I am thrilled to have the Menopause Fitness Expert, Debra Atkinson, joining me today! Debra is the bestselling author of You Still Got It, Girl and Hot, Not Bothered. She is also the host of the Flipping 50 podcast with over 1 million downloads and the TEDx talk Everything Women in Menopause Learned About Exercise May Be a Lie. Debra is a 37-year fitness expert, prior Senior Lecturer in Kinesiology, and founder of Flipping 50, the first and only online fitness membership dedicated exclusively to women in menopause.
There is a common misconception that everyone should exercise in the same way. People tend to believe that because many authorities in the fitness industry are still operating on guidelines and position statements that view men and women of all ages as a collective. In reality, no one fits the norm. Women in menopause might not even be in the same place right now as they were six months ago, or where they will be, three to six months from now. Stay tuned today to get Debra’s insightful recommendations for navigating where you are and selecting a diet and exercise strategy to suit you as an individual.
IN THIS EPISODE YOU WILL LEARN:
Why do women approaching menopause need to exercise differently?
Some of the physical changes that happen as women mature.
The kind of exercise that helps with muscle development and the kind that helps with bone density.
The importance of getting the right nutrition and enough sleep as you approach menopause.
Why you need to tune into the feedback that your body is giving you.
Reversing the effects of aging with strength training.
How to gauge the right intensity for stimulating muscle growth.
The best exercises for middle-aged women looking to lose body fat.
The supplements that Debra most often recommends for her clients.
How the loss of estrogen, progesterone, and testosterone manifests in women approaching menopause.
“Where you are right now may not be where you were six months ago if you are a woman in menopause.”
-Debra Atkinson
Connect with Cynthia Thurlow
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Submit your questions to support@cynthiathurlow.com
Connect with Debra Atkinson
Transcript:
Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health and wellness goals, and provide practical strategies that you can use in your real life. And now, here's your host, Nurse Practitioner Cynthia Thurlow.
Cynthia: All right. Today, I'm thrilled to have menopause fitness expert, Debra Atkinson. She's the bestselling author of You Still Got It, Girl! and Hot, Not Bothered. She's the host of the Flipping Fifty Podcast with over 1 million downloads. Her TED Talk is Everything Women in Menopause Learn About Exercise Maybe A Lie. She's a 37-year fitness expert, prior senior lecturer in kinesiology, founder of Flipping Fifty, the first and only online fitness membership dedicated exclusively to women in menopause. Welcome, Debra.
Debra: Thank you so much for having me. I love chatting with you always.
Cynthia: Yeah. Well, it's interesting because I think one of the misnomers or misconceptions and I certainly would have been one of those people when I was a newly practicing nurse and nurse practitioner is that everyone can exercise the same way. So, let's talk through some of the well-meaning individuals, and I say this from a good place, it's not a criticism, but there's well-meaning 20 and 30 something fit pros that are out there that are advocating for things that could potentially be really problematic for women as they're navigating perimenopause into menopause. So, let's unpack why we have to exercise differently at this stage in our lives?
Debra: Yeah, well, I'd love to start with that same respect to a nod at those people, it's not their fault. We're still an industry operating on guidelines and position statements that collectively look at men and women of all ages, a very wide age range. Here's your frequency, your duration, the intensity that you should do, that's what it's based on is collectively and as you know looking at lab norms, it's very much like that. So, no one actually fits an average or the norm, and so you've really got to look at what's going on for you, and I prefer the blueprint. So, it's a teen TigerBeat quiz. If you said yes, then you go this way. If you said, no, then you go this way, and we finally get to navigate where do you need to be right now, and where you are right now. May not be where you were six months ago, if you're a woman in menopause, or where you will be three or six months from now. So, it's a constant giving the feedback. What's my body telling me, what signs do I have, as well as labs? But we have this immediate feedback when you wake up in the morning, how do I feel? That said, it's neither your trainer's fault or the fitness instructors fault or yours, because that's the way you've been told over and over, and so many authority figures are still using that, because that's the best they have.
You came from the medical world, and you know what are the statistics on the amount of nutrition education doctors received in medical school. Well, if you look at how much exercise education did they receive in medical school, also very small. So, when they give that advocation of exercise or just walk, you've got to realize that skimming the top of the iceberg. Better recommendations would be, "I recommend you go and speak to an expert who's maybe got a medical exercise background, who can really deep dive into what's happening for you."
So, why are we different? Well, obviously, the biggest thing is, I hear this over and over, and I'm sure you do too. We could probably look at our notebooks and they’d be exactly the same. Nothing I'm doing works anymore. What I used to do that worked doesn't. Those statements over and over again. If I can interpret that for everyone in listening, what you're saying is when I had this set of hormones, I was doing this exercise and this diet, and that worked. Now, I have a new set of hormones, I'm trying to do what I did when I have that set, that suddenly a light bulb I think probably went off in your head. I get it. That makes perfect sense that if you're trying to do what used to work with that set, it won't. So, it's just time and it's such a great opportunity to change the strategy in what you were doing so that you can win the game again.
I went off on a rant about this on my own timeline yesterday because I think, there is an almost message that's starting to come out but even in that almost message, something is missing. So many people are now saying women in midlife, their bodies are just not meant to exercise that way, it's not going to work anymore. I think unfortunately, that paints the picture that, “Yeah, you're done, you're dead. That's over. We're slowing down.” That couldn't be further from the truth. The answer is catering to the feedback your body gives you right now, and potentially doing less exercise or less frequently, less intense exercise, and we can talk about those nuances, will get you the fitness you want right now. It's not that you have to settle for less result. You may just need less exercise to get there and it may also be a window in time. It's a moment in time.
If you were pregnant, if you had the good fortune to and the blessing to be there, you did not exercise the same way, healthy you prior to or after pregnancy did. That makes perfect sense because we can see it, because we know we're creating life and it's a nine-month journey. Well, this menopause journey, unfortunately, it doesn't have a timeline on it. For a lot of women, it's ambiguous about when it starts and when it's going to end, but you are in that a moment in time. So, changing what you're doing during this time and yet, when you're in post-menopause, things will change again, and you will be able to do more if you are an exercise lover, and you want to get back to doing more and doing performance-based things, or adventure things, or races, you can do that. No one's saying that you cannot. It's just pay attention to the feedback your body is giving you and the hormones that you have right now.
Cynthia: I think it's really important to, and you obviously allude to this, as bio-individuality piece recognizing that what we need in terms of physical activity at 20, 30, 40, 50 and beyond can look very different. I think it's important because unfortunately, I feel there's a lot of antiquated dogma. I know that we talk quite a bit about this, but the one that I think of the most is this concept of exercise more, eat less as being the mainstay that people really-- they hold tight to this really antiquated belief system, and it can really mess with their heads because I get women that will come to me, and they'll say, "Well--" the same thing that you mentioned. “What used to work for me, it doesn't work anymore. I do CrossFit, and then I'm exhausted, and I can't get out of bed,” and then, it starts this really vicious cycle. I think for many of us like tapping in intrinsic way and doing the things that make us feel good, make us feel energized is a really important distinction, because there were definitely years where I would take essentially, it was like a CrossFit S class. It was like a conditioning class. In my late 30s, I started finding it took me longer to recover. And, then as I entered my early 40s, and this is when perimenopause really hit me hard, I would get migraines. I couldn't stay hydrated enough, I was getting up really early in the morning.
So, let's touch on some of the physiologic changes. What are some of the things that start to happen to women's bodies as they're maturing? When the other day I was saying, they didn't like the middle-aged terminology, they said, "How about we say more mature women?" I said, “Okay, I'm willing to use that vernacular.” But what are some of the physiologic changes that start to happen with regard to our joints and our muscles as we are chronologically getting older. And I want to be really clear, and this is something that I did not know, until I was in my 40s about peak bone mass, peak muscle mass, how critically important these things are to really focus on in our 20s and 30s, and not to wait until you're in menopause to suddenly go, “Oh, that was 20 years ago, or that was 15 years ago. I have no idea.” So, let's talk about some of the physiologic changes, because I think that's really important.
Debra: Yeah, I love that you brought that up too. This is really, I think, the underlying thread. I’ve been in fitness for 37 years you mentioned. So much of the time someone thinks that's about selling sweat, selling exercise in the fitness part of it. But what it's really about is the ability to be a better mom or be a better parent, a better partner, a better CEO, a better employee, the gifts that you have in the world you can't give without this vehicle working right. These women right now, those of us who are in this moment, are the biggest potential health influencers in the world, because each one has such a ripple effect. We will do our job when we turn around to our daughters, and our nieces, and those women, younger women we influence, and have them really put the emphasis in the right place when they were in their 20s and their 30s. I think for so many of us in menopause, midlife and beyond or-- I'm not supposed to use that word ‘prime,’ how's that? [laughs]
Prime and beyond, we got away with much of the things that we did. Many of the things we did truly weren't serving us, but we got away for what you brought up. We were at our peak of muscle mass, and we were at our peak of bone density. So, we peak in muscle at about age 25. That's a plus or minus, we don't know exactly where that point is. We peak in our bone density at about age 30. Meaning, what we're doing is pouring into those banks, really. So, what we do prior to that really matters, more so with bone. If you have young children, you have adolescent children before puberty, they have the opportunity most of all, but even after puberty, and they're reaching that point, younger and younger, young girls for sure, sixth grade and fifth grade, and part of that is because of our weight and obesity issue among children, but we don't close the door. So, there still is room. We used to think that maybe that was it that bone density was really there. Well, we're in big trouble if we lose 1% to 3% of bone density every year, and you want to live to 100, and you reached your peak in your teens or at 25 even then. So, jumping, walking, weightbearing, and if you compare putting kids in sports, swimming to gymnastics, you might say, “Well, gymnastics is so much more risky.” Potentially, yes, but the bone density of a gymnast is far better than that of a swimmer. Yeah, put them in the water. Swimming is wonderful for so many, many things. I think you have swimmers, but we put them in the wave run too. They need surf and turf, just like at the restaurant. You've got to do both, and that will make them better swimmers in the long run. But that is better as we age.
So, there is this moment and every decade of our lives where here's the focus this year or this decade to improve the way you will age later and get to menopause and drive through it easier, cruise through it. So, 20s and 30s, that decade, we want to really take confident young women, get them into the weight room, and let them strut around where they feel good about their bodies, they have confidence, and help them pick up heavyweights. I think actually today, it's exciting, but I think that is sexy. That is actually where young girls want to be and they're seeing strong. We're seeing it all over. I think, yes, there's this era of bar classes and yoga is awesome, but I think we're also seeing pick up heavy things, lift heavy sets, and that's the message we're telling them, and we're creating strong women that way inside and out. So, I love that.
Then at 30, those heavy weights and higher impact exercise help with bone density. Here's where women in their prime and beyond, we have this a little backwards. We think because we've been educated to learn weightbearing exercise is good, we tend to think that walking and walking more will be better. But unfortunately, there's something called minimum effective stress. There's not enough minimum effective stress in walking over and over on the same body weight that you already can handle. So, if you can walk a mile, you're getting some bone density benefit from that compared to having been on the couch. But you're not getting more bone density benefit by walking two miles because we haven't changed the stress on your bone. So, it's not the same if I said, here's how we can affect positively your muscle, reaching muscular fatigue with a lightweight, more repetitions, or a heavyweight, fewer repetitions, will help your muscle. The same cannot be said for bone density. So, we have to lift a heavy weight fewer times in order to really affect bone density. The only outlier is progression. We'll need to start lighter and progressively move to heavier to be safe and lay that foundation. But joints and ligaments need that progressive overlay of stimulus and as we age, we need it slower and slower. The reason being is, we are a little bit more prone to injury.
Here's the caveat, and I think we'll see more of this, but it's a really hard thing to study because obviously, researchers are not real keen on the idea of let's see if we can cause an injury. That's not a great study. So, what we have to do is collect data after the fact of what injuries happened, and we're only able to look at it that way. So, it will be slower to come but we don't know exactly the reason. But women who are probably in menopausal years, perimenopause, just post menopause are more prone to injuries like itis, tendinitis, and many of you will identify better if I just list them off things like plantar fasciitis, tendinitis, hip bursitis, you've got tennis elbow. Those things are definitely more common at midlife and beyond. We know there is a relationship with hormones. We don't know exactly what that relationship is. But it means that we've got to take better care and it couldn't be-- this is totally theory. But I think it's a collective look at--
Our nutrition over the years, if we've dieted, and we've skimped, and not been supplementing, not looked at I've took this out, so how am I taking it in elsewhere, we haven't done a great job of that. Part of it is, we were that era of, “Do I take a multivitamin or am I just paying it out?” A lot of us are just like, “Oh, forget it. I'm not going to do that.” I don't know about you, but if I look at my counter, it's like a pharmacy over here. I'm totally back on the bandwagon and realized I've got to pour that all back in or this vehicle driving down the road is not going to work very well. So, I think we've got to do some catching up and really stay on top of what's our micronutrient sufficiency and are we there.
But we also have to look at sleep, have we shortchanged ourselves there? That's going to play into either illness or injury, and almost always does. So, we know this, because if you're sick, what do we do? We sleep. We sleep to recover. We rest more. It's like your body saying, “If you're not going to listen and do this rest on your own, I'm going to give you a reason to rest. So, here you go. Just take the load off." Likewise, I think some of us know, when we feel we're coming down with something, if we go to bed and we get a really good night's sleep, we can avoid it. And intuitively, we know this is true, and yet we go to bed an hour later, get up an hour earlier, because we want the house to look right or all the other hats that we're wearing, a CEO or whatever, we still cannot stop thinking about the dirty dishes in the dishwasher, and all of the little things we try to juggle. Injury is far more common. So, we've got to really slowly start, progressively, then we can find that fine point where is too much. Before you've really gone too far, you can back off of that point and keep that sweet spot for a little bit longer and avoid injury.
Often, people will start exercising. Who haven't been? And find that they get hurt? The negative is when I exercise, I get hurt and putting those two things together, unfortunately, but what exercise probably did has made you aware of an imbalance that was already there. Because it's like music in the car on the radio, if you there's a rap music in the background, you may be able to deal with it. But if somebody turns the radio up is like, “I can't stand that, can't take it,” and that's what happens to your body. It's like we just amplified it and so now you became aware that that was there. I think if you can reframe, coming up with this happens to me, it's a great lesson and opportunity for it's not just potentially about my foot, this plantar fasciitis. It's maybe a reason to look at my sleep, my micronutrients, and the way I'm approaching my overall stress load on my body, because exercise is stress, diet is stress, and we have to look at the whole thing and more so amplified in that middle of midlife, middle of menopause moment.
Cynthia: So much to unpack there and so beautifully stated. I think that on so many levels, middle age, perimenopause, menopause really forces us to look at what is serving us or not. I love that you touched on the itis. For anyone that's listening inflammation in an acute phase is fine, but chronically-- and if you think about the statistic I read most recently that 88% of Americans are metabolically unhealthy. So, that means 88% of people are their diabetic, prediabetic. We're becoming an increasingly unhealthy population and so inflammation gets magnified in middle age. As we creep closer to menopause, the 12 months and beyond of no longer having menstrual cycles, it's even more critically important to dial in on those lifestyle pieces, and the nutrition, and certainly how frequently you're eating. I would say eat less often. People don't necessarily have to embrace fasting, but we should be eating less often than certainly really getting honest about your connection with nature.
I think one of the blessings that came out of COVID was that, I walk outside every day generally in the morning. Some days, it's a mile, some days, it might be more, but it's become something that I really crave. My body craves this connection to nature that I was probably not doing enough before. But I love that you mentioned for so many women that they enter into this space in their lives, that they have to exercise differently, and they have to be much more attuned to injuries, and aches and pains they didn't otherwise have. I have no problem sharing that I started developing plantar fasciitis, I think, when I was 38. I knew exactly what it was when I got out of bed. I only have it in one foot, and what I found was that depending on how much nightshades-- So, nightshades are tomatoes, and potatoes, and eggplant, which I don't even like eggplant, but I love peppers. If I eat too many, that foot will ache because I'm already gluten and grains and dairy free. So, for me, it's the little clues that I need to tune in.
What's also interesting is I started developing, maybe, in the last six to 12 months, and it's not a weight-related thing and there wasn't a weight change, I started getting some pain in my right knee. I was saying to my husband, it was enough that I didn't want to run. I would still walk. I could walk on a treadmill, walk outside, I was very conscientious about how I was doing box jumps and doing progressive weight training, and I found it wasn't until I started doing hormone replacement therapy and my body started getting a little less inflamed, a little more estrogen on board, a little more testosterone, a little more progesterone, all of a sudden, those aches that I hadn't really thought a lot about, all of a sudden, all those things went away.
As our hormones are fluctuating, as our peak bone mass is reached, as our peak muscle mass is reached and we've gone beyond that, we have to be cognizant of the fact that all these little changes over time can add up. It might be, like my GYN feels strongly, that 35 is really the peak of everything. Then, we slowly start losing those sex hormones. You said, you may not be cognizant of the change in your menstrual cycle, heavier periods, more PMS, tender breasts, etc., until you hit your early 40s, but really that shift starts to happen around 35. I think for so many of us, myself included, I’ve kids in my 30s. I was so tired because I have two kids two years apart, that I just chalked it up to being a parent. But really what was starting to happen, we were getting these shifts in growth hormone, we're getting these changes in sex hormones, we don't bounce back. Maybe, our sleep isn't as restorative as we want it to be. We're not realizing that really intense-- I'm going to pick on orange theory as an example. Orange theory fitness, I know women who do that 4 and 5 days a week and I just look at them and go, “You just look so inflamed. That's the opposite of what you should be doing.”
But let's unpack, what are some of the modalities that are really important for women in middle age? I start to think about, you can still have intensity of exercise, but you're not out there killing yourself. I know, when I look back retrospectively at what I did 15 years ago versus now, I'm like, “I don't even want to work out like that.” I almost want to vomit when I was done working out because it was so intense. I'm like, “I don't even want to do that activity anymore.”
Debra: Yeah, such a great point. Well, we've got to come back to we're peaking in muscle mass at 25, and that means usually for both about five years later, we're definitely starting to withdraw it. So, it's like the bank's closed, and that's how much you have and now, you're going to start to withdraw unless you are consciously doing something about it. Many women who find themselves in menopause were doing something but not strength training often. So, it's like if you weren't, now's the best time to start. By the way, it is never too late. I just recently pulled studies about strength training starting with older adults 85 to 97. That’s the oldest that I can find studies about. We will potentially be that generation where they're studying us from 97 to 105, but there is proof. You can gain strength and at that point success may be getting out of the chair all by yourself. My mom is in the nursing home right now, just broke her hip. So, being able to get up and go to the bathroom by herself when she wants to and not waiting for someone to come and help, that's success.
So, what we need to be doing first and foremost if you're not doing it is strength training. Anything else is a second or third, and that that is the one thing that will help you not only decelerate the rate of aging, but reverse aging, literally. If you thought it was possible or the fountain of youth in that jokingly way we say it, it's absolute proven that we can do it. We improve the mitochondria, and in six months of strength training twice a week, which is very reasonable, I don't think anybody can throw up arms about 20 or 30 minutes two times a week, you can reverse the effects of aging of 179 genes associated with aging. Six months, twice a week. Really get started, because by Happy New Year, we'll be celebrating you. So, hugely important, and that's an under the hood change.
But what does that equate to? If your strength training, you're improving your lean muscle mass. The muscle we so desperately want to see, and the fat we want to keep at bay or lose, if we've got some, you will be doing that, too. So, it's a two for one. We get the effects of vanity that we all want. Truly, that's what gets us all off the couch. My mom is now 94. When she was 87, she said to me, and patted her stomach is there, “Could you show me a few exercises to get rid of this?” I'm just like, “Oh, my God. She's got a hip replacement, high blood pressure, high cholesterol, but yes, whatever you want. We're going to do that.” So, it doesn't matter what motivates you. You get it all, and that's hugely important.
So, strength training, strength training, strength training. Midlife women and in this moment were in really still were coming out of, Cynthia, is we're 18 months basically into post pandemic, and we had a global dumbbell shortage. Who knew? So, you were at home, your gym was closed, and you couldn't order dumbbells from Amazon, though you could order chips, and salsa, and kaiso, and all other things from restaurants that you love. That was a problem. So, if you happen to be in the perfect storm, a woman in her latter stages of perimenopause, early stage of post-menopause, you had the accelerated loss of muscle happening because of that. Because as estrogen goes down, that estrogen is a stimulus for holding on to lean muscle tissue. When that stimulus is gone, that three-legged stool, now you've got to pick up the slack somewhere else. Your two best friends are strength training and increasing your intake of high-quality protein. One or the other of them helps your muscle protein synthesis, but two of them together are even more powerful.
Cynthia: No, I think that's so important, because many people use the pandemic to remain strong and lean, and I happen to-- just purely by happenstance, I had ordered a bunch of stuff before we went into the pandemic, just completely by pure happenstance. So, we had a moderate amount of equipment. I have two teenage boys and I'm not sure we would have survived have we not had TRX bands and all sorts of things. But I know one of the questions that has come up repeatedly for women in my monthly group is, “Okay, two days of strength training at a minimum, how do I know I'm working out intensely enough to stimulate muscle protein synthesis?” Because I think it's very easy for people. Anyone can go grab a kettlebell, or even go grab a 20-pound dumbbell and do some physical activity, do some strength training. But where is the sweet spot, how much load on that muscle?
The other part of that question is, someone at 45 versus 65 are they're parameters that you like to utilize? Because there was one woman in one of my groups who's actually in her late 60s, and she said, “What do you recommend for someone at 70 versus 45 or 50?” I said, “I'll definitely ask Debra.” But those are the questions that start to come up. People aren't sure. They need guidance about how much intensity in order to stimulate muscle growth.
Debra: Yes, great questions. In terms of strength training, when we talk intensity, the way we engage it is do you reach muscle fatigue, and that is the best way to state it. Someone could say, well, if we were comparing the weights, like 20 pounds versus a 10-pound weight, that the 20-pound weight would be more intense if we use that, but it's not necessarily true. If you put that weight down before you've reached muscular fatigue, then you've made it a wash. It has to be about reaching muscular fatigue. What that means is, actually, your selection of the weight is based on, if I said, "I'd love for you to do 20 repetitions," and that's a fairly high number. Low numbers would be 10 or fewer. If you're only going to do five repetitions and you reach fatigue, it's got to be very heavy. If you're doing say 28 to 30, that's about as high as I would go. The reason I would go there would be, we're really wanting to focus on gait. We're really want to focus on some performance related types of things and functional movements, that word is thrown around. So, I really broke one of my own rules by throwing it out there right now. If you have questions on that, we'll come back to it.
But 20 repetitions to point out is mid-range, it's a little on the higher end, a very safe place to start. We're not going to wear your joints out by doing too many, but we're also not going to over stress your connective tissue, the joints and ligaments that need probably more adaptation than your muscles do. You may put that weight down, in fact, and say, "I think I could have done even more," and that's a great place to start because your ligaments need that time in between where you could have done more for the muscle. But fatigue is very different. When we talk about being overall tired like we could wring you out and drag you out of the studio when you're done, that's just overall fatigue and tired. That's not what we're looking at. I think there's a meme that floats around, but it's probably the one of the best things I've ever seen on social media that any exercise can make you tired. Only certain exercise makes you better. That's what you're looking for it.
So, fatigue, when we talk about strength training is in the end of every set, when I've asked you to do 20 repetitions, by the time you're at 17, 18, 19, and 20, you're wondering, “Am I going to actually be able to get these last couple?” or “I'm feeling like I'm starting to cheat and maybe feeling this come up, and I'm using other muscles in trying to maybe swing it a little bit more,” because the muscle is done. It's tired. When you put that weight down, that doesn't mean you then are suddenly sore or broken or hurt. It means probably in about a minute and a half, two minutes, you would be able to pick that up again and do another set. You will recover. That muscle just temporarily got to the point of temporary exhaustion and that overload, what you're doing is that overload causes the muscle to break down and the strength that happens during repair between that Monday session and that Thursday session, that's when the muscle doesn't just repair and say, “Oh, we had some microtears and so, we're going to put that back together." It says, “No, we might have to do that again. So, I'm going to get a little stronger this time.” That's why when you begin, you might be able to pick up 10 pounds and over the period of weeks, you might actually say, “You know what? I need 15 pounds to reach fatigue. 10 is just not doing it anymore.” That's why you get stronger because those muscles are resilient and they overcome what they were first prone to, whatever causes them fatigue.
But here's the thing. Women often premeditate. So, if I say we're going to do three sets of 20 repetitions, it is not at the end of those three sets that you should be at fatigue, it's the at the end of first, that one set. All I want you to focus on is set number one. Before you get to 20, I want you fatigued. Then, when you come back for the second set, you may pick up a different weight. You may need to, but then you do with set two only when you get to set two. So, each and every set then really matters and that's most important.
There's a volume of studies coming out about strength training for women over 40, saying that we do better with a higher volume. We need more volume. Here's the trick. We're on a tight rope and we have to walk this really fine line between how do I get enough stimulus, enough volume and remember that if the volume of my work goes up, the volume of my recovery must also go up so that I don't risk adrenal fatigue, so that I have adequate recovery and so that we all keep in mind, the goal is not to get better at the gym. The goal is for what we do in the gym to help us get better at life and have great energy the rest of the day. You should not feel like you need to spend 23 hours on the couch. You should feel like, "I feel so glad, so invigorated that I did this, and I can think much more clearly and my appetite is stable. I don't have cravings." Anything different than that, disrupted sleep, tons of fatigue, you could take a nap right after your workout or you're craving all day long like, "Got to have carbohydrates. I need something sweet," that's a sign that exercise is not quite right for you.
Cynthia: I think that's really important to be attuned to how your body feels. Now, when we talk about muscle fatigue back in the dark ages, when I was learning muscle physiology and I'm sure we know a heck of a lot more now. Is it the actual lactic acid buildup that drives that muscle soreness because I know there's acute muscle fatigue, and then there's this delayed onset muscle fatigue that can go on and how do we differentiate? I'm presuming that they're both beneficial, but how much is too much? What's the barometer we use? I would imagine, if you can't get out of your chair, you might have done too much, because you're just so sore.
Debra: First of all, I'm going to admit this right now. I can't pronounce this word. I'm going to need your help. The Iowa football players, Rhabinosis, is that the word?
Cynthia: Rhabdomyolysis.
Debra: Thank you. See, I knew you know that word.
Cynthia: [laughs]
Debra: But we're seeing that in even women who are going to boot camps with the four, five, six days a week or who are going to CrossFit in and I don't love to throw any program under the bus and by the way, I give great kudos to the CrossFit environment for what they've done with the culture and bringing people in and keeping them. But the frequency with which you do things, and the quality of any program is still only as good as the coach whose eyes are on you in that program. That needs to be said, no matter what it is you're doing. If we're causing a lot more breakdown than is necessary, we're going way beyond. Yes, if you can't sit down, stand up from the toilet, that's a sign we've really had a lot of microtearing beyond. So, it's excess of damage.
I know a lot of women love to feel a little bit sore, but I will also say this because there are women who are disappointed when they don't feel sore. But recovery and your likelihood of getting sore is very unique to individuals. There are some individuals who really very rarely feel soreness, but they have reached muscular fatigue at the end of a set, they've reached the overload, and yet they tend not to. We don't know exactly why that is. We don't know if that's the certain enzyme in their muscle or their body, and/or the void or lack of one in someone who tends to get more sore, but you probably already know who you are. You've had enough history to know whether it's exercise or it's gardening all day, that you do tend to get sore if you do too much, or you almost never feel soreness or respond very quickly and recover. It's a unique to you thing, and that's true of your time to recover in general.
Olympic athletes, let's say, they were all on a team, and they were all 22 years old and very young, which is probably pretty typical of Olympians. But teammates doing the same workouts could have a very different recovery period. That is true for them. It's very unique. It's somewhat genetic, but it's very unique to individuals. It's why individual coaches will then need to step in and say somebody needs a day off, one more day off before they come back to that workout to attain the same level of fitness and not be breaking down. So, it does not mean that you're less fit than somebody else.
I think we've always thought, the sooner you can do another high intensity, high quality workout, the faster you will become more fit. But as we age, that is less true. If you are only just breaking down those muscles, we will be losing it. At the beginning of the pandemic, I recommend that every household in the world have a smart scale so that you're measuring what is the result of your daily habits and your weekly habits of exercise and the nutrition that you're observing. What's happening with the amount of muscle you have, what's happening with the amount of fat you have, and not just your weight? That feedback there, that is your own scientific study and that will help you uniquely target what's happening for you.
Cynthia: I love that you brought up the smart scale. I've always been a fan of not weighing myself and not telling my clients, but as I've gotten more mature, I use it even if it's once a week, twice a week, couple times a week-- lots of people perseverate over the number because it's very easy to get fixated on number. I want to be X weight. But the smart scale, what's really amazing about it is, I can track my body fat. I can track my muscle mass. I can track my water weight. That is far more important and valuable information than the actual just, here's the composite number of you stepping on the scale this morning, which can go up and down by, gosh, anywhere from one to five pounds on a day depending on what you've eaten the day before, how good your sleep has been, whether or not you're dehydrated. So, I love that you've touched on that.
Now, one question I received over and over and over again, and I have to ask it is, what are the best exercises, or exercise, or combination of exercises for the average middle-aged woman who's looking to lose body fat? Because in our groups, we talk a lot about strength training, and just being active, and doing some type of flexibility training, and making sure you're getting enough sleep, but obviously you may have a very different answer and not everyone can do hardcore HIIT or Tabata. I always tell people, it's good to get a little breathy, but if it leaves you as you mentioned, needing to go home and take a nap, or you're so exhausted, then you've done too much. We can touch on it when we talk a little bit about hormones, how we can overtax our adrenal glands in perimenopause and menopause by just doing too much, which we're all prone to doing.
Debra: Right. Yes. First of all, to answer that, none of you are average by the way. [laughs] But for that woman who has those goals, I want to see more muscle than I'm seeing more fat, and potentially lose or keep the fat off, best exercises are going to be those for major muscle groups that are compound in nature, which typically means we're moving more than one joint. Here's the worst, absolute. If I would see a trainer working for me in the gym clearly standing with someone who most likely had a weight loss goal, doing standing one-arm dumbbell curls, she was going to be in my office as soon as that session was over explaining to me why that was important. There is no way that you want to spend your precious exercise time doing that. Movements like squats, lunges, and I'm going to come back to if you're saying, "But my knees," no, there's a substitute. If you can't, there is also this. If this then that, we'll come back to it. Chest press, bent-over rows, or any kind of pulling. If you're in a gym, a lap pulldown, or a rowing machine, those are some of your best core exercises.
We use that word 'core' a lot but when we say core, the middle and the meat of all that you're doing should be centered around those kinds of activities. You're going to stimulate the most muscle mass, which is going to in turn stimulate the most metabolism boost during that exercise. The difference between say, a bar class-- and I was a dance minor. So, I'm not discriminating, but the bar class and being in the weight room actually doing squats, and lunges, and chest press, although you may get some muscle toning work, the exercises you're doing here are more isolative, and isometric, and small range of motion, and not enough to actually take you to that muscular fatigue. Even though you may feel the burn over here. It's not the same. It's just not the same as going to full range of motion thinking about you've got to push yourself up out of a chair. That's not a big deal right now, let's hope but in 30 or 40 years it is, so you're training for that right now, that marathon that you're going to do.
It's those types of exercises where we're working on big muscles of your chest, of your back of, your lower body, the glutes, the quadriceps in the front of your thighs, the hamstrings in the back of them, and then I like to think of it as a bullseye. That's your middle. That's right there, target. You have 10 minutes to spend three exercises. A squat, a chest press, and a bent-over row done three times. That's the best way to spend that 10 minutes. You're going to get the most bang for your buck. You are staying consistent, check. I'm somebody who exercises regularly and I stimulated my metabolism.
If you have more time than that, then outer range becomes things where you're actually doing a little bit more isolation. Maybe it's bicep curls, maybe it's a tricep press, whether it's overhead or it's behind you depending on who you are. Maybe it's a longer lever with a bicep curl and a tricep kickback. Maybe it is a machine where you're doing a leg extension and a hamstring curl. So, fewer joints involved means fewer muscles involved. Still major muscles, but that's how you would spend the next layer. Then, that outer layer is much smaller muscles and although important, especially, if you have an injury for instance, a shoulder injury, by doing small lateral raises, or front raises, or reverse flys for your shoulders, because we're getting smaller and smaller. If we're talking metabolism, big muscles, then fewer joints, but still large muscles, and then your smaller muscles. So, that's metabolism and bone density in a nutshell.
Cynthia: I love that because it provides this visual representation of what we're really aiming for. Strength training at least twice a week. Being active, I always say that's just part of living, like we breathe, we need to remain active. What are your thoughts on flexibility work like people doing yoga one day a week, maybe, that's on a day where they're taking a day away from the gym or doing solid core? For full disclosure, solid core has become one of my favorite things to do, because it challenges me mentally and physically. In fact, I was away for three weeks. I took my first class this morning, because we moved last month. I actually told the trainer, I was like, “This class is humbling,” because I think I'm so strong and then if you're away for a little bit of time, you're like, “Oh, there's those muscles I haven't worked in a while." I may have worked the larger muscle but now for me, it's usually an off-day exercise that I will do but it's something that I definitely enjoyed. But I'm curious what your feelings are in flexibility work, and yoga, and things like that?
Debra: Yeah, well, first of all, it's a little bit like vegetables. Nobody ever ate too many vegetables. Nobody ever stretched too much or did too much mobility. And for some who might be here and it's been a while since you've exercised, starting with just mobility and take the just out, because that potentially for the first couple of weeks would be the best thing that you could do. You'll be opening things back up, getting rotation, and extension, and flexion, and lateral flexion back into your body and to your spine, so that adding more, that next step will be more comfortable when you do it. When we're exercising and it's more comfortable, that's outside of what you've just said. The challenge of exercise is different than it feeling uncomfortable for you to be in doing the movement. But you're going to want to rinse and repeat, right? So, it should feel comfortable.
But I think flexibility every day and that might mean that at the end of every time that you exercise, there should be some mobility and flexibility work. I'm slipping that mobility word in where we grew up hearing it as flexibility. Muscle strength, muscle endurance, flexibility, these are components of fitness, and yet, we don't necessarily want flexibility for flexibility’s sake. We used to have you sit on the floor and do the seated toe reach right, and then we were like, “This is a really bad test. So, all we're seeing is rounding of the back. We're not really seeing any measure of flexibility.” What we know is, we really need mobility, the ability for you to move in your full range of motion. That's what's truly important.
Whether that is your preference to do Pilates or yoga-- and I'm not familiar with solid course. Now, I have research to do after I get off. So, you've created a little work for me. [laughs] I've got to go look and see what that is. But getting some kind of full range of motion work in every day and the most logical time to do it is doing it after you've done a workout of some kind, gone for a walk, you've done strength training, you've done your intervals because then your body is warm, the muscles are pliable and ready for that range of motion. So, always a great time to throw in five minutes at the end of a cooldown is enough to get regular work in. And then, if you have a Pilates, or a yoga, or a solid core class that you do in a longer stretch, and for those of you who really love exercise and find it really hard when I say, potentially do less and you'll get better results. Sometimes, those kinds of classes feeling in for you instead of doing it, it's like a smoker. If we take that away, we better put a pen or lipstick in your fingertips. Similarly, you can put something else in there just as long as it doesn't throw you under the bus.
Cynthia: I love that, and I think it's important for many of us that really do love being physically active. For me, we're in a position where 90% of our belongings are in storage right now and that includes all of my home gym equipment. Without having a gym, for me, I'm almost like a dog with a bone. It's like I need to do something that keeps me intellectually and physically stimulated at all times. Now, you’ve mentioned at the very beginning that you do take supplements, and I'm very open that I do as well. What are some of your favorite supplements to recommend or suggest to your clients that benefit them in terms of their results? I'm curious because my family laughs. We move, I had boxes of different types of supplements that I like having at the ready. I may not take them every day, but you're starting off with the supplements that you find are most beneficial for the average client that you're working with. Obviously, there is no one that's average per se, but for some of the things that people are looking for when they come to you, would have been some high-point beneficial supplements that you have suggested.
Debra: Yeah, definitely. Of course, just the basics. I take a multi, very high quality. But for a lot of women, these things, and I'm sure we're probably going to be on the same page here, but vitamin D, we all know we need it, we need that sunshine. But as far as exercise goes, it's fast-twitch muscle fiber supportive. What does that mean? Two things. I did a whole media tour around the country back in the day we used to travel. This was a couple years ago about fast-twitch muscle fiber, because even though, a lot of us are doing interval training, we may be doing that interval training, say, running on a treadmill or up a hill, that is still not fast-twitch muscle fiber.
Our fast-twitch muscle fibers are responsible for two things or reaction skills. Fast-twitch muscle fibers are stimulated when you're doing something, your kids might do when they go to camp. You're doing a ladder drills, you're doing quickly moving through the tires, or through a ladder, or you're imagining it on your tile on your floor, or the boards on your deck, and you're moving quickly, and rapidly, and doing a fox trot, like a one, two, three, one, two, three. One, two, three, and that kind of reaction skill, or somebody behind you throwing a ball at the wall and you have to respond to it, that causes fast twitch. If you play with a really poor tennis partner, that causes you to need your fast-twitch muscle fiber. That's good too. Those kinds of things we need so we don't trip when we're older and we need those reaction skills actually now, because we're seeing falls happen earlier and earlier for women who are not training for fast-twitch muscle fiber. I'm saying 40s to 50s is when that's starting. So, that's number one, reason for vitamin D.
The second one is metabolism. It's very related to your metabolism. Fast twitch is also related to anaerobic work, which is what strength training and high intensity interval training are. We need core muscle, you need that vitamin D, and so many of us are deficient and insufficient as you know. I recommend testing, that way you're not just shooting blanks and taking the base, because if you're dug into a hole, you've got to fill that hole up. The base is not enough for you, sister. So, that's one. Magnesium, more so because it helps with recovery and getting to sleep. But a lot of my women will say, muscle cramps. I've got muscle cramps, and I'm getting headaches, and migraines, and I can't sleep. Getting adequate sleep, high-quality sleep, and whether it's longer or not is really crucial to your recovery from exercise, so you feel like you can exercise when you get up in the morning. It's kind of a vicious circle, whichever way it starts for you. Magnesium is a big one. And I've noticed this. Having worked with more women in midlife over my whole career that they don't tell anybody but a very high percentage of us is constipated and we just tolerate it. I found that increasing magnesium will often help them overcome that and stop tolerating it. Then, you actually feel like exercising. Nobody feels like exercising if they're feeling full and bloated for that reason.
Omega-3s. So, if specially if you are somebody who either has joint and ligament issues, and there are some studies about people who have really severe knee issue and pain. The higher doses of Omega 3 that they took, those who were like the worse off, did better, and got the most results which is a lot like having a lot more weight to lose. You'll see progress sooner than those who have just a little bit of weight to lose. But the clinical studies, the doses were something like 6 to 9 grams, which essentially is six to nine times the dose on a bottle, typically. So, I'm just telling you that for information sake and I will tell you what I do.
When I am training or was and I think my days of Ironman training may be done. My body is just telling me I'm done, and the last one didn't go so well for me. There was like, “No, no, no." Typically proved to myself that long endurance exercise is really not great for women in midlife. But I would do three times the Omega-3. So, I was taking about 3000 grams a day, doing 1000 at three different times to help decrease inflammation. Again, you typically have it anyway and then if you're adding exercise to it, that can make it fire up even more. I find for women who've got arthritis, or who've got low cartilage levels in their knees and find they're very uncomfortable, that improves as they experimented with Omega-3s and increasing that more into their diet. So, that was a big one.
Those are probably my biggest three but the last one that, this is more recent for me than normal, and never ever, ever in 37 years, and I bet you can relate to this, have I ever had somebody say, “Debra, I just love taking supplements.” So, I'm not very quick to say, “Have you thought about this?” Because who loves that? Nobody. I don't either. Even though I know this is good, I literally hate taking them. Amino acids. for too many in my community at Flipping Fifty, I'm getting more and more women who want to or have done so for heart health reasons and their doctor has advised go plant based, and it is almost impossible to get adequate protein on a plant-based diet without getting full. Because every plant-based protein source as a lot of fiber, has a lot of carbohydrates, and you just reach a quota where you can't take it anymore, and there's a lower amino acid profile to it. So, comparing a steak, to chicken, to salmon, to plant based, to collagen, that downward slide, we've got to figure out how can I get it, if not that.
Amino acids have really come into conversation with me and clients for that reason. But even me, and I'm diligent about eating three meals a day and taking in at least 30 grams of protein at each, but really, for where I need to be body weights and grams of protein, I'm not there in that, and I can't eat more at each meal. So, I've started adding amino acids, and I've tested them over years, but never consistently and diligently until very recently. So, I've come to introduce them, and I'm using them every day in sliding scale. If I'm doing strength training, I'll increase it just a little bit more, and I'm doing a couple different doses a day. Otherwise, it's there, and yet, as I say that, it's food first. So, I don't want somebody to immediately think, “Oh, good. I can skip that meal, and I can just take the aminos instead.” I think we've got to think about the whole collective micronutrients that we need from the foods we're getting, not just taking it in a bottle. But it's like get there with food as far as you can go and then supplement where you need to go the rest of the distance.
Cynthia: I think that's a really important distinction to make that we-- I always say, it all starts with food and then adding in supplements if you can't get there. Now, vitamin D, for those that don't know, it's involved in immune function and actually given hopefully, the downward trend of the pandemic, we know that those individuals with the lowest vitamin D levels generally tended to be the most metabolically unhealthy and the ones who had the worst outcome. So, vitamin D is involved in immune function as well as insulin sensitivity. So, you obviously want to make sure your vitamin D levels are therapeutic. I like to see values above 60.
Magnesium, without question, this is an electrolyte that all of us need more of in our lives, and I always say if you're stressed, you need more magnesium. Obviously, there's different formulations. I think magnesium glycinate is awesome. If people are dealing with constipation and as you stated, no one wants to deal with constipation. Many people still are uncomfortable talking about the fact they're not having bowel movements. I tell people all the time, constipation is not normal nor should we normalize it. So, it's important that you're having a bowel movement at least once or twice a day. In fact, in my school, I was taught you should have one after every meal, and I'm not sure everyone has enough time in their schedule for that.
When I think about Omega-3s, a lot of this has to do with the fact that the number one consumed fat source in the United States is soybean oil, which is an inflammatory Omega-6 seed oil. If you think about that in and of itself, most of us are inflamed to begin with. I think that's a nice addition.
The amino acids piece, this spins everyone's wheels. I know, when I was talking with Gabrielle Lyon recently, she had mentioned, “If people find one gram per pound of ideal body weight really overwhelming, just aim for 100 grams of protein a day.” That could be your 30, 40 per meal, and then backloading from there. Amino acids are a great option. Sometimes, I'm trying to get them in my kids, because even trying to keep teenagers, they're constantly hungry, that can be problematic.
Now, I want to be super respectful of your time, but I do want to touch on just one more thing. On your website, I read a statistic that I thought was really-- It's a good way to bring home to women, the hormone piece as it relates to middle age. So, the loss of estradiol, which is the most active form of estrogen prior to going through menopause, can increase visceral fat by 10% in six months. I'm going to say that again. The loss of estrogen can increase visceral fat, so the fat around your organs, your belly, etc., by 10% in six months. I want to leave the listeners thinking about how this loss of estrogen, and progesterone, and testosterone as we get closer to menopause, how that can manifest. Because I know both you and I have spoken privately, and I had initially been very anti taking bioidenticals, or hormone replacement therapy until I had-- This is funny. I can laugh about this now, only because I'm now more informed. But until I found out I was osteopenic, I was also losing muscle mass. Over the last two years, I've lost so much muscle mass. And then, my sleep quality was really starting to slide. Despite doing all the things, it was becoming an extra job to try to make sure I could sleep through the night.
The thing that's interesting is the first night I took just oral progesterone, I fell asleep in the bed talking to my husband. He looked over at me and he said, “You just fell asleep like instantly,” and I woke up in the morning in corpse pose, like I didn't move. My body so desperately needed progesterone. So, I don't want anyone who's listening to feel fearful about the possibility of hormone replacement therapy or bioidenticals, and obviously, every person that's listening has different needs, has different philosophies on this, but as a healthcare provider, I have never felt better. In fact, I don't think I realized. I think it was a slow drain on my body that I just had gotten very accustomed to not waking up without an alarm anymore, and really struggling to stay asleep, and losing muscle mass, obviously, bone mass, which is a whole other topic.
I'd love for you to just touch on the things that you've seen working with clients, the before and after. How they feel, how they respond to exercise, how much more metabolically flexible they become with the addition of that hormonal support. Because once we lose it, our body will try to make more estrogen, but it makes a weaker form called estrone through fat tissue. Our body really leans on the adrenal glands to make more progesterone, but it makes it harder for our adrenal glands to respond to stress. So, I'd love for you just briefly touch on the things that you've seen working with clients, even with yourself, as it pertains to replacement of those hormones that we've lost.
Debra: Yeah, you're such a great example really, because you are small. In stature, you're a small person, and yet, I've got a lot of women in our community who don't all need to lose weight. Some of them are small. They really don't have any weight to lose. They definitely have lean to gain naturally so that they don't become frail. They've lost lean muscle or bone density, but they've also gained that belly fat. It's like they've had a relocation, not necessarily a gain, so typical. I think a mutual friend of ours, [unintelligible [01:04:13] will say, that it's like evolution, is that reason for that 10-pound weight gain that happens and tends to deposit around the midsection and or no gain, but still a deposit around that midsection is almost your body is protective factor for you've lost that bone density protector. It's actually gaining weight to help you have more support against your bones. So, the theory behind that is heavy women, so larger-size women very rarely have bone density issues, unless they've been long term on medications that have affected them.
What we've seen, during the pandemic, there's been some really great changes. Prior to the pandemic end of 2019, I had a woman find me-- ironically, she found me online and realized she's 20 minutes away, and she's like, “Oh, my gosh. Can I meet with you in person?” I rarely do that, but it is actually super fun for me to see real people. So, I said, “Absolutely. We'll do that.” She was diagnosed with osteoporosis. As it does for so many women, it feels like somebody just pulled the rug out from underneath you. You feel like you're thriving you're healthy, and then feel threatened, like what does that mean for my future? I'm a grandmother, I run a company, this was all going through her head. We met a few times in a gym, and I showed her, "This is what you want to be doing," very similar to what we talked about. "These are your core exercises. The most important for you. These are the things I want you to do." Pandemic hits, and then we met once or twice via Skype, and I said, "This is how you're going to do these things at home. Same idea, different way of doing it with your dumbbells at home, and this is what we're going to do."
I also suggested something to her that you may want to weigh in on but AlgaeCal. So, she went on AlgaeCal as a supplement. I want to make it clear that weight training alone will not increase your bone density if you're a woman in menopause or post-menopause. We can't do that. What we typically are doing is slowing losses. If we slow them down, and instead of losing 1% to 3% of your bone density a year, you lose 1% or you don't lose any. We've made a significant change in your health, and that accelerated loss of three to five years during menopause, that's going to be significant for your future.
But she contacted me after she went off on her own, she was doing it at home. She's the CEO, she's a woman in charge. She did not need me to connect with her week to week, but she contacted me almost a year to the day. She had her next bone density scan, and she had increased her bone density by 1%. That is so rarely heard of, but in studies for AlgaeCal, and I sound like a poster child, I'm not related or an affiliate for them, but I have found that it works. It works without risk that I know of to date for anyone. The results have shown over time that increase happens even longitudinally in a seven-year study, 1% every year, and that's huge. So, the ability to feel like, "I'm doing something proactive, I am seeing the results, this is actually working," her doctor was thrilled, not only about the exercise program, but the combination of the two. She's like a star in the community for her doctor and AlgaeCal. So, we've seen that.
I've seen a woman who was on her way to losing 100 pounds really seeking that and in her mid-60s. So, listen, it's never too late, and she crossed the 100-pound weight loss threshold exercising at home during the pandemic. So, seven months, she didn't lose all 100 of that, let me make that clear. But she got the rest of the way and I think she's at about 104 pounds loss total now, but she is exercising at home and she's like, “I thought about going back to the gym now that it's open, it's just so convenient. I think I might stay at home,” and she's having great results. So, we know it's possible. If you're at home and you're loving it, you're loving the convenience of it, it's a viable way to do it.
Cynthia: I love those stories. It's so inspiring and encouraging. I don't know about AlgaeCal. Much like you not knowing about solid core, I'm going to have something to go read about. But certainly, for me, that was a huge determinant of why testosterone was something that is part of my hormone replacement therapy, because that was the concern was, it's not going to get better. It's going to get worse unless we're really proactive.
Well, I want to be super respectful of your time. How can listeners connect with you? I know without question based on the amount of questions I got prior to our episode today that people will want to connect with you, how can they work with you, how can they learn more about you? You've got a great podcast. I was enjoying listening to it over the weekend. How can people connect with you?
Debra: You can find me at flippingfifty.com, so that's all words spelled out, and if you're interested in just sticking a toe in the water, I do a 5-day flip, the number five-day flip, flippingfifty.com/5-dayflip. I'm everywhere on social @Flipping50TV. Flipping Fifty TV. So, look forward to connecting and answering questions. So, feel free to reach out. If you've got something we missed and didn't get to.
Cynthia: Well, thank you so much for your time, my friend. I'm looking forward to seeing you next month in California. For listeners, obviously, Deb and I went almost an hour and a half. So, your questions have definitely influenced the direction of the conversation. We'll definitely have you back again.
Debra: Thank you so much.
Presenter: Thanks for listening to Everyday Wellness. If you loved this episode, please leave us a rating, and review, subscribe, and remember, tell a friend. If you want to connect with us online, visit the link in the show notes.
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