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109: Hot Flashes, Cold Facts: Menopause Myths That Won’t Die
4 Playsin 2 hours
In this episode of the Movement Logic podcast, Sarah and Laurel take on the most persistent—and profitable—myths about menopause and women’s health. From metabolism myths to cortisol panic, creatine hype, and new exercise “rules”, they separate marketing spin from actual science.
They also unpack the nuanced role of menopausal hormone therapy (MHT)—who it helps, when it’s useful, and why menopause isn’t a medical emergency needing endless “fixes.”
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10:12 8 Menopause Myths and Misconceptions
37:08 Cortisol and Menopause
43:14 Exercise and Menopause
51:33 Muscle Loss and Menopause
55:00 Hormone Therapy and Muscle Mass: The Evidence
57:56 Debunking the Rapid Bone Loss Myth
01:04:31 The Truth About Creatine Supplementation
01:18:48 Menopause Symptoms vs. Aging: What's the Difference?
01:29:24 Menopause Hormone Therapy: Myths and Realities
01:42:25 Concluding Thoughts and Recommendations
Ep 8 A Perimenopause Perspective
63: Dismantling Long and Lean Pt 2
108: Does it Have to be Heavy?
Study Daily Energy Expenditure Through the Human Life Course
Study Changes in Physical Activity and Body Composition in Postmenopausal Women
Study Evaluation of sex-based differences in resistance exercise training-induced changes in muscle mass, strength, and physical performance
Study Changes in body composition and weight during the menopause transition
Study Association Between Hormone Therapy and Muscle Mass
Study Longitudinal changes in BMD during perimenopausal transition
Study BMD Changes During the Menopause Transition
Study Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass
Study Creatine Supplementation During Resistance Training Does Not Lead to Greater Bone Mineral Density
Recommended
Transcript
Introduction & Personal Stories
00:00:00
Speaker
I'm Laurel Bebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts.
00:00:15
Speaker
or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt? Whatever that means, we're here to change that with tools, evidence, and ideas that center women's needs and voices.
00:00:32
Speaker
Let's dive in.
00:00:47
Speaker
Welcome to the Movement Logic Podcast.
00:00:52
Speaker
I'm Dr. Sarah Gort. I'm a physical therapist, and I am here with my co-host, Laurel Bevesdorf, CSCS. She is a strength and conditioning coach and a yoga teacher. Laurel, what is up?
00:01:02
Speaker
Well, first of all, that was a rousing intro. Thank you. Second of all, what is up? What is up? Well, I'm 44. hey And funny story.
00:01:15
Speaker
Two days ago, I thought I might be pregnant. Hey. Hey. Good job, Nathan. Woo. but And the only, because we are probably going to talk a little bit about cycles and cycle syncing this upcoming season. The only reason, is funny, the only reason I knew that I moved, there was a very, very, very, very small chance that I was, was that I wear a Garmin, which is a running watch in it.
00:01:39
Speaker
is, you know, a place where I can track my cycle. I can push the button that says you started it, push the button says you stopped it, and then it will predict things, right? Well, I looked at my garment. was like, oh, shit, I'm three days late.
00:01:51
Speaker
yeah What the fuck? Like, usually these days I have not been. This is probably TMI, but fuck it. I had a very irregular cycle through most of my early Mm-hmm.
00:02:04
Speaker
oop for various reasons. And some of them probably had to do with birth control and other than had to do with, I don't maybe I just had a regular cycle and I just was never paying attention and had no idea when it stopped or started, which has been actually most of my life.
00:02:19
Speaker
And so when I got this Garmin, actually started to notice that actually I'm very regular, that, you know, I'm getting it even though I'm 44 and maybe things are changing, like getting it kind of the same time that it says it's going to get it to a T. Like it says, you're going to start your period tomorrow. And i start my period tomorrow.
00:02:36
Speaker
So that's why when I looked at my was like three days later. I was like, what, what, what, what? And I have an IUD in, it's non-hormonal. I've been told that it's very, very effective.
00:02:47
Speaker
And i was like, but I know that there's always this very, very small chance. And I'm sitting at the table with my daughter and my husband's still sleeping and I'm, you know, she's having breakfast and my mind is like wandering far into the future of like having a second child. I'm like, what's that going to be like? And what are you going And like, it's yeah, bizarre, bizarre thing. Of course I'm not pregnant.
00:03:13
Speaker
I happen to have a pregnancy test in my bathroom, took it, not pregnant, but it was just a really funny, funny rabbit hole to go down. And then also not funny because then I was like, Oh, I live in Alabama and Being pregnant and having a child in Alabama is probably a lot more dangerous than in other states for various reasons, not least of which the Roe Wade being overturned. But anyway, all this to be said, that was a very strange rabbit hole to go down. That was a funny, not funny, yeah sort of still funny, new new thought.
00:03:51
Speaker
Yeah, right. ah It's always the new thoughts that get you, the one you haven't had before. You're like, huh. Yeah. That's a whole new idea that there would be a second little person running around here. Yeah. But I've never entertained.
00:04:06
Speaker
Yeah. and i And I like went kind of fast forward backwards in time to being a new mother and to like what my husband and and i you know, that period of time when you have a newborn is just a blur. And then also like the period of time which they're a baby and then a toddler and then bringing her all the way up to like six years old. a lot has changed and it it took a lot of work and a lot of energy.
00:04:32
Speaker
And to like suddenly be thrown into this possible world situation where like that, that could all be repeated again. Right. And I'm 44. And I even was like, oh, and so I'll be 55. Uh-huh.
00:04:46
Speaker
There's 10. You go. I'll be going to their college graduation at 70. and Yeah. Yeah. So I was happy that I somehow managed to have some pregnancy tests in the closet and I could just get an answer immediately. And then was like, oh, just kidding. Just just kidding.
00:05:05
Speaker
So that that's what's new with me. That's okay. That's some good banter. Which is actually not new.
Course Promotion & Details
00:05:10
Speaker
Nothing's new. but Nothing's new. The new thought. You had a new thought. That was the new part. Mm-hmm.
00:05:17
Speaker
I was trying to think of like what's new with me that isn't depressing because I'm actually dealing with an injury right now that's like been a bit confusing. I don't fully have the answers yet. It's it's irritating. But I do have a funny story about I was recently in New York with with my friend and we went upstate. We went to the Catskills. We got a little log cabin, Airbnb.
00:05:39
Speaker
It's stunning, gorgeous. and So we decided to go on this sort of relatively tough hike. It's an out and back, but it's pretty steep uphill all the way. Like you're basically just climbing the mountain and then coming back out.
00:05:50
Speaker
Yeah. And we made a fatal error, which is we took gummies before we started the hike. And it was really the timing that was the issue. Like we should have gotten to the top, taken the gummy there, but we didn't. We took the gummy and then started the hike.
00:06:06
Speaker
And it's steep, you know, so we're taking breaks. And then there was one point, I think we were about halfway up the hill and there was this big flat stone and we both sat down on it for a second and we kind of looked at each other and we were We were just like, i don't I don't think I can keep going.
00:06:25
Speaker
Can you keep going? I don't think, my legs just don't, I don't know how my legs work. Like it just became very confusing why we were even trying to climb the hill to begin with. like well And then my friend was like, if we go up more, we're going to have to go down more.
00:06:39
Speaker
And I was like, you're a genius. So we just turned around and stumbled back down the hill. So that was a fun thing that happened recently. Do you think your legs were both tired and were perceiving them differently? Oh.
00:06:54
Speaker
No, i was just it just felt very, I'm not sure how to make this happen. like but what how did how are our legs yeah it was we like we spent the rest of the afternoon and just like lying around watching
Menopause Myths & Realities
00:07:06
Speaker
movies and giggling like that was kind of okay yeah that was more the the more appropriate activity be to be engaging started there and just stayed there but right right i'm a hill that we were unsuccessful well i mean i feel i feel like it's a it's a way to assure that you do some physical activity on a day that you're going to take a gummy is like, well, let's take the gummy while we're doing the physical activity that way. You know, we won't end up in this like puddle of inertia. Right. yeah i It never happens. Right. Exactly. Exactly.
00:07:32
Speaker
Yeah. That's what that was. I mean, that's what we planned. Very strategic. Thanks. Well thought out. Well thought out, Gorge. Thank you. Thank you. Thank you. All right. So before we get started on this episode, ah we wanted to talk real quick about our bone density course, Lift for Longevity. We're about halfway through with our current cohort. Is that right, Carol? Yes, we are. We are almost exactly halfway through.
00:07:56
Speaker
Yeah. And they're they're really killing it. I'm really impressed with this group in particular. And we are now offering this course every six months. It's a six-month long course. So the next cohort starts in November, which might seem like a like a while away, but When this airs, it's going to be September. So it's not actually that far away.
00:08:13
Speaker
Right. It feels far for us right now. For us. Because it's July. ah But you can, there's a link in bio you can get on the special wait list for course. Link in show notes. Link in show notes.
00:08:25
Speaker
There's a link in show notes you can get on this special. ah Everywhere. There's an Abraham Lincoln in Instagram. They're everywhere. Podcasts. are. Just find a link wherever you are. Click on that link and you will get on the wait list.
00:08:40
Speaker
There has been some confusion in the past. I just want to say some people are like, oh, I see that there's a wait list. Therefore, you are sold out. No. You get on the wait list so that you can get the special discount when the special discount is offered.
00:08:53
Speaker
Sarah wants to change it to, say, interested list. Or something like that. Because we do have people writing in being like, oh, well, I wanted to sign up, but I saw that it was full, so I didn't. Yeah. I feel like, you know what? I'm starting to change my mind on this, Sarah. I think you might be right.
00:09:06
Speaker
Maybe should change it to interested list because- there have been an awful lot of emails coming in i'm like, oh, so sad I missed it. Very disappointed, very, you know, like, oh, crap, too late.
00:09:19
Speaker
And I wish, I wish that we just had like thousands of people signing up to the point where we were like, we literally cannot, right cannot take another person.
00:09:31
Speaker
I mean, well the internet will not support that information. or there's no ability to scale up that high on Zoom, but that is not the case, right? I have lately, I've been having about 10 people in class live, and that is a very manageable amount of people.
00:09:49
Speaker
yeah And then- And that is that is from a cohort of about 65, 70 people. Yeah, and we have 90 people. We have had maybe more than that, but generally speaking, we get about between 60, 100 people sign up for this course Only about 10 to 15 maybe come to the live classes.
00:10:10
Speaker
And you are almost guaranteed to get in if you want to get in. The wait list is really just your way of going, I'm interested. And in saying that and telling us that, you're putting your name on our email list, you're going to definitely hear about it. You're also going to get an exclusive discount to the course.
00:10:30
Speaker
Yes. And a bunch of freebies along the way, because we start sending emails to that special mailing list yep with things that you might not see elsewhere. Right. So you're going to get free stuff. You're going to get a discount.
00:10:41
Speaker
You're going to definitely not forget to sign up for the course. so so That's right. Get on the wait list. Yeah. The wait list or the interested list, whatever you want to call it. Well, we will brainstorm a new name yeah at some point.
00:10:55
Speaker
Okay. Okay. So today's episode, let's get to the episode, shall we? Today's episode, we're talking about some of the myths around menopause, specifically the supposed reasons why certain changes are taking place and the supposed fixes for those changes.
00:11:12
Speaker
When it comes to menopause, the myth is typically not that X new experience is happening. It is happening. Like hot flashes, body composition changes, mood changes. The myth shows up around how to deal with it or fix it or whether it even needs fixing or if the fix would work for everyone going through menopause.
00:11:33
Speaker
or whether it's even happening to everyone or just a few people, or or even whether it's specific to menopause or it's just a part of aging and so on. Yeah. Later in this season, we're going to be taking a look at a couple of menopause grifters using our patented GriftoHeater TM, which we debuted in last season where we did an entire episode on bone density grifters.
00:11:56
Speaker
But today we're going to be going through a lot of the mythology that's out there drifting around on the internet. We'll take examples from social media, then take apart that example claim, investigate the so-called solution that's being proposed,
00:12:14
Speaker
maybe also the problem that's been created to sell that solution, and then see if it is a problem, if it is something that even needs solving, if it's solved through that solution.
00:12:27
Speaker
Right. all right. Now, before we get into it, I want to take a moment and talk about where Laurel and I each are in our respective lifespans in relation to the menopause process. transition because having delved into the ugly, and I mean ugly, depths of menno marketing, I've seen a lot of stuff that I was just, ugh.
00:12:45
Speaker
There's a lot of women selling stuff to menopausal women who are themselves clearly nowhere near menopause, right which leads me to believe that it's a very lucrative wagon to jump on. And it turns out that that's true. In 2024, the menopause industry is valued at $17.79 billion. That's with billion dollars that's with them b Wow.
00:13:07
Speaker
mckenzie suggests that it is a still largely untapped market and i saw another statistic that said it's projected to get to twenty four billion by twenty thirty jesus yeah it's both a bit horrifying and it's also kind of unsurprising right because at first Middle-aged women were glad that this population was finally getting some attention since historically our bodies and our medical needs are overlooked and ignored, especially around things like menopause symptoms. People were told to just kind of like get a fan and wear layers.
00:13:39
Speaker
Like I've literally read that as advice. Yeah. Yeah. You know, this this joy that we're finally being acknowledged very quickly mutated into, oh this is a whole new area for grifters to grift and grab some of that sweet, sweet $17 billion. dollars Yeah.
00:13:54
Speaker
So this is completely taking advantage of A, women's gratitude that someone is finally paying attention, B, a lack of widely available information as to what works and for whom and why, C, a medical industry that has historically not given any attention to this population.
00:14:11
Speaker
Yeah. So let's, you and I, Laurel, be 100% transparent. Where are you in relationship to menopause? Are you seeing
Bone Density & Resistance Training
00:14:18
Speaker
any changes? are you Are you peri yet? and It would be a bit early for you, I think.
00:14:23
Speaker
Well, I think I might, you know, I i thought I might be pregnant. so Right. Apparently I'm not that peri or not that, know. No. So I think that I can cautiously say that I am seeing some changes.
00:14:39
Speaker
For example, my period, I'm not pregnant and my period is six days late. that That is actually, if that is going to become like a regular thing where my period is late all the time or early or irregular like this, then I would say that could probably change.
00:14:52
Speaker
signal that I'm in perimenopause. Some other things that I notice are when I get stressed out now, my body gets hotter. like um And sometimes I am awake at night and just feeling very hot for some reason. Now, could it be that I sleep next to my husband who has lot of body heat or that my cat sleeps on top of me. Sure. It could be those things. Could it also be that I tend to wear like sweatpants and a sweatshirt to bed because I'm always cold and I also have a down comforter over me?
00:15:26
Speaker
This could be true too. just feel that I don't remember, and again, memory is fuzzy, but I don't remember having these experiences of just being kind of sweaty hot or like a sudden wave of heat washing over me.
00:15:41
Speaker
earlier in my life when I would say be a little stressed out at the computer or in the middle of the night when I wake up. So yeah I feel like this is probably a clue that I'm approaching or in perimenopause, approaching menopause. But again, perimenopause can last for like 10 years.
00:15:57
Speaker
By the way I just want to cite the podcast episode I recorded with Trina Allman, A Perimenopause Perspective. We can link that in the show notes where she she talks about some of what Sarah and I are telling you about here. When I think about being in perimenopause, I think about my mom because I have vivid memories of her expressing a lot of distress around her menopause symptoms. not She was good sport. I mean, my mom generally was like a good sport about a lot of things, but she was a good sport about it, but she felt like it was just very overwhelming, the hot flashes especially. She would often be walking around with ice water or
00:16:35
Speaker
would swear by the need to like drink ice water before bed or timing when she was going to have ice water. Ice water was like one of her main go-tos. And then also she was prescribed by her Dr. Black Cohosh, which I think has since been shown to not be effective at all. This was in the like late 90s.
00:16:54
Speaker
okay And so when I think about symptoms, I often remember my mother. And I have to say, I don't feel that I am experiencing that level of symptoms, but that makes sense because I think my mother was in her 50s or late 40s, early 50s when these were <unk>re happening. And I think I'm 44, so probably a little...
00:17:16
Speaker
Yeah. A little soon. Yeah.
Creatine Supplementation - Fact or Fiction?
00:17:18
Speaker
You're just getting a little amuse-bouche of fun new symptoms. But I just i want to say it's sometimes, apart from the hot flash type thing, it becomes difficult for me to separate out what changes I'm experiencing are menopause specific yeah versus what changes are just because I am in my mid-40s now, right? like Totally. Yeah.
00:17:39
Speaker
Also, what changes are because I have a different lifestyle now than I did when I was in my 30s or 20s, right? Like, I have a child now. I have a geriatric cat who moves around on me a lot at night. Like, and I get up really early in the morning so that I can get work done before my daughter gets up so that I can be present with her in the morning and These are all reasons why my sleep might sometimes not be as good as I remember it being, right? yeah
00:18:13
Speaker
In addition to possibly these other symptoms. so I mean, that's part of this episode, right? Is trying to tease out, are these specific to menopause or is this just because you are the age that you are?
00:18:24
Speaker
yeah I think from what I've been reading and everything, the anything that appears to be hormone related, like the hot flashes during the day or getting heated. And this is something from my experience that I've noticed as well. Like if I am irritated, instant hot flash. yep like So there is an emotional component to it sometimes.
00:18:42
Speaker
And the night sweats, things like that, possibly your period being late. Those may be perimenopause related, but I think yeah anything else is probably not. Yeah. You know?
00:18:53
Speaker
Yeah. so my
Distinguishing Menopause from Aging
00:18:55
Speaker
story, which some listeners will know, some might not, but in 2021, I was diagnosed with breast cancer and I went through a bilateral mastectomy and reconstruction and I went through chemotherapy.
00:19:07
Speaker
And then I went on a medication called tamoxifen and the purpose of tamoxifen, which I still take, this is my fourth, i think next year is my last year on it. I have to take it for five years, but it it aggressively removes all of the estrogen from your body.
00:19:20
Speaker
I mean, not not actually, not all, all, but you know the majority. right It's sometimes called medical menopause. I was certainly having perimenopausal symptoms. like My period was suddenly showing up every three weeks, which was like, that's more often than I want. But I was definitely noticing a few things here and there. like I was noticing changes, but then when I went through this treatment,
00:19:41
Speaker
It was like just getting kicked off a cliff. So I have experienced really severe hot flashes, night sweats, just general inability to thermoregulate what's called genitourinary symptoms of menopause, which is changes to the tissues in and around the labia and the entrance to the vagina.
00:20:03
Speaker
which I also just read is more common for people in medical menopause for that to be more severe. yeah Awesome. So that's where I am. So we're kind of on two ends of the spectrum. Laurel is maybe starting to approach perimenopause.
00:20:18
Speaker
I've gone through, i mean, I'm still kind of going through this like really aggressive menopause. It's like probably not that similar to most people's. So the women going through a menopause transition right now are somewhere in between the two of us, I think, in terms of like the things they're going through in their bodies.
00:20:32
Speaker
Yeah. But yeah, I just wanted to start there because I'm like, sometimes I'll see like a, you know, fresh faced 29 year old selling creatine and collagen and vitamin D. I'm like, what the fuck do you know about anything?
00:20:46
Speaker
Like you have you have no business and also you're too young. so All right. Well, let's get into our Menno myths because we have plenty to get through. Laurel, do you want to kick us off?
00:21:00
Speaker
Yes, let's talk This first myth, which I think is, i don't know, I think I hear this one the most. Yeah. And it's just a plain, straight up myth.
00:21:13
Speaker
And it's this, menopause blunts your metabolism. Okay, it slows it down. When you hit menopause, your metabolism slows down. So what this myth is claiming is the body composition and or weight gain changes that you might be experiencing around the time that you are also perimenopausal, going through menopause, that these changes are because of menopause.
00:21:42
Speaker
Now, you can be seeing these changes for sure around this time, but the myth part is the reason, the explanation behind these changes. And the explanation is that it's due to menopause.
00:21:56
Speaker
Now, according to the grifters, there are a lot of possible menopause-related reasons that this is happening to you. Cortisol. Your cortisol is too high.
00:22:08
Speaker
Or estrogen. Your estrogen is decreased. this This means, for for some reason, and they don't really, they don't share their receipts on the mechanisms, but this means that your body is now gaining weight.
00:22:22
Speaker
Cortisol is estrogen. Enough said. That's why you're gaining weight. And in particular, it's why you're gaining that stubborn belly fat. well Sarah texted me like two weeks ago and she was like, if I read the phrase stubborn belly fat one more time, I'm going to put it on a t-shirt.
00:22:38
Speaker
I mean, I still think it would be a really good t-shirt. Stubborn belly fat. I think it's as good as the t-shirt you sent me in the mail. Oh, good. I have rabies. Yeah.
00:22:49
Speaker
i have rabies
00:22:53
Speaker
I wore that t-shirt out the other day and I got a lot of looks. Yeah. Yeah. Any laughs or just like... um A few giggles, and but a lot of lot of like stare and look away kind of thing. yeah
00:23:06
Speaker
Those are people with no sense of humor. I agree. I agree. So just to clarify, the difference between body composition changes and weight gain is that body composition is talking about percentages of lean muscle mass and adipose in your body. Lean muscle mass is...
00:23:22
Speaker
We usually think it as muscle, but it includes also bone, whereas fat is fat, right? It's it's about the percentage of lean muscle mass or lean mass, we'll say lean mass to fat, right, or adipose in your body.
00:23:36
Speaker
And it's also about where your body is storing the fat specifically. It could also be about where your body has more muscle mass, right? So yeah where you've hypertrophied versus not hypertrophied muscle. Okay. So weight gain is a little different. Weight gain is associated with how much mass your body has. And that's registered by the number on the scale, right?
00:24:01
Speaker
So you can change your body composition and not change your weight. And you can possibly also change your weight and not change your body composition, I guess. You'd have to be losing fat and muscle and the same proportions, but at any rate, you can actually change your body composition by acquiring more lean mass, but and gain weight, right? You, so more lean mass, you gain weight if you haven't maybe lost adipose or because muscle does weigh a little bit more than fat.
00:24:33
Speaker
And you can also lose muscle while you're losing weight, right? Which is typically not considered to be ideal. They're different. They're different. So some women are seeing in this period around perimenopause menopause or see more fat storage around the waist than they used to.
00:24:50
Speaker
but they didn't necessarily maybe gain weight on the scale. Their body composition has changed, but their weight hasn't. It's kind like that announcement when you're on a flight, like be careful opening the overhead compartments as some items may have shifted during flight. Like during menopause, where your adipose is stored may have shifted slightly in your body. yeah I mean, I have seen this to be true. My waist has expanded.
00:25:13
Speaker
Not an insane amount, but um an amount that is noticeable to me. But I have not experienced any like massive weight gain overall. Okay. All right. Yeah.
00:25:25
Speaker
So then there's gaining weight, which you might still see visually as occurring around the waist, but you're also perhaps seeing the number on the scale has increased meaningfully above an amount that you would consider normal daily fluctuations.
00:25:41
Speaker
So This is also something that people in this age around perimenopause and menopause experience as well, which is just weight gain. they They get on the scale and like, wow, like somewhere along the line over the last five years, I have put on this extra amount of weight and I have no idea where where it came from and how that happened.
00:26:06
Speaker
So there are all kinds of fixes being promoted out there depending on what exactly you're blaming this supposed menopause weight gain on, there's a lot of fixes being pushed from do a special diet. It's low carb, high protein, or it's no carb or it's supplements like take turmeric for belly fat to take menopause hormone therapy therapy used to be called, what was it? It used to be called replace hormone therapy replacement therapy. now's Now the correct term is menopause hormone therapy.
00:26:44
Speaker
These are promoted as solutions to this mysterious weight gain that we want to say is because of menopause or perimenopause. Also, there's lots of solutions around exercise promoted. Like you are exercising all wrong. This is not the way you should be exercising at this time in your life. That's why you have all of this stubborn belly fat. That's why you have this weight on the scale that you you don't like to see.
00:27:09
Speaker
Here, you have to actually exercise in this particular way to lose this fat, to change your body composition in this like more ideal way. But first of all, if we back up a little bit, what we know from a really big study, and this is a really good study, and it was done on a ton of people, men and women, what we know is that metabolic rate doesn't actually change until age 63.
00:27:35
Speaker
Approximately. Yeah, approximately. And that's way past when people go through menopause. Yeah. And I think it also found that it was the same age when metabolic rate change for men and women, right?
00:27:50
Speaker
There's no difference. So this is the study. Daily energy expenditure through the human life course is the name of the paper. Herman Ponser, which you've probably heard us mention his name, was the primary lead investigator.
00:28:05
Speaker
And the study was done in 2022. You may have heard us mention Herman Ponser when we were talking about the book Burn, which we used in an episode called Long and Lean Part 2, where we looked at metabolism and the accuracy of claiming that formats like Pilates can spot reduce fat, basically make you long and lean in this sort of dog-whistly way. Pilates so you can look like this.
00:28:32
Speaker
we We really debunked that claim by looking at Herman Ponser's book, Burn About Metabolism. So in the study, over 6,000 men and women from 29 different countries and a variety of economic backgrounds so were included. And they measured the energy expenditure through something called the doubly labeled water method.
00:28:50
Speaker
Okay. I just want to break in because when I first read doubly labeled water method, I was like, that sounds like hocus pocus. But it's actually the absolute gold standard measurement for energy expenditure.
00:29:03
Speaker
I read the description of what it is a couple of times through, and this is this is the best that i have for you. So doubly labeled water method, it has to do with the rate at which hydrogen versus oxygen is eliminated in the body as a reflection of carbon dioxide production.
00:29:22
Speaker
and they measure it somehow with isotopes. And that's really all I can explain about it because that's as much as I understood. yeah But it is this is the gold standard for energy expenditure measurement.
00:29:36
Speaker
Yeah. Cool. yeah Your Garmin watch is not the gold standard.
00:29:42
Speaker
Spoiler. Spoiler alert. In fact, any machine at the gym or device that you wear that tells you how many calories you just burned is garbage information means them nothing.
00:29:53
Speaker
okay Okay. So they found, the study found that there were four metabolic stages that could be established when you're between zero and one years old. between 1 and 20 years old, between 20 and 60 years old, and 60 and up.
00:30:14
Speaker
So this means that metabolism changes in a significantly noticeable way when you do research on a large population. Between the ages of 0 being born and 1, okay, then after year 1 up until year 20, it kind of stays steady.
00:30:33
Speaker
Then it changes from 20 to 60, kind of stay steady in there. That's a long ass time, right? 20 to 60. Okay, that's 40 years if i'm my math is correct.
00:30:44
Speaker
I think your math is correct. And then 60 and up, and so the average age was around 63, it changes again. Now, yeah perimenopause, menopause, this is happening between 40 and 55.
00:30:58
Speaker
Is that fair to say? Yeah. Yeah. So another thing that's really interesting is that they did not see metabolic changes in pregnant women. I thought that was fascinating. Yeah, it is because I ate a lot more when I was pregnant than I did even training for a marathon, I think. Yeah, yeah.
00:31:18
Speaker
I remember just like pounding food when i was pregnant. And the exercise I was doing in my first trimester was mostly just walking because I was too i felt too ill to do anything else. But I would just... pounds, so much food.
00:31:29
Speaker
So they did not see metabolic changes. Here's the like main point here. They did not see metabolic changes in menopausal women. Yeah. So there you have it.
00:31:40
Speaker
Your body may feel like you have gained weight and you may have gained weight, right? We're not guessing. But it's not because your metabolism slowed down.
00:31:51
Speaker
It's not because it really changed meaningfully at all. Mm-mm. It may be that an area like your waist, which previously was not a place you stored fat, now has become one.
00:32:04
Speaker
So the reasons you might be experiencing increased weight gain could be because over the course of five 10 years without really realizing it, you've just gradually been decreasing your physical activity levels. I find sometimes this is more about the physical activity you're doing between your workouts. Like you're just not walking as much. You're not getting up and doing as much physical labor for whatever reason. Maybe you're also just exercising less.
00:32:28
Speaker
And there's also an incremental change sometimes to your caloric intake that can start to gradually creep up that you don't realize. This very incremental change in weight gain over several years can be a combination of less energy expended because of less physical activity in combination with and or because of this increased caloric intake. And it's something that happens, both of them happen so slowly and so gradually that the weight gain is very gradual, right? You didn't just like take a cruise for a week and like have like an all-you-can-eat buffet three meals a day for seven days and eat dessert at the end of every meal and then come home and be like, why did I gain so much weight?
00:33:12
Speaker
Yeah. it's much more chronic than that. Like it's creeping up on you. And this is something that I was not aware of that I hadn't really considered until I listened to Dr. Eric Trexler, who actually works in Ponzer's lab, which is pretty cool.
00:33:30
Speaker
Yeah. Talking with our friend, Dr. Lauren Kalanzo-Semple. on their podcast, Front Page Fitness. They are both experts in both exercise and nutrition. and they speak often about this tendency toward this gradual weight gain being the result of just a very slow and hard to detect gradual increase in caloric intake.
00:33:56
Speaker
So It's hard to make that a convincing argument for someone who's convinced, though, that it's because their cortisol levels are out of control or because they are menopausal, and this is because their metabolism has been blunted. But that does ah appear to be the most rational, reasonable, evidence-based explanation for weight gain. Now, the body composition change change of storing more fat in the belly, that is because of
00:34:28
Speaker
the hormonal changes associated with perimenopause and menopause. So I just want to also make that distinction, right? We're not saying that really fat is because of incremental increases to caloric intake. No, that that redistribution of fat, like optics may have shifted during your life as you've gotten a little older, as your hormones have shifted.
00:34:50
Speaker
But yeah, when you see a bigger number on the scale or when you notice that you just have less muscle and more body fat, generally, this is explained through this energy balance.
00:35:02
Speaker
And It's become sort of a calories in, calories out is not what's happening. It couldn't possibly be the explanation. That's overly simple, but and it's physics. It literally is how it works.
00:35:13
Speaker
Yeah. And I think it's in a lot of ways, I don't want to like trash talk people, but I'm going to do it a little bit. But I think it's much easier. No, I think it's much easier to accept an explanation that something's happening that you didn't do.
00:35:29
Speaker
Right. Right. Like this is just happening to you because you're going through menopause and guess what? Here, take this supplement and it will magically disappear. I mean, that's, I see these ads for things like this all the time because they know, they know who I am.
00:35:41
Speaker
They know height what I'm dealing with. But the idea that, oh no, actually, if I really look at my lifestyle, like I'm now CEO or I have a desk job, whereas before I had a job where I was moving around a lot. Right. Yeah.
00:35:55
Speaker
I am just sitting a lot more in general for whatever reason. ae I have started adding 4 p.m. snack to my day and maybe that snack is three or 400 calories and maybe on one day that's not a thing. But if you keep doing that and you're not burning the calories needed to keep your weight at a certain level, that's that's that sort of incremental overtime thing that I think they're talking about.
00:36:19
Speaker
It's hard to detect and it's much harder to make those lifestyle changes on a day-to-day basis when so much like subliminally is pulling you toward not being as physically active or yeah not a little snack break or whatever it is. and And it's much easier to go, oh, so what I was missing was turmeric.
00:36:42
Speaker
Right, exactly. Or I'm just not exercising the right way. And so if I start exercising in this right way, and that's That's actually even exercise being the much more difficult solution there than just taking turmeric.
00:36:56
Speaker
Actually much simpler fix than going, I actually need to evaluate how I'm taking an energy all day long. Yeah.
00:37:07
Speaker
Try to figure out or I have to evaluate how much physical activity I'm engaging in all day long. all week long, all month, like from now until forever, if I want to understand why I'm incrementally gaining weight, that's hard. That's really hard.
00:37:24
Speaker
It is. It is. When it's subtle and it usually is, right? Yeah. Like not a week on a cruise ship. No. Although that week you described sound kind of of amazing. Yeah. Well, I mean, I've done a cruise for four days and the eating was ah one of the best parts.
00:37:42
Speaker
All right. Well, let's get into our second myth. Our second myth is that now that you are in the menopause transition, your cortisol is elevated and it's causing all kinds of problems for you. Mm-hmm.
00:37:55
Speaker
ah So what this myth is claiming, that your cortisol becomes elevated in perimenopause and it wreaks havoc on your body from weight gain to muscle loss to being what they call tired and wired.
00:38:08
Speaker
but Let's take a moment and talk about what cortisol actually does. It is a naturally occurring steroid hormone produced by your adrenal glands in response to signals from the hypothalamus, which is in your brain, the pituitary gland, and the adrenal glands.
00:38:24
Speaker
And it's particularly produced during times of stress or when you have low blood sugar. And for this reason, it's often referred to as the stress hormone.
00:38:37
Speaker
ah But cortisol actually does all kinds of things. It helps regulate your metabolism, your blood pressure, your immune response, and your body's use of fat, protein, carbohydrate.
00:38:49
Speaker
It has a daily rhythm. It peaks shortly after you wake up. It's called the cortisol awakening response. And it gradually declines. Yeah. And it gradually declines through the day.
00:39:03
Speaker
Now there are chronic cortisol-based conditions, right? So you can have chronic elevation in cortisol because of intense prolonged stress,
00:39:18
Speaker
certain medications or conditions like Cushing's syndrome. And these can lead to issues like impaired immune function, weight gain, muscle loss, insomnia, and increased cardiovascular disease risk.
00:39:30
Speaker
There's also a condition that's the opposite where you have insufficient cortisol production. That's called Addison's disease, or sometimes it's called adrenal insufficiency. And that can cause fatigue, low blood pressure, weight loss.
00:39:43
Speaker
And if it's severe enough, you can have an adrenal crisis, what they call crisis. Okay, so, and just to give you a sense of like how common Cushing's disease and Addison's disease are they both occur in less than one 1,000 thousandth of a percent of ah ah of the population.
00:40:04
Speaker
that's ah that's ah It's an incredibly small number. It's an unfathomably small number. Yes. So this is another case where the menomarketers have taken what occurs in these chronic conditions like Cushing disease, where your cortisol is elevated, and they also cherry pick a few studies that support the idea that cortisol starts rising in perimenopause They bundle it all together and they tell you that your cortisol is elevated and you need their solution.
00:40:33
Speaker
But as we noted above, your cortisol has a natural daily cycle. It rises pretty quickly after you wake up for everyone. And it declines when you eat for everyone.
00:40:44
Speaker
And it goes up when you exercise because your body perceives exercise as a mild stressor for everyone. None of these things happen to women in menopause specifically. And as for the research, it's interesting because it's completely mixed.
00:40:59
Speaker
It shows that for some women, cortisol can increase in the later stages of menopause, but definitely not for all women. And there's a very high level of individual variability.
00:41:11
Speaker
There's also a bit of a link between women with depression and cortisol levels. But again, that's not all women going through menopause. And when the research is is so very mixed like this, you cannot say with any level of certainty that increases for everyone.
00:41:28
Speaker
But if we look at the list again of the the Cushing's disease symptoms, When you actually do have cortisol levels that are elevated, we see weight gain, muscle mass loss, insomnia. So it's very easy to say to women, oh, like, hey, has your body shape changed? That's your cortisol, it's too high. Sleep issues, cortisol again.
00:41:46
Speaker
Now, there does exist out there, and this is one of the grosser things that I found, yeah something called a hormone balancing coach. laurel Is this a TM? Is this a TM?
00:41:57
Speaker
I mean, and maybe by someone. I don't know. Have you seen this phrase used or seen any marketing? Yeah. So I've heard of like it just hormone tossed into like, here's why we're doing this is we're balancing our hormones for like- Exercise.
00:42:13
Speaker
So it does not surprise me that or hormone balancing diet, right? It surprised me that there's also a coach that does this. Sure. Listen, how are you going to know how to balance your hormones if a coach doesn't take you through it?
00:42:24
Speaker
Right. so So I first heard the phrase on social media, hormone balancing coach. And when I did a Google search on the topic, I found the page of somebody who coaches people how to become coaches. Oh, coaches, coaching coaches. Coaches, coaching coaches. And I read her seven tips on how to become a hormone coach.
00:42:45
Speaker
It had very little to do with education or science, and it had a lot to do with the grift that is the coaching industry. At one point, it said something like, it would be helpful if you had a nutrition background, but don't worry if you don't. You can just speak from your personal experience, which is just as effective.
00:43:01
Speaker
I was like, oh my God, I have to leave. The internet and maybe this entire world. So at the bottom is... That is never appropriate. Like not even for personal trainers to like, I'm just going to give you the program that works for me. Like yeah that's not... No, but that's good coaching.
00:43:19
Speaker
So the bottom line is, look, the evidence is completely mixed on whether or not cortisol rises during the menopause transition, which means it's a very individual thing and cannot be generalized to or sold products for. But that also means it's a very easy area to cherry pick the evidence that supports your claim.
00:43:36
Speaker
And then you can make a product to fix it. Cortisol. All right, so we've talked about weight gain during menopause or perimenopause, cortisol being the culprit. Now let's talk about age-based training.
00:43:53
Speaker
You have to do it differently. youre You're exercising wrong, all wrong. So now that you are menopausal, you just can't work out the way that you used to because, i mean, the evidence is in your stubborn belly fat.
00:44:07
Speaker
And of course, the goal of all working out is to get rid of stum but belly fat. Everybody knows that. Clearly.
00:44:16
Speaker
And to reiterate, you you know, meanwhile, while all of this is being sold to us, there's physics. And we know that for everyone, weight loss is related to creating a calorie deficit.
00:44:29
Speaker
So it we spent a lot of time talking about this in the Long and Lean Part 2 episode as well, which is that you can't say that Pilates will make you Lean, lean implies fat loss because exercise is a poor tool for fat loss and Bern, Ponser's book, goes into exquisite detail about why that is, right? So even just the notion that exercise can cause you to lose fat, does it contribute to energy balance? Yes, but the far bigger driver is nutrition, right? Is that is that you need to be in a caloric deficit.
00:45:11
Speaker
So there are a few claims around what you need to do here by lots of different prominent voices, grifters. I mean, Stacey Sims. Stacey Sims is a big one.
00:45:24
Speaker
She has this wild claim that you should be doing not zone two cardio, but high intensity cardio, like sprinting or plyometrics. Or if you know you're tired on a particular day because yesterday you did your sprinting,
00:45:42
Speaker
Don't do zone two cardio. Again, that's worthless. Go for a nice walk with your friends. Nice slow walk. Yeah, like anything in between, moderate cardio, zone two, you really don't want to do that. It provides no health benefits to you now that you are perimenopausal, menopausal.
00:46:01
Speaker
She also has ah couple of other really specific things. claims like at this stage of your life, you also should lift heavy, but don't go all the way to failure.
00:46:12
Speaker
And, you know, moderate loads probably aren't going to do as much for you. Definitely not light loads. So we haven't been able to figure out where these claims come from in science.
00:46:27
Speaker
Here's a study where Sims was lead investigator. Okay. So she has published some research. This is from 2013. It's titled, Changes in Physical Activity and Body Composition in Post-Menopausal Women Over Time.
00:46:40
Speaker
The study looked at women in three age groups, 50 to 59, 60 to 69, and 70 to 79. It found that there was lean muscle mass loss across all groups, regardless of physical activity levels.
00:46:52
Speaker
And since the physical activity reported was generally aerobic exercise, they concluded
00:46:59
Speaker
Oh, my God. They concluded that aerobic exercise was not going to build the lean mass that you need as you age, and you should participate in resistance training instead. Yeah. Wow. So it seems like this is the study that Sims is using to say that menopausal women should not do aerobic exercise.
00:47:18
Speaker
and instead should focus on resistance training. But here's the thing. We already know that aerobic exercise is not the best way to build lean muscle, just like we know broccoli isn't a great source of protein, right?
00:47:32
Speaker
This is regardless of your age. But so what, right? Like we still need to eat the broccoli or vegetables, right? They're not a great source of protein. We still need we still need those micronutrients from the vegetables. We need that fiber.
00:47:46
Speaker
We still have the same cardiovascular health requirements as well, regardless of how old we are. So just because cardio doesn't build muscle, which we've known forever. Forever.
00:47:57
Speaker
Why did we do a study in 2013? don't i don't know I don't know. Decide that we just made that discovery. Just because cardio isn't building muscle doesn't mean it's useless, I mean, kind like the opposite is true. Like cardio is very important for the other types of adaptations and health benefits that it provides.
00:48:18
Speaker
So this is a both and situation. We still of obviously need to be doing cardio. We don't call cardio hypertrophy training. We call it cardio, right? If you want to put muscle on your body, lift weights.
00:48:32
Speaker
Yeah. the The other t-shirt I want to make is cardio and carbs.
00:48:38
Speaker
Yeah. The two things that that are like maligned right now. Yes. Yes. I have a bumper sticker on my car that says carbs. Nice. That's it. It just says carbs. I love it. Uh-huh. Okay, so here's a much bigger study.
00:48:50
Speaker
This one's called Evaluation of Sex-Based Differences in Resistance Exercise Training-Induced Changes in Muscle Mass, Strength, and Physical Performance in Healthy Older, Greater Than or Equal to 60-Year-Old Adults.
00:49:06
Speaker
A systematic review and meta-analysis. So there yeah let me just give you the Cliff's Notes of that. This study is looking at the differences between sexes When we do resistance training and experience training-induced changes, are there differences right between men and women?
00:49:23
Speaker
Are there differences in muscle mass between men and women? Are there differences in strength between men and women? Are there differences in physical performance in healthy older adults who are older than 60 or 60 between men and women?
00:49:35
Speaker
And this was a systematic review and meta-analysis, which is strong evidence, right? It's not a study. um twenty three one study from 2013. This is a 2023 systematic review in meta-analysis by Holly et al.
00:49:48
Speaker
So study of all studies, right? They looked at data from 36 studies with over 1000 men and women included. And this is from the study, this quote,
00:50:03
Speaker
Quote, there are no sex-based differences for absolute or relative changes in limb muscle size, muscle fiber size, or physical performance. Unquote.
00:50:16
Speaker
Bam. Bam. Okay, so basically there's there's no difference in terms of how much muscle men and women can gain, how much stronger they can become, how much better they can physically perform.
00:50:34
Speaker
Yes, men start at a higher baseline of muscle mass because of testosterone, right? To experience an increase in testosterone during puberty, women do not.
00:50:45
Speaker
But what I find wonderful to know is that we both men and women have the same potential for growth from our baseline. That's awesome. Yeah. So I can get 10% more muscle mass on my body just as easily as a man my age can get 10% more muscle mass on his body if we both train in order to make that happen. So I think that's pretty cool.
00:51:10
Speaker
Yeah. And again, it just shows that you don't need to you don't need to change your training. Right. And it also shows we can't claim menopause has changed the way we need to work out. Here's the thing. Like, if it if menopause really did make this massive change that we see and in data replicated all over the place, then the guidelines for exercise would say that. Yeah.
00:51:36
Speaker
But they don't. They don't say anything different for pregnant women. They don't say anything different, you know? So... It's not like this is being kept a secret from us. Yeah. Like if this was really true, we would know.
00:51:50
Speaker
Right. Right. Right. ask yourself, like, what is the incentive of hundreds of thousands of scientists all around the world to keep this a secret versus what is the incentive of an individual like Stacey Sims to make it overcomplicated so that you listen to her and buy her shit?
00:52:06
Speaker
Right. Exactly. Yep. Yep. Yep. All right, here's our myth number four. Menopause causes muscle loss specifically because your estrogen decreases.
00:52:19
Speaker
So the myth is not that your estrogen decreases. That is true. That's what happens in menopause. But the myth is that you're going to suddenly start losing muscle during this time because your estrogen has decreased.
00:52:31
Speaker
So yes, it's true. Your estrogen is decreasing, but your muscle loss is just age related. it's not menopause related. Sarcopenia, which is muscle atrophy, that starts potentially as early as your thirty s data's a little unclear, but it starts well before menopause.
00:52:52
Speaker
And there's a really there's this interesting study that a lot of people actually use to try to prove that estrogen loss at menopause causes muscle loss. And at first read, it does seem to prove it, but you have to get into the weeds a little and then you see otherwise. So the study is called changes in body composition and weight during the menopause transition from 2019, Greendale et al. They sampled over 1,200 women from the SWAN data set.
00:53:21
Speaker
SWAN stands for a study of women's health across the nation. And it's this group of people who undergo regular assessments. They take questionnaires, they do physical measure measurements, They do biological sample collection, and then it's all just kind of collected.
00:53:35
Speaker
And then researchers can go into this data set and like ask a question. So it's kind of great. yeah So here's here's the quote from the paper that might make you think at first that we do lose more muscle mass during menopause.
00:53:49
Speaker
So this is a quote. The total loss of lean mass during the MT, that's menopause transition, averages 0.5%. zero point five percent and then in parentheses, a mean absolute decrease of 0.2 kilograms, which is about a half a pound.
00:54:07
Speaker
The average SWAN participants saw a 1.9% cumulative decline in proportion lean mass over the course of the 3.5 year long menopause transition.
00:54:19
Speaker
So that sounds conclusive, right? It sounds like you are seeing ah decrease Right? But let's keep reading. And here's another quote, jointly examining the rates of change in fat and lean mass during pre-menopause and the menopause transition sheds light on why there is no measurable change in body weight trajectory accompanying the menopause transition.
00:54:46
Speaker
The rate of increase in the sum of fat mass and lean mass is 0.32 kilograms, which is about three quarters of a pound per year in pre-menopause And 0.4 kilograms, which is about four fifths of a pound per year during the menopause transition,
00:55:03
Speaker
This is not a discernible change in rate. Yeah. Okay. I get it. So yes, there's change happening, but it's not like a sudden spike in change. It's very similar to the change that was happening before and the change that will be happening later.
00:55:17
Speaker
Right. It's a steady decline yeah over a much longer period of time than just the menopause transition. So we can't say that the menopause transition spikes muscle loss.
00:55:29
Speaker
Right. Or specifically in this case, in this case that that your estrogen decreasing spikes muscle loss. Yeah. That's a better way to say And yeah what's kind of ironic is that Stasis Sims study from 2013 that Laurel mentioned earlier also showed no specific menopause related difference in muscle mass loss.
00:55:46
Speaker
So, sorry. Now, if we're claiming that a decrease in estrogen is the driver for muscle loss, then it should follow. that estrogen-based hormone therapy should either bring your muscle back or at least stop you from losing more, right? If we put the estrogen back in, it should help you not lose any more muscle mass, right? yeah Yeah.
00:56:09
Speaker
Yep. Okay. Here's a study. Association between hormone therapy and muscle mass in post-menopausal women, a systematic review and meta-analysis, 2019, Javed This was a review of 12 studies that had a total of 4,474 participants.
00:56:26
Speaker
And while it did actually show that women on hormone therapy lost 0.06% point zero six percent less muscle mass than those who were not on hormone therapy, but this amount was not statistically significant. The p-value was 0.26. And for it to be statistically significant, the p-value needs to be 0.05 or below.
00:56:51
Speaker
Right. So there was too high of a chance that this decline was due to chance, right? Yes, what exactly. That's what means when it's not statistically significant. Exactly.
00:57:02
Speaker
And here's... from the study itself, here's what it concluded. This is a quote, this systematic review and meta-analysis did not show a significant beneficial or detrimental association of hormone therapy with muscle mass.
00:57:15
Speaker
Although muscle retention in aging women is of crucial importance, these findings suggest that interventions other than hormone therapy should be explored. I don't know, like resistance training.
00:57:27
Speaker
ah But, you know, It's easy to see how you could take this study and it's you know very meager, non-significant evidence, but twist it around and say, yes, but they saw some improvement. right Therefore, I'm going to sell you on hormone therapy helping with muscle mass. right Anything but resistance training. Am I right?
00:57:47
Speaker
Now, here's the thing. So MHT, right? Menopause hormone therapy is useful, can be useful for women going through menopause. And we are going to talk about what it can be good for in a moment, but it's unlikely to be related to your muscle mass changes.
00:58:04
Speaker
And here's the shocker, you might be you might need to be doing some resistance training in order to combat this just basically age-related sarcopenia.
00:58:15
Speaker
Yeah. Yeah. like It really does feel like we'd rather, you know, as a whole population sort of generally generalizing here, seem like we would just rather be doing literally anything. Literally anything else. Like, no let me just literally do anything but that. Anything else. Yeah. Seriously.
00:58:34
Speaker
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00:58:51
Speaker
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00:59:05
Speaker
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00:59:29
Speaker
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00:59:41
Speaker
Myth number five, let's talk about rapid bone loss, right? So there's this claim that during menopause, we experience rapid bone loss and that the way that we mitigate this is we need to be lifting heavy to improve it.
00:59:56
Speaker
Okay, so so let's start with Stacey Sims. Stacey Sims claims that women lose up to one-third, one-third of their bone mass during the menopause transition. She's quoted saying this on the Huberman Lab podcast.
01:00:11
Speaker
So when we asked Dr. Lauren Colenzo Semple in our interview with her this season, here's what she had to say about this claim. She says, we achieve peak bone mass in our 20s and then spend the rest of adulthood trying to maintain this bone mass.
01:00:27
Speaker
around the menopause transition over about a 10-year period, we see roughly a 1.5% per year bone loss. So that's maybe 10% over the menopause transition, not 1 3rd of your bone mass.
01:00:45
Speaker
However, it's not really generalizable. because there are a lot of factors that go into your bone mass, including how much you banked during those earlier years, your genetics, your physical activity, and nutrition.
01:00:59
Speaker
And then there are also several risk factors for losing bone mass, including smoking, drinking more than three units a day, excessively low BMI, for example, eating disorders or malnutrition, a family history of fracture, steroid use, and more.
01:01:16
Speaker
It's also looking like the role of genetics is huge with bone mineral density. Yeah. Okay. and Another thing I want to say is you've already heard the first episode of the season where Sarah and I talk about does it have to be heavy and about how Sarah and I have changed our message around what is required with regards to exercise intensity, with regards to resistance training and resistance.
01:01:45
Speaker
you know, slowing bone loss or reversing bone loss or reversing things like osteoporosis and osteopenia. And so, you know, I want to also acknowledge that we prior to encountering a relatively new meta-analysis, but not actually a brand new meta-analysis thought. And by the way, so did, and we and we talk about this in the episode, so did many other people of a much higher level of authority around this topic than we do. We thought that heavy loads were probably...
01:02:18
Speaker
most important for building bone anywhere in the body. And what we've learned, right, and you can listen to the episode, we'll link it in the show notes, what we've learned is that actually moderate loads can be beneficial and heavy loads are also beneficial and potentially maybe in in some circumstances, light loads can be beneficial.
01:02:39
Speaker
Listen to the episode for for much more on this, but I did want to say that we also have learned and have changed our message around this idea that you need to be lifting heavy weights only high intensity resistance training only in order to build bone.
01:02:55
Speaker
Okay. So, all right, back to Sim's claim about losing one third of your bone mass during the menopause transition. Here's a study. Longitudinal changes in bone mineral density during perimenopausal transition the Vietnam osteoporosis study. Okay, so here we're looking at long-term changes to bone mineral density during this period of time, perimenopause.
01:03:22
Speaker
Okay, so this is 2023 study by L.T. Foham, I might be pronouncing that wrong, and colleagues. All right, so over 1,000 women received two DEXA scans of the femoral neck and lumbar spine spaced out two years apart.
01:03:41
Speaker
they found that there was already bone mineral density loss occurring at both locations between the ages of 45 and 49. This is the general perimenopausal age.
01:03:52
Speaker
And this loss was around 0.5%. This did then increase between the ages of 49 to 54 to around 1.3% loss before to around one point three percent of loss before declining to 0.3% loss after age 55.
01:04:14
Speaker
So yes, there is an increase in bone mineral density loss from 0.5% to in this perimenopause Sims claims. time but this is hardly the one third that stacy sims claims Here's another study.
01:04:34
Speaker
Bone mineral density changes during the menopause transition in a multi-ethnic cohort of women. The lead offer author is Finkelstein and colleagues, the years 2008. This study was also one that used the SWAN data.
01:04:50
Speaker
And it indicates that being underweight increases your bone mineral density loss. Okay, so maybe we shouldn't be so quick to try and get it at stubborn belly fat.
01:05:02
Speaker
ah Just saying. Okay, so now to clarify, any decently programmed exercise plan takes you through starting out. If you're a beginner, right? This is for beginners, right? Any decently programmed exercise plan will take you from lifting a light weight to then probably lifting a more moderately heavy weight in order to maybe eventually get you to heavy.
01:05:30
Speaker
Okay? You would never start heavy. Only an unqualified sadist who's trying to hurt you would take you as a newbie from not lifting to lifting heavy.
01:05:42
Speaker
Yeah. So this is great news because it means that even if you want to lift heavy weights, for which there are a lot of positive reasons to do so, many of which we talk about in our episode on if it has to be heavy, right?
01:05:59
Speaker
The work you are doing to get there could also be contributing to your bone density in addition to many other benefits. Yeah.
01:06:11
Speaker
Woohoo. Okay. Okay. Here's our myth number six, you need to supplement with creatine.
01:06:19
Speaker
Okay, so just just as a reminder, ah neither Laurel nor myself are medical doctors or dieticians. Any sort of nutrition or supplement advice, we are presenting the evidence to the best of our abilities. Please consult your doctor about supplementing if it is something that you think you need to be doing.
01:06:37
Speaker
This topic of supplements could be its own episode and maybe at some point in the future we'll do one. We have talked about it. And then we just both went, ugh, and didn't want to deal. so And I actually started looking at like all of the supplement myths. And then I was like, this this is going to make this episode seven hours long. So for today, we're just going to talk about the myth that you need, creatine specifically. Yeah.
01:06:59
Speaker
We're going to talk a lot about the other supposed supplementing you need in menopause, like turmeric and collagen and many others in our Menopause Grifters episode that's coming up later this season.
01:07:11
Speaker
Now, it's true. You might need to supplement. but you also might not. And it's very likely you don't have to do the entire list or stack or bundle, even if you save, quote unquote, save by doing it. It always makes me laugh when they're like, save, buy three and save. And I'm like, but I'm spending more. How am I saving?
01:07:34
Speaker
So when we spoke to Dr. Lauren Colenzo Semple, she made the Excellent. And honestly, kind of seemingly obvious point that if you have to supplement, it suggests that you are lacking in something. So you should probably find out if you're actually lacking in that something before you decide that you need to add more of it to your diet and to your body.
01:07:52
Speaker
Yeah. And then just as a heads up, while there are some regulatory standards that the FDA oversees for supplements, companies do not have to prove efficacy or safety to the FDA before their product goes on the market.
01:08:08
Speaker
They do not have to, for supplements. It's it's a like a little carve out. So you will basically always see an asterisk after a claim like, this product has been shown in clinical trials to make you more attractive to women.
01:08:21
Speaker
And then the tiny writing at the bottom says, these statements have not been evaluated by the FDA. I swear to God, Laurel, I saw one where it was like a list of like, this will happen and this will happen and this will happen and this will happen. They all had an asterisk after them and it all went through these statements have not been evaluated. Like, I was like, you're just admitting on this page that you're making this up. Yeah.
01:08:40
Speaker
Oh, man. I mean, and yeah here's the other thing. Talk about a great market to get into if you're a sleazebag, because the global supplement market is estimated to be worth 192.65 billion with B in 2024. It's projected to reach 414 billion with a B by 2023.
01:08:55
Speaker
excuse me, 2033.
01:09:00
Speaker
by twenty twenty three no excuse me twenty thirty three Another unfathomable fatthomable number. But Laurel, here's the thing. Sometimes I wonder if the high road is really the road. Yeah. Like maybe we should just take the low road and market movement logic supplements and scare women into buying stuff they don't need. And then we can both retire early and sit around and count our money.
01:09:19
Speaker
Yeah. Yeah. Well, until we both turn into sleazebags, let's talk about one of the most commonly claimed necessities when it comes to supplements for women in the menopause transition, and that is creatine.
01:09:31
Speaker
Uh-huh. you have probably seen everywhere that now that you are menopausal, you need to be taking creatine so you can build more muscles. yeah And you're like, well, I know I need more muscle. So this follows, right?
01:09:43
Speaker
The other factoid that I don't think is actually anywhere near fact, I've been seeing everywhere, is something about how women store 70% of the amount of creatine that men store. um And therefore you need to supplement. Yeah.
01:09:56
Speaker
I find this an odd argument because just because we don't store as much of it doesn't it it doesn't automatically mean we're supposed to be storing the same amount. And they also don't clarify if this 70% is a relative amount related to body size or if it's an absolute amount. Like it's just this- 70%, wow. Yeah. Ooh, I need to make up that extra 30% somewhere. All right. Let's have a quick little science corner. what is What's up with creatine? So creatine monohydrate,
01:10:26
Speaker
What does it actually do for you? We naturally make creatine in our liver and our kidneys. And then it's transported for storage mostly to our muscle cells. And that's where it's converted into something called phosphocreatine.
01:10:39
Speaker
And phosphocreatine is then used in the energy cycle. I start to have like hot flashes related to how much I hated the energy cycle just anytime I talk about it. Definitely.
01:10:51
Speaker
It's used to convert ADP to ATP. ATP is the usable energy that we use for movement. And that is the shortest way I just can describe what creatine does without hurting my brain and yours too much.
01:11:07
Speaker
Okay. So here's our question. Does creatine supplementation build lean muscle mass? Here's our study. Efficacy of creatine supplementation combined with resistance training on muscle strength and muscle mass in older females, a systematic review and meta-analysis. By the way, anytime you see something that says systematic review and meta-analysis after it, you should be thinking to yourself, this is probably a pretty good study because it's looking at a bunch of other studies.
01:11:37
Speaker
And that's one of the best ways that we can look at a theory or an argument and say, okay, is there evidence for it? One study on its own is generally not good enough.
01:11:51
Speaker
Okay. So this is a 2024 systematic review meta-analysis from Dos Santos et al. They looked at 10 randomized controlled trials. Now, randomized controlled trials in and of themselves are the gold standard of the type of study that you can do.
01:12:08
Speaker
So this is a very high quality paper already. So they looked at 10 RCTs of older women and their strength measures and lean muscle mass measures.
01:12:19
Speaker
They split the analysis into two groups because the studies had a lot of variation. the group The studies that were under 14 weeks and the studies that were six months or longer. And in both groups, the women were doing resistance training and either taking creatine or taking a placebo.
01:12:37
Speaker
For the studies lasting under 14 weeks, there was no significant impact on strength for the creatine group. But for the six-month studies, there was significant upper and lower body strength increases. But overall, they found, even though they were RCTs, the quality of the evidence overall was found to be low.
01:12:57
Speaker
And they found no change in lean muscle mass for either of the groups. Mm-hmm. And then in the discussion of the paper, they say this thing that seems to completely refute this idea of the 70% of storage.
01:13:10
Speaker
They state, and this is a quote, there is some evidence that females in comparison to males may have higher intramuscular creatine stores pre-supplementation, which may blunt their responsiveness to exogenous creatine. Oh, okay.
01:13:28
Speaker
Right? So- This is in direct opposition to this idea about we're storing 70% compared to men and so we need to take it. Right. The bottom line is it might increase your strength output if you take it for over six months and you are doing resistance training. a key That's the key. It's the resistance training that's really going to move the needle.
01:13:50
Speaker
Yes. And the the creatine might nudge it ever so slightly. Dr. Lauren was like, it might be the difference between you being able to lift a weight 10 times versus if you're on creatine 11 times, right? Right, right.
01:14:04
Speaker
So if you really want to take it, from what I'm reading, it's not dangerous, but it's also, you're you're a little bit flushing money down the toilet.
01:14:15
Speaker
Yeah, and also creatine is not the type of supplement that you would be deficient in and then prescribed. right So creatine is one of the only... safe, affordable, and legal performance enhancing substances that athletes can take.
01:14:33
Speaker
That being said, just as Sarah said, is's it's probably not going to move the needle anywhere near as much as like just training in a sensible way a proper intensity.
01:14:48
Speaker
So. So there's also claims out there that creatine can enhance your bone mineral density.
01:14:58
Speaker
course it does. Not to spoil the the answer, but this study is called Creatine Supplementation During Resistance Training Does Not Lead to Greater Bone Mineral Density in Older Humans, A Brief Meta-Analysis. Womp womp.
01:15:14
Speaker
wampwamp Yeah. This is a meta-analysis by Forbes et al. from 2018.
01:15:19
Speaker
And let's just be, so you know, let's let's look at this question a little more scientifically for a moment. We know that the creatine in our body is stored in our muscles mostly, and it it acts on ADP to create ATP, which our muscles then use for energy.
01:15:32
Speaker
So it's already, mean, it feels like a bit of a leap to try and link that to bone mineral density changes, unless you're claiming that because creatine is improving strength, that means the muscles are pulling on the bones more, thus building more bone density. But that feels like a really big fucking stretch to me.
01:15:48
Speaker
This meta-analysis looked at five studies around creatine and bone mineral density with resistance training. And here's why an example of why it is important to get your evidence from meta-analyses and systematic reviews rather than individual studies.
01:16:04
Speaker
Because two of the studies did show bone mineral density improvement, but the meta-analysis of all of the studies together showed that there was no increase in bone mineral density with resistance training and creatine.
01:16:16
Speaker
Okay. But let's say you wanted to show evidence that creatine builds bone. You would just cite one of the two studies included as proof, right? Yeah. That's called cherry picking. Yeah. And also, I mean, to be honest, how many people go and actually read the study? They just see somebody standing in front of a study and pointing at things. They're like, oh, that's that seems scientific. Especially if the person is a doctor, a medical doctor.
01:16:38
Speaker
Yeah, exactly. So what a meta-analysis does is it zooms out and it looks at all of the evidence available, which in this instance showed that creatine does not have a significant impact on bone. Also, underneath the heading of, I just threw up in my mouth a little bit, there is creatine for women.
01:16:55
Speaker
Pink it. It's up there. Do you remember the Bic pen? Pink it and drink it. Yep. Seriously. Jesus. Bic came out with a pen for women in 2012. Do you remember that? That's No, I don't think that.
01:17:08
Speaker
Yeah. I mean, it was pink. It was pink and purple. Striped that one from my memory. So it's not different than that, right? It's just a way to market and sell creatine at a higher price point. There's no difference in the actual creatine.
01:17:21
Speaker
And the super, super gross selling point that they're using on this creatine for women is that it won't make you bulky. Oh, what? That's the whole fucking point.
01:17:33
Speaker
Well, I mean, yeah, right? Seriously. But it's true because based on research, no research showed that and increased muscle mass. So no, it's not going to make you bulky, but like what something to play into women's internalized fears around their appearance? So wait, so the creatine in this study didn't contribute to increases in muscle mass either. Right. Right.
01:17:52
Speaker
It showed increases in strength. It did not show any increases in lean muscle mass. so So creatine will not make you bulky as long as you don't resistance train. Also, I just want to- but don No, no, no, no, no. no no no the It's not that.
01:18:05
Speaker
you can You can resistance train and take creatine. You'll see strength improvements like doing 11 reps instead of 10. You're not going to see hypertrophy. Ah, okay. No creatine anywhere ever is making anybody bulky, but they're saying it won't make you bulky. Like it's a special ladies only creatine because ladies don't want to be bulky.
01:18:25
Speaker
Yeah. Okay, cool. Right. I think that, yeah, that this whole, I just wanted to explain why I was... you know, suggesting that like we should want to get bulky because bulky is a meaningless term, right? Exactly.
01:18:39
Speaker
Bulky is a dog whistle term. Yes. It's meant to make women afraid to put any amount of muscle on their body. If a woman wanted to actually go from being like whatever size body composition they are to bulky,
01:18:54
Speaker
That would require a lot of like a complete overhaul of their entire life where they suddenly start like eating a lot of food, a lot of protein, like training a lot in like sort of a bodybuilder type protocol. And like, then they might even probably need like some performance enhancing drugs, like on top of that, like, like hormones. So yeah I just wanted to clarify.
01:19:16
Speaker
Yeah. Yeah. Okay. So, but this is good to know. So creatine doesn't actually increase... Muscle mass, it it just increases strength performance, improves strength. I should say this specific study, it doesn't increase muscle mass for older older females.
01:19:32
Speaker
Okay. But these these females were doing resistance training is my question. They were doing resistance training, yes. okay Okay. I'm glad i'm glad i I clarified that because I feel like if you're able to do the 11th rep instead of just 10, that is going to also contribute to muscle hypertrophy, right?
01:19:49
Speaker
You know, if you're doing, if you're able to be stronger and do more reps, this right potentially also cause muscle hypertrophy. So I'd be really actually really surprised if all the research out there on creatine shows that it doesn't contribute to an increase in muscle mass. That's why I was, I was like, wait, what? It doesn't? i think Yeah.
01:20:06
Speaker
Yeah. But it's also like, it doesn't do, it's not like eat the creatine, your muscles like explode. You have to do resistance training. You have to get do a resistance training. yeah And the creatine, all the creatine does is give you greater tolerance for more resistance training.
01:20:20
Speaker
Right. Which is going to, which is a way to progressively overload. it Right. And it's a way to yeah, exactly. Exactly. But it's going to be so small. Exactly. Bitty bitty. ah Very small.
01:20:30
Speaker
Okay. All right.
Menopause Symptoms: Myths vs. Reality
01:20:32
Speaker
Myth number seven, everything is a menopause symptom versus just part of aging. We're not going to talk about the just part of aging thing because that's boring and I can't sell you anything around that.
01:20:44
Speaker
right And I can't differentiate myself in the marketplace and like define my audience. This is a menopause symptom, people. exactly So that includes achy joints, menopause, right? Not age, menopause. Not physical activity levels, menopause.
01:20:57
Speaker
Not stress in your life, no, menopause. Muscle mass loss. Sorry, not possible arthritis. No, no, no, no, no. No, menopause. Normal age-related changes to your joint. ne and No, no, no, no.
01:21:08
Speaker
No. Menopause. There you Muscle mass loss. Menopause. Not related to decreased physical activity levels. No, no, no. Muscle loss is menopause.
01:21:20
Speaker
Bone mass loss is increased because of decreased estrogen. There is going to be an accelerated decrease in estrogen and a corresponding increase increase in the rate of decline of bone mineral density, but you're not suddenly osteoporotic because you're in menopause, right? Yeah.
01:21:39
Speaker
It's not like the bones are just like leaking out of your body. You just wake up one day and they just snap. Yeah. Like one third of your bone mass is not pouring out of your bones into your bloodstream, like a waterfall or a gushing river.
01:21:54
Speaker
Okay. Right. Weight gain, menopause, must be menopause. Must be, can't be anything else. here's Here's a list, here's ah here's a rapid fire list of things that are absolutely because of menopause,
01:22:07
Speaker
And more specifically, to the change in estrogen that is taking place. So these are part of menopause transition, right? Hot flashes. Yes. Estrogen is involved in thermoregulation of your body.
01:22:20
Speaker
Cold flashes. Less well known, but yes, same reason. Mood swings and irritability. Yes. Possibly. Yeah. Because, well, let's think about why we would be irritable if maybe we're being woken up a lot during the night because of hot flashes and then aren't sleeping, right?
01:22:38
Speaker
But here's where I also want to say, like, is it that you're irritable and are experiencing mood swings because of menopause? Definitely. Or is it maybe that your life is a little annoying, right? Yeah.
01:22:52
Speaker
ah Yeah, I'm not denying that menopause could be causing us to have like irritable you know low mood. But that could that is such a multifactorial yeah thing. like It could also be occurring because of other things in your life.
01:23:10
Speaker
I think you know women experience menopause, men don't, right? And they like to slap the it's fucking menopause label onto it. And while, okay, that might be true, so I'm acknowledging that, we potentially then like shut out all the other possible things that might be contributing to our low mood or our irritability.
01:23:30
Speaker
Like lifestyle. Like the fucking patriarchy. Like, are you irritable because of menopause or are you irritable because you're doing way too fucking much? Like, you are the one in charge of the kids. You are the one in charge of the house. You are the one in charge of also bringing in half the income. You are the one in charge of doing the food shopping and the cooking.
01:23:56
Speaker
Right? Right. Is your partner, your husband probably helping out in the ways you need him to, or do you do all this work and then you feel irritable and you go, oh, it must be menopause.
01:24:09
Speaker
I mean, don't know. I would be irritated. Yeah, like and also like we know that exercise has mood-enhancing benefits. Are you exercising regularly?
01:24:21
Speaker
yeah We know that alcohol is a depressant. Are you drinking one, two, three glasses of wine every night? We also know that alcohol is not great for sleep. um So there's there's a lot of, yes, probably true menopause can cause us to experience mood swings and irritability. And this is...
01:24:42
Speaker
probably most especially true if like you've noticed the only thing that has significantly changed in your life is this transition into menopause, right? And then you notice these mood swings and this irritability, but it's also possible that other things have changed in your life, right?
01:25:00
Speaker
Or that things have just gotten harder to handle or to tolerate, right? Like you finally had it with how little time you have for yourself or how underappreciated you you are or feel, right?
01:25:16
Speaker
Okay. There's also, Sarah mentioned genitourinary symptoms of menopause. These are the physical changes to the genitourinary tissues, including general tissue atrophy, clitoral hood covering, the clitoral hood will cover more of the clitoris,
01:25:30
Speaker
vaginal tissue will become dry or painful. Then this is sort of also mentioned insomnia. There are many lifespan sleep studies that indicate that sleep duration decreases as we age just generally.
01:25:44
Speaker
And also that sleep timing changes, like when we naturally go to sleep and wake up also shifts. But there are also indicators that sleep is disturbed during menopause. For example, by those vasomotor symptoms, those hot flashes,
01:26:00
Speaker
or in this case, night sweats, right? These wake you up. Okay. Yeah, so maybe you're not just having random insomnia. Maybe you're getting woken up because you're having a hot flash, right? at A night sweat.
01:26:11
Speaker
Yeah. And I feel like that has even happened, that that has happened to me a little bit here and there. Yeah. So, you know, your point I think is really accurate, you know, that there there are certain things that we can say, absolutely, yes, this is menopause specific.
01:26:29
Speaker
But those are the more, you know, the things that we can talk about where the systems in your body are being dysregulated by the decrease in estrogen. So that thermoregulation, right?
01:26:41
Speaker
This happens to me all the time. If I've been sitting down for a long time, like watching a TV show, and then I stand up to go to the kitchen to get a glass of water, I'm suddenly freezing because my, Decreased estrogen means my body doesn't know how to like start moving the blood around my body faster to keep me warm.
01:26:55
Speaker
And freezing like like shaking freezing. It's the craziest thing. Or I would find that I would lie down and after about three minutes of being prone, I would get a hot flash.
01:27:07
Speaker
Because again, the change in body position, my body was just like, what, where what, what? So those things, absolutely. But these bigger, broader categories like insomnia, like irritability,
01:27:20
Speaker
brain fog, mood, like, you know, we, we like to start to look at these as evidence that like, oh, that's menopause, right? Oh, I can't find that word. That's menopause.
01:27:32
Speaker
There's just as many 20 year olds who can't find a word as there are 60 year olds. Right. So, but we just like to blame it on going through this transition. So I do think it's important to really make this point that like, yes, there are some things, but to just take a huge paintbrush and, and claim every single thing that could possibly be happening in your life right now is because of the menopause yeah is inaccurate.
01:27:55
Speaker
Yeah. And I feel like I also want to add here that this reminds me a lot, like always selecting out these symptoms or experiencing your things that are going on in your life that might be related to menopause, but also might be related to other things like kind of relating them always back to this menopause transition. It's a little bit, it reminds me a little bit of the nocebo effect.
01:28:16
Speaker
Mm-hmm. where you start to feel like this whole time in my life is like a minefield of symptoms, a terrible time to be alive, just an absolute miserable nightmare of an experience and it's gonna last for years. and And you begin to pathologize, actually this completely normal, not easy for everyone and and not easy for most, I would say, this normal transition, yeah right?
01:28:41
Speaker
i think that this will cause you to relate to it more like a disease, more like a pathology instead of this, what is a normal life transition? It really reminds me of pathologizing posture, of catastrophizing aches and pains, of you know thinking that your back or hip hurts because your SI joint is unstable and slipping out of place. it's It becomes a story Not to say that it's a completely false story, right? Like I don't want to minimize any of the challenges and difficulties that people have faced during this time and I'm starting to get just a little hint of, right?
01:29:23
Speaker
Everyone's menopause transition is also so individual and different, right? Which I think is is worth saying. But if people online, because that's where a lot of this conversation is happening, are constantly telling you how terrible menopause is and how awful it's going to be or is for you and naming every possible thing that could go on in someone's life and always tracing it back to menopause.
01:29:49
Speaker
I'd be very skeptical about this entire narrative that they're crafting. And I'd ask yourself, like, why are they telling the story in this way? Why are they framing it in this way? Why are they setting it up as this terrible, all-encompassing problem?
01:30:05
Speaker
When we know that a lot of the symptoms that people like to attribute to menopause could could be caused by other things as well that are going on simultaneously, right?
01:30:19
Speaker
I just, I feel like it can narrow your lens. It can make your body feel like a minefield. It can cause you to continue to spin this like negative story about yourself and your experience. And is that helpful?
01:30:34
Speaker
Not really. Right. Are you being manipulated? Right? Are you being manipulated so that this person can actually bring you into their... Subscribe and save. Yeah. It gets you to click the link in their show notes or bio or whatever it is.
01:30:52
Speaker
i don't know. All right. So here's our last myth that we're covering. There's there's definitely more, but you know we we're trying to make these episodes come in under two hours. We don't always succeed. but And we're close with this one.
01:31:07
Speaker
Yeah. So this is that menopause hormone therapy is dangerous.
Menopause Hormone Therapy
01:31:12
Speaker
Or the exact opposite, everyone can and should use menopause hormone therapy.
01:31:19
Speaker
So the the old story, which hopefully at this point you're maybe familiar with, but I'm going to describe it just in case you're not. There was a study done by the WHI in 2002 that overemphasized the possibility of getting cancer if you took hormone replacement therapy, as it was called at the time.
01:31:40
Speaker
So thousands, I mean, more than thousands, hundreds of thousands of women who could have benefited from the relief that menopause hormone therapy, MHT, which is what we call it now, could have given them, either stopped taking it or they were just too afraid to start.
01:31:55
Speaker
And then somewhere in the past, like five to 10 years, the original researchers on that 2002 study have come out to say that they misinterpreted that research and then in fact the the risk factor for cancer is much lower.
01:32:07
Speaker
It's not nothing, but it's much lower than what they originally reported. So we've moved away now from believing that MHT is dangerous But the pendulum has kind of swung like super aggressively in the other direction where now every single menopausal woman should be on MHT when in fact that's not the case either. Yeah.
01:32:29
Speaker
So let's take a look at this. I got a lot of this information from the Vagenda, which is such a good title. I love it. Which is Dr. Jen Gunter's Substack. that I subscribe to and I've learned a lot of really good, no-nonsense information from, and I i highly recommend it.
01:32:45
Speaker
She has ah this encyclopedic series of blog posts that's called Gunter's Guide to the Hormone Menoverse. That alone makes the subscription price of the Substack worth it. So if you really want to go in there and and understand it incredibly thoroughly, that's a great resource that I really recommend.
01:33:05
Speaker
so Menopause hormone therapy can help a lot of women with a lot of their symptoms that are due to menopause, like hot flashes, genitourinary symptoms of menopause, sometimes osteoporosis.
01:33:20
Speaker
We'll talk about that in a second. So on. But it's often marketed as a way to stay like young and sexy because you still have your hormones, which is just disgusting.
01:33:32
Speaker
There are two ways, essentially, that women can use hormone therapy. And the hormone therapy can include estradiol, which is a precursor to estrogen, I believe, progesterone and testosterone.
01:33:45
Speaker
You can either do oral therapy, meaning it's in a pill form, or you can do topical vaginal therapy, meaning it's a cream or a lotion specifically for the genitourinary symptoms of menopause.
01:33:59
Speaker
Generally speaking, that the the purpose of the progesterone being included, because it's just your estrogen that's declining, but it's included to protect the lining of the uterus from irregular bleeding that would likely take place if you were taking estrogen by itself.
01:34:13
Speaker
So there is a lot of prescription of menopause hormone therapy as preventative for disease risks. And I wanna read you a quote from the Gunter's Guide to the Menoverse that I mentioned earlier.
01:34:27
Speaker
This post is titled, Who Should Take Menopause Hormone Therapy? And it's discussing who should take it for disease prevention. This is not for menopause symptoms. And this is the quote, Overall, the earlier someone has menopause, the greater their risk of heart disease, osteoporosis, and dementia.
01:34:43
Speaker
And the later they go into menopause, the greater their risk of breast cancer. This is all related to cumulative estrogen exposure. Menopausal hormone therapy is recommended for everyone who goes through menopause before age 45, which is not most people, yeah or who experiences primary ovarian insufficiency, as long as it is safe for them to take estrogen.
01:35:08
Speaker
Meaning, this is still the quote, by the way, meaning the answer to the question, should everyone take menopausal hormone therapy is no, not everyone. We only recommend hormone therapy as disease prevention for people who reached menohouse menopause before age 45 or who have primary ovarian insufficiency.
01:35:27
Speaker
So I feel like there's been a bit of a trend of like people perhaps where you are, Laurel, that are sort of starting to see some symptoms of perimenopause and they're like, oh shit, slap some hormones on it.
01:35:40
Speaker
Right. But depending on your age, if you're trying to you know offset the potential of these disease risks that we see when you don't have estrogen in your body as long as typical, right? that's that's it's It's for very small, small, small fraction of people.
01:36:00
Speaker
Now, if you're getting into having menopause symptoms and in terms of symptom management, there's here's a list of symptoms that MHT can be prescribed for that Gunter calls the green lights, meaning there's there's solid evidence to support it. So- Support that support the prescription of MHT for the treatment of these these symptoms. symptoms, yes.
01:36:24
Speaker
Hot flashes, night sweats, vaginal symptoms, right? GSM. But in this case in that case, you want to use topical, not oral. And then this is interesting. Osteoporosis, prevention for those at high risk.
01:36:40
Speaker
Right. Which is not everyone. Mm-mm. Generally speaking, hormone therapy is not indicated as a drug therapy for osteoporosis. Awesome. High risk would be like you have ah it in your family history, you're underweight, you had a history of eating disorders, you were on steroids. Like if you herooid did that FRAX test. Yes, yes.
01:36:59
Speaker
And then you came out like high, high risk. You might be someone for whom that is appropriate, assuming there's not other reasons why it would not be appropriate. Right. She also says there's some yellow light indications for prescription, meaning there's not really solid evidence to to support it, but there's some, and you might choose to try it and see if it helps.
01:37:17
Speaker
So this is for depression and or anxiety, any sort of metabolic syndrome or diabetes, prediabetes prevention, libido, and joint and muscle pain.
01:37:29
Speaker
So it could maybe, but there's not great evidence. There's not like solid, solid evidence to support it the way there is for things like hot flashes and night sweats and GSM. Yeah.
01:37:40
Speaker
And then here's a list of things that it won't do jack shit for. Ready? Skin quality. There was this super gross old idea that you can like look at a woman and tell if she's taking estrogen based on her skin quality. Yikes. No.
01:37:56
Speaker
Brain fog, dementia or Alzheimer's prevention, hair loss, weight loss, preventing cardiovascular disease, or maintaining muscle mass as we showed earlier.
01:38:07
Speaker
yeah Now, just because you can take it, it doesn't automatically mean it's going to fix any of these green light or yellow light symptoms. And it's actually contraindicated for a lot of populations, including people who are at an increased risk of blood clots,
01:38:26
Speaker
because estrogen increases this risk. If you have any sort of liver disease or gallbladder disease, people at a high or moderate risk of cardiovascular disease and people with a history of breast cancer, like myself, you can't take, I can't take systemic estrogen because my cancer was something called ERPR positive estrogen.
01:38:47
Speaker
receptor, progesterone receptor positive, meaning it feeds off of the estrogen in my body, right? That's why they shoved me into menopause. ah But this, and this is new, because like I've been battling about this for a few years.
01:39:00
Speaker
It is safe for people with a history of breast cancer, assuming other risks are not included, that you can do topical. Please do not start doing it because I just said that. Gynecologists, get your team on board.
01:39:13
Speaker
yeah Anyone who has a history of breast cancer, everyone's exact situation is different. In my situation, I'm very grateful that I am able to do topical, but for some people, it's still not, not ah the risk factor is too high.
01:39:25
Speaker
Yeah. Okay.
Navigating Menopause - Finding Specialists
01:39:27
Speaker
So the the bottom line that you yourself, person listening to this, are having a very individual subjective menopause transition experience.
01:39:38
Speaker
And You should talk to your doctor. Doctor as in the one you go see for checkups, the one you're dealing with. Medical doctor. It's just not the doctor on the internet.
01:39:50
Speaker
No. Not that one. You to your primary care doctor. You go to your GYN. You go to literally anybody because they're going to give you the best insight as to whether MHT t is appropriate for you.
01:40:04
Speaker
yeah This is a real thing that exists. Taking a quiz online and having a doctor who you have never met prescribe your menopause hormone therapy is a bad idea. Yeah.
01:40:17
Speaker
So we do want to say as well that not all doctors are completely up to speed because a lot of this is truly like past five, 10 years of, of what's being shown in studies and things. So it it always takes a little bit of time to trickle through.
01:40:34
Speaker
But if you are looking for a doctor who is menopause specialist or perhaps who has, you know, just better education, you can go to something called the North American Menopause Society.
01:40:48
Speaker
And we will link to that in show notes. And you can do a search there for a certified menopause practitioner. Here's what's super ironic. When I did that search just now to make sure that I was going to say the right thing, the first thing that came up, the sponsored one was My Alloy, which is one of these like, online, find menopause relief for you.
01:41:08
Speaker
Take a quiz with our doctor, blah, blah, blah, blah. It's so gross. So don't do that, but do, do, do. Don't do that, do, do. Do a do-do and look up the menopause.
01:41:22
Speaker
Look it up while you do a do-do. That's right. Yeah. And I also just want to add here that it's important to recognize why there are so many menoprificers out there. What is the gap, the void that they are filling? And we'll probably talk a lot more about this in our grifter episode, but We have to acknowledge the fact that it's because women have been woefully underserved by medicine, by medical doctors up until now, and it's getting better.
01:41:54
Speaker
And that's why, unfortunately, in this country, why the grift and capitalism has been able to kind of swoop in and go, oh you're not being listened to? Oh, your symptoms aren't being taken seriously? Oh, it's okay.
01:42:14
Speaker
I have the answers. I'm up on the, quote, cherry-picked research that I'm sharing with you to get you to buy this supplement stack that I've cherry-picked research around that is mostly useless. You know, so this North American Menopause Society is resource where you can actually seek out actual medical doctors,
01:42:33
Speaker
who are up on the research and are not selling you supplement stacks, hopefully, right who are going to take your symptoms seriously, who do know the most evidence-based best practices for handling those symptoms, that aren't going to immediately go, menopause hormone therapy? Oh, no, that causes breast cancer based on this Women's Health Initiative study and and everything that came from that and the fallout from that. they They are going to have ah much more up-to-date and nuanced,
01:43:03
Speaker
way of treating your symptoms. So use this website, use this resource, and just know that just because there are grifters online selling you useless shit and we don't like that doesn't mean that we are saying that any medical doctor is also going to do right by you.
01:43:26
Speaker
Okay, because that's not necessarily true either. Like a lot of them are kind of still like basing their treatment off of stuff they learned in college, maybe. like, medical school yeah being a doctor's hard.
01:43:39
Speaker
yeah And they're busy. And there's a lot to think about. But if you if you want, potentially more careful care around this particular series of symptoms in this transition, check out the North American Menopause Society database.
01:43:55
Speaker
Yeah. And I would say as well, let's say you find a doctor and you're like, they seem good. Do a cross check and see if they have a website where they're selling a supplement stack. And if they do, I would moveon.com and find somebody else.
01:44:07
Speaker
Yep. All right. So let's have some concluding thoughts.
Monetization of Menopause
01:44:12
Speaker
So why is this suddenly such a big industry? Well, we know obviously that there are the financial reasons, right? It's this huge market.
01:44:21
Speaker
We've got this age group of women who've been previously ignored by all of this, now getting a ton of attention. And they're also at an age where they probably have more money available to spend, right? If I earn more now at 50-year-old than I have in my entire life,
01:44:40
Speaker
maybe that has to do with my life choices, but still you're in a more sort of settled phase of your life. You're not like out exploring the world with a backpack and a sandwich, right? So you've got more money to spend, you're possibly earning more money.
01:44:53
Speaker
And so it's this kind of like, untapped cash bag grab that I think is very appealing to people who want to just make a bunch of money. So it also taps into this yet again, patriarchal cural requirement for women to stay attractive and sexy, get rid of that stubborn belly fat. Why?
01:45:12
Speaker
Because men don't like it possibly. I don't know that that's even actually true, but that's the idea, right? Keep staying on the hormones so that you say youthful, your skin looks great, your hair looks amazing.
01:45:23
Speaker
Nobody can tell how old you are. That's a lot of the underlying sales pitch. It's not just help your hot flashes. It's, oh, you're going to lose that ugly belly fat and fit into those jeans from college. you know its It just continues to reinforce this idea that women's value is reliant solely on how they look and that they look youthful.
01:45:47
Speaker
but yeah Like you have to be of childbearing age and appear that way because somehow there's this unspoken idea that that's the time when a woman is most important slash useful slash, you know, are valuable to society. And it's gross.
01:46:03
Speaker
This is gross. I saw also ah headline from National Geographic. I did not read the article because it was behind a paywall, but it was talking about women going through menopause that they're seeing an increase in eating disorders.
01:46:16
Speaker
ah And it's kind of unsurprising to me because again, we're getting this messaging again uh-oh, something's wrong with your body. you're You did something wrong.
01:46:28
Speaker
You're not working out right. You need to take some turmeric or hormones or whatever. Make yourself attractive again. And the other reason it's not that surprising to me is that we are the generation, like we grew up with Kate Moss. yeah we grew up with heroin chic. We grew up having eating disorders. I had an eating disorder. So it's a very familiar landscape to be returning to for a lot of women, I think.
01:46:50
Speaker
And I think we may have mentioned this somewhere along the line, but this idea of optimization that people like Huberman and others sell, where it's like, you have to be optimizing every single aspect of your life. You have to be doing exactly the right exercise and taking the exact right supplements at the right time. And you have to do this and then do that, but never do this before you do you know, all of this kind of thing of like, that you're hacking your life to make it as optimal as possible kind of stuff.
01:47:18
Speaker
It's Huberman optimization for the menopausal women population. It's optimize this experience, fix it for yourself. Here's the best way you can go through menopause. And ah all of that is just about getting people to spend money.
01:47:32
Speaker
Yeah, it 100% is because if we want to talk about optimizing our, I don't know, physiology or biology or mental health or just lives, I guess, in general, in terms of our bodies,
01:47:49
Speaker
Like the basics are still what work the best and they're free. Sleep. and Not that food is free. And in fact, it's uncomfortably expensive, but eat food that's nutritious and exercise. Yeah.
01:48:07
Speaker
and And that's just not, you can't you can't sell a lifestyle stack. Shit. You really can't. Okay. So I also wanted to leave you with some people that you should follow or pay attention to because they are consistently putting out really good information.
Reliable Menopause Resources & Closing Remarks
01:48:25
Speaker
Two of them you've already heard us refer to, Dr. Jen Gunter, and I'll link to all of the social media for these people. And also Dr. Lauren Colenzo Semple. We also really like the Front Page Fitness podcast. There is some good myth busting, but they're also talking about bizarre health headlines from the New York Post. Yeah.
01:48:42
Speaker
And then there's someone that Dr. Gunter recently recommended. Her name is Professor Susan Davis. She's like the foremost researcher on testosterone therapy for women in general. Like she's done just enormous amount of studying of this anabolic steroid hormone.
01:49:00
Speaker
So she's debunking in this video that Gunter shares a lot of myths around like whether or not women should now take testosterone. Right. Because now that's a thing, right? Yeah.
01:49:11
Speaker
And we are trying real hard to see if we can get Jen Gunter on this podcast. or If we can't, I'm going to go after Professor Susan Davis. going to go after her. In a nice way. di Go after sounds aggressive.
01:49:21
Speaker
I'm going to see if she would be willing to come on. going to reach out to her in a well-worded email. Exactly. That's really what I meant. I didn't mean go after her with a machine gun. ah These are all people just giving well-reasoned, well-thought-out questions.
01:49:33
Speaker
advice. These are research professionals. These are also none of them are selling a supplement stack. Yeah. That to me now is like my number one red flag. It's like our friends at Conspirituality, their refrain is watch what they say, but then watch what they sell.
01:49:50
Speaker
And it's yeah usually if what they're saying spins a narrative around what they sell. Right.
01:50:02
Speaker
Usually supplements are at the bottom of it. It just kind of turns out that way. All right, everybody. Well, thank you so much for listening to this episode. I hope you found it useful and entertaining, entertainingly useful.
01:50:15
Speaker
Please sign up if you are interested in are some Our supplement stack. Our supplement stack. Our stack is barbell plates. Yeah. It's not a stack of supplements. we We teach you how to to get stacked.
01:50:31
Speaker
There you go. so yeah, please sign up if you are interested in our bone density course, Lift for Longevity. It's our six-month barbell weightlifting program. You do not have to have any prior history lifting barbells.
01:50:41
Speaker
And the vast majority of people who take our course are beginners. Yep. If you sign up for the list, you will have the only access point to our special discount code. And as well, while we're waiting for November to roll around, we will start barraging you with free things.
01:50:59
Speaker
And who doesn't like free things? Yes. in but Even when they're like thrown at your head. i know what I'm saying at this point. Barrage. Yeah. Okay. Laurel, anything else that I need to say?
01:51:11
Speaker
I think you got it all. Do we get it all in? Rate, review, subscribe. Rate, review, subscribe. That's right. We always forget that one. Yeah. Rate, review, subscribe. if friend Share with the friend. Share with friend. Yeah, share with a friend.
01:51:24
Speaker
if Do you have a friend who is regurgitating a lot of the myths that... we just talked about and talking about how they're on their supplement stack and that they need to lift weights in a certain way and that they do their sprint training and that they are balancing their hormones and decreasing their cortisol.
01:51:42
Speaker
Maybe send them this episode, but beware of the backfire effect. Yes.
01:51:49
Speaker
And truly the rating and the reviewing and the subscribing do make a difference. So we really appreciate those of you who have already taken the time to do it. If you are a regular listener, if you've been listening for a while,
01:52:00
Speaker
and you're like me, when people get to this part of the podcast where you just turn it off, consider please possibly not just turning it off and going in and at least giving us five stars.
01:52:12
Speaker
All right. All righty. We will see you next week. Yeah, I think that's good.