EPISODE 113: Dr. Bill Campbell

0:00Hello, everybody. It is Dr. Jamie and welcome back to the Fit and Fabulous podcast. I could not be more excited about today's recording. I have been wanting to get this guest on here to talk about this topic for a little while and every time he posts something about this topic, I'm like, we got to record this. We got to do this. So please welcome Dr. Campbell. He is a professor and director of the Performance and Physique Enhancement Lab at the University of South Florida. Florida probably much warmer than Nebraska is today. He's authored three books on sports nutrition and author of over 200 scientific abstracts and manuscripts on topics that are related to sports nutrition, physique enhancement, exercise performance. He's the past president of the International Society of Sports Nutrition. He also has this really awesome newsletter called Body by Science and it summarizes all of this research, all of this review of research into one easy to read format. I've seen it myself. It's amazing. You guys can find them on Instagram at billcamblephd or billcamblephd.com. But the reason why I've invited Bill on today is to have a conversation

1:03about menopause. His research is starting to focus on optimizing physique through lifestyle, but he has conducted the first ever women's menopause fitness survey. And I've seen some of the results. The survey is about women's projections and reflections on menopause as they embrace the fitness lifestyle. He's created a free YouTube educational series about menopause and fitness. It has lessons on exercise nutrition, hormone replacement therapy. I am so excited about what you're doing, Bill. Welcome to the Fit and Fabulous podcast. Well, thank you very much for having me. I'm excited to be here. Okay, so my listeners know who I am, but in case Dr. Campbell's listeners are on here, I'm an OBGYN. I have a background in exercise science and nutrition in my adult life after being a collegiate athlete got into bodybuilding and have competed in both women's physique and women's bodybuilding. So as a women's health practitioner, I look through a different lens, I suppose, when I talk about lifestyle with my patients. But what made you, Bill? You have this incredible

2:08list of credentials and sports and exercise nutrition. But what made you start to focus on menopause? Okay, so that's 100% was due to my wife's menopause transition. So if we were to back up five years from today and somebody were to tell me, Hey, you're going to change your entire research program and focus on menopause. I would have said there's no way. It was so far removed from what I was thinking or my interest level. And essentially, so I'm a fat loss researcher exercise physiologist by training. And my wife, um, very fit lifts weights. And then when she got to her late 40s, she started to gain some weight. And in the past, I would always help to some extent. Like, well, she's lucky, right? If she wants to lose weight, she's married to a fat loss researcher. So for the first time when, when I was this, I couldn't help this time. Like, everything that we

3:10used to do didn't help. And then, and let me also say, um, not all women are going to gain weight, not all women that go through menopause are going to have a hard time losing it. So I don't, it's not a doomsday scenario for everyone. But a lot of women will gain weight, especially in the midsection. And in my wife's case, she had a hard time losing it. Um, again, I was kind of at, you know, I was being very stressed with like, well, I can't help you. Um, and her weight gain was not the most, she had larger problems with her menopause transition than just weight gain. But as a lot of women who embrace a fitness lifestyle can, can empathize with, it was hard to gain weight when she hadn't gained weight in the past. I'm really didn't feel like she changed anything um, about her routine. Um, definitely had less energy for sure. So that is why I'm like, hmm, I can't help you. This is a now a challenge to me. And then I started with her permission to

4:12start talking about this a little bit publicly. And, and let me tell you the avalanche of responses from other women who say this and continue to say the same thing. So I'm extremely, and I know exactly why because I have your wife in my clinic every single day, every single day. I'm not kidding. There is a woman. She's in her late 40s or early 50s and she is like, listen, Doc, I'm working out. I'm going 40s a week. I'm doing the same level of intensity. I'm lifting the weights. I'm eating the same diet. I am doing everything I used to do. And hey, you know, I haven't been perfect. But 10 years ago, I used to be able to, you know, manipulate it in this way. And I'd get the 10 pounds off and I'd get back on track. Nothing is working. I'm so frustrated. I think I'm just going to quit doing it. And, um, you know, they're, they just feel so defeated because they feel like they really are doing the right thing. So you've shared a few things on social media about

5:14why this could be, right? Maybe they're not really tracking adequately. Maybe their intensity, their workouts really isn't as intense as maybe they think it is. What was initially your theory when your wife is experiencing this? I mean, with your science brain, like, what, I mean, what were you thinking? What questions were you asking? So at first, I had no idea because it was new to me. Like all of my research or most of my research was in younger, metabolically healthy women. So mostly women in their 20s, maybe 30s. And every time we reduce calories, they would always lose, lose, lose fat. And I also want to say that I'm, I'm what was and probably still am one of the biggest advocates for the calories and calories out. Like there is nobody who beat that drum more than me as a fat loss scientist. And I'm not backing away from saying, hey, yes, you that still applies still applies. Yeah. However, now I have to have almost like a menopause caveat where

6:18I think, or at least I'm open to the idea that some women, a small proportion of women that go through menopause, they, the traditional or what used to work is not enough of a stimulus for causing fat loss. When a few years ago, it used to be. So it, another way to say it is the calorie deficits that they need to employ to lose body fat are so low and unsustainable that it's just not healthy and more importantly, it's, or just as important, it's not sustainable. So I didn't answer your question yet. I'm just trying to give context around this. I'm not running away from, oh, calories don't matter. Of course they do. But why, why does it, why do so many women claim that I'm doing the same thing and it's not working? And why do all of these women seem to be in their 40s and 50s, early 50s, late 40s? So all's I'm doing as a scientist is, is listening to the culture around me in this sub population of women who embrace a fitness lifestyle

7:24and am starting to ask the appropriate scientific questions. So that's my thinking around this. What I originally thought, and again, at first I had no idea. Everything was new to me in my wife. We were completely reactive to this menopause thing, which was very frustrating. She suffered a lot more than she needed to. And my wife kind of defers to me for all of the health-related components of her life. And I defer to her on 99.9% of everything else in our lives. So she does everything. I do the one, I go to PubMed. I'm the one who, you know, well, hey, make sure you ask your doctor these three questions. So she's relying on me. And I didn't have any answers. So one of the first things that started to come up was, well, what about this hormone therapy thing? And I was like, well, I know that that can cause breast cancer. And I didn't know much. So I started

8:27with no knowledge. And I jumped in, tried to, most of what I read is research articles. But I read a few books early on as well. And just to now try to answer your question, what we do know with this weight gain, it happens the same exact time that estrogen. And I'm just going to use the word estradiol levels start to go down. So again, as that causation is a correlation, well, it's clearly correlated. So then I'm thinking, okay, if it's, and a lot of people will point to estradiol levels are getting lower and abdominal fat is increasing. So then I thought, okay, well, this is pretty simple. This is a one plus one equals two. The women who take estrogen therapy, estradiol therapy, they're probably not going to gain this body fat or they'll be able to lose it. And I, and I can't sit here today and say, I don't think that's true for everyone. What I've learned

9:30both in conversations with women. And by the way, as we have this conversation, I talk to through social media a lot. I'm a sponge for knowledge. I'm, I learn, and I read all kinds of research on this, but I don't, I don't want to discount. I'm having conversations. So what I, let me start with the conversations in the anecdotal information. Women would tell me, oh, I started hormone therapy. And it was great. I lost 10 pounds, feel better, et cetera. Other women would say, hey, man, I started hormone, you know, an estrogen patch or an estrogen pill. And man, I gained eight pounds in three weeks. And then other women are like, yeah, I didn't make any difference. So anecdotally, what I'm learning is, boy, it's highly variable. I would think that estrogen would just solve all of this. And then in the research, highly variable outcomes. Some studies show estrogen therapy helps with weight loss. Other research will show it actually can cause weight gain.

10:35Other research shows it will prevent the loss of body fat. So to answer your question, what was my theory? Initially, it was all estrogen, estradio, and man, it was just that magic. Yeah, it was just that easy. And now I'm left with, and this is my lab is literally, I was in meetings with my research team for the last few hours. We're designing a study to answer the question. Well, just a document does it exist? If it does, why? And we're not really answering the why we're going to try to document yes or no first. But I wish it was estradio because then there's a solution for that. But I don't know why it's so variable. So that's what I would love to know your thoughts. Do you know why? So for my listeners to understand what's happening, you know, we're suddenly seeing this shift at menopause. Well, what happens at menopause? Month over month, year-to-year, in perimenopause, there is a average lower estradio level month-to-month. And then finally, once you make this

11:38menopausal transition, it's low. And it's just steady state low. For gestorone, same thing, loss of progesterone. Testosterone does not fall off the cliff like estradio does, but there is a slow age-related decline over our midlife and through menopause. What we know estrogen does, so estrogen plays a very multifaceted approach with human metabolism. We have known that. And it's part of the reason why a lot of people shyed away from studying women across the menstrual cycle. It's really hard. There's not much control when you have fluctuating day-to-day week-to-week levels of estradio. But we know that with because of what estrogen does, we know that it does change energy balance. It changes glucose homeostasis, so it's not uncommon in a menopausal patient. The year she makes this transition, her A1C goes up, her fasting insulin and glucose go up. We start to see lipid metabolism changes. Her cholesterol panel, all of a sudden, is changing. We know that estradio plays a role in human

12:44metabolism. So what's interesting for me, just like you, okay, well, what about the HRT users? That's probably the magic sauce. What I have found clinically, when you say there's this variability in how people respond, is that I explain it to patients that it is like one of the puzzle pieces. And if you have a puzzle that has 10 pieces in it and you're making Mickey Mouse, it is an important piece of the puzzle, but it's not the whole picture. And I find that estrogen replacement works best in patients who are doing a lot of the right things. My kind of like mantras, these five pillars, sleep, nutrition, exercise, stress, mitigation, and kind of environment. So I do think they were on the same page with who are these people that it works best in? How do you select for those people? Obviously, it's always a choice to take hormone replacement. In some patients, I actually had a couple followers messaging, can you please talk about the people who

13:48can't take it? Like, what can we do, right? These, of course, are breast cancer patients or there's some people that just have a risk of blood clot or whatever it is that can't take it or choose not to take it. But when I've looked at the studies and you know this data better than I do, Bill, but, you know, 2019 JAMA meta-analysis on like 12 studies over 4,500 patients, not much different in skeletal lean body mass gains. So it doesn't appear to like, you know, keep a bunch of muscle on patients. When you look at fat mass, you're right, it's all over the place. Some show they gain, some show they lose. There is some favorability when we look at twin studies of people who took it in people that don't listen. I'm a fan of HRT for a variety of reasons that have nothing to do with body composition. There is less diabetes, less cardiovascular disease, less osteoporosis, less colon cancer, and some studies less breast cancer. And if you start HRT between 50 and 59,

14:48there's a 30% reduction in all cause mortality. So 30% less chance of dying of anything. So I'm a huge fan of that. And the listeners know that. But let's go back to what you know and kind of segue into this study. So Bill, if you're talking to somebody that's in their 20s, 30s, 40s, 50s, traditionally, you would have told all these women in all these different decades that the same principles apply if they want to improve their body composition. Because I think vast majority of people listening aren't bodybuilders. But because I've gone through a prep before, I know that those same principles apply if I want to lose 10 pounds before vacation or put on lean tissue. Would you still say until we know more, until we kind of subtle the science more, that the same principle still apply for somebody that's listening that's 30 versus 50? Yeah, I would add a little nuance to this. And this is just based on some preliminary research that we've done in my lab.

15:51So if I have 20, 30 year old, hey, let's do the traditional 25% caloric deficit, optimal protein, resistance training. And for almost all of them, at least in my experience, they're going to lose fat, they're going to retain their muscle. When we get into this, again, I'll just say a subpopulation of women that are going through the menopause transition. So typically, it's going to be late 40s, early 50s. And they have this, hey, it's not working. My suggestion or an option that I would want to have with them is, okay, there could be, you just need to be more aggressive. Now, I've spent a lot of years railing against crash dieting and aggressive dieting because that does a host of negative things. Let's talk about them. When you diet aggressively for extended periods of time,

16:53you lose a lot of weight, you lose a lot of fat, but you lose a lot of lean mass when you do that. If you lose lean mass when you diet, as soon as your diet is over, you are significantly more likely to gain back body fat. And in many cases, depending on how aggressive you were, that body fat comes on not only rapidly, but it comes back on more and more amount than what you had before you started your diet. So we call that fat overshoot. And that is due to a phenomenon known as hyperphasia. So hyperphasia is basically the term refers to uncontrollable hunger or a really strong desire to eat. And that is really tapered to lean mass changes. So my whole career has been built on kind of, you know, been like a bodybuilding perspective, helping people lose weight, but maintain as much lean mass so that they have a greater likelihood of maintaining that fat loss.

17:58So there's the base. And now I'm going to sound like a hypocrite, but I'm actually not for the women that I've had come into my lab who have claimed weight loss resistance. And this is not published yet. We did present some of this data at a conference last year, but we don't publish this study yet. We are very aggressive with walking and low calorie, but now here's the key. The duration is very short. It is about, we have a four day protocol where they walk six hours a day and they're eating about three to five hundred calories of mostly protein. So what does this do? Well, if the theory is that what used to work never is not working, and which would be a normal caloric deficit, but I have to have my calories so low to make the fat loss needle move. What I'm essentially doing is leaning into that, but in such a way where the duration is so short that the

19:03body only responds in our data by losing fat and not losing any lean mass. In fact, most of the women we've had nine go through this protocol actually gained a little bit of lean mass. And these are all women that are fit and many of whom just dieting is not working. So they say, so there is something I would that possibly would be a little different between somebody who says they're struggling, whose older, when I say older 40s and 50s compared to your question 20s and 30s. And one more thing, I'm scared to death of publishing this data because I know what will happen. A lot of people will say, oh, four days was great, but now let's do eight, let's do 12. And that's all of those harms are going to now be in play. Could you, is this like they do this four days a month, four days every two weeks? Like what do you think the optimal ratio of rest recovery is? Yes, so we've only,

20:07we've only investigated this as a one time four day period. And we brought them back 30 days later to make sure because everybody, you know, we, they did these four days. And again, that's that's a very severe protocol. Like if you have a normal job, it's a lot of moving and not a lot of energy intake. Yeah, but on the energy side, because I obviously put myself through this, and I'm a foodie, like I, I think about food all the time, like the GLP ones, like that's me, like I'm constantly thinking of food. But surprisingly for myself, and in most of the subjects that went through this, you're so busy walking that it really does suppress your hungry. Now I will say, for myself, on the fourth day, I was very hungry, but the, I was shocked at how little I thought about food during, at least the first three days of this. And importantly, we put them through the protocol, then had them eat normal calories for three days. And then we brought them back to make,

21:09you know, because their fluids are all messed up. So if you do body composition testing after four days of starvation, essentially, and maybe some inflammation with all this walking, you're going to get wonky values. So we wanted to stabilize nutrition fluids brought them back three days later. And then we brought them back a month later, because that's where we're going to see, did we cause harm by, if they lost lean mass, did they now get this hunger drive, and did they gain fat? And in every situation, they all continue to maintain their fat loss, not lose any lean mass. And we did blood work. So it was, it was, I mean, there was no harm done, at least within the 30 days. And that's when, you know, we would see, so I'd like the health outcomes, or the body composition outcomes without any adverse health effects. Now again, that the key here is we were more aggressive, which I think it's probably what you need to do in menopause, maybe stay away from

22:11the slow, long duration dieting, which again, for much of my career, I said, that's the way to do it. I'm thinking that this should be an option. And I want to, I want to say something else. My world and, and the women that I'm really trying to serve are those that embrace a fitness lifestyle. If, if I have a 50 year old come to me, I'll just use my wife. If my wife said, hey, I can't lose weight. And she's not tracking her food. And she's not lifting weights. I would say, that's the starting point. Yes. Yeah. You're saying you can't, but how do you know if you're not, and again, I'm not saying everybody has to track, but if you're going to claim that nothing is working, and you're not already, you know, I have to say, buttoned up. You're not tracking your food. You're not, you're not, you're not optimizing protein. You're not. I'm, I don't want to say I'm not going to believe you, but I'm, there's a lot, or you're drinking a lot of wine. You've got to have a baseline to start from. I mean, you, yes. So,

23:13when you highlight for the listeners, though, what is the data really show with measuring and tracking? Are you ready to unlock your full potential? I want to introduce you to the fit, healthy, and happy podcasts, a powerful resource to transform your life today with expert interviews, practical tips, and inspiring stories. This podcast is your roadmap to lasting wellness. Here's what a listener has to say. I used to struggle with my health, but this podcast changed everything. It's like having a personal trainer, nutritionist, and life coach, totally for free. With over 2005 star reviews, we're a podcast you can trust. The fit, healthy, and happy podcast available now, wherever you get your podcasts. Oh, it's overwhelming if you track just just calories and body weight, significant improved significantly positive outcomes for body composition. How accurate is that for most

24:18people? Because I have some patients that come in and they're like, oh, yeah, Doc, I've got my app right here. This is what I'm eating. I'm not losing weight. Yeah, that can be, again, we talked about variability. That can be highly variable as well. What I would do if I'm working with clients, I would say, hey, great, you're tracking. But if things aren't working, let's just, I'll, here's the example I use in my class, is like, take a picture of what you just tracked and send it to me. So as an example, if they had a normal piece of lasagna and they say, yeah, I tracked and it's 250 calories, no, what you just ate based on the weight and the picture, you sent me that's closer to 800 calories. So there's a little test. So, yeah, so even then, even if you're tracking, but yeah, that's true. We have to make an assumption that you're tracking well and everything. A lot of people are like, well, I'm not going to count the dressing or

25:22yeah. One thing I always tried to share with followers when I was going through my own bodybuilding prep was like, I mean, you're weighing your food, you're measuring tablespoons. I mean, it's it's a neurotic level of tracking when you're doing a bodybuilding competition because my calories were dropping like 45 calories each week. I mean, that's like one extra bite of food or like one less bite of food a day. I mean, that's like crazy. So I just want to highlight that for people that maybe you are counting and tracking and it's just not good information. So let's talk about another thing that comes up for menopausal women is they're like, I've heard on a podcast, I'm not supposed to do orange theory because hit increases cortisol and I heard not supposed to be spiking your cortisol for menopausal women. So you did walking for this study. What kind of exercise do you think that menopausal women should be doing? Whatever they enjoy, I'm very,

26:23if you like a certain type of exercise, do that exercise. I would really hope and encourage people make resistance training the foundation of what you do. But if you hate that and you love pickleball or you love cycling, I'm not going to any movement is good. So yeah, I'm I don't like I like people to lean into what they like to do. But I do highly encourage resistance exercise as ideally a foundational part or at least a that it occupies some time of your of your fitness program. Do you think there's a population of women that are doing too much cardio for too long or too much hit for too long and really creating a cortisol issue? Do you think it's even a thing? Yeah, I so let me also say what we did in our study when they were doing these these were all resistance trained women in this what we call a rapid fat loss protocol. We said no lifting for

27:28these four days like this is we want you to relax try to walk outside now again depending on if they lived in Florida careful. It it they lost no muscle even though we we again it's only four days of of not lifting. But yeah, if I have if if I have women who are really high volume exercises. I'm all for hey and and and they're coming to me saying nothing is working and yes, you're tracking yes, I'm lifting yes, I'm running yes, I'm getting my steps in yes, I'm going to conditioning classes to me. I'm like okay, I'm just listening to you and and great for you, you're doing all of this movement, but you're also telling me that nothing like whatever you're doing isn't working. If I get the sense that this your volume of exercise is just so high to me, it makes sense that let's dial some of this back and let's see how your body responds and in some cases it really helps they they bring you know they just cut everything in half and that's

28:32a hard conversation for a lot of a lot of the women that I talk to. But you already said nothing's working. So let's let's try something else. Is that a cortisol issue? I it could be I do know that I don't see that in the research literature elevated cortisol. That doesn't mean it's it's not a real thing, but I do get the sense that it's well here's exactly so I'll have women say hey, my cortisol is really high for whatever reason and I'm like oh what were your values? Well, I didn't actually get it measured then you don't know they have a cortisol problem. Yeah, so that worries me. So somewhere they're getting a message that it's their cortisol. Maybe it is. Maybe it isn't. It's not in the research literature and they're not really able to document it when I ask that question. Yeah. What do you think? What are your thoughts on high volumes of exercise in cortisol? Well, I mean we know like if you if you're doing like true high intensity interval training, like you shouldn't be able to do that for an hour, like you're

29:35totally not going to the intensity that you like think you are. But I do I mean I think it's rare that somebody is overexercising like that they're spending so many hours on the stair mill that like that they're creating basically too much sympathetic you know like nervous system stimulation. I do think it's important like people need rest people need recovery like we live these crazy jobs and careers and we're getting just stimulated all the time. So I do think sometimes people can get so neurotic about the diet and exercise portion that it's like hey how's your sleep? Maybe you need some meditation like maybe you need some sauna sessions like I do think there's some women that can benefit from that but I don't think it's a you really are pumping so much cortisol out of your trinoles that it's inhibiting your results. I mean I just don't I just don't think that's a thing. And back to cortisol it's cortisol releases a natural response to exercise and when I was earlier in my career I was really into overtraining and I was trying to look at all the

30:40research on what would predict overtraining. The only thing that jumped out to me was the body's failure to spike cortisol after intense exercise. So if the body didn't respond by releasing cortisol after high intensity exercise that was a sign that that person was going to enter an overtrained state. So it's something I've never forgotten relative to cortisol. Let's talk about sleep. We know the data is very clear. People that have sleep deprivation gain weight. I can tell you right now delivering babies that two o'clock in the morning the next day my satiety is horrible. My hunger is up. My compliance is sometimes down. Thankfully I usually have a night of recovery and I come back but menopausal women, perimenopausal women, they're not sleeping well either. What role do you think that sleep plays in some of this? Well they're the only documented existence of true fat

31:42loss resistance is it comes from a sleep deprivation study. So I'll explain this and actually we just talked about this in my research meeting today. They had middle-aged males and females, mostly males but a few females. They had them live in a metabolic ward, metabolic chamber, room calorimeter, whatever you want to call it for 14 days, two different times. So what is a what is a metabolic chamber? It's a pretty small room that tells you precisely how many calories you're burning and it does that through indirect calorimetry which is basically measures your oxygen consumed and your carbon dioxide that you breathe out. It is the gold standard for measuring metabolism. So there is no better environment to test energy expenditure. They had these subjects for 14 days all on a diet so they reduced their calories by 33%. One time for 14

32:49days they were allowed to sleep a normal night and they averaged seven and a half hours. Of short time later they came back for another 14 days. Same diet reduced their calories same amount but this time they were sleep deprived by two hours. So it was 5.5 hours all randomized the same subject. So the beauty of using the same subjects is you eliminate all genetic variability. Same genes, same metabolism, same lifestyle you will not find a better design sleep study than this and what they found when the subjects were sleep deprived eating the same number of calories in a caloric deficit they lost significantly less fat. They lost 2.5 times more fat. So I used to think now I know you don't because you see this in the real world with patients and third shifts but I'm like yeah sleep it's important but it never really I never really cared

33:53about it and then I've read that study and my position now is if you're at a point in life where you can't sleep don't make that a diet phase. You are literally spinning your wheels and that is you can't read that study and say that fat loss resistance is not real. That's a clear indication so that doesn't mean that menopause of women have it again that that that hasn't been shown yet but like you said which out of all the humans in the world which ones suffer from sleep deprivation the most it would be women going through menopause so it's not a far stretch to say hey if you're having sleep issues and you're trying to lose weight that's a reason why it might not be working well. Yeah 100 percent so I've had so many different people on the podcast and it really was not until my 40s that I realized sleep is like a skill like when you're a kid you just like like down and go to sleep and then suddenly in your 40s and you're like you got this you know you got

34:57red lights and you got a mask and you're taking you know magnesium and you got this chili pad on your bed like I'm telling you I know what these women are doing and like they're trying a lot of things just to get a good night's sleep. I do think that it plays a role because I hear so many of them say they're having trouble sleeping and then they're like I can't lose weight and when people are I think it's almost like this vicious toilet bowl that happens because they're not sleeping well so then they're more hungry during the day and then their joints are hurting because they're getting joint stiffness so they're not mood they're naturally just not moving as much so even though they perceive it as like I'm doing all the same things there probably are some subtle changes and it's not just estrogen and progesterone that go down when we don't sleep well testosterone changes growth hormone pulsatility changes I mean there's there's more things that change you know with poor sleep and age-related changes too. So I'm with you I think I think that's a puzzle piece

35:59that if you're not sleeping well you got to focus on that first and sometimes it is a hormone issue I mean if you're waking up with night sweats 12 times a night that's a problem that's a problem and on that note just for whoever it may help my wife's she started on progesterone it immediately I'll just say the word cured her sleep night sweats hot flashes it was I would just say progesterone dramatically improve my wife's quality of life. Yeah the vast majority of my patients do really well with progesterone there are a few patients that can't kind of quote unquote tolerate it you want to take it at night 30 60 minutes before bedtime I prefer micronized progesterone or prometrium is the trade name as opposed to a progestin yeah and that's because of the breast cancer risk but it does it's very good for sleep and one of the metabolites of progesterone alipregnenalone increases GABA in the brain so it's like it's really calming to the brain it helps

37:04people sleep and even if you've had a hysterectomy you can still take progesterone you just don't have to take progesterone if you're taking estrogen but I use a lot of progesterone impairment before I'm actually adding estrogen yeah we don't have a lot of like robust data to even support that but that's I will tell you anecdotally progesterone and pray menopause if you're not sleeping well is is a is a great thing to try okay I want to touch for just a couple minutes on GLPs you talked about this like extreme dieting really extremely low calorie diet aggressive weight loss fast weight loss and the rebound effect that happens with weight gain and satiety we have seen that in the GLP data but do you think that that GLPs could play a role in weight loss resistance with menopause yes so the the the feedback that I get in the data that I have for the women in menopause who say that they have weight loss resistance when when those women

38:12start a GLP one treatment it's about an 80% of the time that they're saying oh this finally helped this this worked when other things wouldn't work 20% of the time they were non-responders to that so yeah it seems like it's very effective for for these women yeah I've seen that too clinically and you did an initial survey and you shared some some results about women who are taking HRT I'm just going to go we're not going to talk about GLPs we can talk about the whole episode of that but I do I think there is some role for menopausal women but you did a survey that compared to average kind of women only 5% we're using HRT but a fit women 55% we're we're using HRT why do you think that is yeah and let me just let me give one caveat to that we we cited other research for 5% it's probably a little higher than 5 let's say 10 because a lot of women are getting compounded yeah yeah and 55% was from my and my colleagues social media that's how

39:20we recruited so but nonetheless it was five at least five times five to 10 times higher than the normal population so I think that women who embrace a fitness lifestyle they're already more open to supplementation so maybe creating a protein supplement and probably even more so they're more in tune with their bodies and if their bodies aren't performing as well they're going to want to know why so that they are you know they're like finely tuned machines and if things aren't feeling right I'll just like I'll just say like my mom who's not who does who did not live a fitness baseline style I don't even know she would know if things were off she's not lifting weights to have this calibration so I think it's the women who are used to performing at a certain level or recovering at a certain rate it's not happening well and then they're more likely to go to try to solve the problem yeah yeah um I think it's great that most of the women using HRT

40:26fitness scales because like I said earlier in the podcast it's actually those patients that I think probably get the most benefit from it yeah and and part of it in my science brain is that we know that loss of estrogen actually changes the mitochondria in various ways and so you know these women are they're they're already doing things to support their mitochondrial health and then it's just like you know one it's like I tell what I was trying to break this down in a way that my 10-year-old can understand it but it's like if you had like two car engines and this one the oil's been changed the timing belts have been going undergoing maintenance versus this one that's never been serviced and then just try to pour premium gasoline into both of them like they don't run the same way so so I like that that's what it showed um because I do think that people have to do the basic things first and then I think HRT is a is a great addition but I also uh I'll contradict myself sometimes when women aren't sleeping well and they're tired and they're fatigued and

41:28their joints hurt and they can't comply with their diet whatever sometimes age sometimes sometimes HRT can help them feel better and more motivated to start doing those things again you know maybe they did it and now they've just had trouble you know maintaining because they feel so crappy so um just something to consider okay um I want to talk about muscle so estrogen's role in muscle uh we have estrogen receptors in our muscles when we lose estrogen we start to lose um satellite cell proliferation we start to not turn over muscle proteins as well I talked about the mitochondria there's more oxidative stress in the muscle so for a woman listening that she doesn't she doesn't care about the extra 10 pounds of fat um but she's like I want to gain muscle and now I'm you know in menopause can can women gain muscle at any point in their life what does it look like pre-imposed menopause what do you see in the data? Yeah so what I see in the data is pre-menopause your body responds to resistant

42:34training better than when you're parry or post-menopause so same workout program your body is just more anabolic response to the resistance exercise stimulus much better than when you're in menopause now the question could be could maybe that's just aging and menopause doesn't have anything to do with it because anabolic resistance happens in men and women I would my personal thought of reading research and I'm gonna say once again the best research is that estrogen is anabolic so let me um the broad research would suggest that that's not estrogen therapy estradiol therapies the one that that I really focus on that's kind of all over the place too um in terms that sometimes women will gain lean mass sometimes they'll maintain their lean mass but the I guess I'll phrase it as the problem I have with all of this research all of it and I'll just I want to just throw it away

43:41it's always in women who have not embraced a fitness lifestyle so once again the women that I'm with I want to serve we don't have data on them uh I'll share some research that that I've read that that has informed my opinion on this so I already said they respond better to resistance exercise before they're in menopause another another research study gave early postmenopausal women an estradiol patch or a placebo patch the women wearing the estradiol patch gained significantly more muscle compared to the placebo group same exercise program so when you compare hey women respond better when they're younger and so when they have estradiol when as women get older when their estrogen levels are declining they're not responding as well but then we have a study where you increased estradiol and that it was a .1 milligram patch they gain significantly more lean mass so I'm

44:46using all of these data points to suggest as well as anecdotal um it's it's anabolic and it helps and the other the other thing I want to say with this all of this research that shows that women don't lose lean mass during menopause and and there's a lot of research some of it's very well controlled but that's since that's not in women who've spent 10 15 years building it what if we tested them do they lose more I wouldn't be surprised if they do um and again my conversations with women are that they do so to summarize estrogen estradiol is anabolic yeah um we're at best anti-catabolic I mean it even if you can just maintain you know what you have and not lose um but certainly yeah certainly the more muscle you can come into menopause with your risk of sarcopenia that it's same with bone mineral density the higher you can start on that graph even if there's some sort of age-related

45:46decline despite whatever you're doing you're at least starting at that higher point so I always tell my perimenopausal gals get it in order right now get it get it all you can um and we'll support the hormones when we need to but there was an interesting mouse it's of course a rodent study but basically saying that exercise could protect against a lot of the skeletal and mitochondrial changes independent of local estrogen synthesis so I do think for the woman listening who cannot take estrogen I still think they need to hear the message that these things matter how much protein you're eating matters how much you're training and the volume of training and the intensity of training these things still matter um despite whether you use estrogen or don't use estrogen you agree don't you Bill oh yeah it's the foundation yep yep yep there what are the side effects of of a fitness lifestyle they're all they're all positive I mean a little bit of your time but I mean pay now or pay later I mean you like I'm telling you anybody that gets towards the end

46:52of their life and has some metabolic disease cancer diagnosis like I mean something will take all of us out but I think we just like we undervalue our health when we're young and we're so resilient and I think we perimenopause and menopause are a great time in your life to say like I'm in control of this and like this is worth my time and energy and effort um because health is literally the only thing that can't be bought um and I I gave a TED talk on women lifting weights and I have three little girls and I'm trying to set the standard that it's okay for women to have muscles but um I tell my patients all the time that resistance training is the only not if you're want to like hate pharma and hate drugs weightlifting is the only non-pharmacological intervention that has ever been to consistently shown to offset age-related declines in skeletal muscle mass strength and power so they have never come out with some magic drug GLP ones aren't great for your muscle mass I'll tell you that um I mean unless we have some myostatin inhibitor that's coming I mean but even then

47:56everything is gonna have a trade-off so like wait if you want a magic drug weightlifting is the best magic that we have agreed yeah I love it I love it okay um so uh talk about creatine somebody sent in a question can you ask Bill about supplements that menopausal that could be beneficial to menopausal women outside of hormone replacement therapy yeah I'm creatine in my opinion is a is a good supplement to take especially if you live a fitness lifestyle um it's the side effects are there really aren't I mean it is the most studied diet sports dietary supplement besides caffeine in the history of dietary supplement research so we know it's safe it's relatively inexpensive it's not something if if somebody hasn't taken it you don't take it and you you don't feel anything so it's not like caffeine uh but what we know that it does is it increases power production it increases strength and lean mass and now we're getting more recent research

49:00and I haven't read much of this literature yet but I've I'm aware enough that it's also being used to to investigate brain function and what we know is you need higher levels so the sub you need you need to supplement with more um about two to three times more to get potential brain benefits of of creatine so that that's I don't take many supplements that's one that I take it's one that I encourage my wife to take and she never listens to me yeah it's about 20 grams of creatine in the studies on brainhouse so it has to saturate the muscle first and then it spills over into the brain so it's you're right it's uh instead of one scoop it's like four scoops so it's it's a lot of creatine um from a dietary perspective um talk about fat protein and carbs do you think that there is some sort of optimal ratio amount of these things when we become menopausal? No the the historic protein intake research would suggest and again these are these are

50:00generally what I would call general population person but protein intakes tend to be very low in middle aged women uh so and I think we could spend a whole another session on on this but just increasing protein when you do nothing else no exercise if you take a a middle-aged menopausal woman this is this research I'm citing and if they're eating sub optimal protein and the only thing you do is increase their protein they will gain lean mass and they will lose body fat no exercise so that's pretty powerful and that's been shown in more than one study that's that's been shown multiple times so me being an exercise scientist former bodybuilder liking that lifestyle I always gravitate towards a protein anchored diet so what you know I always say hey a good place to aim is .75 grams of protein per pound of body weight or ideal body weight um in terms of carbs

51:03and fat I again I like one of my core values is simplicity so do focus on protein and for carbs and fat just do whatever comes natural um some people like more carbs great have more carbs some people like more fat awesome in terms of body composition outcomes it doesn't matter protein moves the needle um carbs generally you you want enough of them that you can train with intensity recover from your workouts but I I like just whatever you like to whatever your dietary likes are just fill that in get that with your natural food selection you don't have to stress about carbs and fat yeah yeah I um my followers know I'm a proponent of the low carb ketogenic lifestyle just because of the massive amount of metabolic disease and diabetes and things that we see but um I agree first control the amount of energy get the protein as high as you can um we should have a whole other podcast episode on this but Robert Sykes I don't know if you know who he is build uh he uh is a

52:07ketogenic bodybuilder trained traditional way for many years he was my coach through both of both of my preps but the first time that I ever did bodybuilding I actually went into it more as kind of a student and a scientist more than anything because I took care of so many female competitors that um became amenoriac lost their period their thyroid was crap they had no estrogen um and I thought what if what if you in what if you maintain a higher percent of calories from fat as you dropped your body fat solo um and kept carbs lower would it preserve you know sex hormones that was my kind of question I mean this of course it was like an n1 experiment but um but it did and I had the ability to check labs of myself this last show that I did like a week before the show I clearly have an ovulation I had an estradiol level of like 376 like one week before the show with like 13 to 14 percent body fat so my coach and I have like a lot of theories around around women and bodybuilding that there could there could be maybe a sear a superior approach for

53:10sex hormone preservation um and it you know time will tell time will tell and then I saw meadow has a henselman that shared something this week about meta analysis on carbs that they're not superior building muscles so I think it's a I think it's a fun debate because traditionally for so many years bodybuilding has been very low percentage of calories from from fat yeah and you exact pretty much your lifestyle or low carb lifestyle that's or just yeah so I um I was after my third daughter was born I was diagnosed with prediabetes so I started living a pretty low carb lifestyle got back into weightlifting and I just I just feel and function better eating a lot of fat and less carbs trust me I love carbs but um but uh I both of my bodybuilding preps were completely ketogenic and um it uh it was an interesting fun experiment and I don't know I think it I think it's a great approach for women to consider you know from a from a sex hormone standpoint but we need a lot more people we need a lot more

54:14subjects yeah yeah I get feedback from some women where when they've switched to a ketogenic diet or or carnivore diet that they're like hey this has been very helpful so again it's I would always say hey if you're currently eating high carb and things aren't working for you well then let's consider a low carb approach well I think at what it naturally does they I do think it naturally increases the nutrient density of someone's diet when you're suddenly focusing on you know protein and fat you're eating you know more nutrient-dense foods um because there's a lot of very poor nutrient carb foods that yeah across this food industry has saturated our entire life with okay um for the last bit of this bill I want you to tell people about what is what are you what are you now studying what are the questions you're asking how can people become involved because I know you've shared you know some surveys and things like that on your social media yeah yes so right now we're my research team and I are planning a are designing a weight loss

55:17resistance study in menopausal women so this would be for women who embrace a fitness lifestyle and we're going to define that as resistance training that they have to be resistance training but hopefully they're also doing some cardiovascular exercise as well so specifically again a lot of people will claim I can't lose weight despite a caloric deficit so we are unapologetically recruiting that population of fitness women so if you think that you cannot lose weight through traditional dieting we would love for you to um be in our study it's a virtual study so you continue you know you don't have to you don't have to come to Tampa Florida to get testing so you continue you want to come to Tampa that you just you continue your normal exercise routine whatever that is and we will put you on a diet and we're comparing that to women who are pre menopausal and it's a pretty simple design um we're just going to compare hey if you're given

56:18the same diet and you're not changing your exercise routine at all do younger women lose weight at a faster rate and again this is in women who claim weight loss resistance that are in peri or early post menopause so we're trying to match this with the data where this increase in body fat occurs so the few years before menopause the few years after menopause so if any of your listeners are interested um I'll give my email at the end um we're not officially recruiting yet but um and we need younger women too and that that that's going to be our control group so that's um that's the what we're really focusing on so I'm a little bit passionate about this because I know a lot of women who say this what they're told from seemingly everybody what you're lying about what you're eating you're you're skipping your workouts which again probably 75% are I'm I'm listening

57:20to the women who do track everything who do measure in way who don't miss workouts and they're the ones saying this so that's that's who I want to test and my research will um we if there is no difference well this is a study that will say hey there is no difference so um and I also make this a point I'm not out to um try to disprove the energy balance equation I'm an advocate of that I'm not I'm not out trying to to validate everybody's weight loss resistance I'm just trying to further the conversation to get data um and regardless of our outcome one study doesn't prove anything so this is at least there's somebody studying this for women who think there might be something that's different about their situation yeah what are the data points are you tracking body composition dexa what are you what are the actual data points yes so that's that's hard um

58:21with a virtual study so what we're doing we're going to take up to three weeks to to validate energy balance so we're going to have them to eat normally weigh themselves what are your maintenance calories then we're going to give them an eight week caloric deficit so I think it's 25% 20 or 25% caloric deficit anchoring protein like 1.6 grams per kg and we're having them use their own scales for these eight weeks so they weigh weigh in every day track their their their their macros so the main outcome is body weight now we do want and are asking everybody if you have access to a research grade body composition device like a dexa like an in body bod pod something like that we we want you to get that data because then we can actually look at fat and lean mass yeah um I would love to be able to say hey use this home scale that measures this

59:25they're they're I haven't I have the confidence in them so we have to use weight because that's well one it's easy and two I trust weight but I would never do that in my own lab like we would use our our actual ultrasound in body bod pod but when you do a virtual study we're we're we have to use weight and another limitation of our study is we're recruiting women who claim they are weight loss resistant so I don't I don't want them to be biased but maybe they're already biased but the reality is they have to follow the diet we're prescribing them or we withdraw them and we trust that they will just like we're trusting that the younger women do so that's the that's the main study we're writing up all the studies on our menopause fitness survey as well okay well if any of my patients and Omaha are listening I own a dexa at upgrade performance institute so we can we can we can measure you so I love we I love having that I think it's a good objective way not only to track you know obviously you know subcutaneous

1:00:29fat and lean body mass but visceral fat um you know there's some like bit women out there that I scan and they've got visceral fat or I do a coronary calcium scan I'm like you've got metabolic disease you know I think you know there's some women that think they might be healthier than they are sometimes so yes oh and real quick let me give my email now yeah yeah my university email address if you're interested it's be Campbell at usf.edu and we can put that in the show notes too the be Campbell at usf.edu if you guys are interested in being in a weight loss resistance study studying menopause of women and of course we need some younger matched controls shoot bill an email and I'm I'm I'm I'm waiting with beta breath to see what you find and I think this is a good you know like starting point as you said on your social media this will not settle the science but I think that it's uh that a very understudied

1:01:29population and you came in into it you know on a very uh for a very personal reason which I think is how most scientists uh come into some of these these conundrums so Bill you're such a wealth of knowledge thank you if you guys don't follow him at bill cable PhD he has a really amazing social media he shares really really really useful tips and tricks and research you can sign up for his newsletter too but I really appreciate you coming on the podcast and giving us your time yeah thank you very much for inviting me all right we'll talk soon bye