Ep. 327 Navigating Female Hormones, Metabolism, Sleep and More with Dr. Stephanie Estima

I am thrilled to welcome the extraordinary Dr. Stephanie Estima back to the show today to join me in facilitating many questions from listeners. She was with me last on Episode 272, and before that, on Episode 123.

Dr. Estima’s perspective aligns very closely with mine within the health and wellness space. She is an exceptionally knowledgeable and well-informed clinician specializing in female metabolism and body composition. She authored the invaluable resource known as the Betty Body and hosts The Better! podcast, where I have had the privilege of being her guest.  

Today, we answer questions from both our communities, covering topics ranging from managing hormones during breastfeeding while coping with insufficient sleep to issues concerning preconception and methods for cycle tracking. We dive into the best contraceptives for younger women, strategies for supporting detoxification, addressing fibrocystic breasts, navigating autoimmune conditions and fibromyalgia, and determining the intensity of workout routines. There were also many questions about weight training, preferred pre-workouts, favorite supplements tailored for perimenopause and menopause, hormesis, and much more. 

Dr. Estima’s insights are as enlightening as ever, making today’s conversation a must-listen for anyone on a journey toward optimal well-being.

“I like to pair protein with fat because I find that those two together are very satiating for my palate and my body.”

– Dr. Stephanie Estima

IN THIS EPISODE YOU WILL LEARN:

• How breastfeeding can delay menstrual cycles without causing infertility
• Dr. Stephanie discusses fertility and the importance of evaluating both male and female factors
• Contraceptive options for younger women
• The importance of understanding the side effects and implications of long-term oral contraceptives
• The benefits of green leafy vegetables for fibrocystic breasts
• Supplements for breast health 
• The potential drawbacks of mammograms
• Perimenopause and autoimmune conditions, including Hashimoto’s, thyroiditis, and fibromyalgia
• How trauma contributes to the dysregulation of the immune system and autoimmune conditions
• Supplements for middle-aged women
• How cold plunges and saunas benefit physical and mental well-being

Connect with Cynthia Thurlow

• Follow on Twitter
• Instagram
• LinkedIn
• Check out Cynthia’s website
• Submit your questions to support@cynthiathurlow.com

Connect with Dr. Stephanie Estima

• On Instagram 
• On her weekly podcast, Better! With Dr. Stephanie, where she explores the human potential, hormones, metabolism, and a life well-lived.
• Get a copy of Dr. Stephanie Estima’s #1 bestselling book, The Betty Body: A Geeky Goddess’ Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex

Previous Episodes featuring Dr. Stephanie

Ep. 123 – Menstruation, Muscle, Maternity, & Metabolism: What Every Woman Should Know with Dr. Stephanie Estima

Ep. 272 Understanding Women’s Health: Answering Your FAQs featuring Dr. Stephanie Estima

Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:29] I was joined today by the amazing and wonderful Dr. Stephanie Estima, facilitating listeners questions. She joined me most recently on Episode 272, where we dove into women’s health and she had previously joined me on Episode 123. Dr. Estima is an exceptionally well-read and well-versed clinician. She is an expert on female metabolism and body composition and the author of the incredible resource called, The Betty Body, and the host of a podcast called The Better! Podcast, of which I’ve had the honor of being a guest myself. She is absolutely one of the most aligned voices in the health and wellness space with me. And today, we facilitated conversations from both of our communities, including questions on how to navigate balancing hormones while breastfeeding and not getting sufficient sleep, issues related to preconception and how to properly track your cycle, the best contraceptives for younger women, ways to support detoxification as well as fibrocystic breasts, navigating autoimmune conditions and fibromyalgia, and how to determine how hard to push your workouts. 

[00:01:47] Lots of questions related to weight training, especially around your cycle, favorite pre-workouts, favorite supplements, especially for perimenopause and menopause, hormesis and so much more. There’s no question that Dr. Estima is a very popular podcast guest and I know you will enjoy this conversation as much as I did recording it. 

[00:02:13] Welcome back, Dr. Estima. Always a pleasure to have you on. And another AMA, a hotly requested AMA Episode #2 for the year. 

Dr. Stephanie Estima: [00:02:23] Well, I am just thrilled to be back with you, my friend. And I think just looking at some of the questions we were just talking about in the pre-chat, we’re going to have some great conversation today and serving our communities in terms of all the drive, like the pressing questions that everybody wants to know about pregnancy and weight training and nutrition and all the things. So I think I’m looking forward to our conversation today too. 

Cynthia Thurlow: [00:02:43] Absolutely. So this is a question that came in from Martina. It’s a question about the lack of sleep during breastfeeding. And boy, do I remember those days and those years. “I know sleeping is fundamental to hormone health, but I’m still breastfeeding a lot during the night. Is there anything I can do to help stabilize my hormones. The baby is 20 months old. I still don’t have my period back.” Lots of nuance there.

Dr. Stephanie Estima: [00:03:08] Lots of nuance there. Yeah. So first of all, congratulations on your 20-month-old. I remember those days as well. Let’s see, my first child, I breastfed him, we were about 18, 19 months and then he started weaning. And then my second child, we breastfed, it was well over three years, so I know exactly. And then he did not want to end like– He’s like 10 right now.

[00:03:32] If he could still do it, he might exercise that option. So I know where she is in terms of like the waking up overnight, maybe the baby had a nightmare or they’re just establishing their own circadian rhythm still, like 20 months is still quite young for them to have a regular sleep-wake cycle. So the first thing I’ll say is, I don’t have a great answer here in terms of how can you sleep soundly through the night. I don’t think at this point in the game, from my own experience, the women that I’ve talked to, I don’t think that you’re going to sleep through the night, nor should you expect that you or your baby should either. Something to consider though in terms of getting the amount of sleep that you need would be to consider more of like a biphasic sleep schedule.

[00:04:19] So in other words, embracing the siesta, like the afternoon nap. So when your baby naps, the temptation is to cook, clean, get ahead of something. But what you probably should be doing, if you’re not already doing it, is to lay down either with your baby or if the baby’s sleeping in a crib or something, for you to like to go down and sleep and have a nap there. There is some, especially for new mothers and I would classify her still as a new mother with a 20-month-old, that biphasic, like that two times in the day that you’re sleeping. So one overnight, albeit disrupted, and then a second time, can be a way for you to make up that sleep debt that you may be accruing and it’ll help you function. The only caveat, I would say, is if you’re sleeping too late in the afternoon, like typically after 04:00 PM If you’re starting to take, but usually 20 months, they need a nap around like noon, 1, 2 o’clock, you’re probably going to go down at the right time. 

[00:05:19] But I would say that if you’re feeling very drowsy, let’s say at 4 or 5 o’clock try to push that to your bedtime. Like maybe you go to bed that evening at 08:30 or 09:00 with the baby and then however long, maybe you’re up at 01:00 or 02:00 breastfeeding the baby, but then you know that you’re going to get another sleep session sometime in the early afternoon when baby goes down for his or her afternoon nap. What say you?

Cynthia Thurlow: [00:05:42] I think that’s valuable information. I will disclose that I breastfed both my boys for a year and then they weaned and bit and did all sorts of things that I was like okay–

Dr. Stephanie Estima: [00:05:51] Oh, they cut their teeth on my nipples. Yes, they did. [laughs] 

Cynthia Thurlow: [00:05:53] Oh, yes. Oh, yes. Trying to explain to my husband that that was like pain I had never experienced before. And he kind of looked at me like he couldn’t understand. So both my kids, my youngest and I acknowledge every baby is different. This is not applicable to every child. I had one that started sleeping through the nights at four months, another at six months. So this wasn’t something that I had experienced. But I do know, and I do agree with you that sleep when babies sleep. So if your baby is still waking up at night, whether it’s for self-soothing behavior or just habit, finding a way for you to get a little bit of rest during the day. And my mother used to say, “Sleep when baby sleeps.” And of course the to-do list starts to run in our minds and next thing we know, they’ve woken up from a nap and then we’re really chronically tired. The other thing is, it’s not at all unusual while breastfeeding for women not to get their menstrual cycle, I think I went two solid years without a period.

Dr. Stephanie Estima: [00:06:50] Oh, same.

Cynthia Thurlow: [00:06:50] I remember thinking that was pretty awesome. Pretty awesome, not to have to worry about that, but certainly something that I wouldn’t be overtly concerned if you’re still breastfeeding, if you’re a thinner female. I think a lot of the thinner females may go a longer period of time without having a menstrual cycle. But just understanding, I know this wasn’t the question, that doesn’t in and of itself mean that you can’t get pregnant. Don’t assume because you’re not getting your period that may not play a role, but I would say give yourself some grace. Try to rest when your baby rests. It may be that it’s become a habit that he or she is waking up. And so just trying to determine, is it because do they need an extra feeding before they go to bed? What’s going on? Are they self-soothing? They’re just fussy in the middle of the night, and that helps them kind of get settled again. But it’s such a beautiful time in our lives to be able to bond with our children. I don’t ever want to discourage that or let that be the message. If your baby is still interested in breastfeeding, I would just continue until you both decide that it’s the time for you both to end that part of your relationship. 

Dr. Stephanie Estima: [00:07:55] Yeah. I still I mean, not that I miss it anymore. Like, my children are 13 and 11 now, [Cynthia laughs] but it was such a– I wouldn’t be doing it now, but I would say is such a special precious time. And for women who are new, that is the work. Our job at that point is mothering. Like, being fully attentive, like our neurology, our physiology is all directed towards the baby. So you can lean into that and just enjoy it. I know she’s probably heard this before, the days are long, but the years are really short, and you will blink and your children will be 13 and 11 as mine are now. And you’re like and your iPhone sometimes will throw up. Like, remember when and 10 years ago. And you’re like, “How was that 10 years ago?”

Cynthia Thurlow: [00:08:37] I know. 

Dr. Stephanie Estima: [00:08:38] So, yeah, I would just say lean into it. Don’t worry so much about optimizing your sleep. Like, yes, it’s important. Yes, it’s a recovery tool. Yes, it’s helpful for balancing your hormones. And there will be a time when your baby can sleep through the night and there’re growth spurts and regression. Like, there’s times like you were saying your baby slept through at four months and then six months. My babies would do that for, let’s say, a couple of weeks, and I’d be like, “Great, new routine. Got it.” And then there would be some developmental change that they would be approaching and things would get all messed up again. So just have the flexibility of thinking to know that you are just going to be constantly in flux right now until you and the baby decide that you’re not going to be breastfeeding anymore and that the baby establishes, like, a pretty solid circadian sort of schedule in terms of sleep-wake cycles, and it’s okay for you not to be doing perfect sleep. I wrote about this, actually, in my book. 

[00:09:31] At the time when I was writing the book, there were a lot of prominent podcasters and online, they were all men. And they were like, “This is the perfect morning routine.” [Cynthia laughs] And I was like, “Hi, you know what the morning routine is for me, my child waking me up. That’s my morning routine.” Like it was my toddler kind of toddling into my bed and being like mommy or coming in for a feeding or whatever it was. So don’t worry about the perfect sleep schedule, don’t have any anxiety around that, just do what you can right now, because that is your primary role right now as a new mom. 

Cynthia Thurlow: [00:10:02] Yeah. And there’s a season and a reason. Like, I’m at the stage where I have one getting ready to leave the nest. At the end of the spring of next year, he’s going to head off to college. 

Dr. Stephanie Estima: [00:10:12] Oh, my gosh.

Cynthia Thurlow: [00:10:12] And so, I can assure you that what we deal with now at this stage is these kids will sleep all day if you let them on the weekend, because they stay up. They’re like night owls. Now they stay up really late. They don’t get enough sleep during the week. Then on the weekend they try to catch up. And so, with each season as a parent, it’s like we’re trying to kind of fluctuate around their needs and where they are developmentally and growth and everything else. So such a great question. The next one is about preconception. What are recommended tests to obtain for optimizing fertility?

Dr. Stephanie Estima: [00:10:49] The best test for optimizing fertility? Well, first, I would say, track your cycle. So I am a big fan in terms of, you are an advocate of this as well, in terms of understanding your own unique rhythm. So the first thing is tracking your cycle. It could be on an app, it can be on an Excel spreadsheet, Google Sheet, whatever. I would also be tracking– I know there’s a question around contraception and so this is kind of related to that. I’m a big fan of fertility awareness method or FAM and part of that in terms of getting, that’s going to serve you for, as a contraceptive if you don’t want to get pregnant. And if you do want to get pregnant, understanding your cervical mucus, which is, it’s not just sort of like gunk in your underwear, it’s giving you clues and signs in terms of where your estrogen levels are at. Are you fertile right now? And we’ll talk about what that might look like in a moment, but FAM or fertility awareness method, you’re tracking a couple of things. 

[00:11:51] One is the cervical mucus as I mentioned, your basal body temperature. So your temperature will change over the course of your cycle, and that can indicate ovulation. You’ll often see ovulation; you’ll see a bit of a spike in your basal body temperature. So it might be like 0.5 to even like 1 degree Fahrenheit. If you’re working in Celsius, it might be 0.2 to 0.5 degrees Celsius. If you’re wearing an Oura Ring, as I am right now, if you’re watching this on video, you’re going to get knocked on your readiness score because you’re going to be warmer. Oh, you were warm last night and it’s like, “Yeah, I’m ovulating.” And then the other thing this might require a little bit more internal exam or self-internal exam is like the cervical position. So when we are ovulating or ready to receive, let’s say, sperm, the opening of the cervix will be softer versus when we are infertile or not ready to receive the sperm. Your cervix, the tip of the cervix, let’s say what you can sort of feel internally is going to feel quite hard. It might even almost feel like, almost like the tip of your nose. It might feel like a little bit like there’s a resistance there. But when you’re ovulating, that softens up and it allows for the passage a bit more open and a bit more effaced.

[00:13:05] So you’re allowing for sperm to sort of pass through. So that’s sort of FAM in a nutshell. That would be what I would do first, really understand your own cervical mucus pattern, your own basal body temperature pattern. I’ll be doing internal examinations to kind of get to know your cervix, because none of us do. I remember once I had put a post up about cervical mucus and it was shocking to people. It’s like, “Well, this is what we do when we see estrogen rising.” So I’ll answer this question comprehensively. As we see estrogen rising in the follicular phase, so after bleed week stops, we’re going to start to see a rise in estrogen that’s going to coincide with more wetness. So you’re going to see, in your underwear, you might see more slipperiness, more almost clear discharge. And then as you’re getting closer to ovulation, that discharge is going to start to look more opaque, a bit more white. Some people will call it like lotion or even like an egg white almost consistency. If you were to put it in between your fingers, as I have, [laughs] you might find that you can stretch it. It has a little bit of malleability to it. 

[00:14:14] The last day where you see that kind of gooey stretchiness, that opaque presentation, is when you are ovulating. So the next day you’re going to start to see a marked change in the mucus where it’s not going to be as egg whitey, it’s not going to be as slippery anymore. You’re going to sort of move into almost like a bit of a dry, because estrogen falls off. After we ovulate, estrogen comes down. So you’re going to see the same corresponding lack of wetness, let’s say, in your underwear. So that would be the best way for you to be thinking about fertility at least for the first year of trying. If you are trying for a year, even over six months, then I would actually get him tested and you tested. So if it’s oftentimes when we look at fertility, we typically tend to blame the woman first. [laughs] We tend to be like, “Oh, there must be something wrong with her, so let’s just check all of her stuff.” So you can totally get your hormones checked. You can look at AMH, you can look at FSH, you can look at all your sex hormones. And I would also get his sperm checked as well. So we are looking at count, like how much, let’s say parts per million or how much sperm we have in one ejaculate. And then you also want to be looking for the quality of the sperm as well.

[00:15:32] So there’s different sort of presentations of sperm. Like you have the healthy sperm that we think about with the single head and the single tail, and then you see variations. Sometimes you see a double-headed sperm, sometimes you see sperm without a flagellum. You see all of these different kinds of mutations, we’ll say. So we want to look at sperm count, which is a really big problem. Dr. Shanna Swan, I had her on the show, she was talking about sperm decline over the last, I think it was 50 years. I think they were looking at from the 1960s or actually, maybe later, maybe the 1970s, to the last time they looked was like maybe 2010, and it had decreased by more than 50%. So if there’s a problem with fertility, it can be coming from the man or it can be coming from the woman or both. So we just want to look at both. Oftentimes, there is a tendency to look at the female first, but it’s very easy to evaluate male sperm count as well. So I would just put that into the mix initially too. 

Cynthia Thurlow: [00:16:31] Love that explanation, so thorough. And when we’re thinking about infradian rhythms, our internal rhythms, that we have over a 28, 30-day cycle, it’s so helpful to be aware of what’s going on in our bodies. Like, I was just talking to a client who’s in her 50s, and she said, “No one ever told me what to expect at any stage of my life.”

Dr. Stephanie Estima: [00:16:51] I know. I know.

Cynthia Thurlow: [00:16:52] We were just kind of handed off oral contraceptives, sent on our merry, happy way. And then years later, you’re realizing, “Oh, I’ve been so disconnected from the normal physiologic rhythms of the body.” And so, I think that cycle tracking, checking your basal body temperature, looking at cervical mucus, and even if you don’t feel 100% comfortable looking at your cervical mucus, just acknowledging there’re changes throughout your cycle is so helpful and beneficial. The other thing that I would say is, for me personally, I don’t know how much I’ve talked about this on the podcast, but this is how I knew I wasn’t ovulating when I was in my early 30s. When my husband and I got married, I had no idea that I was thin phenotype PCOS, no idea. And it was only because I brought in all these charts back then, you didn’t put them in an app that was preceding the app stage of life, but showing them to my GYN. And the first thing she said is, “You have a luteal phase defect. You don’t have enough progesterone. I need to refer you on to someone.” And that was kind of started our infertility journey. 

[00:17:54] But the acknowledgment of, if I had not done that basic assessment for a couple of months, we would not have been able to objectively look at the information and say, “Well, I’m not even ovulating. No wonder why I’m not getting pregnant.” So you don’t necessarily have to use all the high level tech to start with. This kind of observational data can be very helpful. And as Stephanie indicated, the lab work can complement and also help identify if there are any issues. What we find now is that men in particular, either from insulin resistance or endocrine-mimicking chemical exposure, and we have so much of it, that can plummet sperm counts for men. So you could look healthy on the outside and not either have a healthy, vibrant sperm count, or your motility may be poor, or you may have, as you mentioned, the double-headed sperm with a lack of flagella. You might have a lot of defects in the sperm themselves. 

[00:18:51] So knowledge is power. Most people don’t have any issues getting pregnant. That’s not why I’m sharing this. I’m just sharing that from someone who otherwise was pretty healthy. Being on oral contraceptives for so many years had disconnected me from those internal rhythms of my body, and it took a bit of time for things to start working and being optimized. So such a great question. I would say knowledge is power. Do the low-tech stuff first, get the testing done, talk to your clinician. Make sure that they’re on board with what you want to have happen. But more often than not, I find most women don’t have any trouble getting pregnant, thankfully. 

Dr. Stephanie Estima: [00:19:27] Yeah. And the other thing I’ll just say is just enjoy the process of trying to get pregnant.

Cynthia Thurlow: [00:19:32] Yes.

Dr. Stephanie Estima: [00:19:33] It’s such a wonderful, at least for me. I was raised Catholic, so it was like, “you cannot get pregnant.” That is the goal of your existence as a woman. “You cannot get pregnant.” So it was almost like backwards land when me and my husband at the time, we were like, “All right, we’re going to try for a baby.” And it was so– I was like, “Oh, my gosh, I’m a good girl. I don’t get pregnant.” But then it was like, “No, this is what I want to do. I want to get pregnant.” So just lean into that. Have fun with your partner. Don’t worry too much about if you don’t get pregnant one time. Like I remember, at least for me, I’ll just share my own experience. When I wanted babies, it was like a switch. It was like I went from not wanting them and then all of a sudden, I was noticing all of the babies in this carriages and the strollers, and I would see the babies at the park, and I was the weird person in the park, like, watching the babies play, and I was like, “Okay, I need one of these right now.” After we had been together, I was, like, doing handstands, [laughs] and I was doing all the things. Not scientifically validated technique, just for the record. But I was like, “I have to get pregnant right now.” And it was very easy for me to get pregnant. 

[00:20:38] So I can understand the– because I was like, “I need a child and I need a child right now.” [Cynthia laughs] It was just something switched in my biological clock. Like, I need the child and I need to get pregnant right now. So I can understand the angst if someone’s trying to get pregnant, they’re not. And they have that same feeling, maybe, that I experienced, like, “I want a child. Like, I want it, why is it not happening?” I would just encourage you as much as you can to try and enjoy the process, because two stressed out individuals that are, like, looking at their clock and they’re like, “Okay, we got 12 hours, honey,” it can work. And I would just say as much as you can, it’s not necessarily about the destination as much as it is about the journey together that you’re taking with your partner. So I would just throw that in. It’s sort of related to the question. She didn’t ask it, but I’m just throwing in my own two cents there. 

Cynthia Thurlow: [00:21:26] I think for anyone that’s listening that maybe your fertility journey was longer than others. Just knowing that even though we did use some reproductive technology, it was fairly low tech. And I was so grateful when we got pregnant with my oldest and then we got pregnant with my youngest. And I remember saying, had it been an easier process, we might have had more children, but we just felt so grateful and blessed that we had two healthy kids that we just said, “Okay, we’re going to take a break and reassess things.”

Dr. Stephanie Estima: [00:21:54] Yeah.

Cynthia Thurlow: [00:21:55] The next question is about what is the best contraceptive for younger women? We already addressed some of our other questions. What do you feel like is your favorite contraceptive for younger women? These are individuals that really do need the benefit of having free choice over when they choose to become pregnant. And there’re so many options that are out there. Obviously, I think you and I are very aligned in terms of where our preferences are, but ultimately finding the best option that works for you and your lifestyle. 

Dr. Stephanie Estima: [00:22:29] Yeah. So like many things, I think you have to experiment with a couple of different verticals and see what works for you. If you were asking me the question, I would say start with the fertility awareness method again, because again, I’ll come back to my Catholic upbringing. I used to think that you could get pregnant by going into a pool. Like, I used to think you could get pregnant anytime, anywhere. And actually, the science does not support that theory. I don’t even know where I got that from. But this is not just– I’m just not knocking on the Catholic church. I know that there’re many religions that talk about this idea of waiting until you’re married and all of that, but you are infertile most of the month. This is something that I think most– I mean, certainly there’re outliers, of course, you can get pregnant. Potentially there’s been women who’ve gotten pregnant during their period or even in their luteal phase or what have you. But for the majority of women for most of their lives, most of your cycle, it is impossible to get pregnant. 

[00:23:29] There’s about a five-to-seven-day window in your cycle where you can become pregnant, and that is, of course, around ovulation. So when you release the egg, the egg depending on your age, will be alive for somewhere– If you’re older, the egg is going to be less viable for a shorter amount of time. Like, it can be 18 hours, 24 hours. If you’re younger, the egg will last maybe up to 48 hours. So there’s a day or two, let’s say 24 to 48 hours, where the egg is viable. And if you’ve had penetrative sex, where there’s ejaculate in the days leading up to that ovulation, of course, the sperm, and this is, again, how much I have reverence for reproduction and the propagation of the species, is that the sperm can actually live for up to five to seven days, kind of in and around ovulation. So if you’ve had sex in, let’s say, the five days or even the week prior to you ovulating, you can technically still get pregnant because there can be sperm in and around the area that are waiting to penetrate the egg. 

[00:24:33] So I always like, technically, it’s like a two day, you’re sort of at the maximum, like two days where you’re fertile. But if you’ve had penetrative sex in about the week or so leading up to ovulation, you can become pregnant because that sperm will continue to live for that week. So other than that though, there’re three weeks outside of that window where you are infertile. So at least for me, I would start with FAM. I would start with the fertility awareness method, knowing my cycle, knowing my rhythm, knowing my mucus, my basal body temperature, and then if I’m wanting not to get pregnant, I would be avoiding penetrative sex in week two. It’s around week two of the cycle. So at the cessation of bleed week up until ovulation, I would sort of stay away from penetration. And there’re lots of other fun things that you can do with your partner other than penetrative sex in that time. And then you can rest assured that after you’ve ovulated, about two days or so, depending on your age, after you’ve ovulated, you’re pretty much not able to get pregnant. However, there are many other. I know you’ve talked about the birth control pill, the many different types of contraceptives. So there’re oral contraceptives, there’s hormonal, there’s mechanical. We have the Mirena, we have the copper IUD. There’re many other ways that you can go about it.

[00:25:51] I think that my only caveat there is that you really do understand some of the potential side effects and what we see over and over again. I know you’ve talked about this, I see this all the time in my community, is that women are not communicated. There’s not informed consent. It’s like, “Hey, just take this low-dose estrogen.” Let’s just take this low dose, very safe birth control pill. And nobody talks about the length of time that you might be on it. You talked about your experience, about the length of time that you were on the birth control bill, potentially affecting that brain-ovarian access, where that communication that’s established between the brain and your reproductive system is essentially cut off. So I would say you can certainly explore hormonal contraceptives. And I would probably link out to some of the guests and the topics that you’ve had on previous podcasts where you’ve talked about some of the side effects that you’re probably not going to get that conversation likely in your doctor’s office, unless they are someone who practices functional medicine or is aware of the side effects themselves and are willing to take the time to communicate them to you. So that would be that. 

[00:26:58] And then the only other thing I’ll say is, copper IUD, I’ve never used IUD, but for the women that I’ve counseled and just in my community, it’s like hit or miss. It’s either the best thing since sliced bread, it’s the best or it’s awful. People get headaches and they’re nauseous. It sort of this you kind of have to try it to see if it’s going to work for you and have a good working relationship with your PCP to be able to communicate to them. These are the symptoms that I’m having. This is what’s new. This is what’s coming up. Can we modify the dose or the mechanism for the contraceptive? 

Cynthia Thurlow: [00:27:33] I think you bring up so many good points, and a great deal of this is women oftentimes get gaslit when they’re trying to figure out and navigate contraception. So there is no judgment if you choose to take oral contraceptives. I did a great podcast with Dr. Felice Gersh. She talks about,-

Dr. Stephanie Estima: [00:27:50] Oh. She is great.

Cynthia Thurlow: [00:27:52] -she’s so lovely, some of the side effects and concerns around that, but for some people, they need to take it and forget it and be done with it and then move on. If you want to have a set it and forget it kind of mechanism. I think an IUD is certainly a nice option and I would probably lean into the copper, and I would agree with you for as many women as have found that a copper IUD has been super helpful and low symptoms. I’ve had just as many that have had weight gain, headaches, bloating, cramping, pain with insertion. Anna Cabeca was talking about on our most recent podcast together. She said, “There’s no reason why women can’t get lidocaine prior to the insertion of an IUD. Like no one should have pain because she said she actually had quite a bit of pain with her IUD insertion years ago. And then if you’re interested in looking at apps and cervical mucus and checking your basal body temperature, I mean, it runs the gamut and so there’s no right or wrong. It’s what is going to be most effective for you at the stage of life that you’re in. And I find that a lot of younger women want to have a set it and forget it kind of methodology.

Dr. Stephanie Estima: [00:28:57] Yeah.

Cynthia Thurlow: [00:28:58] They’re like, “I don’t want to worry about the chance of pregnancy.” Maybe in a couple of years I might think more thoughtfully. And I’m using their words, not mine. It’s not pejorative. Think more thoughtfully about what other options are available to me, but the options surrounding contraception more often than not, there’s not enough informed consent, so people don’t fully understand all the ramifications. And I’ll just plug this in here. If you are a perimenopausal or menopausal female, this is not HRT. I cannot tell you how many women will say, “My doctor finally put me on HRT and they’ll tell me what they’re on,” and I’m like, “That’s actually an oral contraceptive.” 

Dr. Stephanie Estima: [00:29:37] Yeah.

Cynthia Thurlow: [00:29:38] And they’re stunned. So acknowledging things have their place, but finding what works best for you and making sure that you’ve been fully informed about all the side effects, all the implications. And if you’re on long-term oral contraceptives like I was, because back 20, 30 years ago that’s just what they did. Help people understand that when you go off, you may not automatically get your period back. That was certainly my experience. And I know Jolene Brighten talks quite a bit about this, about that disconnection between the hypothalamus-ovarian access when you go off of oral contraceptives, it does not per se just come back online. It’s almost like you reboot your computer and you expect the computer to start working automatically. That may not be the case. 

Dr. Stephanie Estima: [00:30:21] Well said. 

Cynthia Thurlow: [00:30:22] Okay, moving on. We are going to talk about a topic that I know both of us love discussing, detoxification. And this is a question from Anna, “What are some of the ways to detox the body besides exercise and sauna?” 

Dr. Stephanie Estima: [00:30:35] This is a good question. I saw this come in. So obviously, when we’re thinking about. So exercise and sauna are the primary way that they’re helping to amplify detoxification is sweating. So, getting rid of toxins via– like, there’re many, among three glands of sweat, the skin is one of them. And just generally detoxification, just for our listeners, obviously, this is where we take toxins and we eliminate them. So we can upregulate our detoxification pathways by, there’re a couple of different ways. So consuming more green leafy vegetables so you can do like a nutritional– Detoxification primarily happens in the liver. There are other areas, but the liver is one of the major sources or major centers for detoxification. And green leafy vegetables and I know you’re smiling because you’re like, “Yup, this is what I talk about all the time,” and I know that you do. [Cynthia laughs]. So diindolylmethane and sulforaphane, these are compounds that are found in those green leafy vegetables are going to help to amplify different steps of the detoxification process. 

[00:31:38] So green leafy vegetables, so what are those? Those are like the kales, those are the broccolis. Those are anything that smells, like, if you leave broccoli or Brussels sprouts in the fridge and it starts smelling like kind of sulfur. Like almost sort of smells like eggs, you know that’s the sulforaphane. So broccoli, cauliflower, Brussels sprouts, arugula, I said kale. Anything that’s sort of green and leafy usually is going to have a high concentration of those two compounds. The DIM, the diindolylmethane and the sulforaphane. You can also supplement. I personally, it’s one of the sponsors of our show, like, Athletic Greens is something that I take every day. In the vein of transparency and honesty, I don’t often get as much greens as I would like. So I take AG1 in the morning. And then, of course, I make a really awesome Brussels sprout, like grilled or sauteed Brussels sprouts in the sauté pan. And I’ll do cheese and broccoli soup and I get greens, but just as sort of an insurance policy, I’ll take a green supplement. You can also supplement with DIM. Like, there’s DIM supplementation that you can do. And I think that this woman’s question was also, she said that she had fibrocystic breasts, was that right? 

Cynthia Thurlow: [00:32:53] Yeah. So the second half of her question was dense breast tissue. She said, “I did the Depo shot for seven years and was told that contributed to it. I was advised to do a mammogram with ultrasound every six months.” Holy cow, “which I will not do the mammogram that frequently.”

Dr. Stephanie Estima: [00:33:10] Yeah, agree on that. Fibrocystic or dense breast that she’s talking about is also usually a sign of estrogen dominance. So I had that for many, many years where my breasts were always a bit lumpy. Part of that is, like, poor detoxification. So green leafy vegetables every day really helps with that. Obviously, drinking more water is going to help you flush out toxins and then bowel movements. Like having a bowel movement on the daily. I would say that when you’re looking for– again, quality of the stool is important. So if the stool was hard to pass. So if you were straining on the toilet, it had a long transit time, like, it actually took a long time like, you were on the toilet for 5, 10 minutes trying to pass the bowel movement, that’s likely problematic. And then also looking at the stool itself. So one sort of long piece is ideal if it’s broken up into sort of smaller, harder, round balls, let’s say that might be a sign of dehydration, might be sign of lack of fiber in the diet as well. So including the green leafy vegetables, one of the nice things is you sort of get a double bang. So you get all those compounds we were talking about and you get a lot of fiber. So fiber, as you’re consuming it, as you know, it attracts water to the stool that’s forming in the intestinal as it’s passing through the intestines, softens the stool as well. 

[00:34:34] So if you have sort of these round, I call them, like, little rabbit poo’s. If you’ve ever had, like, a rabbit in your backyard and you go in, you’re like, “Oh, my God. There’re these little round little presents that they’ve left us.” If you’re seeing that, let’s say, in the toilet bowl, it’s either lack of fiber, lack of water, usually both. So increasing fiber intake, increasing water intake, is also really going to help, and those will help the dense breast tissue, because you’re going to be helping with estrogen detoxification. Like estrogen is again processed by the liver. The process of detoxification, we are also metabolizing our estrogens that way. And so, if you are someone like me who tends to, left to her own devices, will produce, like some of the sort of downstream metabolites of estrogen, I tend to produce sort of the quinone damaging, like DNA damaging. I tend to go down the pathway, it’s called 4-OH or 4-Hydroxyestradiol or estrone. If you are taking green leafy or the DIM actually helps you sort of jump pathways to more of the protective pathway, the 2-OH pathway that will help with the dense breasts. So I’ve sort of taken my breasts from sort of being lumpy masses to relatively soft. I will do a breast check usually the first day or two that I get my period and I would be kind of checking, and it was just a lumpy mess. And not to be too much TMI here, but whatever. And now they’re just soft. There’s none of that lumpy bumpiness that used to be there. 

[00:36:07] In terms of the mammo every six months. God damn it. That’s a lot. I feel like. I hate that frequency. I’m not a big fan of. I’m going to get so much blowback for this, but I don’t like mammo’s generally. I feel like, especially, I’m a small breasted woman, I am like the president of the Itty Bitty Titty Committee. So to take my breasts and to flatten it, everything is getting pulled off of my body. And I’m sure it’s the same for our beautiful, well-endowed sisters as well. But I just think about what the hell is happening to the tissue as it’s being pancaked like that. Like you’re bursting cells, you are completely deranging the material. Like the cysts are being– everything is sort of being compressed mechanically. So I wonder what the long-term effects of that is. And then when you couple that with some of the literature that I’ve looked at in terms of mammograms being a pretty poor predictor of changes in the breast tissue. Like, they can usually see something once it’s been sitting in the tissue, it’s something like 8 to 10 years. So if you had some small mass or some change in tissue quality in the breast, a mammogram is going to pick that up relatively late. So that being, I don’t like mammograms, I’m sure someone’s going to come after me for saying that, but it’s just the truth. I don’t like them. 

Cynthia Thurlow: [00:37:31] It’s interesting, I had Dr. Jenn Simmons, who’s a breast cancer surgeon, coming on and talking about, she doesn’t like mammograms. She thinks that they tend to over diagnose.

Dr. Stephanie Estima: [00:37:42] Yeah. There’re a lot of false positives. That’s right.

Cynthia Thurlow: [00:37:44] A lot of false positives, a lot of women that go through a lot of stress and duress. And she’s actually an advocate of some new technology. It’s ultrasonic technology that is as diagnostic as an MRI without the radiation. And so, she’s looking to bring that technology across the United States. Right now, she’s based out of Philadelphia. But they are working on because as you can imagine, radiology centers don’t want their cash cow to be impacted–

Dr. Stephanie Estima: [00:38:13] And its profitable. Yeah.

Cynthia Thurlow: [00:38:16] Yes, they are making sure that it’s hard to bring this technology to market in a diffuse manner. I know myself, I get mammograms like every three years. I kind of go along with the European guidelines that are less frequent. But I agree with you that we have a tendency to overexpose patients to radiology, radiation rather and that in and of itself can create a lot of problems. But I love how you kind of synopsized all those wonderful things. And for anyone that’s listening, if you’re not familiar with the DUTCH hormone test, it looks at dried urine and saliva. You can get a really nice picture of how your estrogen metabolism is. And so for me, looking at those different pathways that we can break down estrogen, that can be very insightful about, do you need to do a little extra to help phase 1 or phase 2 liver detoxification? Obviously, this podcast is, we’re doing AMA questions, so I’m trying to keep things really brief. But some people need DIM to help with pushing the estrogen down that beneficial 2-OH pathway. Some people need phase 2 support and they might need things like calcium D-glucarate. I’m one of them because I methylate really poorly. And that’s a genetic thing that I have that I was born with. I always say my parents gave me a lot of good things. That’s one of those things that requires a little bit–

Dr. Stephanie Estima: [00:39:35] Genes were not one of them. [laughs]

Cynthia Thurlow: [00:39:36] Yes, exactly. I was like, those are one of those things I have to work extra on.” 

Dr. Stephanie Estima: [00:39:41] I’m the same. I have very poor methylation pathways as well. 

Cynthia Thurlow: [00:39:44] Oh. See, we have so many similarities. 

Dr. Stephanie Estima: [00:39:47] If I go to my naturopath, there’s a naturopath around the corner. She does IV therapy and once she gave me methylated, what was it? I think it’s, like methylated B vitamins. And I just had the wickedest headache. And I said to her afterwards, I’m like, “I don’t think I can ever do that again.” And it was, like, methylated with some glutathione, and everything was methylated. And I just had the worst headache because my relay system, like, the process of moving the methyl group along the pathway is so slow that there was just this big backlog with the IV therapy. All the methylated B, the methylated this and methylated that, my body didn’t. It was just too much for it. So everything was sort of backing up. I had the worst headache. Yeah. 

Cynthia Thurlow: [00:40:28] Never a fun thing to go through. Okay, we’re going to pivot because we have a lot of weight training questions, and I just want to quickly get them through some of these perimenopause questions. “In perimenopause, I have Hashimoto’s and fibromyalgia. I find if I push too hard in the weight room, the next day I feel like crap. How hard should we push it to still gain muscle but not overdo it?” Such a good question. This is from Leandra.

Dr. Stephanie Estima: [00:40:53] Well, Leandra, this is a fantastic question, and a very common one as well. So the guiding principle, so she has an autoimmune condition. So she Hashimoto’s thyroiditis and fibromyalgia, which is not. When we think about Hashi’s, this is sort of a classic AI, autoimmune condition. But they’re starting to look at things like fibromyalgia, depression, as sort of subclasses of autoimmunity as well. So she’s kind of got two going on there. The overriding principle for anybody with Hashi’s, like the class, the multiple sclerosis, the lupus, the Sjogren’s, all of that. You want to stimulate, not annihilate, okay. And this is the hardest for our autoimmune ladies and we’ll just jump to the trauma conversation right away. A lot of the residue that we– The reason why our body, in some cases, not all cases, but in many cases at least, my clinical experience with working with a lot of these women is that their immune system has become dysregulated and has sort of turned against them essentially, that’s what’s happening in an autoimmune process. But part of the reason for that is unresolved trauma. So that can be any type ‘Trauma.’ It can be sexual abuse, physical abuse, all of the things that you might find on adverse childhood experiences, like an ACE questionnaire. 

[00:42:16] But it can also be ‘trauma,’ right, the death of a dog or moving a lot or being bullied in school, things like that. That sort of still live in the nervous system. And so when we pair the nervous system, we have this psychoneuroendocrinoimmunology kind of conglomerate that all works together. When you are stuck in this sort of fight or flight from things from your past, you tend to at least, and I can say, I know my ACE score is a 5, which is very high, which also puts me at a higher risk for things like autoimmunity. So I’m always looking at my thyroglobulin antibody, I’m always looking at some of those things on my blood work. So I know that I have a higher propensity for that. But a lot of women who have experienced trauma in their earlier years, typically they become hyper independent, very self-sufficient, like, “I’m an island. I’m going to do everything myself. Nobody’s going to help me, because anytime I ask for help, I’m disappointed.” At least that was my story for a long time. And so, when you get to the gym, it can be very difficult to know what gentle is. And so all that, I’m giving you some of my backstory here demonstratively to tell you that it might be harder for you to know when you’ve reached your limit, because that internal GPS system about when you’re about to burn out or when you’ve done too much might be gone awry, because you are so fiercely independent. 

[00:43:47] So I just want to say we want to stimulate, not annihilate. So what does that mean in practice? Typically for my Hashi’s patients or anyone who’s dealing with any type of autoimmune condition, I want you to be thinking about in the gym, just to give you something tangible, like when we think of RPEs or rate of perceived exertion, it should be something like a 5 or a 6 for you, because that is going to be enough of a stimulus to get the muscles working, releasing the myokines, driving hypertrophy. But it’s gentle enough that you’re not annihilating the immune system, because your immune system is sensitive. It’s exquisitely sensitive to external and internal stimuli. So we want to be thinking about 5 or 6/10 as a general guideline. So that might be different for everybody. But when you’re doing even one set, if you say, “Okay, I’m going to try to go for 10 reps,” let’s say, at the end of the 10 reps, it should be like, “Okay, that was about a 5/10, 6/10 maximum. And that’s going to help with you not feeling bagged for several days. 

[00:44:55] The other thing I will say for my autoimmune men and women, but primarily women, it affects women much more than it does men, is your recovery practices are also of the extreme– most importance. So dialing in sleep, assuming you don’t have a 20-month-old baby, [laughs] like our earlier question, being very strict about sleep, cold plunges, cold showers, saunas or hot showers, making sure you’re taking enough time off in between gym sessions. So you, let’s say you do something on Monday, maybe the next time you go back is like Wednesday. You’re not going every single day and you’re not annihilating one body part. I would probably say for an autoimmune protocol, you probably want to do full body every time. You don’t want to break up your workouts into just legs. So you’re just annihilating the legs and then you can’t walk. It would be just like a flush throughout the entire body and that would apply for everyone who’s dealing with any type– so this could be this– I know this woman has FM and Hashi’s, but anyone who’s dealing with an autoimmune condition, like 5 to 6/10 should be the intensity and then becoming a master at recovery. 

Cynthia Thurlow: [00:46:04] Those are also important. And I would tag in there that if you are stable on your autoimmune protocol, like, let’s say you’re being treated for Hashimoto’s, your antibodies are coming down, you feel good, you’re sleeping well. That’s when you go to the gym and you push yourself to that perceived exertion that Stephanie was referring to. And afterwards, you don’t feel like you need to take a nap. That is the check in point with yourself. If your thyroid antibodies have suddenly gone through the roof, you’re really tired, you don’t feel good. We talk about this role of hormesis, this beneficial stress in the right amount at the right time, that’s the time that you’d better off going to take a walk. So as someone who does actually have Hashimoto’s, which, thankfully is in remission, my tell is, I know I’ve worked out too hard. When I need to take a nap afterwards, you try to go to the point where you know you’re pushing yourself, but not so hard. And it doesn’t mean I’m not pushing myself. It just means for me, because of my autoimmune history, because of my ACE scores, because of my trauma history, I know where that fine line is.

Dr. Stephanie Estima: [00:47:13] Yeah.

Cynthia Thurlow: [00:47:12] And I can tell when I overdo it. Usually, my tell is I’m really tired. It’s like, “Okay, I overdid it.” Now I have to do five extra things to help quiet my autonomic nervous system to reassure my body. Okay, next time, maybe I don’t need to do box jumps that are like the three-foot-tall box jumps. Maybe I need to do the one foot. I have a tendency to be very competitive and I’m sharing this with listeners so that they understand, like we’re all humans, but helping people understand there’s that fine line, and I think for a lot of women and this is something you and I were talking about in our DMs one day. There’s that fine line between pushing yourself and then overdoing it and trying to find where that is for yourself, I think is very, very important. 

Dr. Stephanie Estima: [00:47:57] And you’re going to play, and there’s going to be some times where you’re totally going to overdo it, and there’s going to be times when you get it just right. And again, that flexibility of thinking around. Okay, I have to figure out what’s right for me every time I’m in the gym. I think is that’s one of the things I love about weight training in some respect, is that it forces you to learn about yourself. Because we can all talk about squats. But we’re all going to squat slightly differently. Our femur lengths are slightly different. We have a pelvic tilt that’s going to be different, a lumbar lordosis that’s going to be– There’re all these differences between us, these bio-individual nuances that make our approach to the exercise different. And so, it’s okay to play and it’s okay to miss the target sometimes. Sometimes you’re going to overdo it and you’re just going to forgive yourself and you’re going to say, “Okay, what can I learn?” And the next time that you go to the gym, you’re going to say, “Okay, those box jumps really did me in last time. I’m not going to do them or I’m going to do the one at the lower level instead of the 30 inches I’m going to do the whatever it is, the 12-inch jumps or whatever.” So I think that’s a point well taken. 

[00:49:01] It’s something that– it actually took me a long time to learn, even without an autoimmune condition, because I tend to be very driven, very competitive as you said, tend to be self-sufficient as well. I’m like, “Oh, I’ll do it myself. No one’s going to do it as well as I am.” And so for years, I would call it my internal GPS. Like these internal antennas, they just didn’t work. I just couldn’t tell when I was tired. I couldn’t tell when I was pushing myself too hard, and then I would just collapse, [laughs] and I would just be on the couch for a day or two, and I’m like, “How did I get here? Why didn’t I see the signs?” And of course, hindsight is always 20/20. You’re like, “Oh, yeah, when I was getting those headaches and I was still punching out my work, when I should have been stepping away from the computer, maybe that was a sign.” All that to say is that individuals with autoimmunity, we tend to be very driven individuals, so we don’t know what our line is. So part of the healing process is actually learning where our limits are, finite matter, like, our finite matter, the limits of our finite matter, and our mental capacity and our mental faculties as well. 

Cynthia Thurlow: [00:50:12] Also important. Next question. “I started weight training thanks to you both, but hunger in my luteal phase is now insane.” 

Dr. Stephanie Estima: [00:50:23] [laughs] So eat it, girl. [laughs] 

Cynthia Thurlow: [00:50:24] Mm-hmm. 

Dr. Stephanie Estima: [00:50:26] That’s actually really exciting. Whenever you are starting to get hungrier, it’s usually a sign that your metabolism is kicking up into a higher gear. So again, just kind of what we were saying with our autoimmune girl, don’t ignore those signs. Like, listen to your body, feed your body. You’re typically hungrier in the luteal phase anyway because it is a metabolically active time. We’re growing the endometrial lining, prepping it for shedding if you’re not going to become pregnant, so I would say increase your calories. General rule of thumb is, like, up it by about 10%. So if you’re someone who’s having, I don’t know, 1800 calories, let’s say maybe you’re going to up it by 180 to 200 calories, and that should be sufficient. You know hope making sure that it’s higher proteins that you’re satiating that hunger, because protein is very satiating, I tend to like to pair protein with fat because I find those two together are very, at least for my palate and my body, very satiating. I really like the eggs and the avocado, that kind of combination. So I would definitely be increasing protein and celebrate that your metabolism is increasing. That’s awesome. 

[00:51:38] That’s what happens when you have more muscle, by the way, is your muscles are metabolically active, and it will, by necessity, drive up your metabolism. You will become hungrier. I remember when I was doing, I can’t remember what I had started doing, like a new leg routine. And I don’t remember if it was just a volume increase or maybe it was a weight increase, but I was starving for. I couldn’t get enough food in, like, the next day. I could not eat enough. And it was just like, I just followed those cues because my legs were healing. My legs were needing that substrate in order to grow to adapt to the stimulus that I had just given them the day before. So I would just say, listen to your body, celebrate that you’re hungrier. It means that your metabolism is increasing and don’t ignore those signs and have some more protein. 

Cynthia Thurlow: [00:52:24] Yeah. All such good points, I would say, the one thing to add in there, and I don’t know if this young woman is fasting, but I typically will say, as you’re getting towards when menstruation will start, those five to seven days preceding menstruation, which is part of the luteal phase, that’s the time to back off on fasting. So if you are lifting heavy and fasting and starving, to Stephanie’s point, eat. Number two, sometimes you need a little bit more discretionary carbohydrate. Not a lot. It might be that you need half a cup of sweet potato or maybe you need some low glycemic berries. But don’t be afraid to adjust your macros accordingly. I always found that for me, I needed a little bit more carbohydrate because at that point, when I was still in my early 40s and lifting what I thought to be heavy at that time, now I know better, but I would sometimes find that that week I would be really hungry and I would remind myself that, “Okay, my body is giving me these cues. It needs a little bit more of certain macronutrients.” So protein without question, maybe a little bit more carbohydrate, and definitely avoid fasting. Like, 12 hours of digestive rest is certainly fine, but that’s not the time to be doing long fasts 16,18, 20 hours. That’s usually the time that I will encourage women to take a little bit of a break and have a little bit more rest in between their feeding schedule. 

Dr. Stephanie Estima: [00:53:46] Yeah, beautifully said. Yeah, the carbs is that point is actually well taken in the luteal phase. I would completely agree with that. We need more carbs and it’s not something to be afraid of. 

Cynthia Thurlow: [00:53:56] Unfortunately, they’ve been demonized. Okay. Favorite pre-workout. This is from anonymous. 

Dr. Stephanie Estima: [00:54:01] Favorite pre-workout. I’m going to say coffee. I love coffee. I have been changing– I used to work out fasted. I used to always– because of the time of the day. Like, I’m usually in the gym quite early in the morning and I had this aversion to eating. I have been trying lately some protein and oatmeal. So when I wake up, I’ll just have some protein. I’ll actually have oatmeal, and I’ll put a scoop of protein powder in it and with my coffee. And I have been finding if I can eat and then I’m in the gym about 45 minutes later, that’s the amount of time that my body’s processing the oatmeal and the protein powder, it’s starting to spill it into the blood. I’m finding that my performance is actually much better. I was doing it on the weekends for a while, and then I was like, “Let me try it during the week as well.” So I’m loving right now, eating prior to my lifts. My cardio, I’ll still do fasted just because if I’m running, it’s just like, I feel like my stomach is like [crosstalk] glug, glug, glug. [chuckles] Like jostling while I’m doing the workout. 

[00:55:05] But the weight training, I like some protein and carbs before, and then after I eat as well, I’ll have my breakfast when I get home. But shot of coffee primes the dopamine receptors for dopaminergic activity, like lifting. So you’re sort of waking up the brain, waking up the motor cortex. You’re getting all these mood-altering effects with the dopamine and stuff. And I’ve been eating a little bit, so the oatmeal and the protein is probably like 200, maybe 250 calories. So it’s not like extreme, but it’s enough substrate. By the time I’m at the gym, I’m warmed up and I’m ready to lift. That I have a little bit more kind of precursors for energy that I can really get a better performance in the gym. So that’s the thing I’ve been changing recently. 

Cynthia Thurlow: [00:55:51] Yeah. I love that you have a degree of experimentation because I think that’s so important. Sometimes we get so rigid about what works for us that we’re unwilling to change things. I definitely can’t do it before cardio, but I haven’t actually experimented with eating before going to the gym because I feel like for me, we’re in a new city and I don’t love the gym we go to. And it’s such an effort to put my butt in the car, to drive to said gym that I’m like, “Anything that delays me getting in the car, I will make an excuse.” And I’m just sharing this just to be completely forthright. I love the gym where we lived before. Now it’s a little bit more effort, but I sometimes– I’m not a coffee drinker and I wish I was, but I will sometimes drink green tea. My kids are always talking to me about pre-workouts because they hang out with the gym bros and the gym bros give them all the things and then I have to explain to them, well actually that aspartame and the sucralose and all that junk that’s in a lot of the pre-workouts you probably might want to avoid. I know that Redmond’s had sent me a pre-workout powder that had beta-alanine in it, but it made my skin itch.

Dr. Stephanie Estima: [00:56:53] Oh. 

Cynthia Thurlow: [00:56:54] And so I was like, “Okay, that experiment at the N of 1 did not end well.” But I do know many people that will use Redmond’s pre-workout and do fine with it. So I just add that as a– That was my N of 1 experiment. Okay, I want to make sure that we’re mindful of your time. What is your favorite supplement for middle-aged women? I need some sleep support. I know that maintaining muscle is something you both discuss and speak about frequently. 

Dr. Stephanie Estima: [00:57:20] Yeah. So there’re a couple of things I would say for muscle, we’ve been talking a little bit about protein powder. I’m a big fan of whey protein powder. So if you consider that a supplement, I would consider it a food. But because it’s a supplement, it comes in a tub usually. So whey protein is something that I use. Creatine, again, just in the lens of muscle, I would say 5 g daily. I typically take it after my workout. You can take it before too. I don’t think there’s a big difference, but that’s just the rhythm of my morning is I’ll take it afterwards, so 5 g. I would say, in terms of other supplements that are important for women, midlife, let’s say perimenopause, wrapping menopause in here as well, I would say omega-3s are super important for brain health and for reducing inflammation. So something like 1 to 3 g of omega-3s daily. And if you have a supplement where you can rack up about a gram of DHA. So omega-3s are sort of two main. There’s like the EPA, as you know, and the DHA. The DHA is specific to brain health. So I would say for women who are experiencing like brain fog, general malaise, even like joint aches and pains, 1 to 3 g of omega-3s. I typically take around 3 g daily and 1 gram of that is DHA. 

[00:58:42] Let me think, what else? Vitamin D would be another big one, at least 4000 IU– depending on where you live and how much natural sun exposure you have. Like, I live on the east coast. So we have all four seasons. At the time of this recording, we’re sort of late fall moving into winter. So my supplementation for vitamin D tends to go up in the wintertime when there’s less available light. So it’s like 4000 IUs I would say at a minimum. And then for me, in the wintertime, I tend to up it a little bit. So I’m like 5000, 6000 IU units of vitamin D. And then the other one, I would say is magnesium. Big one, the big favorite for women is like magnesium. I typically take it in the evening. I’ll take a combination of glycinate, which is very highly absorbable, very well tolerated by most people and then I’ll also take an L-threonate, which is the magnesium type that will cross the blood-brain barrier. Perimenopausal women, you probably find this. Cynthia, one of the biggest complaints is sleep. All of a sudden, we can’t sleep well or awake. We can’t maintain it, we can’t initiate it. So magnesium, I like glycinate and L-threonate for that reason. 

[00:59:57] And I would say if you’re still cycling, like you’re still a menstruating woman, you can cycle the magnesium. Like I typically will have about 400 mg like 400 milligrams, sort of as the baseline. And then in that luteal phase, I typically amp it up again because we’re more metabolically active in that time. We’re developing that endometrial lining. I typically will up at 600, maybe some cases even as high as a gram. If I’m particularly stressed or particularly overworked. I know that I can go up to about a gram of magnesium without any of that the digestive upset. A gram is about my upper tolerable limit for magnesium. And you can play with this again, everybody’s a little bit different. The way that you know that you’re overdoing it is you’re going to start to see loose stools, maybe some cramping, that kind of thing. Any other big hitters? I think that’s my list. I would say that those are the– I typically am a supplement minimalist. I don’t like taking gobs and gobs and gobs of supplements, but really good omega-3 for brain health as we age, as we’re moving through perimenopause as well. I think that’s super important. The vitamin D, it’s not really a vitamin, it’s like a prohormone, magnesium, creatine, whey powder.

Cynthia Thurlow: [01:01:12] I think those are all great. I would say the thing about creatine that I’ve learned, it can be helpful for metabolic health, muscle health, but there’s also the sleep architecture piece. You need more of it to cross the blood-brain barrier. But I’ve been experimenting quite a bit with the sleep piece and that has been helpful, I would say. The only thing I might add is inositol because I think I’ve been very transparent with my listeners and said that completely changed the game with my sleep. And depending on how much stress I have, whether I’m jet lagged, I will increase or decrease. I could have 1 gram or 3 g of Inositol, and it’s super easy, really well tolerated, and helps with insulin sensitivity. Okay, a couple of other things that I want to make sure we touch on, hormesis. So we’ve kind of touched on some of these things. Cold exposure, cryotherapy, infrared sauna, HIIT, fasting. What are some of your prevailing wisdom around hormetic stress and middle-aged women? I’m going to just pick on middle-aged women because we tend to be a little less stress tolerant at this stage in our lives. Because I think I recall Sara Gottfried saying on the podcast that you can have some genetic susceptibilities to maybe you don’t need to do ice baths. I swear I’m one of these people. I think we were having a conversation in your DMs. [crosstalk] I was like, “I’m so impressed with your plunge pool. [laughs] I think I’m just going to do cryotherapy.”

Dr. Stephanie Estima: [01:02:34] Yeah.

Cynthia Thurlow: [01:02:34] But we are at the happy places. Like, how much exposure do we need to get the hormetic benefits? 

Dr. Stephanie Estima: [01:02:43] I think it’s hard to quantify person to person. Again, it’s like this individual, you have to play a little bit. So for me my background is Mediterranean so I have parents from– my father’s from Portugal, my mother’s family is from the Middle east. So we are, like, warm blooded, we love heat. So the cold is–And then, of course, I live on the east coast. So you take that genetic archetype, which is used to the warmth, you put her in an environment where there’s a very long drawn out winter and it can be painful. I think, for me, I’ll wrap in the cold plunge here because I was reticent to do cold. I was like, “I’ll do sauna all day long.” [Cynthia [laughs] I’ll do sauna every day.” I can do the warm. But the cold was something that I was avoiding. And it’s one of those things where you’re like, “Okay, why am I avoiding this? Is there some benefit that I, you know, is that where the work actually lies?” So I am somebody who, like you, and I think this is why we get along so well, is like, I value excellence. I want to be self-actualized and I want to be working towards expressing all of who I am. So I was like, “All right, the cold plunge seems really difficult and it seems really awful. So I’m just going to try it to see how I’d like it.” 

[01:04:02] And when I first started doing it, I was only able to really tolerate, like, 16 degrees Celsius. That’s probably like 57, maybe 58 degrees Fahrenheit. And I’ve worked to 13 degrees Celsius, like 54ish, 55ish Fahrenheit. I’ve been in colder pools, but it has been like, my cold tolerance isn’t there yet. Like, if you look at Susanna Soberg, she’s plunging in. I think she’s in Sweden, and she’s in, like, 2 degrees Celsius water, which is like 30, maybe 40 Fahrenheits. It’s insane. But her cold tolerance, she’s worked up to it. She’s built up a cold muscle– She’s built up her tolerance to the cold. So in the same way that if I were to do, let’s say, I don’t know, bicep curls and I pick up a pair of 25. Someone says, “Oh, my God, that’s impossible.” I could never do that. I can only pick up fives right now. It’s like, “Okay.” And with time and with exercising that muscle, you’ll be able to amplify and you’ll be able to jump from 5s to 7s to 10s. So I would say often the work that you’re repelled by or repulsed by is probably the work that you need to lean into. At least I found that for myself. And with cold plunge, I should also say the science only in order to get some of the best. It’s like 11 minutes a week. It’s not like you should be staying in there for hours on end. It’s like a really short stint and then you’re out. 

[01:05:30] The cold plunge for me is grit and it’s mental resilience because I don’t want to get into the cold plunge. I want to be warm and comfortable in my bed. But then I wake up and I go and do the cold plunge and I do something uncomfortable first thing in the morning. So everything else in my day is easier, [laughs] even the weights that come after the cold plunge. Everything else in my day is easier because I’ve already overcome this sort of monkey in my mind that’s like, “Don’t do it, you’re not supposed to be cold. You want to stay warm.” So it’s just a little stressor there. I think it’s actually great for women with autoimmunity as well because it’s cold. So it quells the inflammation or that pro-inflammatory state that we can see with women with autoimmunity. And it’s just a little stimulus. It’s just a little like two-to-three-minute stint. Same thing with sauna. Same thing with– like the whole theme is stimulate, don’t annihilate. Like, you don’t want to stay for an hour in the cold plunge, you don’t want to stay for an hour in the sauna, you don’t want to overdo it at the gym. You want to be able to stimulate the body enough so that you are getting an adaptive response. 

Cynthia Thurlow: [01:06:37] And I know this question will come up. You want to do cryo before lifting not the opposite. Because I think one of the things-

Dr. Stephanie Estima: [01:06:43] Yeah.

Cynthia Thurlow: [01:06:43] -I read was there’s a 4-hour window after lifting that if you get into a cold plunge or cryotherapy, you can interrupt the muscle-protein synthesis process. At least, that was what I took– [crosstalk]

Dr. Stephanie Estima: [01:06:57] Exercise is a you stress but it’s a stress. So you have this pro-inflammatory response that happens after you tear up the muscle. But if you cool that down, like you actually want the muscle to be a little hot right after the training. So if you are going to cold plunge and you’re also training, the order would be cold plunge first and then train. Or if that’s not possible for you, at least, as you said, put that 4-hour buffer in so you train, let’s say, in the morning or whatever time it is, and then you wait at least 4 hours before cold plunging. Typically, cold in the morning. It wakes you up. So you’re going to have this shock response because you’re get like– And I’ll tell you very honestly, when I first started, every single cell in my body was like, “Get the hell out of this tub. [Cynthia laughs] Get out. Get out right now.” It’s like an alarm, it’s like a shock response. So there’s a lot of cortisol, there’s a lot of the catecholamines, the epinephrine, the adrenaline, which then drives like dopamine and everything. 

[01:07:59] So it’s nice to do it in the morning because that’s actually when your cortisol is supposed to be high. If you do it too late in the evening, it can be a little bit, I find a little bit too stimulating. So I don’t like to do cold in the evening. So if you work out in the morning, maybe like a noon or like midafternoon plunge might be fine. And then heat, of course, is really nice in the evening for those of us that are trying to augment our sleep, because what will happen is this rebound, where you are going to overheat the body, essentially in the sauna. And then your body is going to work really hard to reduce your core body temperature once you get out of there. So that’s also going to help you fall asleep and stay asleep. So the general rule of thumb is cold in the morning and that can be in your shower. You don’t need to have a cold plunge, although if you do have a cold plunge, I highly recommend getting one with a chiller so you don’t have to constantly throw ice. And I was like, going to the gas station [Cynthia laughs] a couple of times a week, getting these huge things of ice, and I was like, “Okay, this is ridiculous. I’m just going to get a cold plunge with a chiller.” So I would say cold in the morning, heat in the evening, and then it’s the same with the sauna as well. There’re some people who can– and we all know this, my mother could take a bath, that she could sit in a bath, and if I put my hand in it, it would be scalding. So we all have sort of these different nociceptive inputs in terms of our tolerance to heat and tolerance to cold, which can be worked, which can be improved the more we do them. 

Cynthia Thurlow: [01:09:27] Yeah. And I couldn’t agree with you more that more often than not, the things we try to avoid doing are the things that we need to do. Well, as always, an amazing conversation. There are a lot of questions that we didn’t get to, but please be reassured if you asked a question, we didn’t get to it. We’ll save it for the next conversation. Please let my listeners know how to connect with you, how to listen to your amazing podcast etc. 

Dr. Stephanie Estima: [01:09:49] Oh, thank you so much. So Cynthia and I are fellow podcasters and we’re going to release this together. So this will be on my show and on hers at the same time. My podcast is called Better With Dr. Stephanie, so very similar to Cynthia insofar as I like to speak to world leaders, scientists, and doctors and people who are changing the game and changing the way that we think about what it means to have a well lived life so Better With Dr. Stephanie. We have weekly episodes there. I’m pretty active on Instagram. I try to be active on Instagram. So you’ll see me posting a lot of workout things. And whenever there’s a really interesting clip from the podcast, I’ll be there. I’ll post that there as well. And I’ll post educational content. So it’s @drstephanieestima. So Dr. first name, last name. And then if you want to watch the show, we’re on YouTube as well. So you could just look up Dr. Stephanie Estima and there’s my channel there as well. And then the last one is the book. So starting to get ready to– I’m thinking about writing another book, but my current book, my baby, is called, The Betty Body. So it’s about cyclical living, how to alter food and training and sleep and all these things in accordance with a woman’s menstrual cycle. So that’s called, The Betty Body. And you can find know any good bookstore, Amazon, Barnes & Noble, all the places. 

Cynthia Thurlow: [01:11:06] A great book. Thank you again. 

Dr. Stephanie Estima: [01:11:08] Thank you, my friend. It’s always great to spend time with you. 

Cynthia Thurlow: [01:11:12] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.