Nutrition and Exercise to Optimize Female Potential Dr. Stephanie Estima

Content By: Ari Whitten and Dr. Stephanie Estima

In this episode, I am speaking with Dr. Stephanie Estima – who is an expert in female metabolism and body composition. We will talk about the best application of nutrition and exercise for optimizing female physiology.

Table of Contents

In this podcast, Dr. Estima and I discuss:

  • Why you should organize your diet and exercise around women’s monthly cycles (and how)
  • The link between leptin and weight gain in women
  • The biggest hormonal differences between men and women and why it matters when it comes to training
  • How stress and inflammation affect the menstrual cycle
  • How you can treat PCOS
  • Why wearing socks to bed might help you sleep

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Ari: Hey, everyone. Welcome back to the Superhuman Energy Summit. I’m your host, Ari Whitten. And with me now is Doctor Stephanie Estima who is an expert in female metabolism and body composition. She specializes in the application of the ketogenic diet, fasting and exercise to female physiology. Using her framework, The Estima Method, she’s focused on distilling strategies, nutritional proxies, movement, posture, and mindset to actualize female potential. Doctor Stephanie has lectured at conferences and corporations over the past 17 years, is one of the top writers on Medium. And has been a featured expert in Thrive Global and on various morning TV shows. she hosts the podcast Better! With Dr. Stephanie and lives in Toronto with her three children. So welcome such a pleasure to connect with you.

Dr. Estima: I’m so happy to be here. Thank you for having me.

Ari: And obviously very much in line with your bio, you’re going to be talking about those things about nutrition and training in the context of optimizing female potential. I like how you phrase that. And I’m really excited to dig into this as I was telling you just before we started recording. The idea of training, according to per iodizing your training in line with a women’s menstrual cycle is something that they’re starting to be research on, really impressive research, and yet very few people are talking about it. So I’m really excited to dig into this content with you.

Dr. Estima: I’m excited to share it. And we were talking in the pre-chat. This has been born out of my own story and working with patients. And really seeing that for the most part, when we can become attuned to and tuned into our own natural rhythms, our own natural cadence and we can nuance the protocols, whether it’s fasting, whether it’s the food that you’re eating and the variation of macronutrients and your training, this is when we can start to really move towards optimizing the female potential and what it’s really supposed to be. So very excited to be here and to be nerding out with you.

Ari: Beautiful. So first of all, tell me about, I guess the three types of energy or three ways our body produces energy.

Hormone balance and energy levels

Dr. Estima: So often when we think about energy, we want to be thinking about where it comes from. So when I am talking about the ability to create energy, we’re talking about from precursors. So precursors can come from within the body and they can come from outside the body. So this can be internal or endogenous sources of precursors and exogenous or external sources of precursors. And really what we’re talking about here is food. So when we think about external sources of fuel, of course, we’re talking about our dietary carbohydrates, our dietary proteins, and our dietary fats. Those are going to be broken down into precursors for energy. So I hope I’m not giving anybody nightmares from high school biology, but what we’re talking about here is creating ATP, which is the energetic currency that every single cell trades in.

So those external sources of food can be used to and are used to create energy. When we consume excess food, so when we consume more carbohydrates than are needed, more fat than is needed, our body doesn’t throw those away much to our chagrin. Our bodies will keep those for a rainy day. So we will store excess carbohydrates first in the form of glycogen and the two areas where we most readily store glycogen is in the liver and in the muscles. And then excess carbs and excess fat after that are then stored in the adipose tissue or in our fat cells. And of course, we know that a triglyceride, which is the storage molecule of fat, we have a backbone of glycerin and then three fatty acids that are there. 

So when we are thinking about where food comes from first, we want to be thinking about the precursors, like the substrates. The other things that affect energy are hormonal responses, so whether or not you have an appropriate hormonal response. A really good example of that would be the glucose-insulin dance. So when we think about a type 2 diabetic, this is an example of the glucose-insulin dance. Every time you eat something, there’s going to be a hormonal response to it. So a type 2 diabetic is going to have a deranged insulin response in response to glucose. So we want to be looking at hormones that are in balance. There are hormones, particularly with women that can become imbalanced and deranged, and that can cause chronic low-grade inflammation and stress. That can influence our menstrual cycle, it can influence our moods, it can influence our sleep, our circadian biology. 

So I wanted to talk today about some of those and do a bit of a deeper dive with you in terms of some of the different parameters or some of the different hormones that can go awry that are both specific to women. But also, there are some hormones that we share with guys, that we have a particular sensitivity to or a particular pattern that is unique to two females.

Ari: Beautiful. 

Dr. Estima: So whenever we think about women, of course, the thing that pops to mind is the dimorphism that comes up is, well, women have a menstrual cycle. And of course, that’s very true and we’re going to be talking about that today. Before we get in there, though, I wanted to talk about some of the other ways that females and particularly our hormones are distinct from our male counterparts. And the two hormones I want to focus in on are leptin, which is a hormone that is involved in keeping us feeling full, it’s our satiety hormone and the other branch or grouping of hormones, are our stress hormone. So we want to be talking about cortisol. We want to be talking about adrenaline and in general, the sympathetic nervous system. And before I even get into that, the other two areas that I just wanted to plant seeds for the listeners listening to this is we also have sexually dimorphic organs as well.

So we all think, well, a liver is the liver. And what we understand about women and men is that there is different expressions of genes in the female liver versus the male. There’s different pulsatile patterns, specifically I’m talking about growth hormone in the liver. And we also have differences in other organs like our brains. So when you marinate a brain in testosterone, they’re going to have different areas of the brain that are going to grow and that are going to proliferate. And the same is true when you marinate a brain in estrogen, which is typically the phenotypic expression of women or a female. When you have areas that are marinating in estrogen, during development, you’re going to have an estrogen as a growth factor. You’re going to have different areas of the brain that are larger. 

So just as a point if you want some random knowledge at your next party, or random party tricks. Things like the amygdala we know is a hyper-responder to testosterones. So what we find is in the male brain, the area of the brain that’s involved in emotional regulation, it tends to be larger. Areas in the female brain that tend to be larger are the anterior cingulate cortex, which is involved in emotional regulation and being able to perceive in another person their emotional state. And there’s other areas we can go on a different geeky magic carpet ride another time.

Ari: Just real quick, you said for the amygdala emotional regulation?

Dr. Estima: So when we think about the amygdala, when we think about anger and being fearful, that is the area of the brain that is involved in that. 

Ari: So for men it’s more like fear and stress sort of danger perception rather than emotional?

Dr. Estima: Yeah or the other way that that can manifest is an aggressive behavior. So you’ll often find when you look at before we see socialized little girls and boys, you’ll often see that boys are much more physical than their female counterparts are.

Ari: Okay. I just wanted to clarify, because you said emotional regulation for both of them, and I thought maybe you meant to say more anger, stress.

Dr. Estima: I meant anger. Thank you for clarifying that. Yes.

Ari: Cool. Just wanted to make sure because I don’t want any of our listeners to come away thinking that men are better than women at emotional regulation.

Dr. Estima: I would argue that that neither are. It really does depend on the integrity of your prefrontal cortex, which can be, and this is maybe a different conversation, but the prefrontal cortex is the area of the brain that is involved in dampening the response in the limbic system, of which the amygdala is a part of. So we’ll talk about this in terms of parasympathetics, tools like meditation, tools like exercise, where we are increasing blood flow to these higher centers of the brain, are what’s important. And we’ll be talking about some of those strategies today too.

Ari: Awesome. So where do we go from here? What are some of the biggest hormonal differentiators between men and women? And how does that relate to nutrition and exercise factors or other lifestyle factors, that women in particular need to be aware of?

How leptin works in the female body

Dr. Estima: So we had talked about or I’d sort of introduced a few hormones, leptin, cortisol, and the sympathetic system. And then I also want to talk about sex hormones today. So we can start with leptin, which is the satiety hormone. That is the hormone that makes us feel full. It is secreted from our fat tissue, our adipose tissue and it’s in response to caloric consumption. So when you have taken in enough calories, leptin is going to start being released from your fat cells. That’s going to go up to an area in your brain that regulates your appetite and it’s going to tell you that area of the brain it’s time to stop eating. You’ve had enough and to put the fork down. What’s interesting about females in particular is that, and this is particularly true of women who’ve been on a diet their whole life. So they’ve practiced some sort of caloric restriction or they are engaging in fasting. And I want to put a little asterisks next to fasting, because we’re going to come back to that in our conversation today because we should not be fasting like men. So I’ll just kind of plant that little seed. 

For women who’ve been on a diet their whole lives or even for women who have excess wait on them, what we know is that women will hit the point sooner of getting hungry. Any woman who’s been on a diet knows that she can’t necessarily or she’s calorically restricting, she can’t be on that diet for a long time. And it will also take her longer to feel full. And I can include some of the research that has gone in around this for your listeners, if you think it’s useful. But what we’re talking about here is what is known as leptin resistance. So females are much more susceptible to leptin resistance than their male counterparts. So what that means is, normally when you eat leptin is released, the brain picks up on that signal and it says, okay, I’ve had enough calories, I’m going to stop eating. For women, we need to secrete much more leptin for that signal to get through because the brain for whatever reason has down-regulated its sensitivity, the area in the brain is called the hypothalamus. The hypothalamus has down-regulated its sensitivity to leptin. 

As a result, what happens is of course we continue to eat, so we continue to consume calories. Of course with excess caloric consumption, we have weight gain with that. So there was a really great a study, and this was around the time when I was actually discovering leptin. I was still a student at school and I had put on about, I can’t remember. They always talk about the freshmen 15 and I was like the overachiever. I put on the freshman 40. I remember with my student subscription to Pub Med at the time finding this study and I’ll send this link, Ari. But for every measure of obesity, so every given measure of BMI when women and men were matched pound for pound, what they found was men exhibited lower levels of leptin for every measure of obesity. So that’s important because that means that as women, we don’t get that hunger signal as quickly as the guys do. So that’s one way and it’s very similar when we think about leptin resistance, it’s very similar to insulin resistance. 

So when we think about a type 2 diabetic again, using that example. Smeone who has their insulin levels constantly elevated through because they’re taking in that excess carbohydrate, that excess exogenous substrate, the cells will, down-regulate their sensitivity to insulin, so that it is harder to get the blood glucose into the cell in order to in order to create ATP or in order to create that energy. Of course, as you very well know, one of the common symptoms of a type 2 diabetic, in addition to likely being overweight and inflamed, is they suffer from brain fog. They suffer from fatigue, from sleep disturbances and wake wakefulness. And feeling like they have a consistent amount of energy throughout the day without needing to go on that sugar roller coaster that they often do. 

So I wanted to talk about leptin. The other hormone or cluster of hormones that I wanted to talk about are under the branch of what I would call the sympathetic nervous system. So when we talk about epinephrine, adrenaline cortisol. We know that if you are a woman and you have leptin issues, which most of us do to begin with, you were already by default in a state of chronic low-grade stress because if you are consistently not putting down the fork, because you’re not getting that signal of satiety or fullness, you’re going to have excess adipose tissue. You’re going to have excess fat, that excess stored food. Being overweight is one of the ways that we generally can be more inflamed over the long-run. So we have the leptin issue, particularly if you are a woman, somewhere around your 30s and beyond. 

She’s had one or more pregnancies. She’s had one or more labor and deliveries, recovery from said, pregnancies, breastfeeding. And then the wild ride of sleep deprivation that’s commonly referred to as parenting, leaves these women completely exhausted. They’re running on adrenaline all day long. For the women that I’ve worked with, what I find is that, and I’ll also say this, even if you don’t have children. So even if there’s a woman listening, it’s like this doesn’t apply to me. I don’t have kids. If you don’t have children, you likely are working. And what we know about women in general is they also do the majority of non-paid work in the home. So if you have a career with or without kids or you have kids thrown into the mix, when you come home at night, you’re probably doing the laundry. You’re probably doing the cooking. You’re probably doing the cleaning. If you have kids, you’re doing the homework and the kids scheduling and all that kind of stuff.

This is data that’s collected year over year from the United States, from Canada and from Britain. I look at these three countries because these are the populations of people that I work with. And generally a woman does somewhere between 60 and 70% of the unpaid work at home. So in addition to the chemical stressors of pregnancy and recovery and breastfeeding and all of that and the physical and chemical and emotional stressors of working in a career, she’s also burning the candle at the other end of the stick at home. Usually when I’m speaking to a live group of women in a corporate setting or at a conference or something, I’ll say to them, “Okay, I’m going to give you a list of a few items. I just want you to raise your hand when you hear one of them that you’ve experienced in the past week.”

Ari: I’ll raise my hand on my wife’s behalf.

Dr. Estima: And there’s nine items here. So it’s just in the past week and I rarely get through the list without the everybody’s hands up. So I’ll read them and you can tell me if your wife has experienced any of these in the last week and anyone that’s listening also please take notes. Brain fog, needing to get coffee in the morning to get you going. Energy dips through the day. And I’ll specify that by saying after lunch, so let’s call it 1 o’clock to 4 o’clock in the afternoon.

Ari: I would say yes. I’ll also mentioned that we have an eight-month old baby. So she’s in the midst of that. There’s some bad nights.

Dr. Estima: Difficulty falling asleep. So mind is racing or she’s just wound up from the day. Difficulty maintaining sleep and specifically waking up in the middle of the night, between two and four in the morning. Inability to lose weight no matter what. Needing to eat or snack frequently. Moodiness and salt cravings.

Ari: I hope she’s not listening, but yeah. 

Dr. Estima: It’s like eight of those nine things. And I share these things not- Ari: She was listening. She just came over from the kitchen to point at me.

Dr. Estima: She’s like, that sounds like me. Was she describing me. What’s going on? 

Ari: She’s like, no, I’m going to break out the whip and you’re going to be doing 70% of the housework.

The autonomic nervous system

Dr. Estima: And I say this not to shame anybody. This is not like, look at all the things that you have wrong with you. This is really just trying to demonstrate that we are in this constant running on adrenaline, contractive state. And when I say contractile or contractive state, what I’m talking about is your sympathetics. So we have the autonomic nervous system, which kind of sounds like automatic and it sort of is. It happens involuntarily. And there’s two main branches of it. We have your sympathetics often called, fight or flight and freeze. Those are the three F’s and/or your stress response. And then we have your parasympathetics, which is the rest, digest, stay in play. And when we are in this state of survival, which is your sympathetics, this is very contractile, everything gets shut off. If there is a threat or a perceived threat to the organism, you are not going to be thinking about reproduction. You’re not going to be thinking about digestion. You’re not going to be thinking about your immune system. All your body is concerned with is surviving the impeding or the imposing threat. 

So your body is going to oppose insulin. So cortisol is a counter-regulatory hormone, meaning that it opposes insulin. Its job is to keep the glucose in the blood, so that I can throw it to the periphery, so that it can throw it to the musculoskeletal system because you either need to fight, flight, like get out of dodge. The other option is just to freeze, like the deer in headlights sort of look. So when you are constantly in this contractive state, you cannot repair. Your parasympathetics is where you repair, where you sleep, where you regenerate. And who this applies to is any woman, I’m sort of building this classic woman that I constantly see is like. She’s between 30 and 55. She’s either a new mom, like your wife is or she is a as a mom to two to three kids, balancing a career. She has had these sleepless nights. She’s trying to figure it all out. It’s like when you look at your gas tank on your car and you see the gas is starting to get into that red zone, and then you get the little thing up on the dashboard. Most women are like, I need to find a gas station, but just not yet. I just need to get one or two more things done on my to-do list before I go and find the [SO] or whatever. 

The issue around this is, if you do not get a handle on your chronic stress, and when I say stress, I use the word inflammation and stress interchangeably. So chronic low-grade stress or chronic low-grade inflammation over time, if you don’t get a handle on it, it’s going to supersede your body’s ability to maintain balance, what we call homeostasis. And we talked about what stress does; keeps you in a state of threat or survival. I wanted to just define for a moment, the different types of stress that may be applicable to you. We have acute and chronic, but then there’s also different verticals in terms of what would constitute as stress. So we would have physical stress. Everyone’s sitting at their desk all day or if they’re a new mom they’re breastfeeding and they’re sort of flexed over. We have chemical stress. So the foods that we eat, the environment we live in. 

For women, it’s the makeup that we put on day in day out that has like all the toxic stuff in it. And then, and then our mental health as well. Our early childhood experiences, what we were told in terms of our worth, the cultural norms around, whatever culture you grew up in, in terms of what the view was on women. Any maltreatment that you may have sustained as a child, we call this big T and little T trauma. Big T would be physical abuse, sexual abuse, emotional abuse. Little T trauma, things like bullying, being harassed, death of a pet. Things that are that can still play in and are on our psychology. So we want to be thinking about how we can get a handle on acute stress, because if we can’t get a handle on it, eventually we have to cut it out as cancer. Or we have to take medication for our cardiovascular disease. Or we have a lifestyle disease like diabetes or stroke or any of these things or mental health issues. So I wanted to just carve out those two as predecessors to the way that it affects a woman’s menstrual cycle. 

How the menstrual cycle affects the body

So I wanted to move into, if I can, talking a little bit about menstruation. The most beautiful blessings that we have is the ability to bring life into and onto the planet. If you think about it every single month, every single month for about 35 or 40 years, we are growing a new organ, getting rid of it and starting again. It’s the most beautiful thing, but it can also be really energetically taxing. And by the way for the women that are listening better in their 40s and perimenopausal, this is also for you. So I find a lot of women are lie, my period’s starting to change frequency. I define perimenopause as after 35, because we start seeing a stepwise attenuation or a stepwise decline in progesterone from about 35 to 49, 50, which is when menopause tends to happen for most women. So we want to be thinking about ways that we can understand our menstrual cycle, and we’re going to get into some of the fixes. I know I’m like painting this picture of doom and gloom right now, but I promise that there’s solutions.

So we want to pay attention to our menstrual cycle like it’s a vital sign. So if you were to go into a hospital, they would take your temperature, they’d take your heart rate, they’d take your blood pressure. They would look at your oxygenation. And for women, I want us to start looking at our menstrual cycle as an additional vital sign for our health and vitality. It is a great marker of the hormonal integrity and the hormonal landscape that we have every month. So what is a normal period. And then we can get into how we can start eating and training and fasting in accordance with that.

Ari: Sounds good. 

Dr. Estima: I’ll just pause here for a moment and say, I was at a female entrepreneurial group. And I was like, okay, we’re just going to start by explaining to you what your period is. We’re going to talk about each, the things that happen in each of the four weeks. And these are some of the most intelligent women I’ve ever met in my life. And they were like, holy crap, I didn’t realize that all this was happening. So I think that there’s value in empowering you with the different cyclical changes that happen through the month. And then we’ll play into how you can change your food, how you can change your training and all that. So we’re assuming that your cycle is about four weeks. It’s about 28 days. And the only reason why we’re doing 28 days is because I can’t do math. And it divides evenly by seven, which is a week. So normal menstrual cycle can be longer than 28 days. It can be up to 35 days is considered normal 26, 27, up to 35. So we’re just going to generally speak in weeks. Of course, if your menstrual cycle is longer than 28 days and you’re just going to divide it into those four quadrants.

So week one of your menstrual cycle is what we call the bleed week. So this is what we traditionally call your period. All your hormones here. This is when you are shedding, the endometrial lining. Your estrogen levels are low. Your progesterone levels are low, testosterone level. Everything is low because you’re shedding the organ, you’re shedding the endometrial lining. Just as a side, this is a great time for you to play with fasting and we’ll get into the different types and the different lengths and the different frequencies of fasting in a moment. But the first two weeks in general of your cycle, you are much more resilient. It is a much more hormonally resilient time for you to be experimenting with fasting or fasting mimetics like a ketogenic diet. And we’ll get into what constitutes an appropriate ketogenic diet for women, but just in the back of your mind, the first two weeks, great for fasting, great for keto.

Week two is the week before you ovulate. So I actually think that we have the naming of the menstrual cycle all wrong, because the main point of your menstrual cycle is not to bleed. The main point is to ovulate. So I actually think that ovulation should be your week one, like when you ovulate is week one. There’s no clear and distinct marer like blood is. So I just wanted to make that little note that, the point of your menstrual cycle is not to have a period or not to bleed, the point is to ovulate. And between days seven and 14, you’re seeing estrogen’s first rise in that 28 days cycle. So estrogen is a potent growth factor. She is trying to mature the follicle and the egg within it. And we are also seeing a rise in testosterone. So this is really important and I’ll come back to this when we talk about training. If we’re talking about profiting from testosterone, like testosterone is involved in keeping our lean body mass high, it’s involved in fat burning.

This week is my favorite time in the whole cycle to do very heavy resistance training. So we’ll come back to that. But I wanted to just mention testosterone comes up this week. This is when we feel really flirty, really sexy. This is when we want to have a lot of sex. Because mother nature, she’s a wily minx. She knows that the egg is coming around day 14. So if she can get sperm in and around the egg, we know that sperm lasts for about six to seven days on either end. So you’re going to feel flirty, sexy, extroverted in that week. So it’s just a good little reminder. So if you want a baby, this is the time where you should be ramping up your sex. And if you don’t want a baby, then we want to be thinking about other ways that you could be having fun with your partner or yourself.

Ari: Then you have to suppress all of your biological urges and everything nature is telling you to do.

Dr. Estima: Right. And there’s other things that you can do other than penetration, but yes, that would be the week. Just depending on what your goals are, baby or no baby, you want to modify your behavior appropriately. So then we have the main event. We have luteinizing hormone, which I always liken to that awkward uncle that comes in, smacks everybody on the back when they come in for Easter and then you just spit your food out. I mean, I have an uncle like that.

Ari: That’s quite a metaphor. 

Dr. Estima: So just think about luteinizing hormone, comes in like a bang, and then outcomes the egg from the follicle or in my case, whenever my uncle comes over for Easter, he hits me on the back and I’m often-

Ari: Is your uncle named Lou by any chance? We can think of this as the crazy weird Uncle Lou in every woman’s uterus.

Dr. Estima: It’s not Lou and I won’t out him, but he’s the crazy uncle. So that’s luteinizing hormone, and now we have the egg. So now she’s out and she’s waiting for fertilization. So in that third week, now we are moving into the second two weeks of your menstrual cycle. So it’s called the secretory or the luteal phase of your cycle, because now the follicle becomes, I always call it the artist formerly known as the follicle, it’s now the corpus luteum. So the luteum is now going to be secreting progesterone and other things. So we’ll get to progesterone in a minute. Week three, your entire hormonal milieu changes. So now we go from being sexy and wanting lots of sex and being extroverted and flirty and all that. Now in terms of personality and hormonally, we tend to become more inward. Metabolism changes during this time as well. So we’re starting to see progesterone and I have it on the slide here, which is the purple line. We’re starting to see progesterone’s rise during these last two weeks. 

She peaks at about day 21, so end of the third week, beginning of the fourth week. And we know that progesterone is a potent stimulator of your appetite, slows down your bowel movements, can affect your mood as well. So for any woman who thinks that she is crazy or there’s something wrong with her because she has more cravings in her third or fourth week, it’s not you, it’s progesterone. She is the dominant hormone in these two weeks here. In week four, this is the week leading up to your period. So at about day 21, we said, progesterone peaks. And then over the course of the next seven days or it’s really the next three or four days, if there’s no fertilization of the egg progesterone drops. And then that’s when we start to get what ends up happening is we get a schema of the endometrial lining and then the lining dies. Then that’s when we start to shed it and then week one starts again. 

In week four, what I wanted to say is most chronic issues. So if you are a type 2 diabetic or you have irritable bowel, or you suffer from PMs or PMDD, these are the times when, this last week, all of that is going to be amplified. You are going to feel like you are more inflamed and we’ll get into some of the particulars in terms of potential hormonal derangements that can amplify that. But just know that in the last week in particular, you have increased metabolic demands. You are utilizing glucose. You are utilizing amino acids. You’re utilizing free fatty acids at a much higher rate than you are at any time of the month. So it is an appropriate response to increase your caloric consumption during this time, because everything is going, whether you want to or not. All of your energy as a woman, your sex hormones are going towards creating or going to perpetrate the thickening of this endometrial lining in anticipation of pregnancy. Throwing a lot at you. How are you doing so far? 

Ari: I’m doing wonderfully. But I’ve had a lot of courses covering this material. So I’m fairly familiar with it, but it’s, it’s nice to hear you inject the aspects of caloric intake and just start to see how the pieces of how you can modulate your food intake and your training in accordance with this menstrual cycle. That’s all new information that I get to layer onto this picture and it’s fascinating to hear you talk about that.

Dr. Estima: Amazing. Okay, can I keep going on the magic carpet ride?

Ari: Yes.

Common symptoms of hormone imbalance

Dr. Estima: So you can see that there are a lot of potentials here for hormonal imbalances. Like the hormonal landscape, here can be disturbances in the force. There’s a lot of potential areas where we can see derangement, imbalances, impropriate responses, et cetera. As it relates to women, the two most common things I see are excess androgens and excess estrogen. So androgens are the testosterones. PCOS is the most common embodiment of that or polycystic ovarian syndrome. This is often one of the classic hallmarks of a woman who has too much testosterone, is that her body behaves in a more male fashion. So she will have more weight through the belly. She may have excess hair through areas that she may not want. So she may have excess facial hair, hair on the chest, hair on the back, and then she may lose hair where she doesn’t want. So losing a hair sort of in align with male pattern hair loss. So at the temples, around the crown, that kind of thing. We also typically see with her hyper-insulinemia. So remember I was talking before about that glucose-insulin dance being often type 2 diabetics. A woman with PCOS also displays that.

We know that insulin and testosterone are very intimately related. So when you have too much insulin, you also have too much testosterone. Maybe I’ll ask you before I before I go on, I can talk about PCOS and sort of how we modify that through her menstrual cycle. And then the other one I wanted to talk about was estrogen dominance, that’s the common term for it. It’s unopposed estrogen in the luteal phase of her cycle, but people can’t call it estrogen dominance. So we can talk about those.

Ari: I would go with estrogen dominance just because I think it’s probably way more common. I’m curious if you’d agree with me on that, but that’s my understanding.

Dr. Estima: I would say that they’re like tied for first place. So PCOS is probably the most common hormonal derangement that I see and I would say one estrogen. Those are lie one and two, like estrogen dominance and PCOS. 

Ari: Well then we’ll do it as a coin flip and I will leave it up to you to decide where we go.

Dr. Estima: Love it. Okay. Maybe what we’ll do is I’ll talk about a woman. The challenge with a woman with PCOS is because her luteinizing hormones, that funny uncle that comes in, that doesn’t necessarily happen. We don’t see that surge. He doesn’t blow into the door and hit you on the back and then leave the way that he should. He’s kind of always there. So you don’t actually get that surge of LH. So what we find is that first, you don’t have the correct follicular development and then we don’t have that appropriate release there. So for a woman who is dealing with PCOS, I’ll say three of the most powerful interventions is we integrate fasting. So there’s different types of fasting, frequency and the duration of fasting. So women with PCOS, I really like to give her what I call a non-caloric liquid fast, which is a basically water and herbal tea. And like anyone when you start fasting, you have to slowly increase tolerance to it because it is a stressor. So I like to use a non-caloric liquid fast with a woman with PCOS. 

I love a low carbohydrate or a ketogenic application for her because we want to lower the insulin burden. So we are getting those insulin levels lower so that the cells become more sensitized to them. And then the other thing we want to do is resistance training. Really when we’re talking about some of these different hormonal pieces, resistance training is always going to be part of my recommendation. And the reason for that is, the more lean muscle mass that you have. We were talking before about substrates, and we were talking about where we store our substrates. So the two biggest glucose depots if you will, the glycogen storage sites, are your liver and then your muscles. The more functional tissue that you have, the more active, alive tissue that you have, the more carbohydrates you can actually eat. You will be a much more efficient dispose disposer of glucose because your muscles are going to require that for upkeep. So it is really useful for a woman who is already hyperinsulinemic to be training and using heavy weights. And I promise for any woman, you will not turn into the Hulk. I mean, this is still a persistent thing I have to talk to women about.

Ari: I was a personal trainer for many years in my 20s, so very familiar with that belief. And I used to tell my female clients, I used to say, “I wish it were true that it growing muscles were this easy,” because I would be huge by now. I would have 50 pounds more muscle than I have, because I’ve been weight training since I was 14 years old. I’m 36 now. And I really wish it was that easy to get muscle.

Dr. Estima: We see men who want to put on muscle struggle with it. And when we think about the difference in testosterone levels between men and women, it’s something like a 10x difference in terms of the amount of testosterone that we have. Even in someone who is androgen dominant. Even someone who is not aromatizing her testosterone into estrogen, is the way that somebody with PCOS is doing. So resistance training is going to also help with, like I was saying, the glucose disposal, helping with her hyperinsulinemia. In terms of how we would nuance that throughout the month, the first two weeks, I would say first week is sort of medium weights. And when I say medium weights, this is eight to 10 reps so you’re struggling on rep eight, rep nine. That would be like a medium weight and maybe three sets, in that week before ovulation. So for a woman who has PCOS, often she doesn’t know when she’s ovulating. So sometimes we just pick a line in the sand and just start.

If you have a general sense of when you think your period should be coming, we can sort of triangulate generally within two or three days when we think your ovulation should happen. So seven days leading up to that heavy AF weights. We want to be like four to five repetitions and I mean heavyweights. As that changes in the luteal phase, we want to go back to medium weights into that third week. And then in the week leading up to her period, I’m really a big fan of being not so much a movement specialist, but more of a movement generalist. Like we have all these like CrossFitters and SoulCyclists and people who can just do this one particular activity really well. But what we’ve lost as a society, and I think this is true for women and men, is this idea of just low-grade general movement through the day, like walking, yoga. Things that are not particularly strenuous, but they are moving our bodies where we are getting blood moving and it’s gentle exercise. 

So that week four is where I like to give … Because progesterone is of dropping at that point, testosterone is typically low there. This is a recovery week for most women that I work with. And I’ll say that for the type A women that are listening to me that don’t want to take a recovery week, who do SoulCycle, and nothing against SoulCycle by the way. I think it’s a great class, lots of fun, great music. But if you’re doing that four or five times a week and you continue to put your head down and punch out these high intensity interval training exercises every single day, no matter where you are in your menstrual cycle, your body will hold on to fat like it is an insurance policy because you need to give yourself time to recover. That’s where all your gains come, is in the recovery. That’s a pet peeve of mine, as you can probably tell because I, myself am a recovering type A person and I used to do that too. Like it doesn’t matter. I’ll pretend I’m a guy. I’ll just punch it out, get through it. But that’s where we make the mistake. That’s where injury happens. If you’re injured and you can’t work out and if you need to silence your ego by getting to the gym and you can’t because you’re injured, this is really when you can sort of start to lose your marbles.

Ari: It’s not just true of women. It’s also true of men. Obviously we don’t have the menstrual cycle factor, but it is certainly true. I can speak for myself that there were many years where I was in a chronic state of overtraining and trying to do two hours of intense exercise every day, seven days a week, not giving my body enough time to recover. And it was only when I eased up a bit that I started making progress and then I just felt more vitality and energy because I was in a constant state of feeling drained as a result of overtraining.

Dr. Estima: What you’re doing is, you’re just driving sympathetic dominance. Exercise is a hormetic stress. It is a stress sore, but over the long-term, there are lots of benefits from it. We have sirtuin activation. We have longevity things that come from it. There’s metabolic and cardiovascular. It’s all these different, great things that come from exercise. But if you are not varying the type of exercise that you were doing and you are simply just driving yourself into, it’s just like an adrenaline, you’re constantly driving yourself into this like survival state, essentially your body is going to say, okay, like we have this high intensity output every single day, five to seven days a week. I have to hold onto fat. I need energy. 

Optimizing your lifestyle to fit your cycle

Ari: So you mentioned movement variety, exercise variety. How big of a factor do you think the variety aspect is relative to just the proper balance between exercise and recovery? 

Dr. Estima: I think it’s important to vary your exercises, otherwise, like I was saying, we’ve become more movement specialists. Like if you only go to the gym and you do bicep curls, like you’re going to get really damn good at doing a bicep curl, but what’s your posterior delt look like? What’s the integration of your shoulder stability? Can you activate your multifidi independently? No. So for sure, I think that we need to have variations. And even within the weight training protocol, you need to have variations in there. I have talked a lot about the coronal plane versus the sagittal plane in terms of training. We live in, in the midline. We’re here all the time. We’re at our computers, we’re on our phones. We go to the gym, we do the elliptical, which is just back and forth. For those of you that can’t hear me right now or see me, I’m doing like the elliptical hand thing. You do the bike, you’re doing this, you’re in the midline. We never do anything that’s out here. We never do anything that works the midline or moves away from the midline AD and adduction.

So I’m a big fan of that because there’s a lot of evidence to support that. It also supports the lateral aspects of your brain. We look at spec scans and we look at a degeneration of the brain over time. And if you’re constantly in the midline, just working sagittal, maybe the transverse plane and you don’t work out here, then you lose it.

Ari: So just for people who maybe don’t have the technical background, follow the planes of movement that you’re talking about or who are not watching the video and can’t see which direction you’re pointing. Can you give some specific examples of like what you would consider too much of the sagittal plane type of movement in the absence of the side to side frontal plane movements? What specific exercises or examples?

Dr. Estima: So sagittal plane is basically any cardio machine that you see at your gym. It would be things that are moving forward and back. So this is like flection and extension. So bicep curls would be, well, maybe bicep curls would also do transverse plane, but anything that’s like flection and extension. So we think about the elliptical machine, your legs are going forward and back. We think about the bike, your legs, even though they’re going in a circle, they’re going forward and back. It’s quads and hamstrings, quads and hamstrings. And I love the bike. I’ve fitted my outdoor bike inside now. I do my bike two times a week, three times a week. The reason why I bring that up is we spend most of our life in the midline. If you are sitting at a computer desk all day long, your keyboard is likely in front of you, your screen is likely in front of you. And over the course of the day, what we know is that your head comes further and further, your thoracic cavity flexes and you become more and more rounded. And these are all in the sagittal plane. 

So the coronal plane is moving away from the midline. So if we think about exercises like Warrior II in yoga. So you have your legs that are spread apart, your arms are extended out. That would be a coronal plane exercise. A curtsy squat would be a coronal plane exercise where you’re taking one leg stepping behind and out to the side as the stationary leg and squatting. Anything that uses, like jumping side to side. If you were to do a what are those things called? Ski skaters? What are they called?

Ari: Speed skaters.

Dr. Estima: Thank you. Speed skaters where you are jumping from side to side. Things like that are coronal plane exercises, lateral raises with your shoulders, even rotatory motions. So when we use some of the smaller stability muscles in the spine, so the rotatory, the multifidus being a really big proprioceptive input to the brain. When we look at the orientation of those muscles, they come out to the side. So we can talk about longevity and spinal stability and maintaining the curves in the spine and all that. But the multifidus muscle, when we look at it, it originates off of the spine and it sort of goes out and it almost makes a triangle and attaches to the top of the hip. So rotational type of movement.

So if you’re sitting on your bum and you have like a medicine ball and you’re rotating side to side, you’re going to be activating some of those coronal muscles, particularly in the back. So these are really important to be thinking about when you’re thinking about functional training, because we already do a lot of this midline movement. We’re already in the sagittal plane more than we should be. We can talk about ancestral like the way our ancestors moved and stuff, but right now one’s getting away from the computer. So we have to figure out a way to adapt to that. So the way that I think about this problem is in integrating more coronal plane stuff, so the squatting and the warrior pose and all the things that we’ve described.

Ari: Excellent. So do you want to get into more details of the framework of practical recommendations around the specific way to modulate your nutrition and your training around the menstrual cycle?

Dr. Estima: Yeah, I would love to. Thank you. I feel like I could talk to you all day. I can go on all these different verticals.

Ari: This is fascinating. And I have to say that on a personal note that, I’ve done 250 plus interviews with a lot of experts and all kinds of topics. And I can really tell when somebody has a superficial knowledge of their subject matter, and when somebody has a really deep knowledge of the subject matter. And there are certain people that I interact with where I can tell, I can ask them anything on any topic in their domain of expertise and they’re going to know all the research on that topic and be able to just spout it off of the top of their head. And I can already tell you’re in that category for sure.

Dr. Estima: I really appreciate that. Thank you. So the one thing I wanted to say for the women that are listening is, we’ve been talking about PCOS, we’ve been talking about estrogen dominance, we’ve been talking about some of these hormonal things like the leptin and the sympathetic dominance, you feel like you’re running on empty. I just also want to say that, I do have the philosophical perspective and underpinning that you have an inborn and innate capacity to heal. Your body is not your enemy. The symptoms that you’re experiencing is just your body’s way of asking you to get out of your head, to sink beneath your throat. It’s an invitation for you to deepen the relationship that you have with yourself. At the end of the day, you have kids, you have partners, the most important relationship that you will ever have is with yourself. And getting to know your cadence, getting to know your cyclical biology is one of the most empowering things you can do as a woman. 

I say this as an empowering statement, because I want us to shed the victim’s story that we may have adopted, whether that’s cultural norms or our upbringing or what have you, and into a place of power where we can actually say, okay, so this is where I am, and these are the steps that I need to take. And the steps that I’ve outlined, we’ve talked a lot about them already, but just some foundational basics. We’re going to talk about some circadian biology stuff, nutrition, stress management, we’ve talked a lot about movement. And I always like to just invite the women that are listening to just put on your big girl pants. You are already a goddess. You are ready exactly who you need to be. It’s just about like peeling off some of the layers. I just wanted to just plant that because I can give you all the information, I can geek out with you on nutritional science. We could talk about movement, but if you don’t believe that you’re worth it, you are going to find a way to medicate or do things that, and not to poo-poo medication, of course sometimes it’s necessary.

Ari: I don’t mind. You’re not offending me.

Dr. Estima: You can’t medicate your way out of a problem that you behaved your way into. So you have the capacity, it’s just a matter of unleashing. Did you watch the movie Captian Marvel.?

Ari: Captain Marvel? I don’t think so. No. 

Dr. Estima: She’s one of my favorite superhero films. And so she has this like chip on her neck the whole time, and she’s like controlled by this higher power. And at the climax of the movie, she says, I’m paraphrasing it, but, “I’ve had this chip on my neck the whole time. It’s I’ve been fighting with one hand behind my back. Like what happens when I finally set myself free?” Everybody has that capacity to set themselves free. So I just wanted to start with. The easiest way to help with your energy levels is circadian biology. And by that, I mean sleep. So I always joke that this is the cheapest diet on the planet. Before you shell out the bucks to any nutrition program, before you work with me or any other person, commit, pinky promise that you will sleep eight hours every night for the next seven days. And you will see, your belly is going to go down, your weight is going to drop, your mood is going to be better. The brain fog that you may have experienced is going to be gone. You’re going to be motivated to do right by exercise and by and by nutrition.

 Ari: Unless we forget energy.

Dr. Estima: And energy, of course. Your energy is going to be higher. And we know that when you have poor sleeping, of course, your wife may be able to really relate to this now. But when you don’t sleep well, we know that you have inferior fuel partitioning. And what I mean by that is, you have a tendency to eat more crap. You’re going to want to eat more of the simple processed sugary, simple glucose, simple sugars that can be readily switched into glucose. And then we also use that fuel in an inferior way. And of course, when you’re sleep deprived, like who wants to go to the gym? 0% of people want to do that. And your regulation. Your emotional regulation is also poor.

So when we were talking before, but the prefrontal cortex, your prefrontal cortex is very much sensitive to blue light technology, but sleep deprivation is the thing that your PFC is very sensitive to. And, the SHEEO,as I like to call it for my ladies or the CEO, the prefrontal cortex right behind the forehead, that is the area that is regulating those lower emotional centers in your in your limbic centers. So eight hours and by eight hours, that means that you’re not in bed for eight hours. That means you’re probably in bed closer to nine because you have the latency, you have to fall asleep and, you know, the waking up and then, maybe a little bit of buffer time there. A couple of really best practices for sleep, the room is cold. So 65 to 68°F, for the rest of the world, that’s 15 to 18°C. Room is dark. No devices an hour to two before you’re going to go to bed. No meals, same time, timeframe. You want to allow the stomach to empty. So that would be what we would call time-restricted eating or intermittent fasting people. Sometimes people refer to it as that.

If you’re traveling, this is my best travel tip. So a lot of people like, well, doc, I travel a lot. Bring warm fuzzy socks to your hotel room and you’re going make the hotel room as cold as you can and you’re going to wear socks. You can do this at home as well, but this is particularly good if you are traveling. Because the way that we fall asleep is we have to lower our core body temperature. So if you have warm, fuzzy socks on you are literally going to charm the heat away from your core down to your extremities, where it can be evaporated. So if you’re traveling and you’re having trouble sleeping, warm, fuzzy socks, that’s my best travel tip for you. And of course, sex and orgasms. That’s a different conversation, but orgasms are nature’s Lunesta. It is the best way to hack into your parasympathetics. It is the best way to have that expansive … we’ve been talking about the sympathetics being this contractile, energetic, like just in survival mode. The ability to let go and literally let go and have an orgasm is very expansive. It’s very parasympathetic. And of course it’s the comedic, you finish you roll over and you fall asleep. Like that’s a best practice for sleep. So that’s what I would start with. We’ve talked a little bit about movement in terms of the coronal plane.

Ari: Quick question on circadian rhythm. I will say circadian rhythm is a big area of specialization for me and something I emphasize a lot. I agree 100% with you. I’ve actually pulled my audience on consistently circadian rhythm optimization stuff, I teach around that, people rate as the single biggest needle mover in what fix their energy issues. So I agree with you 100%. Just out of curiosity, is there any relationship of the menstrual cycle with circadian rhythm? Is there a particular time of the month that maybe women should prioritize it even more and prioritize maybe an extra half an hour or hour of sleep each night?

Dr. Estima: Thank you for asking me that. And I forgot to mention that. Yes. So when we think in general, a woman’s sleep cycle tends to be longer than a man’s. Maybe this is a different topic around sleep divorces and sleeping separately and stuff. But we know about on average, a woman’s sleep cycles about 15 to 20 minutes longer than a man’s sleep cycle is. So what that means, our total sleep cycle, not just the 90 minute, like going through REM and phase 1, 2 and 3 sleep. So what we know about sleep disturbances in terms of a woman’s cycle is she is going to tend to, because we see progesterone, a peak at the end of week three and the beginning of week four. We tend to see her core body temperature beginning to rise. Progesterone, I didn’t mention this before, but just as a little hack to remember it progestation, pro-pregnancy, it’s your pro-pregnancy hormone. So this is going to start increasing your core body temperature. 

And as I just mentioned with the little travel tip with the socks, the way that we fall asleep is when we lower our core body temperature. So if your core body temperature is now up to a percent, which is a huge, like for any of the women who wear their Oura rings and I always get dinged. I want to write Oura can you please account for our menstrual cycles? Because the week before my period, I always get dinged on my readiness because my core body temperature is up like 0.9°F. So your core body temperature raises. It’s much higher in week four. So you will notice that there is going to be a harder time not necessarily initiating sleep if you’re being conscientious of the blue blocking and the device use and the feeding times, but you will notice potentially that you might wake up during a sleep cycle. So this is the issue of maintaining sleep rather than initiating. So it’s not necessarily a melatonin issue. It’s more of an issue of maintaining that sleep cycle because you’re being pulled out of it because of your temperature. And that’s actually how we wake up. We wake up because our core body temperature over the course of the night begins to slowly rise. 

So for women who are having trouble sleeping, the tips and tricks that I talked about in terms of like the cold room, the dark room. There’s a company, I have no affiliation with them, but it’s called the Chilly Pad, it’s like something that just goes right underneath your sheets and it makes your bed colder and you can modulate up or down the temperature. I have found that to be a lifesaver for the women that I’ve worked with, who particularly deal with PMS type syndromes. And they get that sleep deprivation. So pay particular attention to your sleep hygiene in the end of week three and into week four, leading up to your period. 

Ari: Awesome. What about nutrition and training?

Dr. Estima: Perfect. So what I wanted to talk about in terms of nutrition is, and this is if you’ve identified maybe have you a leptin sensitivity issue, I have chronic stress, I have androgen issues, I have estrogen issues. There are a couple of things that that I love. The first is green leafy vegetables across the board. So things like kale and broccoli and Swiss chard and cauliflower is not green, but it’s part of the Brassica family. These have all been shown to lower inflammation, they’re fibrous as well. So when we think about insoluble fiber, it cannot be broken down in the small intestine for use as a fuel. So it makes its way through the gut, sort of cleans up. The roughage will sort of clean up the gut. It attracts water to it, bulks up the stool. So you’re helping with your bowel movements, which is really important in week three and week four as well, because we have that peak of progesterone. And I said before progesterone as an appetite stimulant, it’s also slows down your bowels. So making sure that you’re eating fibrous vegetables all through the month, but in particular in week three and four, is going to be really helpful for you. The Brassica family, I always joke, it’s like the Kardashians of the food, food family, because there’s so many great ones. You don’t know which one is your favorite. They’re all beautiful. They’re all great. 

Ari: That’s how I feel about the Kardashians. So many great ones, it’s hard to decide.

Dr. Estima: Like that one’s sulforaphane and that one’s, yeah. So when we think about cruciferous vegetables, like the Brassica family, this is like the royal family. We know that it decreases pro-inflammatory pathways like the NF-kappa B pathway, all these different pathways that are involved in just in general inflammation in the body, general stress. One of the big things that we think about as women or we should be thinking about as women is cardiovascular disease. It’s the number one killer of men and women reduces all-cause mortality. There’s a direct link, the more of the Brassica family, the more of the cauliflowers and the Brussel sprouts and all, the more that you consume of those, you will live longer and it will improve your lipid profiles. It decreases your breast cancer risk. And if I can’t convince you on that, you have better skin, hair and nails. If living longer and not having breast cancer, and sometimes I have to say that. The other thing I’ll say with the hair thing, it stimulates hair. So this has only been done in rodent studies, but it reduced balding. So giving mice sulforaphanes reduced balding. 

We also know that the more cruciferous vegetables that you eat, the more fat burning, lipolysis, the breaking down of fat as a constituent for energy we have. So no matter where you’re coming from chronic low-grade stress, androgen stuff, estrogen stuff, leptin stuff, integrating more of the green leafy vegetables into your diet. And whenever I’m teaching about this, when you’re building a plate, and this is what I do with my kids. So this is how I’ve taught my kids to build a plate. Where’s the plants? That’s the first question. Where’s fats? And then where’s the protein? So the plants should make up the bulk of your plate. So if you’re having, maybe it’s like a bit of kale or sautéed Swiss chard or Brussel sprouts. Then the protein, we can talk about protein cycling through your menstrual cycle as well because I think that we should be protein cycling through there as well for driving muscle protein synthesis too. But protein in general I like it to be for women about the size of your palm.

Mark Hyman talks about it as the word condiment. He’s like, “It should be like a condi-meat, like the size of your palm,” which I think is so clever so I take that from him. So if you ever a child and you had French fries and you were like, I have to put ketchup next go it. The amount of catch up that you would sort of squeeze is about the amount of protein if you’re doing a ketogenic diet.

It’s a moderate amount of protein, maybe 20 to 30% of your protein intake. And I would cycle that just while we’re talking about proteins. I’m a big proponent of animal products as your protein source, but I am open loving to those who choose to be vegetarian or vegan. You will just be mindful that whenever you are choosing vegetarian protein options, that in order to get the amount of leucine, in order to get the amount of muscle protein synthesis from vegetarian sources, you’re going to need more calories. So just be mindful of that. 

I like to cycle protein through a woman’s menstrual cycle. So week one, like the bleed, I definitely like it to be a classic keto diet. Like that’s the time when you could play with fasting. That’s a time when you can play with keto. In week two, where we’re seeing testosterone peaking right before ovulation, that time when you’re feeling kind of flirting and sexy, this is also a time, like I said, do heavyweights, but also up your protein consumption. Because the thing that we know about protein is that it drives something called MPS muscle protein synthesis, which just does what it sounds like, it makes muscle protein. So you need about a 2 ½ g of leucine. So when we’re thinking about a whey protein with maybe 20 to 25 g of protein, to start that. Leucine is like the forewoman. She’s the kind of girl that comes in and gets the gears started in order to start making protein. So you need a minimum of about 20 to 25 grams of protein to start that.

During that week, right before your ovulation, I love for you to be having somewhere around 40 to 50 grams per meal. There’s also the whole conversation around like anabolic resistance as we age and stuff. But we’ll keep it with keto, 20 to 25 grams or 20% of your macronutrients in week one. I like to up it to about 40% in week two. And then in week three, I cycle the keto. So keto on and off. So one day doing a classic keto ratio, which would be about 70% fat, 20% protein. And then the fill would be carbohydrates, like 10% carbohydrates. And then the other days we start to increase. We will do a carb day with more fibrous vegetables, root vegetables, turnip, even things like squash when it’s in season. 

Ari: I like that you’re not a hardcore, just full-blown keto non-stop. I’ve seen some people with that position and I’ve seen a lot of people, especially women who seem to have been harmed from doing that long-term. 

Dr. Estima: It destroys your neurotransmitters, it messes up your metabolism, your period. I’ve had women come to me who’ve been [inaudible], but they’re in ketosis. I love the keto diet. I have a program that runs, it’s ketogenic principles that are baked into the DNA of that program. But it is important for women to understand and I think this is true for men, but particularly because we have of reproductive cycle, we are not meant to be in ketosis all the time and long-term. So again, harnessing that cadence and that cyclical ebb and flow of our metabolic requirements through the month is really important. 

Ari: Interestingly, I had a woman who specializes in chronic fatigue. Who’s an advocate of non-stop keto all the time and comes from the narrative, which is not true, that our ancestors all ate keto diets and these kinds of things. She thinks it’s the one true diet. I actually challenged her on a few points brought in a lot of data to the contrary, for example, on actual evidence on the diets of hunter-gatherers in the world today. Anyway I got some negative blow back from people who are just committed to this dogma that you have to be keto all the time and anybody who doesn’t understand that, they just don’t get it. And so there’s so many people out there who are dietary ideologues, who are slaves to their own belief system and their dogmas that they’ve created. 

Dr. Estima: It’s religious, isn’t it? It’s become cult-ish. And to back up what you were saying, if you are a woman who we’ve spent some time describing; like chronic low-grade inflammation, the leptin, the hormonal derangement. When we think about this in terms of energy, and of course, I know I’m speaking to the choir here, but if you are in a chronic low-grade inflammation, that is going to induce a metabolic switch. So you’re going to go from ATP-rich oxidative phosphorylation, to a much less energetically efficient. You’re going to move into aerobic glycolysis and you’re going to be increasing your oxidative damage in the cell. You’re going to have a reduced glucose availability because your insulin is going to be off. You can’t be in keto all the time. It’s important and for a woman in the first two weeks of her cycle, she’s much more resilient. She’s much more adept to do longer-term fasts or to do the ketogenic diet, but not all the time. I’m with you on that one.

Ari: I’m with you. So just one more thing, you mentioned fasting very early on in this and you mentioned, I think the first week of the menstrual cycle is the best time to experiment with fasting. Do you want to briefly talk about that?

Dr. Estima: Sure. So this is a big part of what I teach. So when we think about fasting, there’s different ways that we can apply it. So there’s type of fast, there’s length of fast and there’s frequency a fasting. So there’s a lot of different types of fasting. I’ll sort of categorize them as non-caloric, liquid fasting. So we talked about this as it relates to PCOS. So things like water and herbal teas, that’s the most aggressive type of fast. There are caloric, pardon me, liquid fast. So things like bone broth or a lot of people will drink-

Ari: Vegetable juice.

Dr. Estima: Yeah, it’s a model of caloric restriction, truly. Like you’re having maybe 500, 600 calories, a Bulletproof coffee, like the butter coffees. That might be a caloric liquid fast. And then there’s like the caloric restriction and the fasting mimetics. So what’s Valter Longo’s, I forget the company.

Ari: The Fasting Mimicking Diet.

Dr. Estima: The Fasting Mimicking Diet. And what’s this product? ProLon is the name?

Ari: ProLon, yeah. 

Dr. Estima: So he has a product where I believe it’s prepackaged foods. You can do this at home truly, but the first day is, call it 800, 900 calories. And then there’s like a stepwise attenuation as the five days goes on. So maybe day one, you have like 800 calories, on the second day 600, 500, 400, et cetera. And you could truly do that with just like avocados at home, but if you want to try his product, that’s fine too. So there’s fasting mimetics where you’re still eating, but you are maybe restricting your macronutrients. So a ketogenic diet is technically also a fasting mimetic because you’re restricting the

macronutrient carbohydrate, you’re restricting carbs. So the way that I like to play with fasting through a woman’s cycle, the first week, like I’ve said a few times, my favorite time to play with fasting, if you’ve never done fasting before, because you’re most resilient during that time. If you are a seasoned faster or someone who fasts regularly, you can try to go for a longer period of time. 

So playing with, if there’s a couple of levers when we think about fasting, like playing with the duration lever. In the second week, I still think it’s a great time to fast, but because the testosterone is there, I want to limit the fasting to more of a time restricted eating model. So this is what people call intermittent fasting. It’s really, you’re eating every day, you’re just restricting the hours in which you eat. In week three. Again, now we have this different hormonal landscape. So I like to have more, if you are going to play around with fasting, for this to be a bone broth fast or the caloric liquid fasting. I only like it to be 24 hours. So again, when we think about we’re pulling two levers, it’s the type of fast and the duration of the fast. And for women who suffer from estrogen dominance, this is my favorite type of fast to prescribe for a woman because she’s often feeling bloated. It’s like her rings typically don’t fit during like that week three and week four. So a caloric liquid fast is still a really nice way for her to be getting calories. And if it’s bone broth, she’s still getting a certain type of protein, which I’m a big advocate of, but she’s also giving her gut a chance to rest. 

Often with women with estrogen dominance, we also see that there’s a lot of sluggishness in her detoxification pathways, particularly when we’re thinking about conjugation. So bringing the intermediate and actually getting rid of it. So this is why I also love, by the way I know I’m jumping a little bit, but green leafy vegetables. I love his for my women with estrogen dominance because when we think about detoxification, I’m not talking about like a silly juice cleanse. I’m talking about actual detoxification. The liver has a couple of main roles. One of them is creating glucose. The other is getting rid of endogenous toxins. So sulforaphanes, which is in those green leafy vegetables, that is a compound that has been shown to upregulate phase two detoxification in the liver. So really big fan of bone broth for a woman with estrogen dominance, as well as lots of green leafy vegetables. 

Ari: You went to training earlier and I think you pretty much covered it. Do you want to just wrap up with the quick summary of how to optimize training in accordance with the menstrual cycle?

Dr. Estima: Yes. So I would say the week one, I want you to be doing resistance training. And this would be a minimum of three times a week, medium weights. So when we think about medium weights, it’s like eight to 10 reps and that’s like a good amount. You’re exerting a lot of effort there, three sets. Week two is like do or die. That’s when we got testosterone, we got a profit from her or profit from him, if we’re thinking about the phenotypic expression. So we want to have high weight, low reps. So as much weight as you can punch out, four reps, that’s really what we want. And I like to do four sets because I’m crazy. But if you are just starting out, we can do three sets.

Into week three, you can start bringing it back down to that moderate weight. So the moderate weight is like eight to 10 reps, three sets. 

In terms of the resistance training realm, I also like to start increasing the reps and doing lighter weights. So instead of now doing eight to 10 reps, maybe now you’re punching out 15 to 20 and it can be two to three sets of that. And then in week four is really when I want lighter things, so that can be Pilates, it can be, I shouldn’t say yoga is a light thing. It’s a calisthenic, but it’s not resistance training in the classical sense. So this is more of a recovery week that I like to prescribe for women where we are allowing all the gains, gains with the Z, all the gains that we’ve had in the first three weeks of training, where we’re allowing for that integration. And there’s a recovery week there so that you can go hard again next week.

Ari: Beautiful. So protein cycling, fasting, some tips on veggies, circadian, rhythm tips, training tips, all on how to work with the female menstrual cycle. Doctor Estima, this has been awesome. Thank you so much for sharing your wisdom with all of the listeners. I really appreciate you coming on. And as you said earlier, I feel like I could talk to you for probably three more hours on all these things.

Dr. Estima: Yeah, man, we have to do in a separate time, but thank you for having me. It’s been so fun. I love the opportunity to go on these on a geeky magic carpet rides. So thank you for indulging.

Ari: Thank you for coming on this one with me. For everybody listening, who is interested in working with you or doing your programs, following your work or working with you directly, where’s the best place to do that?

Dr. Estima: It would be my website. So The program is called, The Estima Diet. 

Ari: Beautiful. Thank you so much. Really appreciate it. And look forward to the next conversation. 

Dr. Estima: Thank you.

Show Notes

Hormone balance and energy levels (13:00
How leptin works in the female body (20:53)
The autonomic nervous system (30:12)
How the menstrual cycle affects the body (35:20)
Common symptoms of hormone imbalance (46:51)
Optimizing your lifestyle to fit your cycle (57:50)


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