Body Composition, Muscle & Hormones: The Gap Between Research and What Actually Works | Proof of Practice

0:00Today, we are going to start our discussion about research, because we've heard so much about research and how it's the be-all, end-all, and everyone knows that science evolves. So part of it is understanding where we've been, where we're going, and part of the myth and the reality of what we're seeing and hearing from influencers, from popular media, from the scientific journals, we hear a lot about how there isn't enough research done on women,

0:31and the methods aren't that great. We know that this has been in the past, but there is a huge influx of properly well-done science that is occurring now, and we're starting to see the evolution of some of the practical aspects that we're seeing applied to women. So part of the conversation we want to have today is to talk about the different perspectives, because that's what we do with all of our different expertise, but also try to disseminate some of the realities behind the practical outputs that we're seeing in some of the research.

1:03So I kind of want to start this discussion with some of the things that we have been talking offline about how we, from our medical background versus our applied science background, how we might view something like a DEXA. So I know from looking at some of the DEXA research and stuff that I've been doing that the interpretation is really about body fat or how much lean mass is there, but what is that as a practical outcome? For me, I'm looking at visceral fat or that active belly fat that can impact so many things

1:36like cardiovascular disease, diabetes, metabolic syndrome, and no one really discusses that. So if we look at it from a patient point of view or even athletic point of view, there's so many people who are so determined about getting a low body fat and higher muscle output, and then they're relying on the DEXA to tell them that. But when we look at the pure outcomes, the health outcomes can be different from what we're seeing on the results outcome. Yeah. And I actually think that that's a great place to start, body composition. Who doesn't want to talk about that?

2:07Um, the challenges I think that we have is that for the longest time, we have not really been looking at skeletal muscle. It's a relatively new science. And when I say new science, you know, when I was in fellowship, they had just begun, and that was 20, well, let's just say 20 years ago is when we really started, roughly 20 years ago is when we really started looking at skeletal muscle directly. Um, and, you know, Abby and I were talking about what that means and, and really thinking about the quality of the skeletal muscle, the quantity of skeletal muscle, because right

2:42now the obvious is body fat, and it's extremely relevant. The way that we measure body fat routinely is a DEXA. It's wonderful at body fat and bone. It extrapolates the rest of lean tissue, which is in entirety, organ systems and everything. Um, and why is that challenging? I think that from my perspective, the positive is it allows us to track over time something to change. The negative is it tells us very little about the metabolic organ of muscle.

3:13And, um, with more advancement, like utilizing an MRI, most people won't use a CT or something like a tagged creatine is how do we then advance to looking at skeletal muscle? And I don't actually have that answer on a totality, um, you know, population level. So I want to bring it back also because, um, I understand exactly what you're talking about, but then there are other people who don't even understand what muscle is. So we talked about skeletal muscle, but then there are other types of muscle in the body

3:43too, cardiac muscle. So when we're looking at overall metabolic health, yes, skeletal muscle is the primary driver of what we're looking for. But if we were to, like, if I were to turn to Amber or Gabby and say, what do you want to know about muscle? What is it? What is skeletal muscle versus cardiac muscle? What are some of our general questions? Yeah. I think when I think about muscle, we don't even, you don't even get into the idea that there's different types of muscle doing different types of function. You just think I have it. I don't have it.

4:14How do I build it? How do I keep it? And I think what you'll see with a lot of people is they can hear all of this and they go, I get the test and even I get that input, but they don't actually know how do I either stop losing muscle? How do I really gain muscle besides lifting weights? How do I attack that process? But then also how do I support that process through my eating and my resting and such? And I think for a lot of, let's say householder individuals, it feels like an impossible uphill

4:44climb, especially if you didn't start early. I'm looking at everyone at this table. There was some kind of beginning and start early. No, mine was last week.

4:56But I'm just, you know, it's like one of those things where, so it's one thing if you have momentum. So maybe the starting point would be if I have no momentum and I'm starting out and maybe I'm not even metapausal, maybe I'm just a busy adult woman or male. And the other part is I have momentum, but I want to turn it up because I think we get stuck in both places. Absolutely. Can I add from a measurement? So I spent a lot of my career dedicated to measurement. And when we think about DEXA, it goes a little bit back to what you were saying of it doesn't

5:29measure what we think it measures, but it's a very good tool for tracking changes. And so if someone's starting, we actually use DEXA a lot because now there's many places people can get it measured. And it allows you to say, where's my starting point? How much muscle do I have? What's my bone look like? Where's my fat stored? And how much do I have? Is it actually measuring muscle? Not really. And how valid is it? Meaning how accurate? It's not great accuracy, but at least gives you the starting point. And then so when you make those changes for everyday people, it's helpful to see, am I

6:03making a change? And what are you doing having an impact? And that's sometimes helpful for behavior too. I think as an everyday person, I'd even start with, when do you get a DEXA? I've never had that. I work in fitness. So I'd be interested to know, when do you get it? And then what is the data that matters? You were talking about the different types of fats and different types of muscle. To be honest, I wouldn't know what's good. I wouldn't know what to ask from the results from that test. What do you two think about that?

6:34Or maybe all of you? Well, I can kick it off with a clinical perspective. And starting at baseline, everybody gets a DEXA. Again, it is very accessible. And the thing that we're looking at is percent body fat. And depending on their age, bone density is important. And then visceral fat. From a muscle mass perspective, I've deeply struggled with this for a very long time because we don't have an optimal muscle mass. Someone could say, all right, well, you want it 50% of your body weight or, you know, whatever

7:05the number. It makes up 40% typically. But I would argue that I couldn't tell you what your optimal muscle mass is. We just, again, the interpersonal variability is extraordinary. But what I can tell you is that if you are 30% body fat or if you are 25% body fat for a male, you would be considered overweight. Would you say it's accessible to most people? I feel like your clinic is a bit unique. So most women can't and most people can't get a DEXA unless you pay out of pocket or you are much older until you hit 60.

7:36Great question. And what I would say is there are other tools. Again, whether you're using an impedance scale, an in-body scale, many gyms will have it. Let's say an individual is, I don't know, in a rural area, one could potentially use a waist-hip ratio. But I think that the scale, like getting a scale on Amazon, because again, from what I understand, the accuracy, the error rate is about 3% to 5%. Is that – would you say that that? Yeah, the scales, you just have to be careful. One, that you have more points of contact and you do it in the morning after you've gone

8:10to the bathroom. So then they are about the same as DEXA for tracking changes. I'm buying a scale. Yeah. If I look at it all as tools, like people are so dedicated to the data and that starts to get people in the weeds. So as you're saying, it's a starting point. So do we need a DEXA as a starting point? It's becoming one of the trendy things. And yeah, it is a really good tool, especially for women who are looking to track bone or see changes in body fat or visceral fat. But part of it is we also need to be able to teach people what inherently they feel.

8:44And research will say one thing, but is that really optimal for where I am in my life right now? And I think we've gotten so involved in data and listening to external factors that people have forgotten what it means to feel good in their own body. And if you're putting in the work and your body composition is changing, you're going to feel that. But it's not immediate. I have so many people who don't understand that it takes time to put on body fat. It also takes time to take it off.

9:14It seems like it takes very quickly. The body fat escalation seems to happen, you know, and it's kind of like money. You can lose it way faster. Yeah. Gabrielle, I'm curious when people come to you and you can lay it all out. Like you have a patient, let's say they live a moderate lifestyle. So they're at least aware, like I'm trying to walk after dinner, I'm trying to eat real food. And they come to you and you go, okay, we're here. Here's your test. Here's your scores. This is what it looks like. If what are, what are the things that you have to reinforce or put in place for them?

9:48And typically what are the things that they have to add to their practice to kind of support this quest of moving in the right direction? It's a wonderful question. And I think that if we looked at the totality of our environment, the majority of people don't work out. Plain and simple, 50% of Americans aren't even moving. Over 70% are not, meaning these baseline recommendations that are 150 minutes a week and two days a week of resistance training. The fastest needle mover is going to be the input of exercise, which actually all of you

10:19can speak to. Nutrition is crucial. It's something that everybody does. We all eat. We should identify what works best for us. I think for myself and our practice, we have foundational protocols and ways of thinking about things to support skeletal muscle. But I will also say that you can take the best of evidence-based research. So we know that dietary protein is important. We know that we need more as we age. But there's also flexibility in that inter-individual variability.

10:52And so that's what I would say. You have to assess where someone is and ultimately what their goals are and their standards for where they want to be. Some people, they're not necessarily interested in losing body fat or gaining muscle. True. They're not? Sometimes. They just want them to be skinny? Or they're coming to us for other areas. For example, if they have gastrointestinal problems. You know, whatever is most painful will drive decisions.

11:22Whether it's gastrointestinal issues, whether it's joint pain, you name it, whatever is most painful will dominate. And you have to address that first because underlying to that will be motivation and the ability to execute. We were joking around about dinner where something we're talking about, like certain protocols or, or, or workouts or things like that. And somebody said, it might have been you, Amber. Yeah, take that money and get a personal trainer. Do we think that that might be a fundamentally like sound starting point for people?

11:56Because I think a lot of people are overwhelmed. Like if I go to your page and see you lifting weight and, you know, Dr. Sims, like doing all these different lifts, I think for a lot of people, this, you've lost them. They're gone. It's a language they don't understand and they don't know the entry point. And, and I think it's really important to, to delineate from what everything you guys are saying, that that's not what you're talking about when you're talking about lifting weights and building muscle necessarily. It doesn't have to be this sort of max effort, huge weight, all these things.

12:29So I think that that's also really important to parse out for people because they think, oh, I have to be like them or lift that and do that. And, and that's not actually what you're talking about. Yeah, not at all. And I'll just mention this and then kick it over to you guys. We, I worked on some of the early body composition studies in perimenopausal, postmenopausal women, and I worked in Dr. Donald Lehman's lab. He would cringe if he knew I'm going to tell you the amount of exercise that these untrained individuals did. Are you ready for it? Yeah. Abby knows.

12:59This was five days a week of 30 minutes of walking. That was their cardiovascular activity. And two days a week of quote, in the papers, it says resistance training. It was yoga. It was body weight stretching. Wow. They were able to, with appropriate dietary protein, calorie control, were able to lose body fat and maintain the majority of their lean muscle or lean mass. Sorry, we didn't measure muscle directly, but lean mass. And that's what they did. That was their regime. That's it. I think that's awesome. I think it was between 12 and 13 hundred calories.

13:31I can do that. Yeah. Oh, okay. I think it's because I work in the gym space and we're seeing people start up to pre-pandemic what they were going to the gym before, but it's still a big startup. People fell out of it. But I think to your point and to what we were talking about earlier, some people just don't know where to start and the research does get confusing. It either looks like I need to lift super heavy, which I'm trying to do more now because I learned from all of you, but then people get scared and they don't even walk in the door or they don't start it in their living room.

14:02So I love this research that says if you can start just with anything. Any movement is better than none for the most part. And I, I come from high performance background. So everyone thinks that I just work with high performance athletes. It's not true. I did, but now I'm working more with general pop and women who are active or want to get more active. And I'm always like, it's not a training block. We're not looking at a periodized program. We're not getting into the weeds of high performance. I want you to think about what are you doing now that's going to benefit you 10 years from

14:35now, 20 years from now, 30 years from now, because we think about strength training and if it's starting with body weight and you're doing body weight squats, and then maybe you're adding a backpack with some home goods in it to add a little bit of load. It's about loading the body in different ways. And over time, you're going to be able to increase that load to maybe you're doing dumbbells, kettlebells, and then you feel confident enough to go to the gym and learn more compound movements. It doesn't mean that you start from nothing and you have to go immediately into the gendered

15:06idea of a gym where, as I was saying the other day, you walk in as a woman and the first thing they say is, how much weight do you want to lose? And here's the cardio. And as a guy, how much weight do you want to gain? Here's a lifting platform. Like, it's a very intimidating area to go into. So if you can start small and know that this is a lifestyle change, it's not a training block. I think that really gives people the ability to understand, okay, well, there's this one small thing I need to change right now. And I'm going to focus for the next three to four weeks of really implementing two to three

15:38days a week of just maybe 10 to 15 minutes of body weight work. That's a start. It's not, I have to carve out time and go to the gym for two hours, four days a week, because that's not feasible for a lot of people who even make exercise a priority. So I think part of this discussion of busting myths and understanding research is where do we start? What's the ideal? How do we pull it back to general pop? Yeah. I mean, because we all work with varying different levels of activity, varying different levels

16:11of motivation. The other conversation that ever, never is really pulled into is the sociocultural process. Like how do people grow up with the idea of exercise or not exercise? As you were saying, Gabby, what's your starting point? Did you start in sport young? Well, if sport is a really foreign thing, then the conversations that we have about lifting and high intensity and doing this and doing that is completely foreign and scary. Yeah, very scary. And it's, and I think you get, then you add to that, and like if you didn't grow up with

16:43brothers, let's say, I think brothers are helpful with kind of knock around practices is, is they, they have this idea if they have no relationship with it, I'm going to go into the gym and I'm going to get muscly. Yeah. And we all know here at this table, how difficult that is to build muscle. So I think it's also, um, I know I don't want to mess up my makeup and then I've done my hair. There's all these weird variables that keep people from getting sweaty and getting out of their day. Yeah. That they'd rather not do it. Um, I'm curious because you, all of you are busy people, very busy and you have children

17:18and so bringing it to real world and the low hanging fruit side for, for you all, you know, what would you, if on a day you had 15 minutes, cause I think that's what a lot of people are looking at and like the decision to do it or not, but they do have 15 minutes, you know, what are some ideas that you would give them as, you know, something that they could start to implement and maybe build, you know, get these mini wins in their week.

17:48One of the easiest ways that I have people start is thinking about doing, uh, one exercise, well, four different exercises every minute on the minute. So it might be doing, uh, air squats for 50 seconds and you translate over into wall pushups and then you translate into maybe doing step back lunges and then you translate into doing, um, setups and then you have a full minute off and you go through that circuit two or three times and you're getting relatively total body and you're done and dusted within that

18:20whole 15 minutes with a warmup and a cool down. So it doesn't have to be like really high intensity, it's just the movement and you are putting load on the body.

18:30And, you know, um, I was talking to Abby yesterday and Abby, um, has done a lot of work in high intensity interval training. And I think that there's a lot of good dates. So number one, I would definitely start with what you're talking about. The less time you have, I don't want to use the word, the more aggressive you have to be, but you do. Well, that's reality. I think that's the other thing too, is you don't want to, I always say it's like approach all of this with a hundred percent accountability and grace. You can't BS, you can't say to them, you can't, your patient can't come see you and you go, Hey, you say these are your goals and I'm not going to tell you the truth about

19:02how to get that. At some point people have to get involved. And I will tell you what I tell them. Are you ready? Yes. If you feel like you don't have time for exercise, how the hell are you going to have time for sickness? Right. I mean, that's way more time consuming. It's a big statement. But it's way more time consuming. Yeah, it is. Wow. We talk about 15 minutes. Do we really only have 15? I mean, I don't know. Priorities. We could probably get in 20 minutes.

19:33And listen, you could have a great workout in 20 minutes. If you, the more untrained you are, the beginner listening, the better result they're going to get. The more advanced. I know that for all of us, we could all get a great workout in 20 minutes. I've seen this one workout. Kettlebell sprints, whatever it is. And, you know, you build up to that, but it is dialed in, focused intensity with meaning full body movements. Yep. You don't meander in. You have the plan before you walk in. Absolutely. Yeah.

20:03And part of it, I think we were asking, like, how did we get to this point? Why do people not exercise when the body is inherently made to move? Like, I feel like we've all been conditioned to live in a certain temperature. Everyone's around 68 to 70 degrees Fahrenheit in their rooms year round. Don't like to be challenged. Find the sweat part uncomfortable. Some people don't like the heart, high heart rate. And there's so many variables because we've just become so inherently conditioned to not

20:36be uncomfortable. Whereas I, as a person, push myself to be in uncomfortable situations to grow and to learn. But I don't think that's the norm. This is where I would say it begins with our youth. And if we can train them young to understand that the body loves stress and uncertainty and chaos. I mean, listen, we were talking about Rich DeVinney before, might not love it. But if you learn that that is a normal part of life, then you are much less likely to become

21:10sedentary and seek comfort. And really, it's our responsibility. Well, you look at kids on the playground, they're all over the place, right? They're playing, they're running, they're trying everything. And then you have to throw them into a quiet space to learn in a classroom. Where I like the idea, some schools have kids come and they run first thing in the morning or play really aggressively first thing just to get some of the energy out. And then they have the opportunity to sit and learn. And then they go out and they do more playing. But we pull that out.

21:41We don't have recess when we're going to work. Yeah. We don't have. But we should. We should. We should. Because like when you said you only have 15 minutes, my palms started getting sweaty. I want 25 minutes because I want to do a 5K run. Except I'm trying to get the weights in and more of the circuit training that I'm learning from Stacey. But I think that's only because starting young and starting those habits. But then even in adults, we see that once people start, and ideally if they get into a community that's holding them accountable, then they'll keep the habit.

22:12But it's really hard to go from zero to one. And then again, to know what you do. So I like your circuits and going in with a plan. Because if you're going in not knowing what to do, going into the gym, I don't even know what to do with some of those things. And I work in the gym industry. So you need the plan. And then the 15 minutes is fine. But I'll get up earlier. I'll get up at 530 if I have to to get my run in. Because I know that it's better for my brain. And that's like the kids running around before school. And if I don't have that, I'm a total bitch at work.

22:43And overwhelmed. And anxious. And I don't want any of it. Yeah. Yeah. What is it? A friend says, I'm like a dog. I need to go outside and play every day to be human. And I was like, yeah, that's exactly it. I love that. So when we talk about studies, I think for people, now we have, you know, you guys went to school and we're seeking out this information. But now what you have is the regular person who has their phone. And it's hitting them all day long about what they should do. And this says that. And this exercise. And this trend. And this fast.

23:14And all these things. And what people say to me all the time is, where can a regular person, not with tons of resources, because that's the big thing, decipher. Where do you go for the good information or the studies? Or if you want to try to figure out where it leads. I'm just curious, because you guys have a lot more experience where you could hear it and be like, oh, that's nonsense right away. To another person, they might say, well, maybe I should do that. It was like fasting forever.

23:44Remember when fasting got so trendy? Then it was like, wait a second. But that doesn't mean for, you know, performance women or middle-aged women's calm down. And that was eight years in. So what places do you guys like besides yourselves? I mean, that's part of why we're here is because it was like, hey, can we create a place where there's at least we know what we know today, solid information coming out? I'm going to give a research perspective because, and the benefit of us all being here since

24:18I'm in the lab, but research is very slow and answers one small question at a time. So I almost think it's a bit of disservice to try and soak it all in and make a decision from there. One key takeaway is just start. It doesn't really matter what the science says, like movement is really valuable. But then the study that we're referencing usually was planned four or five years ago. And by the time it's published, it's old, which is why this is so important so that the data that, you know, Stacey and Gabrielle are using in the clinic is coming from things

24:51that are happening now, because then every study answers just a tiny question going back to, you know, your, your data on, they were just walking 30 minutes and doing yoga. You have to control so many things in research. So then to say, this is how we all need to translate it and implement it. It is hard to do that by just one study. And so collectively you also have to say, well, what's the reality of how do we use it and how do we implement it? And something is better than nothing. So I would push back a little bit of science and data is good, but also we have to weigh

25:25what it's saying. And just to say, okay, this one study says hit is really good. Well, that doesn't mean I should just do hit. It's one tool in the toolbox. And then like as a scientist, I'm continuing to refine it and to translate it. And so I just would say, uh, figuring out what network and looking in lots of places and then adapting it to what works for you. I think there's an element too, that we've discussed why we're here of it's overwhelming and there's a lot of, oh, I'm not good enough. Well, I can't, I can't do the 30 minutes and I might as well not start, or I don't know

25:58how to do that. But a lot of it is just saying, let's start based on, um, we know it's good. And then if you're elite, we maybe need to spend a little bit more time at, on the nuances. Yeah. And I think there's been this huge shift of the silo effect of now we hear about strength training for women. So women are just strength training and they're like, no cardio, or I'm just doing high intensity. And I'm like, yeah, I talk about high intensity because it's not done well, not done correctly. So I'm trying to push, how do we do it correctly?

26:30What does it mean? It's not the hour long bootcamp classes and stuff. So, you know, I've talked about it ad nauseum, but I don't want people just to do that. I want people to enjoy their soul food. Like I come from an endurance background on the weekend. I'm going to be out riding my gravel bike for hours and hours, but that's not something I would tell everyone to do, but that's my soul food. And for Amber, it's running, right? But we want you to strength train and not just run. Whereas power lifters, I want them to lift, but I also want them to put in some

27:00cardiovascular work for metabolic and heart health, right? So I think, again, it's the starting, where do we start? It's start how your body feels and how, you know, like improving range of motion. That's a really good start for improving range of motion. Then we're also preventing injury because then when we start adding load, we're in full range of motion and we're not going to get into a sticky point where we have soft tissue injuries. So it, yeah, we see the science, science evolves. And what I was saying five years ago is in what I'm saying now, because science evolves.

27:32We see this upsurge of all this research come out on women. So of course it evolves. So we're not stagnant. And I think also to your point, Gabby, is really understanding rating perceived exertion or how I feel today. It's like if I wake up and mentally I'm a two and physically I'm an eight, I know that I could push my body hard, but mentally I'm not going to be able to go what my body really needs. So I'll dial it back. Or maybe I wake up and physically I'm a two and mentally I'm an eight. Maybe I warm up and then all of a sudden I can do more.

28:04So people, again, lean so much into science and data and they forget what it intrinsically feels like to move or what's appropriate for our bodies. They don't even have a reference of understanding themselves in the environment. We've been talking about feeling good. It's like people are like, well, no, don't you always feel this way? You always feel a little tired or you always feel a little swollen or a little this or a little that instead of like, oh, I feel rested today. Really understanding the difference.

28:34I'm curious, especially with the three of you, because you're very analytical and there's a lot of information and data. So what happens for you? You all have children.

28:46You're at a place, you're in a day where you have the end, you know, but you're feeling something different. How do you bridge between yourselves as the doctors and scientists and you, the busy human beings, moms and wives? Like where do you, how are you navigating that bridge? Because sometimes ignorance is bliss. I have sheer will, right? I'll just put my head through it because that's what, that's what you do. Yeah. You guys have a lot of information. So I'm curious on the days where you're like, I don't want to do this.

29:17I want to eat that. I do it. You do? Yeah. Yeah. I mean, like I know that there's a persona that people see out there, but it's like days I don't want to go hard. I don't, if there's a cookie, I'm going to eat it. I think I've posted about that before. I eat the damn cookie. Like there's so many rules around what you should and shouldn't do. But if you're eating the cookie every day, maybe we shouldn't be doing that. Right. Right. And also why are you eating the cookie? Yeah, exactly. Right. Yeah. But if there's a really nice single malt whiskey, I'm not going to say no to that, but I'm not

29:54going to do it every day. Right. That's that 20%, that 20% rule of life. But like traveling and jet lag, you're like, okay, I know that if I get up and I do something, I'm going to feel better for it. But when that alarm goes off, you're like, oh my God, I'm so tired. I don't want to get up. But sometimes I sleep and other times I'm like, no, I need to get up because I know it's going to be better for me and I'm going to get better in the day as I go. Yeah. So it is really kind of listening and understanding. Yeah. I would say I do it a little bit differently.

30:27Mm-hmm. Um, we are a military family. I was going to say that doesn't surprise me. Yes. Tell us. We do it differently. I was like, no, tell me, Gabriel. You do it differently? We do it slightly different. Um, we think about, you know, I was pregnant, so I had already had my daughter. I was pregnant with my second. My husband was in medical school and I was trying to finish this book, this first book. Mm-hmm. And I was like, honey, you know, and I know I have to train. I know I have to eat right. And I said, okay, well, you're going to know you're a SEAL for 10 years now.

30:57You're in medical school, whatever. What do I do? He looked at me, he's like, just get up earlier. And his earlier was 4.30. He was then seen on milk cartons, but he was actually right from our perspective, like from my perspective, our household perspective. And this is not a typical way of thinking about things. And it's very rigid is that we think about, okay, what needs to get done in this week? I know that I've got three days of training. I'm going to hit those three days of training. They might not be perfect, but it's going to get done.

31:30In terms of nutrition, we're pretty structured. If you called me and you said, hey, what did you have two weeks ago on a Wednesday for lunch? I could tell you. And it's not that, let's say I wouldn't have the cookie. I would say that the structure helps us operate. There's a lot of variables in life. And if lifestyle is not one of them, we're good. Yeah. Can I ask, on the data one, because this has been driving me nuts recently, we were talking a little bit about HRT, you called it something else, MRT, MHT, and you both just said a different

32:09way of doing things. And I think they both make a lot of sense. Eat the cookie, have a regime. And they both make a lot of sense, but- I'm rigid too. Okay. Be rigid and eat the cookie. No, no, no. The assumption is they are rigid. Look at them. I know. I mean, you know. I know. I want to flex sitting at the table next to you. But it's this idea too, when you have a lot of information, there's an emotional component to this pursuit that you're always having to overcome, even when you know better. And that was the point. It's like, even though you know better, you're still always contending with yourself.

32:41Yeah. There's the emotion, but where I get really confused is when you have conflicting answers. Like even when we were chatting right before this, the two of you have different research and different ways of doing things, and they're both right. So in the example of the HRT one, I thought I was losing my mind, and I just started it. And I told my mom, and she's like, oh my God, don't do that. You're going to get cancer, and you're going to die. Old research. But what do you do when you hear conflicting answers as an everyday person who's not in research and who's not deep in the field?

33:12Because I'm not taking that sticker off. I want to keep my brain not going crazy for me because I feel better. Yeah. But there's totally conflicting, old or new, it's conflicting. So what do you do? Yeah. I mean, that's a good question. Like I look at it, and I blame popular media for the clickbait and taking small snippets out of science and out of research just because it grabs attention, but it proceeds to have a big snowball effect of misinformation. I mean, that's how we got into the whole situation with hormone replacement therapy and

33:45menopause is someone misconstrued some of the data and then put it out before it was actually assessed. And then that made everyone so afraid. And so there's a whole generation of women who, like your mom, afraid of taking menopause hormone therapy when it is a tool in the toolbox. It helps with brain anxiety. It's not a prophylactic. You still have to put in the work. But the data shows that now we see all the different formulations and it's safer and there is still research coming out on it.

34:17But where do you get the information? You can go to the Menopause Society and see all their guidelines. But if you go to the Australasian one, it's a little bit different than the American one. Yeah. So it's like still conflicted within the research. And that's why there's so much misinformation. So I want to speak to that because I was just looking at some of the data and I was looking at testosterone numbers for men. And in the US, low testosterone is 300. But in some parts of Europe, low testosterone is 350.

34:47And then in Canada, it's like 288. If you look at the Endocrine Society or the AUA, they have different numbers. I mean, maybe not so much on testosterone, but various groups have various numbers. The question – and I really feel for people in two ways. Number one, we have access to more information than we've ever had. I remember when I used to have to go to the library to pull out those journals to look at them and find the research. I mean, I don't know if we had PubMed. Did we have PubMed? I don't know if there's PubMed.

35:18PubMed, things were very inaccessible. And now it's wonderful that there is this level of accessibility and it does raise awareness, but it is a double-edged sword. And we also have a level of information that is not accurate. And science is a science of uncertainty. I mean, we can say, again, that this is science, this is truth, and it is just this understanding and this knowledge-seeking experience. I'm going to tell you what I do personally, is that I have people that are smarter than

35:52me that I trust because I am not an expert in everything. It's impossible. So I ask my colleagues because that is what they are doing day in and day out. For the general population, I don't know if I have an answer, but I would say that more and more groups of researchers are coming to the forefront and saying, okay, this is a totality of evidence. Here are groups that they trust. Let's say in protein research, these are protein research groups that we trust.

36:24And again, I don't know if that's helpful for people, but that's how I think about it. Yeah. I would add, too, like two things. One, if it sounds too good to be true, it is. And the science, meaning if someone is pushing science, it's all positive. That's probably not the best source. And then you said it, if it's working for you, sometimes that's all that matters because science is mean, average data. Those individual responses are really important. And so even advocating, like if you're feeling good, well, talk to someone that has that experience

36:56or the provider that can give you more insight or address your concerns. That's taking my research hat off. Yeah. I mean, we look at some of the people we were talking about earlier and they're going and creating a big explosion of information based on an N of one, meaning one person's experience. And that is not appropriate either. Which is a good, valid starting point. It is. But how do you then, again, it can't just be one single view. And even as a scientist, which is what we were talking about, I want you to say, no,

37:26that's not how I see it. Or have you thought about it this way? And it is always evolving. And one more thing to that, I have never, in the academic space, it is not disrespectful for the most part. Would you say that that's true? No. So my experience is that, for example, in lab meetings, we have a series of researchers and there is discussions and it can get heated, but it's never outwardly disrespectful to the

37:56mass public. I have not experienced that. And again, that's just from where I haven't been doing it long. You know, I did it for six years. But from what my experience was, is that the conversations were held within the universities or scholarly places. It wasn't like, hey, you're an idiot online. And I've never seen a tenured professor make rude videos or, I mean, we were just in a

38:27totally different landscape of disrespect that I think really undermines science. Yes, absolutely. Well, that's how they get attention. The thing is, you'll see people who've been in the space and maybe they even have good information and they've tried to penetrate and that didn't work. So then they create a caricature and that's how they get that penetration that they're looking for. But then they have to die, live and die by that formula. And I'll be interested, because, you know, the other side is thoughtful, nuanced, slow.

39:00Nobody's paying attention, right? What do we have? Eight seconds? Where are we at? So I think this also is a bigger conversation of you saying, for example, just start or people spending a little bit of time. Because otherwise it's just lip service. Oh, I want to be healthy. What does that mean? You hear that all the time. So it is also pushing it back to people going, hey, it is on you also to spend a little bit of time figuring out this information on the baseline, because you don't have to be in this space to go, all right, I should move.

39:33I should eat real food. I should probably get to bed, whatever the variables are. So I think there's part of that where it's kind of like, who's going to do it's going to do it and who's not is not. Maybe that could be one of the takeaways. Take ownership. I mean, of everything. Exactly. I mean, that should be one of your guiding things. It's like, oh, my marriage isn't the way I want. Okay, well, be this person or bring the energy you want to that. Like, the more we can do, usually the more it works out the way we want. And we live in a time where someone's either like, tell me what to do, or I'm the victim

40:05of my circumstance. And that's never going to get us where we want. I do have a quick question, because I am the oldest person here. Not by much. Who also looks the youngest. Yeah, I know. It's because my kids are older. No, I'm just kidding. No, is on the hormone replacement therapy, because I haven't touched it. What happened is I got a little bit of AFib after I got COVID in January, and I started getting AFib.

40:36I did take a little bit of testosterone, but I haven't really gone down there. And I know it's time, because I don't want to drop off a cliff. Like, I know it's coming. It's so interesting. It might not be, though. Well, yes, maybe not. Because the other thing is how you enter, right? Like, in my mind, I'm like, I can't do that, because of my age. And I live with somebody who's the same way. So it's kind of like, oh, we can play, and we're, oh, yeah, great. But I am going, hey, the difference between 50 and 55 is noticeable. I will tell you that. But I am going to start exploring some type of, just even doing the conversation around it.

41:11Would you do, do you guys like pellets? Do you like shots? Do you like oral? Do you like patches? Like, I'm always curious about that. Or is it just different case by case? I would say no to pellets. Okay. See, I like that. That's so clear. I'd also agree with that. We don't do pellets. No. It's just the testosterone, the numbers just go really high. And listen, some women feel amazing on it. No, I'm asking your opinion. Yeah. Like, what you guys. Yeah. So I'm going to pull on the scientific evidence on that one. Okay. And there is no real compelling evidence to show that pellets are the way to go because

41:48the bioavailability is very different. Like, if you're using a transdermal patch or you're using a cream, you know, they can actually see the entry into the system. And we know that when you're using an estradiol patch, it peaks after two days and drops down. So, you know, and some of that's even individual. What would the pellet and how fast it dissolves or how much is being uptaken? Can't quantify that. So we hear all these women like, I want to use pellets, pellets, pellets, pellets, pellets.

42:20But it's, I feel like it's the cheap and dirty way of doing things. Okay. I love that. And what about, is it different for men? Or would you go the same other route for male or for females typically on this kind of stuff? I mean, I can share what we do in clinical practice. For women, the first thing that we like is patches. It also depends on the brand name or the brand of the patch and the skin type of the person. Yeah. You're only going to figure that out by testing.

42:48The other thing is after patches, would it be oral estradiol? I'm not a huge fan because it can increase something called SHBG. Hormones are like children. They have to go somewhere together. Not a super fan. So it can bind, it can, it can bind other hormones. Again, clinically, we tend to use a patch. For testosterone, for women, we like sub-Q injections as opposed to intramuscular injections. For men and women, the reason is IM injections can increase erythrocytosis.

43:20Again, the data is still out as if that is meaningful or not, which is the blood cells, the red blood cells. So we'll use a small sub-Q. After that, creams. I don't like a ton of creams because I worry about transference. Oh, yeah. Little kids. I just, I don't like it. Your husband starts crying all the time? No. Mine? I don't know. I wish, but no, that would be the day. But there are also new, more novel routes of testosterone replacement therapy. And I am very big on testosterone replacement therapy for women, and we can talk about this.

43:54But there is also oral for men and women, which is lymphatically absorbed, doesn't go through the liver, something like chisotrex. There is also intranasal. Intranasal testosterone we use a lot for women, that it peaks quickly, goes away. Prior to workout, doesn't seem to have a large effect on blood levels over time. And for men, it helps protect fertility. Interesting. So those are kind of, you know, as we think about the evolution of hormone replacement therapy.

44:25And then progesterone, at night, orally, micronized, easy. Yeah. So I'm going to ask maybe, we are trying to capture some of this with data. So, like, let's say you start hormone therapy. How often can you measure those levels? And most people don't have the resources that you have. Like, how do you start and where do you get the data? So you threw out, what, four different hormones and approaches. And I feel like there's such few resources for women in particular. How do we go about it? How do we take the data?

44:57Or even, you know, we're trying to look at some at-home trackers. And now it's in urine. But there's a big pushback on there's no need to get your hormones taken because what's it going to tell us? And so what would be your advice even? What do you get in the blood? How often? And then how do you, like, we have to take some ownership in that because our providers don't. Any advice on that? Yeah. I think that there are ways to do it without major barriers to entry. For example, home blood draws.

45:29You know, we often use inside tracker. A mobile phlebotomist comes out. Here is your blood panel. And they take it. And you get results. Huh? Yeah, but you guys live, you know, hopefully you're moving. On the other side of the planet. Do you need a provider too? You don't. Okay. You don't. And there are, I think, a lot of blood draws that you could get that you don't need a provider. And what would you recommend? For the actual panel. Yeah. Free testosterone, total testosterone, sex hormone binding globulin, estradiol, progesterone, a full thyroid panel.

46:00So that would be TSH, free T3, free T4, reverse T3, which is somewhat controversial. I would also recommend an iron panel and ferritin. Yeah. And that would just be – and then listen, could you get other lipid markers like ApoB and looking at LP little A? Yes. But from just a baseline hormone perspective?

46:22Yeah. And then how often? Oh, and then there's FSH, LH. But again, how often? It depends. Definitely a baseline. Once we initiate treatment, we test four weeks later, four to six weeks later. Did you get recommended testing four weeks later? Not four weeks later. But I'll tell you the thing that my doctor did that I actually really appreciate. Well, because first, you brought up wearables. I have every wearable. I'm interested in the data, but I don't actually know how to read all of it. So maybe that's a conversation for a later time. But what my doctor did is she called me a month after and just said, how are you feeling?

46:55What effects are you feeling? And then I'll sound like a raging hippie here because I am. I have a gratitude journal that I do every day. And what I found is I was better at writing and feeling gratitude after I got it. And so I was measuring myself through how I felt. And then the doctor called me and asked about it. But I need to get the follow-up blood tests. But I can track how I'm feeling just through that and through her checking in. Which is really important when we talk about data. Like, it's hard to measure gratitude in a lab, but arguably more important.

47:30And so I think you speak to that, like, how do we take ownership of how we feel? And how does that resonate? And I mean, gratefulness is a really good way that we wouldn't be able to quantify in a lab. Yeah. And I think that that kind of sums up what we've discussed here today. So we discussed the variation in literature, research, the exposure to all of these things, some of the very fundamental things starting with body fat and moving to exercise implementation,

48:02starting where you're at, and then figuring out where you want to be and what are the necessary steps to make that happen. Yeah. I think that's important is building the plan. I really appreciate that because you have all the knowledge. But to your point, really building that plan is the only way to get it done. And that's exactly what we're going to do. I really appreciate it. Thank you. I really appreciate it. Thank you so much.

48:31Thank you.