles. But I haven’t can’t say I have an exact model that I use for that. And it’s hard because of the juniors. That’s not one thing that’s easy to talk to with juniors and kind of gets into this like, awkward area, even though that’s you know, that’s what coaches have to do is try to like dig in and say, you know, it’s okay to discuss this because it’s important for your progression. But typically, that’s that’s been my approach is want to learn more about it and be better. I don’t currently coach a lot of women. And usually it’s through a club platform to where it’s most people are trying to give if then scenarios. If you’re feeling this way, don’t disregard it, and do the other like resort to an aerobic route versus intensity or listen to your body a little bit more. So and that’s been my coaching mentality is try to give people the tools to not need to maybe on call basically, like because that’s not coaches don’t get paid enough, like doctors do to be that way. So I try to give them the tools to where they can understand and make those real time calls. And the same thing with women of like, you you can’t just blow your cycles to the to the back and say I’m going to train this hard, irrelevant. There’s certain times you need to be cognizant of what’s going on inside because your hormones are changing.

Julie Young  34:55

Hi, listeners, it’s Didi Berry and Julie young and we’ve been here aren’t at work creating a new podcast featuring content for female endurance athletes and coaches of female endurance athletes. We’re thrilled to announce an upcoming series from fast talk fast tuck them podcast. Listen, for our first episodes coming this fall, join the fast talk labs newsletter for more information.

Rob Pickels  35:23

Stacy, this conversation about tracking the menstrual cycle is super interesting, in part in this question, or the wording of it, is there an app for that? How do we as an outside third party have a sense of what’s going on to track not just one but maybe multiple athletes on a roster?

Dr. Stacy Sims  35:43

Yeah, so full disclosure, I’ve been involved in wild AI. So it’s, it really hit the market. And the reason for that is it uses artificial intelligence. And the algorithms are written for women in a female environment. When you’re looking at something like Garmin or aura ring, even all those algorithms are based on male vision and male idea of what it is to be in a female environment. And they don’t use artificial intelligence to learn the woman’s cycle and to be able to feed back information specific to her about the days of her cycle. If you’re looking at using wild AI, they have a coaching app too. So you can have all your athletes on the same platform. And they’re logging into their phone and keeping track and then it comes up on your coaching dashboard. And it also integrates with so many of the other wearables. So you can have heart rate variability pulled in, you can have sleep data pulled in. So you get a complete picture and the metrics. This also eliminates sometimes that tedious conversation or uncomfortable conversation about menstrual cycle status. Fitter woman is another one as well, where they have a really good coaching platform where the coaches can log in and see where their athletes are, who’s in what phase and be able to understand what’s going on with their athletes.

Rob Pickels  36:59

For the listeners. I just want you to know that was not me putting out an opportunity for Stacey to plug her involvement in with wild AI. I honestly didn’t know she was involved with that. Just a recognition that something like that seems really important for working with female athletes. Yeah.

Dr. Stacy Sims  37:14

Which is why I put the disclosure.

Trevor Connor  37:16

No, but it’s an important thing. Because I’ve worked with a lot of women and some women, absolutely no embarrassment, when we’re on the phone, they’re telling me exactly where they’re at and what’s going on. Others don’t want to discuss it, but might be willing to put in an app or as an as a coach, you can see where they’re at in their cycle and what’s going on.

Dr. Stacy Sims  37:35

Yeah, and I know that there is hesitancy now in the current political environment about using menstrual cycle tracking apps. But fisherwoman and wild are European based companies. And so there is no legal hold from the US over there. And they all are very anonymous. And you can put in an anonymous note. So all of your data is just you on your phone, and you can delete it at any point. So there they are very aware of the political environment. And I wanted to share that because of all the conversations around it that have been coming out.

Trevor Connor  38:08

So something I’ve always wanted to ask you about because I was having a conversation with Melanie McQuaid right before we had her on the show. And guessing you two probably raced each other a little bit at some point didn’t Yeah. So we actually had this whole conversation. And forgive me, Melanie, for bringing this up with it without talking to you beforehand. But you did say you you want to have this conversation at some point. She didn’t like the idea of basing training around menstrual cycle because her comment was my races are going to be when they’re at. And I can’t control that. So I need to learn how to train through the different phases.

Dr. Stacy Sims  38:46

Yeah. And that’s what I mean. Like there’s no difference between menstrual cycle phase for performance. So we’re leveraging hormones for training. Unfortunately, we have that negative self talk as women like, Oh, my a race is gonna come two days before my period comes. And I always feel super flat on that day, I get these kinds of emails all the time. I’m like, Well, what kind of flat because we know that we can put some protein in or some branched chain amino acids. And that helps with central nervous system fatigue and helps you fire we can increase hydration, we can enter increase your daily carbohydrate intake leading up to the race and all of these things will minimize and level the playing field with regards to how the hormones are treating you. And when you implement that and see oh yeah, this takes away the flatness. It gives that positive reaffirmation that you can nail that race. It’s there’s so much negative talk around the menstrual cycle. And we see it ingrained in the culture of who it’s that time in the month, and all of these negative jabs of Oh, when you’re bleeding, you’re a delicate flower, you shouldn’t race on your period, when in actuality that’s when you should because your body is so physiologically primed to take on stress. So it’s that reeducation and changing the language around it and not having Seeing things like girls do this and girls can throw and girls can’t perform on their period. It’s trying to get people to understand that we have a menstrual cycle for a reason. And none of us would be here, if it didn’t exist for one. And two, we have a ability to be very resilient and do whatever we want. It’s not a hindrance. It’s just part of our physiology. Understanding how the hormones affect us is great, because then we can leverage them to our advantage. And also being aware of how the they affect you, from a mental standpoint, gives you the opportunity to do something before you get to the race. So I’ve worked with many athletes who now have implemented that, and they’re like, I’m not afraid to race on any day. Matter of fact, I want my period to come on race day, because it’s my superpower. So it’s a lot of education around it and understanding that it’s not negative, there’s no negative point. It’s cultural, that we now perceive it as being negative. But we need to break that and be like, No, it gives us a really fantastic way of keeping track of women’s health, as well as their adherence and their adaptation, and that they can actually go nail anything on any day,

Rob Pickels  41:07

Stacy and Trevor, you know, as female athletes get into their 30s, what considerations are we having here? You know, I know a big one. That’s, that’s when my wife was pregnant. You know, and so maybe we can start there around pregnancy and working with female athletes in that regard?

Dr. Stacy Sims  41:25

Yeah, for sure. So when, well, in my experience, when women start to hit their 30s, and they’re so racing, they also have the kind of in the back of their head? Well, I’m in my 30s. And I want to start having a family or think about having a family. And if they’ve had menstrual cycle irregularities, or they’ve been on oral contraceptive pill, and they’re really concerned like, well, what if I’m not fertile, because it tends to come up a lot in the endurance space. And we do see women who have had bouts of a Maria, and their hormones aren’t quite right. So we start looking at, well, let’s dial down the volume, and we can maintain the intensity. And again, dialing in the nutrition like we did in our 20s. And our 30s, to really make sure that we’re fueling for it carbohydrate is very essential. And when you start getting that, then you get your luteinizing, hormone pulse and fertility comes back. So it’s never an issue of not being fertile. It is an issue of how are we addressing it? And how long has an issue been going? For the most part, of course, there are exceptions, unfortunately. But when a woman becomes pregnant, there is so many, I guess, myths around being a pregnant athlete, you hear you shouldn’t get your heart rate up 140. I mean, when I was pregnant, I was told I shouldn’t be riding a bike, because you know what, if I crash, I shouldn’t run because I might shake the baby loose, like all of those myths. And this is coming from physicians who should know better, when we start to look at the research that’s coming out on fetal development and aspects of better DNA for better health outcomes being really active. And having times where the uterus is having restricted blood flow is actually super beneficial for the developing fetus, because it creates a little bit of a stress environment so that the baby’s learning how to deal with stress. And the cells learn about metabolic stress as well. So it’s really good for the development aspect. And when you have a bit of hypoxia, because of the blood flow diversion away from the central area to the working muscles, you enhance the vascular aspect of the placenta. So then after exercise, you have much better blood flow and nutrient exchange with the baby. So when you’re looking at what are recommendations for active women keep doing what you were doing. Because your body will tell you when you can’t. Like most women can’t go anaerobic because their body just doesn’t let them. We know that we’re looking at strength training and maintaining strength training all the way through is super beneficial. Because it helps through the birth and postpartum where you now have the strength. You have less joint issues that come with increased Lacson relaxing and when you’re looking at the health of the baby as well, the more they have that exercise stress, the more robust and healthy the baby is when it’s born. So when we have specific guidelines of the heart rate and moderate intensity activity, again, it’s for women who have not been active, they should start being active, of course, because we know all this great literature about helping babies develop well. But if you’re active, it doesn’t mean stop and slow down there. Again, exceptions. If you have medical issues, then yes, for sure. But with all the misinformation out there, I want to reassure pregnant women that you don’t have to stop you just keep doing what you’re doing. I was riding my bike up big hills a day before I gave birth and she was fine. It was great. So coaches did you get a PR not up that hill because it was freaking hot.

Trevor Connor  45:00

So that’s actually really interesting, because I mean, we’re training science show. So this is all about adaptation, adaptation adaptation. And that never occurred to me that you can have beneficial adaptations in the placenta, I would have thought the fetus is going to grow the way the fetus is going to grow. And you don’t really have much control over that. But you’re saying exercise and other things can actually produce adaptations that you want. Exactly. Exactly. That’s fascinating.

Rob Pickels  45:29

Now, Stacey, there are physical changes that are happening throughout pregnancy for the female athlete, at the very least some weight gain, maybe some postural changes, are there considerations for activity, maybe just to avoid any musculoskeletal issues? Or is it for the most part, keep on truckin like you normally would,

Dr. Stacy Sims  45:49

for cyclists looking at bike fit, you’re gonna have to change the bike fit because the hip and the sit bones are widening, and you center gravity’s definitely off. So in order to be comfortable and not have soft tissue injuries, you do have to look at bike fit, more upright, you can look at some of the gravel bikes or some of the hybrids that are more upright, and you’re not going to be racing when you’re pregnant. Definitely not. I mean, you can in the early stages when you’re not showing or you don’t have all the changes. But once you are visibly pregnant, then I always go back to what my husband said, he’s like, I don’t care if you feel like you can keep racing and your body says you can keep racing. One, you shouldn’t be going anaerobic, and two, I don’t want you to crash because that’s the health of my baby. So just being conscious about that. That’s not science. That’s, you know, anecdotal, but so when we’re looking at bike fit is definitely changing that if we’re looking at running, you can look at the different mechanics and running shoes, you might have to change running shoes, because your stance is different. But otherwise, it’s just keep going. Just keep on truckin.

Rob Pickels  46:52

Keep on truckin pretty good advice.

Trevor Connor  46:55

Good recommendation. I mean, we’ve done bike fit episodes, we’ve talked about the with Dr. Pruitt about keeping the knees healthy. And he talks about she get refitted every year because your body is constantly changing and your body is going through a lot of changes when you’re pregnant. So

Dr. Stacy Sims  47:10

yeah, and that’s one of the things that I think women don’t realize after pregnancy, how much their mechanics have changed. Vaginal versus C section that definitely changes things as well. So it’s super important. Like you might end up needing a wider seat, even though you never really thought about you’re like wait, I haven’t changed that much but your sit bones have. So it’s important to get a bike fit after you can get back on your bike after birth.

Rob Pickels  47:32

Now, Stacey, you mentioned that the body will really tell the female athlete maybe when they’re doing too much, or how much they can do and that listening to that is important. Can we expect though, because of the health of the fetus and everything the mother’s body is doing to support that? Are there adaptive or recovery changes for the female athlete? When exercising? Do they need increased recovery perhaps between workouts or, again, really no different maybe as long as they are addressing any low energy availability or issues there have?

Dr. Stacy Sims  48:07

Yeah, I mean, you have to have the eye that you’re increasing total blood volume, and your nutrient needs are increasing. So you have to maintain the hydration like really stay on top of hydration, because your body’s like I need more blood across the board not only for the mom, but for also for the developing baby. Nutrition is important not eating for too. But it’s like an extra 150 calories a day for the first trimester extra 200 and some for the second trimester and only 300 to 350 for the last. So it’s not a massive amount, but it should come from good carbohydrate and protein. So having that I have just increasing the small amounts, women will be more fatigued, and they might be nauseous. So really paying attention and being intuitive about what you can do and when you should slow down. And that’s part of listening to like what your body’s telling you you can do. From a recovery standpoint, you’re in a faster metabolic rate. So if we’re looking at pregnancy, it’s equivalent to doing adventure racing for 10 days. So your body is now up to a baseline of anywhere to three to 4000 calories a day with everything so it’s a metabolic stress. So yes, you need to eat more but your core temperature is going to be elevated. So you should take an eye to how am I bringing my core temperature down, especially if you’re exercising in the summer, because if you maintain a high core temperature then it’s reducing blood flow post exercise to the baby as well as your muscles. So bring core temperature down by taking cool shower not cold could be two to four minutes of around 60 degrees it’s a cold on the on the shower tap just to change blood flow changes to put more blood central so you have better adaptations with blood flow. So it’s just small little things that actually help with recovery as well as encouraging the health and development of the baby.

Trevor Connor  49:51

So going back to the coach. Yeah, obviously this is going to be things are going to change for the coach as well. And I know a lot of women athletes They want to keep their routine, they want to keep things going with the coach. But goals are going to change focus is going to change. How does a coach help a female athlete through this phase when they’re when they’re going through a pregnancy?

Dr. Stacy Sims  50:12

Initially, it’s reducing the intensity. Because the first 12 weeks, you might get hit with nausea and morning sickness, which is actually all day sickness. And it’s precarious with regards to if the pregnancy is going to be viable or not. So the first 12 weeks is being very cautious of intensity. After that, you can prescribe intensity, but again, it’s going to be based on RPE. And what the woman’s body can do, having the reset of goals of maintenance of you know, trying to stay fit, and putting an emphasis on resistance training as well. Women are in a catabolic state for themselves, because if they’re not eating enough, or they’re highly stressed, the nutrition that they consume goes directly to the baby. So the priority, so for doing resistance training, we’re also getting the signaling to maintain our lean mass and strength. So we’re doing that modifying volume and intensity, then on the other side of birth, she’s not starting from really far down below, she can pick it up. This is why you see a lot of athletes who come back racing strong and hard afterwards is because they’ve had this boost of blood volume, they’ve had this boost of neurotransmitter changes. And they’ve maintained Fitness based on what their body can do. So that when they are okay to go back to proper training, that they actually feel like they’re fitter than before pregnancy. So it’s tying in with the coach to have those conversations with their athletes and say, Okay, what do you feel like you can do this week? How are you feeling, what’s nausea, what’s not. And there’s the window of, they say, the honeymoon window of the second trimester where the woman isn’t too big from the baby growing, so our center of gravity isn’t so far off. And she feels amazing. So this is where you can leverage some of that training to increase the fitness aspect as she’s going into the later stages of her pregnancy. So there’s a lot of conversation that goes in. But it’s, you know, women want the structure, they want to know they get up and they do this, or they have the option to sleep in. A lot of runners have switched from land base running to water running in the summer, so they can maintain fitness and it feels good with the buoyancy, but they can also get a bit of intensity. So there’s those kinds of conversations to have as well.

Trevor Connor  52:20

Glad you brought up the nutrition side, because that’s so critical. As you said, the baby gets priority. So a lot of women when they’re pregnant, if they’re not eating well, they’re not getting enough nutrient density, the child might be fine, but they will actually produce serious nutritional deficiencies for themselves.

Dr. Stacy Sims  52:37

Yeah, so the side story is, I had really bad nausea and vomiting throughout my entire pregnancy. And I found I was pregnant two weeks before a race Mallory worlds. And so I started at race weight, which was around 59 kilos, and I got out of pregnancy at 51. But she was seven pounds three born. So that just tells you how much a baby will take. Because I couldn’t eat enough. I was too sick to eat enough. So it’s very real. And then people like oh my gosh, you’re so skinny is like I didn’t choose this way. If I had been able to, I wouldn’t have chosen. Yeah. It’s opposite from most of the stories. Most people are like, how do we get rid of this pregnancy weight? It’s like, well, there are two sides to every story. Yeah, basically sound nutrition across the board.

Rob Pickels  53:20

Well, Stacey, I want to use that to transition to postpartum. Let’s get this baby out into the world and talk about what happens to the female athlete body and what should we be aware of, as they’re returning to sport returning to training?

Dr. Stacy Sims  53:34

Yeah, so they’ll say you need a six week check from your doctor. And it is really important because you can have things like prolapse after birth, you can have soft tissue that still hasn’t realigned, you have pelvic floor issues, of course, that might need to be addressed. In early stages, I always tell women who have given a vaginal birth to seek out a pelvic floor specialist so that you know a physiotherapist or physical therapist who understands pelvic floor health. Because the unfortunate thing with female athletes, they could have really strong pelvic floor muscles, but they can activate them properly. So they either spasm or they’re strong but weak at the same time because they’re not innervated because of the push through the vaginal delivery has disrupted all of that. So it’s really important to get pelvic floor health sorted in that first time period. When you get clear to start training again, a lot of women like yeah, let’s go but remembering that your biomechanics have changed, because of holding the baby your center of gravity still off, you’re going to have to get another bike fit and running shoe assessment, all of those things to make sure that you’re not going to injure yourself. And it’s slowly getting back into it. Your anaerobic capacity is going to come back quickly. But when you are thinking about anaerobic capacity and doing intervals, if you’re breastfeeding, then you want to think about how my timing that so you can still do proper training and breastfeed is just knowing that you want to To feed, then do your intervals. So instead of like getting up and going, I’m gonna go out and do this. Now, the timing is very different. And one of the other really big things postpartum is understanding, you need a support network, because there’s a super, super high incidence of postpartum depression, especially in female athletes, because their whole life has changed. Like, even if they wanted to kid they don’t understand the magnitude of the change. And you’re close enough that remember what your old life was. But now you’re thrown into this new life of sleep deprivation. And it is a passing period. But understanding that it is good to have a support network and reach out. And it’s not good to hold it all in. Because this is how really serious postpartum depression occurs. And you can’t fight that with sport, a lot of women will dive back into sport and training trying to alleviate that, but it doesn’t go away. And it can really become a significant problem. So reach out for that support network. So those are like the physiological comes back rather quickly after you get cleared and you don’t have any ensuing complications from childbirth. And you slowly get back into it just the same as you’ve had any kind of injury. But knowing that you have a boost of blood volume, we have a boost to pain tolerance. So you can start putting some hard training sessions in rather quickly. But really taking care of the mental health and understanding sleep deprivation is going to have a play into that. And then when you’re six or eight months down the track, that’s when you can really start planning. What am I going to do next? How am I arranging this around my new life. So it is a time period where when people are like, Oh, I’m having a baby on I’m pregnant is not just the 10 months of pregnancy, it’s actually a two year period where you are not yourself. And when you know that you’re not yourself, you’re going through all these changes and postpartum is still a big part of that pregnancy aspect of healing from something like a massive vaginal birth or cesarean section, understanding the mental challenges that are coming not only with sleep deprivation, but the new life, and then trying to put training into it. The training shouldn’t be specific, just like it wasn’t right before you gave birth, but using it as a way of starting to get fit again. And then in that six to eight month mark is when you really start planning to train appropriately for something you want to do.

Trevor Connor  57:18

Proper bike fit is essential for female cyclists at any age. Let’s hear sage Rountree share her thoughts and some of the important considerations for women

Sage Rountree  57:27

off the cuff, thinking about physiological differences. Thinking about you know, even just like equipment differences of finding a saddle that fits a different pelvis. Because if you can’t get comfortable in your first few rides, you’re just gonna say Screw this, I’m not doing it anymore. So I think that getting the like, for me a cut out saddle made all the difference in the world. And then like once I found the right cut out, it was gradually making it thinner and harder and thinner and harder. So it was like it kind of went wide and then came back down again, to a pretty minimalist saddle. Also just finding the right shorts to work with that saddle, so you don’t have too much cushioning. I’m sure this is the same for men. But like too much cushioning is almost worse than not having enough. So it was finding the right balance so that I could be physically comfortable. Because if you’re not physically comfortable, it’s just a horrible experience from start to finish. Also, physiologically different is not just the pelvis, but the relationship between the pelvis and the knee, I guess we call the cue angle, which can lead to some knee pain if you don’t have like well balanced strength through the hip and the quads. So making sure that you have a good strength training routine or a good physical therapist to help you figure out like, what is it going to take so that your knees are having a good experience when you’re on the bike, especially if you’re locked into the pedals. Those are the two that jumped out at me apart from the obvious like, yeah, psychologically, and physiologically, the guys are all out. Yeah, we’re out here. And you know, you’re just getting started and you’re always feel like you’re getting dropped off the back or you’re getting condescended to that’s, that’s a negative psychological experience.

Trevor Connor  59:05

So I think we need to move on to that next phase when women start getting into their 40s and 50s.

Dr. Stacy Sims  59:13

Yeah, so early 40s women will start to kind of look and go, my training and nutrition isn’t quite working for me what’s going on. And this is the time like, you know, super early 40s 4142 43 You’re still going to be as if you were in your 30s like nailing it really good. Good power, good. explosiveness. Adaptation is really good. But then when you get to your mid 40s, you’re gonna start feeling some changes going, huh? I just not recovering how I should be. I’m putting on a little bit of extra belly fat. What’s going on? And this is where a lot of the self doubt starts to come. I’m not training hard enough. I’m not eating right. I’m too stressed. But really what’s happening is there’s a shift in estrogen progesterone ratios because women are starting to enter perimenopause, and you’re having more and Avi LaTorre cycles so that you don’t have as much progesterone, you’re having more estrogen dominance. And we start to see all these shifts. So if you’re thinking about puberty, and everyone talks about, oh my gosh, kids are going through puberty, it’s a nightmare hormone nightmare. It’s kind of the same thing, except now the hormones are dropping instead of coming up. So your body has been used to having exposure of estrogen and progesterone in a cyclical pattern for 20 plus years. And now all of a sudden, that cyclical pattern is changing. So every system of the body is being affected. We know that estrogen is like men’s testosterone for women, it directly stimulates the myosin part of the myosin actin filaments. So when we start having a misstep in the myosin integrity, we start having less of a strong muscle contraction and losing our power, we see that with estrogen and progesterone missteps, we have signaling to put on the serial body fat, and more insulin resistance. So all of these things start to occur, not really powerfully, but just enough for women start questioning what’s going on, I need to reassess or, unfortunately, like I said earlier, the first answer is I need to eat less train more, which is not what we should be doing. Because we’re having these changes in these hormones, we need to look at what kind of external stress we can put on the body, that will cause the body to adapt and respond as if these hormones were working for us still. So the biggest changes we start to see is about the five years before menopause, knowing that menopause is one point in time that marks 12 months on the calendar of no periods after that is post menopause. And the time period before that is perimenopause. So if we’re looking at what we should be doing to stress the body to support it, how these hormones used to, we have to look at the type of training that we’re doing and the nutrition. So if we look at that modern intensity long, slow stuff that we’re seeing a greater amount of older women in ultra endurance, like ultra running, the 100 mile gravel races, all of the ultra endurance stuff, because that’s where they naturally fall, we’re starting to go slower, we’re starting to become more endurance, because that’s where from sex differences, women naturally fall. But there’s a whole bunch of women that don’t want to do that. They don’t want to quote, age out, you don’t have to, because if we change the training to look at doing the very top end, like true sprint interval training, or true high intensity interval training, not the F 4545 minute bodyweight stuff, but actual hard sprint stuff, and recovering from that. And then the endurance stuff is super, super easy. So it’s the polarized training idea, dropping volume, maintaining intensity. This is how women progress in their power and their performance, even in endurance sport, specially in endurance sport. And the reason for that is we start to get epigenetic changes to maintain power within our muscle fibers. We’re getting more recruitment, we’re getting the signal for more fast twitch action. And we’re not losing it, which is what we would do if we weren’t changing our training. The other thing to remember is resistance training is super, super important, because women lose their lean mass, and they lose their bone density as these hormones start to shift, because estrogen like I said, is tightly tied to muscle integrity, muscle development, progesterone and estrogen both work together for bone mineral density. So when those ratios change, we start to lose it, we have to look at resistance training and plyometric work. So resistance training is heavy lifting, it is that three to five. So it’s three to five exercises, three to five sets, three to five minutes recovery, not cardiovascular work. And it might take 30 minutes, but we’re looking at heavy work. So by the last rep, you’re really not finishing it, because you can’t. So it’s true power training. This recruits more fibers, it increases the action of that neuromuscular connection. So you’re maintaining the power. It’s increasing the integrity of the myosin and telling the body Hey, we need myosin still. So let’s keep going. And it also instigates that muscle protein synthesis response with lean mass as well. We know that in the reproductive years, there are three pathways for muscle protein synthesis. One of them is IGF one, which is tightly tied to estrogen. So when estrogen starts to drop off, we lose that pathway, or it’s significantly attenuated, I should say. So the other issue that we have is mechanical stress and amino acids. So we’re doing the mechanical stress through high intensity work and resistance training. We have to follow it up with a very good dose of protein around 40 grams because women are now becoming more anabolic ly resistant as well. issue with muscle protein synthesis. So we need that higher level to instigate that response because we don’t have estrogen. So it’s looking at that nutrition timing that we’ve talked about, but it’s changing it to increase the protein, carbohydrate comes down. Because we are more insulin resistant. In and around training, you can definitely have carbohydrate rich, you should for sure, but the rest of the time, it’s the i Two more fruit and veg to take care of gut microbiome and also address some of the insulin resistant aspect. Plyometrics super important as well, if you have to choose between doing sprint interval training and plyometrics plyometrics is the way to go. Because you’re gonna get epigenetic changes within the muscle that encourage the muscle to pull more carbohydrate in without insulin. But you also have multi directional stress, which is what the bone needs to maintain bone density. So when we’re looking at endurance athletes who are like, but I love my endurance, what do I do, we look at implementing quality, high intensity with resistance training during the week. And then on the weekend, we might have not group rides, because that ends up falling into that moderate intensity, but really controlled low intensity, soul food type exercise, so you’re not giving it up, you’re just switching it, where the focus of that 80% of polarized training is on that quality, high intensity resistance training work. And then the 20% is on that volume. And this is how we keep performing. We keep our power, we keep our bone density, we keep our lean mass, and we don’t age out.

Trevor Connor  1:06:29

So some of these other conversations, you’ve brought up the mental side. I think there’s a big mental side here. I’ve coached a few women who have gone through menopause. And it’s life changing. And they were not they were not happy about it. Yeah. So how do you as a coach, help a woman through that? Yeah.

Dr. Stacy Sims  1:06:49

So one of the other things to understand is that with the fluctuation of estrogen progesterone, it directly affects the neurotransmitters. So you’ll have episodes of high anxiety, depression, you also have irritability that isn’t really sparked by anything. So people like why am I so irritable? And all of it has to do with neurotransmitters? So we can look and say, Okay, well, what do we need to do? So this is where things like adaptogens and creatine really come into play to help modulate those mood changes that are neurotransmitter based. The other problem with menopause in the mental status, I shouldn’t say it’s a problem, but it is, it’s culturally, we don’t talk about it. As much as people don’t want to talk about periods and menstrual cycle that is becoming more normalized. But when we talk about menopause, the automatic image that comes to so many people is the Golden Girls like old women, right? Right. And this is another reason why people are like on that menopause, I’m not perimenopause, I don’t want to talk about it. And so they have a hard time discussing with a coach which is going on because of that cultural nuance. And it can be perpetuated, if we keep doing not the right kind of training and matching nutrition. So then we can start falling into the I’m too old to race mentality, which is super hard, because women who race and are competitive, their identity is wrapped up in it. So when we start changing things, and we start seeing performance improvements and body composition changes, it improves also part of the mental status, and it’s hard. I’m not gonna lie, like salines work with her community of pairing postmenopausal women, you’ll see it all the time. They’re like, I’m going crazy. I don’t know what’s going on. And so that support network where people can go and talk about it. So they know they’re not alone. And so as a coach, you can approach and say, look, there are neurotransmitter issues that are going on, we know that there’s a cultural issue going on, and it’s okay to talk about it. Like it’s okay to say I’m in perimenopause, and I’m going through these changes and know that you’re going to have days that are really low and days that are really fantastic. And that’s all part of it. Because men age in a linear fashion. There isn’t this discernible point where all of a sudden, they’re changing so rapidly. So we don’t hear about it in the cultural context.

Trevor Connor  1:09:04

That’s always good to say and a strange way we can kind of fool ourselves like we might get some gray hairs Yes, like that. But there’s no event in Herbalife that says you’ve hit a certain stage in your life. Right? Exactly. Women have,

Dr. Stacy Sims  1:09:17

right. And even with testosterone, it’s a slow decline in men, where all of a sudden women are boom, losing estrogen, right. And so there’s all of those rapid changes, so as to support so if you have an endurance athlete, he’s really fighting against putting some resistance training in its small doses of it to really start to address some of that. And then as she gets stronger, she’s starting to see your performance come up. So it’s it’s small strategies because not only the training nutrition part that changes it’s the whole aspect of who she is her identity. It’s the whole aspect of changing everything that she’s doing that she’s been used to for however many years she’s been in sport, and it’s also the time point where A lot of women are finding success in career, they might have younger kids, or they might have teenagers, they might have aging adults. So there’s all these external pressures to consider as well. So all of those impact on the mental capacity that women have, plus the issue of changes in neurotransmitters, plus brain fog, which people are like, what is that it’s, you’re walking through the day in a gray haze. That’s the best way it’s been described to me. But you can do things with that with adaptogens. Some women are using SSRIs. Because we know that that helps with vasomotor symptoms and brain fog. We have some women who turn to menopause hormone therapy, and that’s fine. But understand that it’s a therapy, it’s not replacing your hormones. Because as you’re going through this, you’re also losing estrogen receptors, they’re becoming less sensitive, some are more sensitive, some are less. So when you’re adding exogenous hormones, don’t expect that to do the same thing that your natural hormones did. It helps slow the rate of change, it definitely helps with mood. It helps with a lot of the other symptoms that interfere with life. But it’s not the panacea that we want to avoid this aging process.

Trevor Connor  1:11:09

What is your feeling about that? Because I know a lot of physicians, as soon as their patients hit menopause, they put them on hormone therapy, it’s just a almost a given.

Dr. Stacy Sims  1:11:18

I know it’s like when a teenage girl comes in with irregular periods and upon No, no see, yeah, there’s a time and a place for exogenous hormone use. And like you can, if you have serious health issues, like PCOS or endometriosis, that’s great for OCS when you are going through the menopause transition, and your symptoms are interfering with your daily quality of life. So your mood is one where you’re so significantly depressed, and you’re very lethargic, and you can’t sleep because you have lots of vasomotor symptoms, and you have no sex drive. And there’s all these things that are interfering with who you are, then there’s a time and a place to talk to your physician about using menopause hormone therapy. Notice I’m not calling it hormone replacement therapy, because we’re not replacing it’s a therapy. But you also need to change training and nutrition with the hormone therapy to maximize your potential. And then down the track. We know that five, six years post menopause, this is where you want to start tapering off because you’ve gone through the transition. And if you’ve changed up training and nutrition to help with body composition, that when you taper off the hormones, you don’t have this massive backlash about being on them. So again, it’s a therapy to get through things, because it is a very difficult time for when. But there’s also other options that you can use, you can look at using like I said, SSRIs. You can look at using adaptogens. You can look at using cognitive behavior therapy. So there are other things to do before the automatic response of here’s some hormones.

Trevor Connor  1:12:52

Now what about women? We talked about contraceptives? What about women who, before they were on menopause, were on birth control for years and years and years? Do they continue that? Do they get off of that? And what is the impact on them if they come off of it? Yeah,

Dr. Stacy Sims  1:13:08

so this is something they need to work with their physician. And there, there are medical recommendations for women who are over the age of 40 to get off oral contraceptives, because of some increased DVT risks, but also because we don’t know when they’re hitting that perimenopause, the general recommendation is to go up OCS and then use an IUD. And then because your body may or may not start ovulating, again, depending on if you have ovarian failure from menopause or not, they can keep track of that on an IUD and help you understand where your body is. So there’s definitely a phase in phase out with using OC. And it’s something you should talk to an endocrinologist about. First, you can talk to your GP, but it’s doubtful they know a lot about it. There are some really good specialists in a chronologist around the country now that are working specifically with active Peri and postmenopausal women. So it is definitely something to have a conversation about.

Trevor Connor  1:14:03

We’ve talked about a lot we’re getting towards the end of our time here. So before we finish up, we did want to ask you about your new book.

Dr. Stacy Sims  1:14:10

Yeah. So on the offshoot of the first book, roar, there was one chapter on menopause and had so many women who were looking for information because most of the information out there was on sedentary women who are inactive. So the active women got a plethora of questions about it. So then we wrote a book that was specific to Peri and postmenopausal woman next level guide to kicking ass through the menopause transition and beyond. So the small little bits that I talked about are just highlights, really, but the whole book is a bunch of information to really help navigate all of this.

Rob Pickels  1:14:44

I’m glad that there are increasingly worthwhile resources for women, right that are specific to the women, the female athlete. I know that Trevor and I were involved on a podcast with Tenille who Kurland called perimenopause and beyond. And I believe, and it’s just it’s, it’s so nice to see, you know, to round this conversation back to where we started of. There hasn’t been enough research, there isn’t enough information. I’m really excited that we do have these experts now who are taking women into consideration, you know, as they should be. So, yeah, thank you. Me, too. It’s, yeah, I bet. Where was all this information? Stacy? You know, ya know, 100 years ago, you know, not even where was this information five years ago? Right. Right.

Trevor Connor  1:15:33

Finally, let’s hear from Kristin leagan. And her thoughts and how things are changing for the better.

Kristen Legan  1:15:38

I think Stacey Sims is doing incredible work on the the physiological side of female athletes, and what does it mean in terms of how we should be training, how our bodies are reacting to the training. And so because of her kind of leading the way, there’s more and more research coming out, that’s helping us kind of identify those things. But I’d say maybe even bigger of a challenge or difference is just the there’s a big mental difference between female athletes and male athletes, I find, for the most part, this isn’t across the board. But just the way a lot of women approach sports, it’s more about themselves. It’s more about this internal pressure, or the satisfaction of completing a workout because that’s how they feel. And it’s not as much about beating the person next to you, or, you know, getting a podium. And, you know, of course, there’s always women that are interested in that. But I just think the way you set up goals and motivation for women can be really, really different. And it’s just about having that conversation and kind of figuring out what drives each individual athlete, whether they’re male or female.

Rob Pickels  1:16:48

Listeners, we have an exciting announcement, we’ve lowered the price of membership by 75%. Now you can enjoy all the training science at Bastok laboratories for just $60 a year. Join today at fast talk labs.com/join.

Trevor Connor  1:17:09

At that note, I’m going to do a quick little plug here. They’re coming out this fall on fast talk, we have a special podcast that’s going to be hosted by Julie young and DD Berry, talking about all the different sides of training and racing for women’s cyclists. So we’re really excited about that. But truly enjoyed your first book roar. have actually read it twice now. No thanks. And excited to see your new book. And I’m glad that you got that feedback and are able to give women athletes this information I know that they’ve been looking for that they’ve been searching for

Dr. Stacy Sims  1:17:44

Yeah, yeah, I It’s I was really nervous as I was with roar of backlash, because challenging the dogma. But it’s just gone crazy. Like people have been wanting this information. And the first week we hit the bestsellers list. And I was like, Oh my gosh, wow. And just gotten lots of thank yous about it. So I’m excited to see what what else comes out of it.

Rob Pickels  1:18:09

So that was another episode of fast talk. Subscribe to fast talk. Wherever you prefer to find your favorite podcast. Be sure to leave us a rating and a review. The thoughts and opinions expressed on fast talk are those of the individual. As always, we love your feedback. Join the conversation at forums doc Bastok labs.com to discuss each and every episode. Become a member of fast talk labs at fast dog labs.com/join To become a part of our education and coaching community. For Dr. Stacey Sims, Rebecca rush, Daniel Mulvaney sage Rountree, Kristin leagan And Trevor Connor. I’m Rob pickles. Thanks for listening

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