Perimenopause, Protein and Power with Dr Abby Smith-Ryan

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In this episode, I’m joined by exercise physiologist and nutrition researcher Dr Abby Smith-Ryan to unpack what really happens to women’s metabolism through perimenopause and beyond. Abby explains why a sufficiency-based approach to women’s health research matters, and why “the science is settled” is the wrong way to think about female physiology. We dig into metabolic changes in midlife, low energy availability, and why so many women are unintentionally under-fuelling while feeling “weight-loss resistant.” Abby shares her latest work on nutrient timing, fed vs fasted training, pre-exercise protein, and how progressive resistance training (with and without creatine) can rapidly improve muscle, fat mass, bone and confidence in midlife women. We also touch on GLP-1s, metabolic flexibility, CGMs, and daily urine hormone tracking as emerging tools for understanding this life stage.

Episode highlights

• Why women’s research needs a “sufficiency” rather than “scarcity” mindset
• How under-eating, stress and low energy availability drive metabolic slowdown in midlife
• Fed vs fasted training, pre-workout protein, and practical nutrient timing for women
• New data on resistance training, creatine, and rapid changes in muscle, fat and bone in perimenopause
• Using CGMs and daily urine hormone tracking to better understand symptoms and tailor training

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Creators and Guests

Host

Mikki Williden

What is Mikkipedia?

Mikkipedia is an exploration in all things health, well being, fitness, food and nutrition. I sit down with scientists, doctors, professors, practitioners and people who have a wealth of experience and have a conversation that takes a deep dive into their area of expertise. I love translating science into a language that people understand, so while some of the conversations will be pretty in-depth, you will come away with some practical tips that can be instigated into your everyday life. I hope you enjoy the show!

00:00
Hey everyone, it's Mikki here. You're listening to Mikkipedia and this week on the podcast I speak to Dr. Abby Smith-Ryan, scientist, researcher, educator, mother and lifelong advocate for empowering women through evidence-based knowledge. In this conversation we dive into everything from what a sufficiency-based approach to women's health research looks like to the metabolic mysteries of perimenopause.

00:28
the science of muscle quality and why women often respond differently to training and nutrition strategies. And we talk about the state of the science, what settles and what there are still questions over. We talk about protein, we talk about HIIT, and we talk about what it really takes to preserve muscle and metabolism through midlife. It's a wide ranging, evidence driven discussion with one of the leading voices in exercise physiology today. For those of you unfamiliar with ABBY,

00:58
She is a professor of exercise physiology and nutrition in the Department of Exercise and Sports Science and co-director of the Applied Physiology Laboratory and Human Performance Center at the University of North Carolina Chapel Hill. That is a mouthful. Her career in exercise physiology and sports nutrition has been driven by deep passion for improving health and quality of life across diverse populations through feasible, effective and science-backed strategies.

01:27
Abby earned her undergraduate degree from Truman State University before completing her master's of science and PhD at the University of Oklahoma. Her current research focuses on exercise and nutrition interventions to optimize body composition, cardiovascular health, and metabolic function, particularly in women's health, perimenopause and postmenopause, and in overweight and obese populations.

01:53
She has led NIH-funded and industry-sponsored clinical trials, published more than 230 peer-reviewed papers, books, and book chapters, and presented her work globally. Her contributions have earned her distinctions such as Nutrition Researcher of the Year, Young Investigator of the Year in 2015, and Outstanding Sports Scientist of the Year in 2022 from the National Strength and Conditioning Association.

02:21
Beyond her academic achievements, Abby is deeply passionate about mentoring the next generation of scientists and helping people translate research into practical life-changing applications. I have got links as to where you can find Abby over on Instagram and also her personal website, which is really lovely and up to date. And I really think you guys are gonna love this conversation. Before I crack on into it though, let me remind you that the best way to support this podcast

02:50
is to hit the subscribe button on your favourite podcast listening platform. That increases the visibility of Micopedia and it makes literally thousands of other podcasts out there. So more people get to hear from the experts that I have on the show, such as Dr. Abby Smith-Ryan. All right team, enjoy the conversation.

03:11
Abby, thank you so much for joining me this afternoon, your afternoon. You know, I look at the work that you do and it looks like you sort of hit that sweet spot between looking at that sort of rigorous physiology in the research setting, yet also think about the practical application, which is so important for everyone to sort of just like open themselves up to thinking about training and metabolism, not just how we see in the research. So, I'm super excited to have this chat.

03:39
Yeah, I am a huge fan of yours and love your science-based approach and practical applications to nutrition. So I'm sure I'm going to learn a lot. And I'll just say, ah maybe this is my imposter syndrome. But as a scientist that does bridge both, sometimes I'm like, oh, I need to be a better mechanistic scientist. And then some days I'm like, oh, I need a better translation. So I'm sure I'll miss some things. uh

04:03
I do think both are important, especially right now in this midlife space, and it's a space for always learning. So I don't have all the answers, but look forward to chatting through some of them. Yeah, nice one. And so you've been studying exercise physiology nutrition for years, I assume, at this point. And of course, lately, your work has seemed to be centered more on perimenopause.

04:27
Is it the fact that you're also in that age group that sort of drew you to that area? Yeah, it's not. So I would say I have always had a passion for including males and females in my research from day one. But then early on, I started to realize that the females had a slightly different response. Or in some scenarios, I might get a reviewer's comment of like, oh, you can't do that in women because of the menstrual cycle or this.

04:56
It was probably about eight years ago, we were doing a lot with females but also males and I still study males but identified and did some look at kind pre-perian postmenopause. And when looking at the literature, we knew a lot about postmenopause and I still do a lot of work with pre-menopause across the menstrual cycle but really started to...

05:23
dive in and identify big changes in that perimenopause space. And I do all human subjects clinical trials. And so when we also were bringing these women into the lab, I can't tell you how many were like, I just need help. you know, how is this responding? And so uh some of it too is like, I want to have an impact. And it seems like this group of people really need that. And so it was,

05:50
Several years before I entered midlife that I was started studying this and then I am thankful now that I have some of those tools as I transition into that midlife space. Yeah, nice one. And I can imagine that that many of your questions maybe would have been informed by those participants coming into your labs. And you'd be like, oh, my gosh, that's a thing or I've not seen this. I feel like that would be a thing. Well, yeah, and even doing these things like my favorite thing about

06:19
not only translating science, but is informing science from real world of yes, clinically, how does that happen, individual experiences, like I have the ability to go answer those questions in a lab. em Abby, I mean, it's such a contentious space, what we should be telling females in perimenopause, is like best practice recommendations. And obviously, it isn't just actually on social media where there are quite a few loud voices.

06:46
uh Or at least it seems like maybe it's only in that point zero zero one percent of the internet we hang out in. But is it like that amongst researchers as well? Yeah, and it just like it actually breaks my heart a little bit of like we I do feel that it shouldn't be contentious should it and it very much is. And so I hope I don't make it any more contentious. I really hope that we can continue to build this space. uh I do think in the research world.

07:13
Yes, it's become even harder to publish in this space and to dive into female specific work. so my hope is that we can continue to change that by talking about it. So yes, it's contentious everywhere, even in the government. Yeah, well, that's interesting that it's become harder to publish in the space, whereas it feels like that it's sort of just been spotlighted.

07:39
you know, now, you know, we're all about female physiology and particularly in the exercise physiology space where females have sort of been excluded, actually. Yeah. And so what I have seen is that unless you are capturing all of the hormones multiple times, like unless the methods are extremely rigorous, there's a lot of feedback of it's not high quality research. And as someone that does sit in that space of research and translation,

08:09
you don't always need all of the hormones to ask the questions and to inform and to translate. And so I do love that we're adding more rigor to science, but I often think of like, if I were to publish that same paper in a mail data set, no one would ask me what their hormones were. And so I feel like we almost need to take a step back and say,

08:31
what are the minimum criteria and how do we use, we don't need hormones unless it's the primary outcome. Sometimes we do need the hormones, but it's also characterizing and improving uh the literature in this space that it's not always like, here's the exact recipe that we need. So yeah, it's definitely become harder, but hopefully that will swing back around. Dr. Lauren Calenzo-Simple, her work looking at hormones.

08:58
made me think that potentially it was no longer going to be as much of a barrier, but maybe I'm thinking about something in a different area. Well, and I love, like, I think every study provides some sort of value. And so in a lot of our work too has looked at, okay, when do you need to control for hormones? And like, when does it make an impact on performance and nutrition uh so that you can control for it? And when does it not so that we can include more females in research as participants?

09:27
um But I also think, and maybe this is because I'm a research nerd, of one really high quality study, which that study was with 12 individuals, awesome. Let's go do it again in some different populations or let's add some additional markers to see, like, can we replicate? And if great, awesome. And so I think it definitely moves the field forward. But then as a research nerd, it just leads me to more questions too, you know?

09:56
Yeah, to your point, actually, I was looking at someone on social media shared a page from a book suggesting that this is a bit of a tangent, but to your point on one study, and this whole chapter had been framed around this one study showing different responses in the follicular versus the luteal phase. And that's what the premise of their practical applications were. I'm like, that's one study when, to your point, it's not a body of research.

10:25
Well, and I do think that this is getting pushed back to in the in the media is there's a blend of science and real person application of sometimes it's hard to take one single lab based study and say, here's how I would apply it and vice versa. And so it does have to be like a culmination. And so there is some nuance, but I do think there's still a lot of value in those single studies and saying, OK, what does that lead to our next study? Yeah.

10:54
Yeah, nice. I think I have a similar conversation with Dr. Mike Ormsby actually about that sort of translational research and some of his earlier super interesting findings and his pushback was sort of similar in that, doesn't have, not that it doesn't have the rigor, maybe he said that, but it's just different, I don't know, like what is meaningful and what is statistically significant and scientifically interesting? guess they can mean different things maybe.

11:22
Well, yeah, and I would tie that into exactly, uh so we will always have some rigorous clinical trials, but then we work pretty closely with several of our athletes, like let's say our female athletes, and what we capture with them, we might need to do like a controlled study and then see how it applies to the field. And they're very different things, but they can inform each other. So I think it just goes back to what are we trying to do and what are we trying to...

11:50
help with and it's not always black and white, but it can still be research informed. And Abby, what is your perspective on how much um sex-based physiology changes outcomes in training? Yeah, that is a big question. it's hard to, in general, here's how I will answer that. We very clearly know that there are sex-based differences in physiology.

12:18
especially in acute and chronic exercise. And I love, I'm sure you read, I love Paul Ansdale's paper that clearly outlines some of those differences. uh But in reality, that doesn't mean we change all of our training. And we've seen this repeatedly, we do need to have that open conversation that there are kind of quantitative differences and qualitative differences uh across the cycle.

12:48
And if we are doing good program design, it should integrate both. So my take generally is that we should be asking a female different things about herself and considering our training program. uh But I wouldn't necessarily say like, I would never say this is exactly what you need to do in the follicular phase and the luteal phase.

13:09
But I do think we're at a space where we should start asking like, oh, is someone not recovering as much? Should we dive into our nutrient timing based on the luteal phase versus the follicular phase or just in general, the woman by itself? Should we ask them, your menstrual cycle habits, or are they changing those characteristics? Like viewing more of a whole lens, just say, here's my training uh and then you are a woman, but kind of bridging those both together.

13:37
Yeah. And I hear people talk about it, you know, like using sort of self-regulation, just any, at any place in your cycle. And in fact, we're talking about females, but males as well, you know, like using how you feel to sort of, which makes intuitive sense, not necessarily, and surely that should just be the way we, I guess, recommend everyone do anything in any area of exercise and nutrition.

14:05
Yeah, and I agree with those people too. There is an important amount of self-regulation, but I will maybe add a spin of as a female, former female athlete, active woman, no one ever taught me about how that self-regulation might be different across the menstrual cycle or things to consider. So there's this element of self-regulation, but also understanding there are physiological things that are changing, whether it's across the cycle or into perimenopause.

14:34
And those things we should consider and almost use to, it's empowering as a woman to know, like no wonder I feel terrible, or I'm more sore, or why do I keep getting those small musculoskeletal injuries of like, then what? Do I then use or understand my hormones to start uh individualizing a little bit more? Yeah, no, I really like that. That's really great because if we start saying there is no difference between female and males, then,

15:03
where you're not really informing females of why they're experiencing what they're experiencing. Absolutely. And I mean, we all experience things differently, but how do you do that without that initial knowledge? Yeah, nice. I kind of feel like some people are talking about this like it's a closed book, move on, there's no differences, know, like the science is settled. science is never settled. It's super interesting.

15:30
Thank you for saying that, because sometimes I'm like, well, I should just quit. Why do we need science if we already know? And then I take a step back of like, OK, no, we do know that there are physiological differences. That doesn't mean that we need to necessarily train our women totally different. Instead, I would go in and even one study we have in review of, uh should we evaluate our work to rest ratio slightly different for our high intensity training? What are the small changes that we

15:59
know uh may be different based on metabolism and vascular changes and blood flow, those are the things we target versus we know a woman can gain muscle. It's more about then how do I optimize that, for instance, for a midlife woman who has joint pain? I can't have her do the same thing and I know joint pain is very much a symptom of perimenopause. So it's almost to bringing in the environmental components as well.

16:27
So Abbie, where do you see, with the work that you do with women in perimenopause, particularly like, where do you see sort of the biggest dial movers are in terms of, let's start with like nutrition. Like what changes do you think a woman needs to make in your experience and maybe in, of course, in your research that might help them optimize at a time where they're feeling pretty rubbish? Yeah, I'd love to...

16:57
I'll answer and then kick it back to you maybe, because you work with so many women. I guess, so one of the things that we're trying to explore with a couple of our current projects is really understanding some of the metabolic changes and how those are impacted by nutrition and exercise and hormones. And I will say that it's not just driven by hormones. to answer your question, the first thing I see with most of

17:25
particularly our midlife women, it's also this time where they're not feeling very good about themselves and we see a lot of caloric restriction. And so one of the things I would say is like, are you eating enough? And one thing we've looked at is how do you even determine what is enough? Are you estimating basal metabolic rate or are you measuring it? Because a lot of the formulas uh are not.

17:51
or there's a pretty big discrepancy if we're estimating energy expenditure. So are we capturing that? And then a lot of women are notorious for not fueling throughout the day, which can impact hormones. So one thing that I think is really interesting, especially with this interesting group of more active women uh going into perimenopause, it's slightly different than what we've seen before because of Title IX. uh

18:19
I'm seeing this group and we're exploring this of active women that are experiencing symptoms of perimenopause, but it's very similar symptoms to relative energy deficiency syndrome. And so is it coming or can we help with those symptoms by increasing calories? And then a lot of my work focuses on nutrient timing, which is also crazy contentious.

18:46
Which is silly. My view on it why I'm passionate about it is because you can't often change the 24 hours in a day, but you can often take advantage of those few hours around your training that then can accelerate those kind of adaptations. Yeah. Well, first, can you explain Title IX? Yeah. So in US, it was about 1972 that Title IX was put into place in

19:13
really what it did, it said that we had to have, or it allowed more women to participate in sports. And so now those women are like into perimenopause, but it allowed for like a younger generation, like a generation above me and mine, like we were always active. That was what the, that was, know, and so now we're aging and most of our medical system isn't.

19:38
wasn't trained on that population of like, now as I'm aging, I also have a good fitness level. How do we deal with those people? Yeah. Okay. No, that makes sense actually. Yeah. Thank you. Tangent, but one of the um family doctors I was speaking to here in New Zealand was just talking about how most family doctors are actually trained on infectious disease and not actually the chronic disease that's coming through with. And I'm like, oh, that's a point.

20:03
Yeah. And Abby, to your point, what I see in a lot of perimenopausal, I see a couple of things. And there are more than just two subtypes I know, but this is how I sort of think about like women who have always struggled with their weight or they feel like they've always struggled on and in their head, they've always been on a diet. But in reality, they sort of yo-yo between being like heavily restrictive or

20:30
like completely off a diet because they're not on a diet right now. that, you know, so I see that sort of avatar, but then also like women who have never had to think about their weight, they've always been lean and they've never had to think about what to eat and they've never had to exercise. And maybe they've been active or maybe not because they've never really had to be. And then their body composition changes and they're gaining weight around the middle. And they're sort of a little bit like,

21:00
I wouldn't even know where to start. um And I wonder if a lot of women who do, to your point, under eat calories a lot during the day, but then there are just pockets of time where they more than make up for it. um Yeah. I think that's, and so I had this question because I know Bill Campbell's been doing work in that sort of weight loss resistance space. And um when I work with women,

21:30
feel like they've got weight loss resistance and they'd all tick the box here, I can't lose weight. But then when I sort of dig a bit deeper, I sort of see some of these behavioral things which are actually impacting. And so I don't, I'm unsure yet whether I think there's something unique about a woman in that space that makes her resistant, but I'm super into it. Like I wouldn't be surprised, but I don't know how much of it is behavioral and how much of it is actually hormonal.

21:57
Well, and I would add that on, like we're doing a project right now with uh heavy resistance training uh in our perimenopausal women. And so that's another, I guess, really important component is with anything, we like another avatar I see a lot is the female that's always been active and always kind of taking care of their nutrition and they're doing the same things, but now they're gaining fat or, you know, they're not

22:26
at the composition that they want based on their training. And so I think there is this conversation of how do we optimize nutrition, but also how do we optimize exercise at the same time of really supporting their cardio metabolic health, because there is really good science that there's health changes that are happening. And that's where we're spending a lot of time too. It's not all about weight. oh

22:55
drives women, but then how do we really alter muscle and bone and aerobic capacity so that they have a better quality of life later? Yeah, nice one. I see people say that women are more metabolically flexible than men. And I'm like, you know, everyone's born metabolically flexible, but in this modern environment, feels like it's very difficult, unless you're actually actively working on it, to actually stay that way.

23:24
Well, and I often think of like most of us aren't metabolically flexible because we eat so many carbohydrates all throughout the day. And so I think that's too, most of our research and my research is focused on these small behavioral changes. And that's when we start to look at, you what do you eat around exercise or high intensity training? That's not the only way you should do it. But if you have little amounts of time or we want to make small behavioral changes, what are the things that will have the biggest amount of impact?

23:53
Yeah, okay, so as I understand it, Abby, you do advocate for pre-training nutrition. I mean, I do if it's, it depends, but it is in a window that could be um advantageous depending on our goals. Yeah, and I entirely agree with you. it's like that sort of fed versus fasted debate, which is something I get questions on all of the time, and I'm sure you do.

24:22
as well. I feel it's because so many women come to see me and they are restricting their calories. And further restriction in the morning actually leads to behavior that is unhelpful. Then of course I'm going to say train fed. But of course people push back and they're like, well, it's not the training fasted that's doing it. And uh it seems like such a ridiculous argument that we get into.

24:51
Yeah, I'm curious, like, can you chat us through actually just even your research looking of clearly your research looking into it and then sort of what your recommendations are based on, on? Yeah. On? Yeah, I again think this is such a funny thing of we're having a contentious talk conversation about whether women should eat before they train. ah And so some of our initial work started in young women just trying to understand

25:19
kind of carbohydrate versus protein versus fasting before different types of exercise, resistance training, interval training, aerobic exercise, to really address some of these myths. This was probably maybe 10 years ago and identified that protein prior to exercise stimulated energy expenditure after and fat oxidation after.

25:43
And then when combined with resistance training, it led to slightly nonsignificant benefits in lean mass and strength over post-workout feeding or fasting. And so it was really telling, and at that time, all of the nutrient timing data had been done in men. And so I don't necessarily think this is purely sex hormone driven. It comes back to

26:10
what we were taught of exercise more and eat less. Of course, I'm going to go exercise fasted. But in reality, what we're seeing is that if my goal is body composition, if my goal is fat utilization, which is not always the same thing, but having some protein prior to exercise and then carbohydrate depending on what intensity, volume, et cetera, first and foremost, it increases exercise volume and quality of the workout.

26:39
which then indirectly can help with these body composition changes. And so we have then since looked at that in perimenopause. So we just finished a study trying to dial in, okay, what happens to fat metabolism specifically, both indirect calorimetry and using micro dialysis. So really looking at the interstitial fat uh to understand what happens if we take...

27:05
protein versus fasting before something like an interval training session. uh And we're just in the process of analyzing those results. But it does seem first and foremost, food, if it's protein, doesn't blunt any of those effects, which is important, and indirectly, does that then help with energy expenditure or exercise volume? And it continues to tell us a story that like

27:32
pre-exercise feeding might be really valuable, especially for this group of women that maybe aren't getting enough of those substrate or we're trying to manage insulin sensitivity and some of those things. Yeah. um so that's very like, that, um I know you're just analyzing the results, but if that's what you're finding, uh Jeff Rothschild did a similar study in athletes, like male athletes, and found the same thing with protein.

28:02
And in this audience of women who struggle to get in protein anyway, like having this extra feeding of, how much did you study, Abby? what- Yeah, so we're just doing like 20 to 25 grams. Oh, cool. Yeah, yeah. Just like a scoop of protein powder, basically. Yeah, nice one. And that seems like an easy win for a lot of people. Yeah, and that comes back to behavior change of, can I use that pre-

28:31
workout protein or even pre-workout feeding as another opportunity to be fed that can impact hunger hormones later on. I should say too, have you chatted with Jenna Gillen? No. I love her work and she's looked at some post-workout or some of this fasted exercise. And I say that like, it goes back to a lot of times I get the question of like, well, what if I trained in the morning or what if I don't want to eat before I train? That doesn't mean you have to.

29:01
but it goes back to optimization. And so she has some interesting work that shows that whether you're fasted or fed in our women uh interval training, it doesn't make a difference. And so uh some of how I would translate that is if we wanna take the most advantage of our workouts or on those days where you do have a pretty heavy workout, I would go into that fed. And if you like uh are someone else where you're just trying to get something in,

29:31
and you can't eat or it's not optimal, like you can still do that training session, you don't need to eat, but I then would definitely optimize something after I finish just for pure recovery and kind of reducing muscle damage. Yeah, nice one. And Abby, how long, like what did you measure after the fact, after the interval training session? Were you asking about appetite? Did you look at it over several hours? Like, can you share any of that?

29:55
Yeah, so most of our studies right now have gone um only up to about an hour for our blood and our indirect calorimetry and our micro dialysis just because they're such long visits. uh But then in our current study that we're still analyzing, we also have some isotopes, so doubly labeled water and protein turnover to look at some of those more longer term effects. uh And so up to an hour, like

30:24
an hour after interval training, typically things come back down to baseline. But within that hour, they're still pretty active. So we didn't ask about appetite, uh but we have looked at all those other markers and some blood markers. also, some of them, have the continuous glucose monitors to see how is that impacting a little bit longer term. is interesting because I wonder whether, this is again, because I'm just in social media a lot,

30:52
the messaging that I see always comes from that. And everyone is just absolute. And probably it's just a way to make yourself stand out rather than, you know, like, rather, you know, from a social media perspective, like if I'm more definitive on something, then people are going to listen to me more. And actually that's probably quite a good social media technique. I'm not very good at being definitive, if I'm honest. Well, and I guess I always try and give people the benefit of the doubt. I do think

31:21
women really want information right now. And I think they're confused by all the messaging. So sometimes I think, okay, if you're black and white, is that really trying to help? But then as a scientist, I'm like, it's never black and white. Like it's so individual and each science and each research project that we do, it tweaks to impact the next thing. And so it's, it's always a little bit gray. And as you know, working with individuals, every individual is so different.

31:49
Yeah. And I think when people hear fed versus fasted and the fed, they're thinking, God, I've to sit down to breakfast rather than I've just got to swig this like 120 calories, basically like drinking water, but I've just happened to have protein powder in it. Yeah. And it's such an important comment because I think a lot of times now people are talking about fed versus fasted. When in most of that research is done with carbohydrate feeding.

32:16
eating carbohydrate versus fasted. And that is different and obviously impacts, you know, if we want, if we're going to use muscle glycogen, which is we have looked more at protein, not because carbohydrates are not important, but when we are trying to optimize things like body composition and insulin sensitivity and those sorts of things, uh there's some really interesting work around the amino acids and then amino acids around exercise that also optimize uh lean mass.

32:46
We showed that as well in men and women when combined with interval training. the question I would always respond is, what are they feeding? What are they comparing it to? Because that matters as well. Yeah, nice one. I've spent a lot of my time in that sort of more lower carbohydrate space. So I am not as, and I've seen a lot of athletes come into um labs here at AUT, what I say here in Auckland, um when I used to work there. And a lot of those athletes, endurance athletes,

33:15
had poor fat oxidation because they were slamming carbs pre. Exactly. Right. And so I think that part is missing of most people. And we've looked at this too. If you can just slightly lower your carb to protein ratio, and you can do that by adding protein often to your meals, that really optimizes fuel fat.

33:36
oxidation and prevents carbohydrate kind of glycogen depletion. So it's not just about carbohydrate, it's about baseline intake too and can we slightly optimize that? Yeah, nice one. Are you familiar with Bob Seberhor in his? Oh, I love his work. Yeah. ah Yeah, we've I've got some very interesting data kind of using that approach with our active women and that does set the foundation for a lot of our midlife women because if we

34:04
are more metabolically inflexible or not able to maximize fat oxidation uh and we're under fueling, or it's just slightly higher carbohydrate, then we can modify that with very simple, swap out some carbs for some protein and look at that metabolic flexibility. Yeah, nice one. He was my sort of introduction into this whole thing. Like however many years ago I read his book, but it was, yeah, super interesting. I knew we had a connection somewhere. Hey, Evy, what about...

34:34
post-workout nutrition, again, another contentious area with that nutrient timing. So what's your take and what would you say? My take is always, when did you eat last? And so, you know, now if we're talking about someone that just depleted muscle glycogen, then you want to get something that will replenish that pretty quickly. But if I have someone that's normally active and they didn't...

35:00
they ate a couple hours prior to training, then you want to eat something more quickly after to refuel. But if you just had a meal or you had a pre-workout feeding, then you don't necessarily need that meal right after. And it's always a funny question of like, we should look at that total daily requirement. And we want to plan that with exercise in mind, and then take advantage of it. Meaning if I've already planned my meals of my total caloric intake and macronutrients,

35:29
and here's where exercise fits, that doesn't mean I need to like grab something as soon as I walk in the door, unless I've just totally depleted muscle glycogen. So it very much depends on when the last meal was. uh The flip side of that is it is a nice window to consume food to help with recovery if you haven't, or if you're trying to optimize that. Like that's when your body's gonna utilize it the most. So I always tell people, know, if you love

35:59
ice cream or you love certain foods, like post-exercise is the best time to have it, because that's when your body is going to really utilize it and help it with recovery. Yeah, yeah, nice one. Have you ever used CGMs in your research? Yes, we have done consistently. I will just say that the data is very cumbersome. So yes, we have used it and we've analyzed. Yeah, we're using it in a couple of our projects now. Yeah, and

36:26
Do you have any, mean, obviously you think they're valuable enough to use in research. what about for the general women in perimenopause? Do you think it could be of value for them to know how their body handles glucose or like, again, it's contentious for whatever reason, but yeah. Yeah, I mean, it wouldn't be the first thing I'd go tell a midlife woman to buy. But I do think there's some really interesting.

36:50
individual responses. Like the classic example I always give is I think we need more data around what happens at nighttime with men and women, but um like night sweats, you know, not necessarily hot flashes driven, but we do know that nutritionally it also can be hypoglycemia. And so, you know, that could inform in the US we always tell people don't eat after 7pm. Well, when in reality, like

37:17
if it's a hypoglycemic thing, well, that's an easy pre-bed snack that I'm sure maybe you and Dr. Ormsby chatted about. So I think if it's a woman that's pretty informed and had done some other measurements um or really feels these highs and lows, I think I'm totally biased, but data is very valuable and uh that can be empowering depending on the individual. Yeah. Have you used one? I have not, no. um

37:45
I've used every other technique, but I have not used it. I've used one a couple of times. Do you know those protein bars, the no-cal protein bars? Yeah, think so, yes. Yeah, these vegan, they're delicious actually, protein bars. And I remember seeing, they've got this um type of fiber in them. They said their net carbs is like two grams, but the fiber in them really spiked my blood sugar, which I found interesting. Yeah, and so I think if I'd never...

38:14
Necessary, well, not never, but I seldom recommend someone use it. But when people come to me and they're like, could I try it should I use it? And they want to do it. Like I'm all for it. I think you can learn so much about those different types of foods. 100%. And I would say I haven't tried it because I'm like trying to figure everything else out. But it's a good reminder. Yeah, I think those numbers are really empowering. we've used instead of CGMs, we've

38:43
we've started to use at-home urine hormone trackers to allow, and I found that we're using it as a research of daily urine where it gives us estrogen, progesterone, LH, FSH, well, derivatives of estrogen and progesterone. But it allows us to see, and for women to see, oh, there was a spike, oh, there was a drop, or there's no changes throughout. And we've started to compare that with the idea that could that be paired with some clinical practice?

39:12
or how does that relate to more of those regular measurements? And my hope is that becomes more available. Oh, that's interesting. they uh the daily urine trackers? Is that something you can just get in a pharmacy over there? um Yeah, so most of them were originally designed in the fertility space. we've used, um so the three that come to mind, Mira is now on one stick, Uva has a couple sticks, and then we are using a Neato.

39:42
And you can just buy them online. I know some of my international collaborators couldn't buy some of them, um but it's very helpful. The values aren't the same as you would get in blood, so there's some validity work that needs to be done. But really helpful to show how variable those hormones are every single day. And then can you pair that with some of the symptoms so you at least know of like, oh, I'm not crazy. Like, no wonder I didn't sleep well or like I

40:11
I didn't feel as good when I was training. Yeah. Oh, interesting. Yeah. And I guess because it would still be showing trends despite the fact that they're not necessarily lining up with what blood values would be. Right. And then blood draws are not, I mean, they're all expensive, but like you wouldn't want to do daily blood draws.

40:29
But really trying to, can we inform or better inform of how often we do a blood draw? Like now you might just go in and they say, well, what phase of your cycle are you in? Whereas these daily urine hormones, we can start to say, okay, yeah, here's our area under the curve or what are those trends of, are they peaking? Is there none there? And then, are you getting prescribed hormone therapy? uh And then how does that influence those markers? Yeah, yeah. Super interesting.

40:59
So Abbie, with regards to, if I just bring the conversation back to um protein and carbs actually, do you have base recommendations uh that you might suggest a woman in perimenopause might, I don't know, start with or what are your sort of, I don't know, base recommendations? Yeah, sure. Okay. I would say, mean, broadly speaking, a starting point of 1.6 grams per kilogram of

41:27
protein for women and that's based on actually Mark Tarnopolski has some really great initial work. ah And then, you know, all that depends on how many calories, but that would be like a base recommendation. And then often for carbohydrates, what I tell and I guess I should expand that 1.6 grams per kilogram shooting for about 30 grams of protein per meal. And I, when I say that like

41:52
most women need more than three meals a day. So that's, know, 30, 60, 90 grams, you need more than 90 grams most women. And so that can inform the dosing and the timing. And then for carbohydrates, I often really focus on fiber. Most women in this space need those whole foods and a minimum

42:12
amount of fiber of 28 grams, that's the bare minimum. But then they start to learn of like, oh, I need a protein and I need a fruit and a vegetable. And that really starts not only their dietary intake, but also the whole cascade of cardiometabolic health into midlife. Do you collect diet information? I imagine you do on the participants in your studies? Yeah, so we collect repeated dietary intake. And often there's also uh

42:39
a 24-hour recall involved so that we can, because there's always obviously nuance and uh negative limitations with dietary intake. But yes, we have multiple repeated dietary intake assessments to be able to capture that. Yeah. How do women eat? Oh my gosh. um Well, many of them don't. So that is one interesting, like I had this hypothesis that

43:08
metabolic rates would be lower in midlife. But what we're seeing is so driven by caloric intake. just for instance, we had a couple women that had basal metabolic rates of 500 to 600 calories. Yeah. And when you look at their intake, they weren't hardly eating throughout the day. And then on the opposite, we had one woman that was drinking like, I think she went through four gallons of milk in a week.

43:38
Like she, yeah, and she like ate really consistently. And her estimated basal metabolic rate was like 1200, but her measured was 1900. Like it was, yeah. So like, and I'm not, I don't think eating more necessarily increases your metabolic rate. I do think there's like this, you know, sweet spot of a bell curve, but it does seem to be quite driven by caloric intake and obviously macronutrient intake.

44:06
So is there just the adaptive sort of thermogenesis going on, eat less body dials down? I mean, that's what I would assume. The other thing that we're adding in is we're waiting on our analysis of our uh doubly labeled water for our kind of more 24 hour expenditure. And I really want to dive into that. That will inform our next study.

44:30
because I do think some of it is adaptive thermogenesis. But then my question is, well, how do we change that? how do we modify that with also accounting for these body recomposition? Because these women, they're not necessarily thin and lean. There is some adaptation happening. And then I'm sure hormones are part of the puzzle. But what part and what contribution? Yeah, nice one.

45:00
when I chat to women about their diets and they do, to your point, like eat very little throughout the day, they also don't move a lot because of course you don't. You don't have any energy. No, you don't. And it's like, they're like, oh, I'm not hungry. But you don't often feel that lack of calories as hunger, particularly if you're used to not eating. just, but you just have brain fog, you have no energy and you think that's how you live your life. Exactly. A hundred percent. And that's where

45:27
Those kind of scenarios, and maybe it's narrow-minded, but those have informed a lot of our research because then, all right, so you're not going to get that woman to eat, and maybe you will, but if you have a short period of time of how do we then optimize some of that exercise and that nutrition to upregulate some of those metabolic processes. And is that where you see your research sort of headed? No. So I'll tell you two things. We have this super cool study right now looking at um

45:56
progressive resistance training with and without creatine supplementation and perimenopause. uh The creatine supplementation, I think there are some benefits, but we also have such little data on progressive resistance training and perimenopause of how does the muscle actually respond and what is the impact of hormones. I am so, uh I can't tell you how cool the results have been of the increases in muscle.

46:23
decreases in fat and trends for an increase in bone in six weeks. And these are, yeah. And we're not changing diet, like minimal, know, like we're giving them general recommendations and we're tracking diet. uh So it's been very cool. And I think qualitatively too, these women are like, I feel so empowered. I can lift heavy things. I'm seeing changes in my strength and my energy. And so,

46:52
I've been wanting to do that study for a long time. uh And so we will continue that space. The other thing that we're building is, and I would love to get your insight on this, uh combining GLP-1s with exercise with this minimal effective dose of how do we really help these women lose weight, but also in a healthy way and feel good with behavioral change with like our...

47:20
exercise and our nutrition. So trying to kind of tie in that. Oh, nice one. Have you started that study, the GLP-1? We are, I have not started it. No, in the process. I'll just make this one plug for research. I don't think people realize how long and slow and how much money it costs. like,

47:42
research takes so long and there's so many. So we have not started it, but we are in the planning phases version. Yeah, that is super interesting. Like I, I know you'll know Don Layman's um work and stuff. And a lot of his earlier study showed that was like with his overweight and m I think they were obese women, like it didn't have to do a lot to preserve muscle. Which I think is super exciting. feel like that's not the message people are given.

48:12
uh And I think those are really important messages. They're like, you don't have to go crazy and you can do a lot to, or a little to maintain, which is important. Yeah. Do you see a lot of women on GLP ones, Ebi? Yes. So I have seen a big influx of now we're calling it menopause hormone therapy. So that's a much bigger uh conversation and I have an interest in tracking that.

48:39
and a lot of GLP-1 users. And there's a lot of conversation around not dosing, but such a nutrition component where they're not getting a lot of nutritional support. So yes, those are two really big areas, especially around here. Yeah. And uh with respect to your first study that you mentioned, which sounds amazing, actually, are the women like

49:09
you're tracking their diet, are they eating what you would say is sufficient calories to get the muscle gain and that like, how's it? Yeah, are they in a deficit? Like, that's a good question. So I would say we have done a similar study with women and they didn't gain muscle. And I, came back to, it seemed like they were under consuming calories.

49:32
This study, we are in the process, it is very crazy. um And we have all that data, but haven't analyzed it. And that's what I think I'm so surprised by. But we have, it's a pilot study. So we have quite of a range of background and nutritional intake, but they're all improving. It just shows me that even individuals that said they were doing a lot of exercise and they were lifting weights, uh

50:02
They weren't, most women aren't doing like pretty controlled progressive resistance training. These women are coming in and training with us twice a week, but there is no aerobic capacity or aerobic training. So it's almost surpassing the nutrition piece, which is really informed this idea of not just with GLP ones, but then think about what we could do with the nutritional component. Those studies are just really expensive and lots of controls within them.

50:30
Yeah. And are these trained or untrained women? So not highly trained. They needed to be able to lift weights and not injure themselves. So this is a bit more of a wider inclusion criteria because it is pilot. But that's what's so cool is they're all responding to a different degree. And we're going to exclude some of those more trained individuals.

50:56
But we said, you know, we need a couple of them to see how it would informed and even they are responding very, very strongly. ah Because earlier in our conversation, you talked about like women lifting heavy or you didn't talk about it, but you just had mentioned like heavy. And so of course, people think it has to be the five by five or whatever heavy is actually.

51:17
Well, yeah, and that is not the only way to lift. We know repetitions to failure, lower volume, that is also effective. um The study that we are doing is a bit more time efficient. We're trying to get them in, have this progressive load, and get them out. And so it all comes down to program design. You do not have to lift heavy, but you do need that progressive stimulus if the goal is changes in muscle and bone. Yeah.

51:46
Yeah, I that makes perfect sense. do you work with endurance athletes? Do you see a lot of them come through your doors? We have some, yeah. Like we have focused on some endurance athletes for sure. And I am an endurance athlete at heart. uh We haven't recently done any kind of targeted study with them. Yeah, like I feel like it's almost like with nutrition and endurance, the conversation is almost always on carbohydrate.

52:15
But there doesn't appear to be a lot of talk about endurance and perimenopause, unless it's to say that, know, some people, well, not some people, that's not true. But you see random memes like, women should not be running if they're over 40 or something ridiculous like that. So I was just curious as to any thoughts you might have. Yeah, I have a couple of theories. I think some of it is, and our work has shown this as well, that

52:42
Exercise, if you are a trained individual, particularly aerobically trained, you're very good at vasodilation and your body composition is a bit better, which down-regulates some of those symptoms. Or those women don't experience menopausal symptoms the same. And so I think some of it is related to, like, if you've been active in your endurance athlete, like, you might not see or maybe complain, you might not see the same effects.

53:10
as some more sedentary individuals. So more power to those and to do some of that aerobic exercise. Yeah, nice one. uh Ebi, how has your research changed what you do? Oh, that's a good question. I mean, from early on, so I was a collegiate runner and I felt like you had to exercise all of the time. And so it definitely has empowered me now when I have two little kids and a full time job of...

53:38
being more intentional with my training and oftentimes it's higher intensity, lower volume. And then very much I have to remind myself of like, yes, you have to fuel and this will actually help. And so, you know, I can do less work and optimize my nutrition to have, you know, better outcomes for health and body composition. What about sleep, Abby? Is this something that your lab sort of is investigating?

54:07
ah I mean, I wish that we were. So what we've started to do, I'm not a sleep researcher, but we know sleep impacts everything. So at a minimum, what we tried to do is capture sleep using some wearables, aura, whoop, um just to be able to understand the impact. I don't think I'll ever study sleep directly, but my hope is that we can continue to integrate it because it is such an important component. uh

54:32
Thank you so much for your time this afternoon. You're super busy and I really appreciate you taking time out to chat. And it's really exciting to hear of your research that's going on and about to be published. Can you let people know where they can find more about you and your lab? Sure. Well, first, thank you for all that you're doing. I love the information you put out and it's a good love the education. thanks for letting me be part of that.

54:58
um And then I do a terrible job on social media, but trying to do better. So I am at A Smith Ryan on Instagram. I try and put some on um LinkedIn. Most of my papers are on PubMed. And then I do have a personal website, asmithryan.com. Nice one. Abby, thank you so much. Yes, thank you. Take care.

55:35
Alrighty, I imagine that you guys who are really into this space and really love hearing from experts would have loved that conversation as I did. And as I said, Abby can be found on Instagram and at her webpage and she's super approachable. Next week on the podcast, I speak to Brandon D'Cruz on nutrient timing. Now, Brandon and I actually recorded this way back in June and it is only now that we are able to publish it. So...

56:03
I'm super stoked to bring you that conversation and I also have another one with him in the banks. ah But that is next week. Guys, hope you're having a fab week. You can find me over on Instagram, threads and X @mikkiwilliden, Facebook @mikkiwillidenNutrition, or head to my website, mikkiwilliden.com. Scroll right down to the bottom and pop your name on for my email that comes out each Monday. All right guys, you have the best week. See you later.