Dr. Stacy Sims: Women Are Not Small Men: How to Finally Train in a Way That Actually Works

Stacy London (00:01) Dr. Sims, so happy to have you here. I know that you're an exercise physiologist, and I want to talk about whether women — especially women in midlife — are getting their advice from the same information we've always heard about male physiology. Is there enough known about female physiology for us to be getting the right advice as we age?

Dr. Stacy Sims (00:28) There is enough information, and more keeps coming out, which is great. But unfortunately, the translation of that into practice is still behind. A prime example is when we start talking about strength training. We see that any strength training is good, but to optimize women as they age versus men as they age is different. Women lose their power first — they lose the fast-twitch fibers and their power first. And then they have cell death, meaning they lose lean mass, whereas men have a more gradual projection of losing lean mass.

So if we're really going to optimize women, yes, we want strength training across the board — but to truly optimize it, we have to look at that neuromuscular connection. It helps with cognitive function, but it also helps with power. And that is critically important as we get older — being able to catch ourselves if we fall, step off a curb, that sort of thing. That kind of information isn't really getting out there, because it's still being treated as general physiology that applies to everyone, rather than being specific to muscle physiology and brain neurophysiology — all the things that actually optimize women.

Stacy London (01:37) And this is what makes me so crazy. The idea that there is so much more that women need to know, and that we're not getting that information simply because historically men and male physiology was what was studied. Those nuances are not just nuances — they really are the roadmap for getting a modern woman to exercise correctly.

Dr. Stacy Sims (02:25) What frustrates me is that in every other field of science — besides exercise science and sports science — there is specificity about sex differences from the cellular level all the way up to whole body systems. And then you hear in the exercise world: "No, there's no sex difference. There's no difference." And I'm like, of course there is. There's absolutely a difference.

If we look at heart cells and how heart cells remodel — estrogen and the XX chromosome have an extreme impact on how our cardiac muscle works and functions. The way I like to describe it is through heart rate variability, which we think of as our stress monitor. In male physiology, the heart rhythm and autonomic nervous system don't really fluctuate that much from month to month or across life phases. But for women, we see a definitive switch in heart rate variability across the menstrual cycle, across oral contraceptive pill versus an IUD versus endometriosis, PCOS, perimenopause — and then a new baseline postmenopause. That's not being captured. No one knows that. So women look at their heart rate variability and go, "Oh my gosh, I'm so stressed and I need to take it easy." But in actuality, it's simply the way the autonomic nervous system and the heart have switched in response to different hormonal signals. It's normal physiology.

And when we look at lifelong exercisers, we see that women's hearts remodel differently than men's. We hear about all this sudden cardiac death in men and male athletes — it's because the cardiac muscle itself gets incredibly strong and tough, but the chambers don't expand. For women, we develop the muscle around the chambers and the chambers expand. So in women it will show up as an arrhythmia — which is not clinical or a problem — but it's being read against male data. Whereas men will show up with what looks like a normal arrhythmia and then suddenly go into VTAC. It's the way the heart remodeled. There are so many sex differences across so many different systems — it frustrates me every time someone in the fitness world says there's no difference. Of course there is.

Stacy London (04:49) That seems like such a no-brainer. And I also want to ask you about the microbiome, because you touched on estrogen — estrogen in the heart, estrogen in the brain, estrogen and bones.

Dr. Stacy Sims (05:41) Yeah. Even things like IBS — we know there's a far greater prevalence in women than in men. I think it's two-thirds of IBS sufferers who are women.

Stacy London (05:53) Wow. Why is that?

Dr. Stacy Sims (05:55) It's the way the immune system changes across the menstrual cycle. It's not necessarily purely hormone-driven. We also see that estrogen affects it — it's the way these cells have conversations. So we see huge fluctuation because of immune differences across the menstrual cycle and perimenopause, and it's somewhat estrogen and progesterone driven. So it's not just hormones. Everyone says, "It's estrogen, it's estrogen," but it's not.

And that immune system shift changes the gut microbiome. When we look at women who suffer from IBS, their gut microbiome is different from men who suffer from IBS and from women who don't suffer. So that brain-gut axis is critically important.

Stacy London (06:50) And that brain-gut axis — when women start dealing with issues like brain fog, mood, energy, or weight gain, does the microbiome drive some of that? We're so often focused on the superficial symptoms. What can the microbiome tell us about our physiology that's helpful in terms of how we take care of ourselves? Is taking a probiotic or prebiotic consistently important?

Dr. Stacy Sims (07:23) Yeah. So we want to make sure we have a high-fiber diet — fruits and veg, right? And if you've had a course of antibiotics, then we look at using a really good probiotic. But when we're looking specifically at the gut microbiome and how it changes, we see a definitive switch in diversity in about the four to five years before that one point in menopause. And this is contributing to changes in body composition as well as changes in resting metabolism and sleeping metabolism. All of these things can contribute to increased body fat and visceral fat.

One of the biggest things someone can do is increase that diversity by eating a lot of fiber-rich foods and protein. It's so important. The reason diversity goes down is, yes, we're losing our sex hormones — which has a direct effect — but also because we're so sympathetically driven during perimenopause, our body just can't come down. And the sleep interruption that comes with that creates a push for more of the obesogenic type of gut bacteria to grow. That means they take up more of the energy from food and make you crave simple carbohydrates. They dampen your immune system. They reduce serotonin production. So all of these things that tend to be more overt menopausal symptoms — yes, we have the hormone factors, but we can also trace them back to the gut.

Stacy London (08:26) Wow. So you're saying it's not necessarily about taking an additional probiotic or prebiotic — it really should be coming from diet. And how do you feel about fermentation? I'm a big sauerkraut fan.

I'll say — both before and after menopause for me, I've always had a sweet tooth. But my sugar cravings went through the roof during perimenopause. I know quite a bit about diet in relation to physiology because I have autoimmune diseases. So I took a lot of things out — gluten, dairy, soy, sugar, I quit smoking, alcohol — all of the things. Everything except gluten and dairy slowly came back into my diet, but in a much healthier way. I've been off gluten and dairy for about 16 years. And so much of that has to do with inflammation.

How does inflammation work in perimenopause? Because I felt like mine just skyrocketed — everything from swollen hands and feet to headaches to constantly feeling dehydrated.

Dr. Stacy Sims (10:54) And frustrating, because you're like, what's going on? I don't feel like myself.

So there are a couple of layers here. We know that autoimmune diseases show up much more frequently in early to mid perimenopause because our immune system is taking a hit from being sympathetically driven, and we're having changes in hormone profiles. And we know estrogen is a big driver for anti-inflammatory responses. So we do see an uptick in autoimmune disease, and a significant sex difference there, of course.

When we look at what's happening from the inflammatory drive, we have a whole-systems check. Yes, we're having a decrease in estrogen, which is a significant anti-inflammatory agent at the cellular level. But we're also having changes in the gut microbiome. We're sympathetically driven — tired but wired — which is a stimulus for the brain to stay on all the time, which actually reduces our immune system. We end up craving simple sugars and simple carbohydrates because our brain is tired, so we're not feeding the body what it needs to build the immune system. There are all these things from a whole-systems perspective that contribute to inflammation.

And when people think "inflammation," they go, "I'll just go on an anti-inflammatory diet." Yes, but we also have to ask — is this a trigger because you're going down the path of an autoimmune disease? Or is it an anti-inflammatory diet that's trending versus one that's actually right for your body, because these are the specific things that are inflaming it?

Stacy London (12:38) Right. And that requires extra time with your doctor, testing, all of those things. I did not realize the chronic nature of inflammation over time — that if we are already stressed in perimenopause, the additional stress we're putting on our bodies is so taxing that we feel completely exhausted. There was a point where I couldn't sleep at all, and once I went on hormones I had to find that balance.

Inflammation is sort of the root cause of a lot of dis-ease in the body. So from an exercise standpoint, is there something we can do about it, particularly as women?

Dr. Stacy Sims (13:35) Absolutely. When we look at what an inflammatory process is — we have good inflammation, which happens right after higher-intensity exercise. That's a positive inflammatory response. We want it, because it's a signal to increase anti-inflammatory properties.

Exercise is a huge driver for improving immune system function and the signaling for anti-inflammatory responses. And when we look specifically at what we want for health span — we know that inflammation within brain tissue is definitely a risk factor for Alzheimer's, dementia, and cognitive decline.

If we're doing resistance training on the heavier end — higher intensity with regard to resistance training — we're going to get that signal for anti-inflammatory responses post-exercise, but we're also getting a neural connection. We see that heavier lifting increases neural adaptation in the prefrontal cortex — that's our memory and cognition. It also affects other areas of the brain, improving the remodeling of brain tissue. So it's really important for brain health and anti-inflammatory responses to do a periodized resistance training program.

I know that can feel like a non-starter — and I come from a massive endurance background. Then we have cardio, and we all grew up with the calories-in-calories-out mindset. But we're not talking about that. We're talking about small, strategic bouts of super high-intensity work.

Stacy London (15:06) Run as fast as you can for as long as you can?

Dr. Stacy Sims (15:15) And we hear all the time that perimenopausal women shouldn't do high-intensity work because it increases cortisol. But if you're doing all the typical high-intensity classes — F45, Orange Theory, even some of the CrossFit and Hyrox-type stuff — those are what I call "sometimes foods." Just like cookies are sometimes foods.

Stacy London (15:38) Like high heels — sometimes shoes.

Dr. Stacy Sims (15:42) Exactly. There's a time and a place for it — usually social. Just like high heels are social.

What we want to do is some bouts of 30 seconds or less of super high-intensity work — three or four intervals with two to three minutes of recovery in between. Because we're trying to create a response that is extremely demanding on the body — on purpose. The signal is to create what we call an epigenetic change. We have our genetic blueprint of DNA and a lock mechanism. A really high-intensity session unlocks parts of our genetic code to improve inflammatory responses and increase anti-inflammatory properties. It improves the way our muscle responds. It also creates a conversation between the liver and other systems to decrease visceral fat gain — and visceral fat is itself an inflammatory property.

I don't want people to think of exercise as a chore. I have so many people say, "What if I don't want to exercise?" It doesn't have to be something you hate.

Stacy London (16:54) How do you make it better, Dr. Sims? Because I really was into weight training, I was into very low-impact cardio. I was into it, and I saw huge changes — I saw my cholesterol go down. I want stability, flexibility, and strength.

Dr. Stacy Sims (18:26) Yep, exactly. And I think — I mean, I'm on podcasts and I have this appearance of having it all together. But this is history, right? I started strength training at an early age. I was a rower, I was a swimmer. So all of that is training history, and I have to work to keep it. Every time I travel, I come back two or three kilos lighter in lean mass.

Stacy London (18:34) Look at your shoulders! Hello! You are buff, lady.

Dr. Stacy Sims (18:53) And it's really hard. I have injuries, I have problems sleeping, I'm highly stressed. But what I've noticed — and what I tell people — is: have a wellness meeting with yourself.

If you think about yourself now and how you want to be in three years, five years, when you're 80 or 100 — however long your health span should be — start with a wellness meeting. Have checks and balances and go, "Today, I really feel like I just need to stand outside and do some mindfulness and some deep breaths." That's fine. That is your wellness meeting. It's going to help with parasympathetic activation and help you calm down. And then the next time: "Okay, I want to push it a little bit. I'm just going to start with some bodyweight resistance work." Ten minutes. A 10-minute circuit.

And it's all part of the wake-up process. I tell people to try to do it first thing in the morning, before the day gets busy, before all the lights and sounds start coming in. Just make a point in your calendar to have a wellness meeting with yourself at least three times a week. And as that becomes a habit, it just keeps evolving.

Stacy London (20:05) I didn't mean to interrupt, but I just want to say — having a wellness meeting with yourself, making a wellness appointment with yourself, is already softer and more welcoming terminology than "I've got to go exercise" or "I've got to figure out how to make myself stronger." We're so inundated with information about what we should be doing or what we're not doing that it's really easy to get overwhelmed. So I love this idea.

Dr. Stacy Sims (20:21) Exactly. Yes.

Stacy London (20:34) Three times a week — because we are action-oriented on this podcast. Three times a week, you're going to make that appointment. I'm starting this week because of you. Whether it's meditation or taking it up a notch — what would that be? Would that be a nice walk?

Dr. Stacy Sims (20:43) At the start, whatever feels good — what is going to become your habit? For me, I need to be outside every day. I'm like my dog — I just need to go outside every day. Get away from the noise and see what's going on. I know that if I have a few days inside, I'm absolutely stir crazy, even if I've done gym work. I need that time in nature. It's so important for people to have time in nature.

So if you're meditating, going for a walk, or doing some wall push-ups and air squats — if you can get outside, it really accelerates that feeling of "this is for me, this is great." The research on being outside is significant, as is the research on social connection and avoiding social isolation. So as your wellness meeting evolves, you can find a friend who might want to do a 20-minute session with you. It just becomes part of your life.

Stacy London (21:46) It's funny because I used to think of that as an accountability partner. But the way you're talking about it is so much more inviting — it's taking the same information and reframing it in a way that feels more kind and insightful to women in midlife experiencing all these physiological changes. And social connection is one of the pillars of wellness that we sometimes breeze past. Because really, isolation is terrible. Just terrible.

Dr. Stacy Sims (23:17) It is awful. I was thinking of these two women — I explained all of this to them and they were like, "Yeah, okay, we're going to start this." So they started with 10 minutes and would meet for coffee first. And then they took their coffee and started going for a walk. Then they stopped doing the coffee together and just met for the walk. Some days one of them wouldn't feel like doing much, but the other would say, "I want to do my sprint interval." So one would be the cheerleader walking behind going, "Go, go, go!" It wasn't running sprints — it was stairs. And then they started doing rock walks, seeing how high they could climb. So it became this whole challenge within a 20 or 30-minute set. It was really cool to see the evolution from "let's meet for coffee for 10 minutes" to "we're going to encourage each other to be physically active in all these functional ways."

Stacy London (24:28) I love that. And I also feel like — Gen X in general — we were brought up to be so competitive with other women. There was only one job, or only one guy to marry, or whatever it was. We were not taught to work together the way we're learning those lessons now. And from my menopause experience — and certainly one of the reasons I feel so strongly about this podcast — you need people you can trust and people you want to hang out with. If you have both of those things, it redefines the way we think about being social in midlife.

The rest of my life, I should be able to walk on the pier or take my dog for a walk. That's what matters to me. But let's talk about effective nutrition, because a lot of women say they eat healthy and it just suddenly stopped working. All of a sudden they're gaining weight, and it doesn't matter how much they exercise — they're holding onto weight or water. What would you say to them?

Dr. Stacy Sims (26:31) I hear this so much. And you have the whole crew that says it's calories in, calories out — just move more and eat less. No. It's about being strategic in how we're eating.

We have to work with our circadian rhythm, because this is becoming more and more apparent as we look at chronobiological research. Our circadian rhythm includes our cortisol awakening response — why we wake up in the morning. We need that. And we need little bouts of cortisol throughout the day to stay awake and be reactive. If we don't eat in the morning — and a lot of people are fasting or trying to reduce calorie intake — if you hold that fast past 11, hitting 12 o'clock, we have effectively phase-shifted. That means all of the normal hormone pulses have become dysregulated.

And when we're phase-shifting, we're also disrupting our melatonin production. So we have a harder time falling asleep and staying asleep. And that creates more metabolic dysfunction, because if we're not sleeping well, we don't have the opportunity for metabolic control. So it becomes this big compounded problem.

A lot of women are following trends — fasting, calorie restriction — out of fear-mongering about their changing metabolism. So they'll skip breakfast because they're not hungry, then have their calories between 12 and 6 or 7 p.m. And we see definitively from research how bad that is for women. It's also bad for men, but not as bad, because our circadian rhythms are a little bit shorter than men's. And it disrupts all of the normal hormone pulses — luteinizing hormone, FSH, our testosterone, a little of our estradiol that's still there, our cortisol responses. We see women who are much more susceptible to severe responses to small stressors when they're not eating according to their circadian rhythm.

So the first thing I talk to people about is: we want to have more of our calories with a big protein hit towards the morning, keep protein throughout the day, try to have more calories towards the front end of the day, and then have a break about two to three hours before we go to sleep so we can get into good, deep restorative sleep.

And the other thing about sleep — a lot of women, including myself, want to spend time with our partners or have time to ourselves around nine o'clock. But we're really sleepy and we push through it. Then we get into bed at 10:30 and sleep fitfully. It's because we've missed our melatonin rise. We missed the first one at nine, and then we're trying to catch the one at eleven, but it's too late. So we end up with interrupted sleep.

Stacy London (29:55) And imagine pushing through sleep and then having ice cream as a midnight snack. Then you're really messing with things. I just want to reiterate what so many other experts have said — breakfast is kind of a requirement at this stage of life. It really is.

Dr. Stacy Sims (30:12) It is. So let's just have it earlier.

Stacy London (30:18) And this idea — I know so many people who swear by intermittent fasting, who are happy to be in ketosis. It seems like the benefits of intermittent fasting are being misrepresented or misused for women in midlife specifically. This idea of front-loading calories earlier in the day — and I know calories are not all created equal. When you talk about that big protein hit, you're talking about fiber throughout the day, fruits and vegetables. We can get enough protein and fiber if we're front-loading and continuing to eat through the day. We don't need extra supplements as long as we're getting the regulated daily amounts, right?

Dr. Stacy Sims (31:10) Exactly. And there is a time and a place for supplementation — you could be busy, or you may not have an appetite because things have changed and you're stressed. So yes, real food first. We can call it intermittent fasting where you're eating during the day and then have your fast from about 6 or 7 p.m. until the next morning. That's intermittent — you get a 13-hour fast. We can be trendy about it, but it works with your body.

Stacy London (31:42) We can multitask — we can fast and sleep at the same time.

Dr. Stacy Sims (31:44) Exactly.

Stacy London (31:44) That's good to know. The other question is — we're obviously seeing this huge rise in GLP-1s. A lot of people are losing weight, but we're also seeing a lot of people lose muscle. What would be your recommendation if someone is taking a GLP-1, is trying to eat as healthy as possible, and has weight to lose? What is the best way to safeguard muscle?

Dr. Stacy Sims (32:23) We have to be muscle-centric. We have to think about resistance training — working with a really good periodized program, going from lighter loads to heavier loads, and putting in some plyometric work. Because it's not just muscle, it's also bone. We see a significant drop in bone density not only through aging and perimenopause, but also in people who are on GLP-1s. So we have to be very skeletal and muscle-centric. It's your protein, it's your resistance training, it's your jumping — and eating according to your circadian rhythm. Because if we have a big fast, one of the first things to go is muscle and bone.

Any older literature on severe calorie restriction shows that the very first thing to go is lean mass. So the interventions are the same now: muscle-centric approach, protein, resistance training, movement. Instead of severe calorie restriction from withholding food, you're using a GLP-1 to reduce appetite and facilitate weight loss — but the strategy for protecting your body is identical.

Stacy London (33:37) Just so everybody heard that correctly — your diet and exercise regimens stay healthy and the same when you're on a GLP-1. And if anything, be more strength training-centric, because the potential to lose muscle is so much greater.

Dr. Stacy Sims (33:56) Absolutely.

Stacy London (34:13) Exercise touches on everything, right? We've talked about the brain-body connection, social movement, nutritional health — and mental health as well. Do you see the deep connection between mental health in perimenopause — when anxiety, rage, and depression are so much worse — and exercise? We know exercise is an antidote for some of those things. Maybe not completely, but it certainly helps, correct?

Dr. Stacy Sims (34:52) Correct. And I bring it back to reframing. When we look at our puberty-going children — boys and girls — we say, "Go outside, go for a run, go do some activity," because we know they'll be calmer. Same thing applies to us. We're at the other end of the hormonal spectrum. And when you push your body and get that feedback from exercise, it changes neurotransmitters. We see a big increase in serotonin, dopamine, and norepinephrine. All of these are calming.

I know — and I've talked about it before — one of my menopausal symptoms is severe rage. I put a hole in the wall the other week with one of my daughter's slime toys because I was so mad. I was like, "Oh my gosh, I just put a hole in the wall." I'd rather have gone for a run. But you think about these things, and you realize — movement, especially when you have the ability to push really hard, like just going for a big sprint down the road or running up the stairs — even a small amount significantly helps.

Stacy London (36:14) I find the easiest parallel in life is that you start to feel like you can do more when you physically do more. Not just multitasking — literally, when I lift weights, I'm like, I am Superwoman. I can do this. I can run my own life. It gives you this unbelievable sense of confidence that doesn't come from looking in the mirror. And that's something I've really struggled with in midlife — I don't look like I used to. I don't want that to be my value system. I want my value system to be based on how strong I feel, how competent I feel, how confident I feel. And I have never come closer to those feelings than through exercise. Even though I hate it and I don't want to do it — that's where I build so much confidence.

Dr. Stacy Sims (37:21) Yeah. I tell women: you want to take up space. We tend to round down — looking at things, walking down the street, not feeling that great, kind of moving out of the way. None of that. The very first thing in your head when you wake up: I'm going to take up space. I want to take up space in this world. And as soon as you expand and open up your chest, you just feel better. You're like, yeah, I can do this.

So when people get into hard situations — because emotions are so strong during perimenopause, whether you're at work, dealing with partners or kids — take a deep breath and take up space. Drop your shoulders, open up your chest. And all of a sudden you feel confident and you can take control of the situation. And I find that as women develop strength in the weight room and take up space — because they're like, "I'm going to use this lifting platform, I'm going to use this machine" — they become very confident in the way they move in their own space. That exudes outward, and people are like, yeah, she's someone I can listen to.

Stacy London (38:24) Just practically — if there were three things you'd want somebody to take away from what you talk about most: what are the three exercises most important for women in perimenopause? And from a nutrition standpoint — we know protein is one — what should people actually be paying attention to?

I'll also mention: I just had a physical and got a very low vitamin D reading. I've been very tired. So are there things we should be looking for when we go to our physicals, in terms of where to pay the most attention?

Dr. Stacy Sims (40:10) So the very first thing I'm going to tell anyone is sleep, because we cannot invoke any kind of change without good sleep. We also see that poor sleep contributes to brain fog — if we have lots of interrupted sleep, we'll have moments of mental lapse and forgetfulness during the day, because the glymphatic system is trying to clean the brain while we're awake, because it didn't have enough time to do so overnight.

And it's a catch-22 because you're in perimenopause and you can't sleep. So we look at what might be at play. The first thing is circadian shift — if you're fasting and doing things that are creating a shift, we need to work on that. Are you newly diagnosed with ADHD? That's also a circadian shift. So instead of taking melatonin right at bedtime, take it three or four hours earlier so it helps with the melatonin peak and you can get into deep restorative sleep.

And how close are you eating to bedtime? There's so much around sleep hygiene — different supplements, cognitive behavioral therapy — many approaches, but it's very individual. Sleep first. There's no change in body composition or anything without good sleep.

Then we talk about exercise — and this is a woman's own journey, depending on what she likes. Ideally the non-negotiables are strength training, jump training, and a little high intensity mixed with your "soul food." Your soul food is whatever movement you love. For me, it's going out and wandering on my gravel bike for hours. That's not necessarily optimal for health span — but during the week: yes, some strength training, some high-intensity work. It's time-efficient, and it's beneficial for dementia and Alzheimer's prevention, body composition, mental clarity, and improving sleep. Because a little movement and high-intensity work feeds forward into better parasympathetic activity and better sleep.

When we talk about food — every time I go back to the States, I go into grocery stores and I'm like, what is going on? There's nothing real to eat in here. And if you want to eat well, it's more expensive. So how do we navigate this?

We want foods that have really good protein and fiber. That's the bottom line. Every time you have a meal or a snack, you want protein and fiber. That could be edamame with a cheese stick. It could be some whole grain crackers or sourdough with grilled chicken. Maybe yogurt or cottage cheese. Maybe eggs. We're looking at all the things our grandparents used to eat — it's such a cliché, but it's true.

And it ends up being cheaper than buying all the packaged stuff. I get frustrated now that we have protein Pop-Tarts and protein chips. No. That's ultra-processed — that's not what I mean. We want real food. And if you start gravitating more towards real food and make an effort to get 30 different plants a week, you start to feel better. Your gut microbiome flourishes, you're getting adequate protein for your immune system, and you're able to produce more serotonin — because 95% of the serotonin we produce comes from our gut. So if we have gut dysbiosis, we reduce serotonin.

Make an effort to get those colorful fruits and vegetables, whole grains, good food. Not only are you feeding your body — you're also feeding your soul. You start to feel better. Those are the non-negotiables.

Stacy London (44:27) That's amazing. Are there things we should be looking for when we get our physical results back? When we get that list of numbers — is there anything in particular you want us to look out for? Cholesterol levels? What are the biggies we need to pay attention to?

Dr. Stacy Sims (45:05) Vitamin D — like you mentioned, you're low. Vitamin D is really a hormone, and it's important for so many different systems in our bodies. Understanding your vitamin D levels is essential.

We also look at traditional blood tests and cholesterol. A lot of women will now see that their LDL is elevated when it never has been before. That is linked to the disconnect between estrogen and our liver. To work on that — fiber, and some anti-inflammatory high-intensity work, to help with the conversion of cholesterol into beneficial forms.

We want to look at bone density. If we have a risk factor for osteoporosis, a family history, or we're within two years of that one-point menopause transition, we see a significant drop in bone density — and we can do something about it. We can do hard-landing jump training, because that significantly improves bone density.

Stacy London (46:13) Like jumping rope?

Dr. Stacy Sims (46:25) Not quite. When we jump rope, we tend to jump on our toes and absorb the impact through our calves and muscles — and we don't want that. We want to land hard. So it could be a double jump where you're not jumping very high, but landing hard and then immediately taking off again, because we want that multi-directional stress through the entire body. That's what creates bone density. But we don't start right away — we have to phase into jump training before getting into the full version.

That is one of the biggest ways we can improve bone density. A friend of mine created a whole app called Osteogains — it's 10 minutes three times a week, or you can divide it into three minutes five times a week.

Stacy London (47:19) How can three minutes or 10 minutes be enough? That does not sound terrible to me. It's when we get into an hour that I'm like — doing what?

Dr. Stacy Sims (47:31) Exactly. Too long. And this is why — having the mentality of an athlete means every session has a purpose. If you're going to get up and exercise on purpose, then in my book, you're an athlete. I want you to think like one. I want you to understand what you're doing, why you're doing it, how to recover from it, and how to fuel your body so that it adapts and you can keep going.

Stacy London (47:55) Okay. One last question — peak performance. I know you've said it looks different in midlife. Our peak performance is not what it was in our 20s. What does it look like now?

Dr. Stacy Sims (48:11) It depends on what's going on in your life. Are you looking for mental performance? Physical performance? Are you training for something? Do you have an eye toward being strong and capable at 80 or 90? All of these things come into play.

When we talk about peak performance, I really want to shift the narrative and have women think of themselves first — because we're so focused on pushing other people forward. This is why I tell women: have a wellness meeting with yourself, and make it non-negotiable. There's no deleting it off the Google calendar. It's a permanent meeting. Because in that context, women go, "I need to take care of myself first." In order to show up for anyone else, we have to have a good mental state and a good physical state for where we are at this point in our lives. To me, that is peak performance. You're showing up for yourself — and you're showing up for your family or your work — without the extrinsic pressure of imposter syndrome or any of the other things we've been so conditioned to feel.

Stacy London (49:30) Yes. And we're conditioned to optimize everything. There are so many people online joking: "Okay, eat your protein, but don't eat too much protein, and don't forget fiber, and don't forget..." — and we can get completely overwhelmed with the idea that we're never doing enough.

This makes it very clear. I am definitely making a wellness appointment with myself, and I hope our listeners will too.

Dr. Sims, thank you so much for your time. This was wonderful. Now, you have a newsletter — how do people subscribe?

Dr. Stacy Sims (50:09) Yes. Just go to drstacysims.com and sign up for the newsletter.

Stacy London (50:19) drstacysims.com.

Dr. Stacy Sims (50:22) That's it. Yep.

Stacy London (50:24) How is it, might I ask, that you're living in New Zealand?

Dr. Stacy Sims (50:27) I know, it's strange. I came down here in the very late 90s on my own — I was living in San Francisco and some triathletes came through and said, "Oh my gosh, it looks just like Wellington." A job came up, and I was like, you know what? I'm 26, single, no attachments — sold everything, moved down to New Zealand. And after two weeks, they made me redundant. They closed the clinic and were like, "Sorry, we didn't —"

Stacy London (50:49) You are kidding.

Dr. Stacy Sims (50:56) So I found my feet, ended up doing my PhD down here, and met my husband — who was my supervisor's best friend. Then we moved back to California for about 10 years. And it got to a point where we were in San Francisco with a very young daughter and it just wasn't a great life. Too expensive, childcare was impossible. The idea of moving back to New Zealand made sense. But now I'm like, I need to move back to the States — and then again I'm like, I don't think I want to. It's a bit crazy.