Transcript
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This is the Eat Well, Think Well, Live Well podcast.
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I'm Lisa Salsbury, and this is episode 91 midlife fat loss and brain health principles with Barbie Boules.
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I had someone ask me this past weekend, what my favorite episode was for her to know where to start with on the podcast.
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And I thought, oh, uh, it's not published yet because this is my new favorite episode.
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Barbie Boules.
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AKA the cognition, dietician.
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Lays out the four pillars of fat loss specifically for the midlife woman and tells us what's different.
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And what's not in that time.
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We shift gears midway and get into brain health and how to really prevent.
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Cognitive decline as much as we can.
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You'll be fascinated to hear as I was how much overlap there is on these two seemingly unrelated topics stay to the end because she gives the best last tidbit to wrap it up.
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Welcome to Eat Well, Think Well, Live Well; the podcast for women who want to lose weight, but are tired of counting and calculating all the food.
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I'm your host, Lisa Salsbury.
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I'm a certified health and weight loss coach and life coach, and most importantly a recovered chronic dieter.
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I'll teach you to figure out why you are eating when you aren't hungry, instead of worrying so much about what you are eating.
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I'm delighted to have Barbie Boules here with us today.
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She's a registered dietitian and specifically focuses on taking care of your brain, which I absolutely love.
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So welcome Barbie.
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Please tell us all about what you do and how you came into this space.
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I would love that.
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Oh, thank you.
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Well, first of all, thank you for inviting me and helping me spread the word about women's brain health, particularly in the menopause transition.
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It's a really crucial time.
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For us to start paying attention.
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So I really appreciate you having me.
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Um, I am, like you said, a registered dietitian and, um, I have been for about 25 years in private practice.
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And, you know, my practice has always focused on women, but over time with my own evolution, uh, you know, getting older, um, and the new challenges that come up, it has evolved my practice has.
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And as when I turned probably around 43, I started.
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started to really pick home in on the metabolic changes that happened with the menopause transition.
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Then of course, understanding how that impacts the brain came a couple of years later.
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So now it really is my focus really is, uh, Alzheimer's in particular risk reduction.
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and, uh, women's metabolic health because our metabolic health is the foundation of our brain health.
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There are lots of other things that play into, and a few that have absolutely nothing to do with nutrition or lifestyle that are really important for brain health.
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And we can get into that too, if you'd like, but that's sort of the evolution of, of how I've come to be where I am right now.
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Okay.
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Perfect.
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Let's start with the definition of metabolic health.
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I think that that seems like foundational for your work and I think is maybe a little misunderstood.
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absolutely.
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Um, yes, usually.
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Thank you for asking.
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Usually when people think about the hear the word metabolism, what they're thinking about is metabolic rate or how many calories you burn in a 24 hour period.
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That's mostly what people associate.
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Well, and also, well, just that, does that help me lose weight?
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Right.
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you know, women's question.
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Okay.
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Yeah, exactly.
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We think about, um, our weight when we hear the word metabolism, but metabolism is actually, uh, how your body uses the energy that you give it to perform its daily functions.
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So all of the food that you intake, everything that you provide your body with, and then how does, how efficient is your body at taking all of that energy and using it in appropriate ways?
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That is your metabolism.
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It's essentially all of the functions that keep you alive using the food that you've consumed.
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Metabolic health is represented by blood pressure, blood sugar control, your lipids, so your cholesterol and triglycerides, um, and your body composition.
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So excess intra abdominal fat is a marker of poor metabolic health, high blood pressure, um, elevated HbA1c, so insulin resistance, prediabetes, type 2 diabetes, and then dyslipidemia, so elevated LDL P.
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cholesterol, or really ApoB, we refer to now, um, low HDL, high triglycerides.
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Did that answer?
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Yes, I think that there's going to be some Googling on the part of the listener.
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I am more than happy to, to piece apart any of that,
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It's just more, I, I love hearing that though, because it's just way more than the calories you burn, which is, I think what people think of as.
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You know, their metabolism, it's just so much more your metabolic health effects.
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So many
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it's, it's what keeps you alive.
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It's, it's far more than just, you know, your weight.
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Mm hmm.
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Mm hmm.
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So let's talk about this, this menopause transition.
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Many of my listeners, I believe are in this transition.
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And I think what's surprising, let me just say that your hormones do start to decrease somewhere around the age of 30, because that's when we, so All of those things that were happening to me at like 35, I had no idea were part of possible coming into perimenopause.
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So as young as you might be, you're either on the cusp if you're a listener in that age range, or, you know, you're in the forties and fifties and experiencing it.
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So I think this is just, it's important to every woman, but let's talk about a little bit of the principles of fat loss during this menopause transition, because it's I think getting a lot of good press right now, menopause itself, but there's so much out there that's like, well, if you just balance your hormones, you're just going to be able to drop that weight right off.
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And you and I both know that's not the way it is.
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So there's, I feel like some things that are going to be the same for the menopausal or pre menopausal woman, as they are for, um, you know, the, the 20 year old or the 75 year old, and then there's going to be some differences.
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So let's get into some of that.
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Yeah.
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So as you alluded to the menopause transition, otherwise known as perimenopause, but the menopause transition is becoming the favorite term begins, um, with this erraticism in, in estrogen and decline and progesterone and then ultimate decline of both with it.
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being postmenopausal.
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And it can be, it's usually between four to five years, but it can be as much as 10.
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So if you're in your late thirties and you're starting to feel certain things, hot flashes, vaginal dryness, poor sleep, um, you're, but the very first indication is that your periods are becoming irregular, but for people who have irregular periods to begin with, that might not be a great, you know, classic sign.
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Also, I have a Mirena IUD right now, and so I a lot of times didn't cycle, and I thought, well, that's because of the Mirena, but now that I'm really tracking it, I'm like, oh, no, I do cycle.
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It's just sometimes 17 days and sometimes 48 days, which is fun.
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Mm hmm.
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Yeah.
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Yeah.
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Um, and those changes for many women, it's, it's menstruation cycles getting closer together.
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And for many women, it's farther apart and for some women it's all over the place, but that for women who aren't using hormonal birth control and who have always had regular cycles, that's one of the first indications.
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Um, and then as you progress, you know, more symptoms and it is this erraticism, this high, low, high, low, high, low with the estrogen, which is what causes a lot of the discomfort that we can experience.
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but also with this decline in estrogen and progesterone, we lose a lot of the metabolic protection that we had in our teens, twenties and thirties.
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Um, early thirties and that can impact our metabolic health in terms of our blood pressure.
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It can be higher, our blood sugar, we can have less control.
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Our elevated LDL is new for a lot of women, even if they've always been healthy and haven't changed anything about the way that they've eaten elevated LDL can happen.
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Um, and, and of course, uh, one of the things that happens with a decline in estrogen is a redistribution of fat to the belly.
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So even if you don't gain any weight, the fat from your butt, hips, thighs, arms, face, you know, can start to accumulate in the belly area and any new fat is going to favor that area.
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And it does become, I want to be very clear about.
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The fact that menopause and the menopause transition does not directly cause weight gain.
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It creates an environment where fat gain is more likely because it's easier to get into a calorie surplus, meaning it's easier to to be consuming more calories than our body needs to thrive.
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And that will end up as excess fat.
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And this can happen because of that decline in muscle mass, which does begin at age 30, between 30 and 35.
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But by the time you're 50, unless you've been consuming enough protein and strength training, you will have lost a significant amount of muscle.
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That's going to change your metabolic rate.
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not favorably.
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Um, we are, we may also be struggling with energy.
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We may not have what we used to have, you know, to work out.
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We're not sleeping very well.
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That can impact our insulin sensitivity, our appetite and our desire to work out.
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Uh, we're not, I mean, a lot of women get very upset about this comment, but it kind of It typically bears out that we are, we are less active, um, and that doesn't mean that we're not working out because a lot of us are maybe even more than ever, but our NEAT non exercise activity thermogenesis tends to decrease as we get older.
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We're not chasing around small children.
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We're not lifting them.
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We're not going out dancing Friday and Saturday nights.
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We're not walking on our errands.
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That's partly modern convenience too.
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I mean, I remember when I was.
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35.
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I was not ordering things on my smartphone.
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And, you know, it was I had to move to
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I go to Target way less than I used to.
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I know that's silly, but like, I
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no, it's not
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out more when they were younger and just having to run them back, you know, run them around, generally speaking,
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right.
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And we tend not to think about this, but little moves like that, that unintentional movement can add up to thousands of calories a week.
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So, and over time, it's very gradual, but it accumulates, and then suddenly we're 10, 15, 20 pounds outside of our comfort zone at 55.
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But, the good news is, we can, you know, combat it, um, with some strategy.
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Oh, you were asking about kind of the difference.
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The truth is, there's no real difference in terms of recommendations between your 20s and your 50s.
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It's just that in your 50s, it becomes that much more important.
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Does that make sense?
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So like, we can like kind of get away by with doing like 75 percent in our twenties in our fifties, it's gotta be like 95, a hundred percent with the exercise, the non exercise activity, thermogenesis, getting really high quality sleep, managing our stress in a non food way.
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Um, and eating in a way that.
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that is going to translate into keeping our cholesterol healthy, keeping our blood sugar healthy, keeping intra, intra abdominal fat at bay.
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So it's, it's not that it's anything new, all that low hanging fruit still applies very, very much.
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It's just that you gotta do it and you have to be consistent about it.
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That's what's different.
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Does that make sense?
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Yeah, definitely.
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Um, I, I have a question on the fat redistribution.
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When you say that during that time, you know, we have this redistribution, do you mean like that, like actual fat cells that used to reside on our thighs, like travel in the body?
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Or is it just that we, when new fat cells C come onto the body, they go into the belly area.
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not the fat cells, but the tribe, the fat storage moves to the belly area and then favors the belly area, but the decline in estrogen causes a more androgynous shape because we don't have the estrogen.
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I mean, for, you know, to, to wet vastly oversimplify, we don't, we lose the hourglass and we are more straight up and down.
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We become a more.
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Androgynous in shape.
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And that is partly what happens that the fat storage moves to the belly area.
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and, yeah.
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Yeah.
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Tell me more also is, do you mean it specifically, is it subcutaneous fat in the belly area or is it that visceral fat?
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Because I know that is also a big concern for the menopausal postmenopausal woman is the visceral fat accumulation around the organs.
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Yeah.
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Thank you for asking.
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I was going to follow up with that.
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It's both.
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Okay.
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Um, but that visceral fat is the highly inflammatory type of fat that we really want to keep at bay.
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And that can go up to quadruple in midlife.
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Um, I really do recommend if, if you, um, really want to know where you stand with this, I do recommend getting a DEXA scan, a body composition DEXA scan, not just a bone mineral density DEXA scan, which is what your doctor will order for you.
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Unfortunately, not, not typically until age 65, which can be way too late for women in identifying osteopenia and osteoporosis.
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I really feel like that needs to be done like 50, but, um, body composition dexa scan.
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You can just Google it.
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They're, you know, all over the place, typically costs about a hundred dollars.
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It's a tiny bit of radiation, kind of like a, dental x ray, but it can tell you, um, your body fat distribution and body fat percentage.
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And most of them will also tell you your, roughly your visceral fat.
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It's not perfect, like down to the ounce, but it's, it's good enough to let you know, are you way outside of where you should be, um, in terms of, you know, uh, having good metabolic health.
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So yeah, it's that visceral fat.
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That's the main concern metabolically speaking.
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Yeah.
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I'm, I'm smiling because I literally just had this done
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Oh,
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and yes, I found there's a Dexa fit close by me and I actually am having the owner on the podcast in a couple of weeks.
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And so that'll be a great followup to this conversation because, um, they certainly make it seem like they're measuring the visceral fat to the ounce because it was like 0.
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5 blah, blah, blah.
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Like it was, but I thought.
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Those kinds of tests also are the kinds that can be compared to themselves.
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So even if it's not exactly right, if I have it tested again in 3 or 5 years, I can see what the percent of change is and know if I'm going, moving in the right direction, staying steady, because even if it's off some ounces, If it's off the same amount of ounces, you know, the next time.
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But yeah, I, I do think it's really interesting because I, I take my mom to all of her doctor appointments with my podcast listeners.
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No, I talk about all the time, but, um, we were talking about a DEXA scan for her.
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She's in her late seventies.
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And I said something about it to her doctor, like, Oh, I just had a DEXA.
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And he looked at me and he's like, how old are you?
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And it was like, super judgy.
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Like, why would you to do that?
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And I'm like, Well, I'm 48, but I wasn't really, wasn't really checking on the bone density as much as, you know, the other body composition part and the visceral fat was something I was really interested in learning about.
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So yeah, I totally recommend that.
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Yeah, and I agree with you about watching trends because we're each physiologically unique, so we can't even really say with absolute certainty what percent body fat is quote healthy, but you really need to be comparing yourself against yourself.
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I mean, sure, there are parameters for sure, but, what the threshold is on the high and low end.
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No one can say with absolute certainty.
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but as minimal as visceral fat as you can possibly get, and to just be looking at trends over time, two things about DEXA.
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Um, you want to be well hydrated, not over hydrated, but well hydrated, um, for sure.
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And also, you know, it, it is going to depend on the skill of the technician a little bit too.
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So just, you know, You know, making sure that you've got someone who's really looking at what they're doing, not kind of like talking to you, you know what I mean?
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Like really make sure, you know, even if you have to say, hey, listen, can we just like do the test and chat afterwards?
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You know what I mean?
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You really want to focus.
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Um, so that's all, you know, that's what I want to say about that.
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But, um, yeah, I think it's a great idea, especially as a baseline.
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Yeah.
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Perfect.
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Okay.
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Um, I'm going to go back, rewind a little bit.
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when we were talking about the principles of fat loss, You said, you know, it's all that low hanging fruit.
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Let's detail out what that low hanging fruit is because I am just constantly hammering on things like there aren't hacks for weight
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Right.
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Right.
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There are just core principles and they're actually Well known across the board and every diet you've ever been on is feeding on those core principles, but also feeding on your insecurities and trying to make you think it's easier than, than it is, but it is simple, right?
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So tell us, what would you consider the low hanging fruit for weight loss, fat loss?
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So obviously there's the nutrition piece can't get around that piece, but you are far better off.
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going slowly than trying to go too rapidly for lots of reasons, but the primary being, it's not going to be sustainable and you're wasting time.
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You are just wasting a giant chunk of time.
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If you try to go down to like a 1200 calorie diet or something, you're not going to be able to sustain, sustain that.
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And you will regain the weight.
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Secondly, Rapid weight loss also causes muscle loss, and that's antithetical to a healthy body composition and healthy blood sugar metabolism and being strong and functional independence and all the things that we want later on in life.
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So what I always tell people is give yourself a year.
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at least, you know, and if it's significant amount of weight, maybe two years, stop trying to do the six weeks to your summer body because it's just never going to work.
00:18:26.842 --> 00:18:35.261
Forget about the timeline and just approach it as if what you're really concerned about is your health and not just your physical appearance.
00:18:35.301 --> 00:18:39.571
I am all about women looking like whatever they want to look like and rocking bikinis.
00:18:39.602 --> 00:18:40.541
I'm all about it.
00:18:40.582 --> 00:18:52.906
I don't have a problem anything against that whatsoever, but you'll get there a lot faster in the long run if what you're focused on is the health of your brain, healthy blood sugar, healthy lipids and healthy blood pressure.
00:18:53.170 --> 00:19:01.549
And really like, if it takes you a year and what you've learned in that year is how to maintain that, those lifestyle
00:19:01.785 --> 00:19:02.605
far ahead.
00:19:02.799 --> 00:19:03.089
Yeah.
00:19:03.140 --> 00:19:07.130
you're you're really like, enjoy it then for the rest of your life.
00:19:07.160 --> 00:19:17.890
Because once you learn to change your lifestyle, instead of going on that six week diet and then going back to what you were doing, you're, you're just not gaining anything that way.
00:19:18.329 --> 00:19:23.960
I'm always like, we're, aiming to Like your future self who maintains her weight.
00:19:24.140 --> 00:19:27.539
Let's eat like she does let's aim towards that goal.
00:19:27.579 --> 00:19:30.369
And, and then you're way ahead.
00:19:30.954 --> 00:19:31.795
Way ahead.
00:19:31.835 --> 00:19:40.684
And you don't even have to, some people want to and it works for them and it is sustainable, but you don't have to majorly overhaul your diet.
00:19:40.724 --> 00:19:43.444
You could just eat less of what you're eating right now.
00:19:44.345 --> 00:19:48.474
You could change absolutely nothing about what goes on your plate, but just eat less of it.
00:19:48.865 --> 00:19:54.234
Or you could make more nutrient dense choices or include more plants or whatever you want to do.
00:19:54.234 --> 00:19:59.674
But it can be that simple as just eating maybe 75 percent of what you're currently eating.
00:20:00.305 --> 00:20:06.464
Um, so there's the nutrition and we, you know, I've got, we can get super detailed and go down a lot of rabbit holes with that if we want to.
00:20:06.464 --> 00:20:09.734
But just basically the nutrition piece cannot be avoided.
00:20:09.734 --> 00:20:09.904
It's so important.
00:20:09.904 --> 00:20:18.734
super important, not only to your body composition, fat loss, but also your long term health, um, exercise obviously is, is key.
00:20:18.744 --> 00:20:20.944
It's not going to be enough all by itself.
00:20:21.829 --> 00:20:30.950
especially if significant fat loss is what you're desiring, but it is certainly crucial for maintenance, and, and for your health, you know, for your metabolic health.
00:20:30.960 --> 00:20:39.529
And we need both, we need both cardio and strength training and about 150 minutes of zone two cardio a week is what I recommend.
00:20:39.539 --> 00:20:42.380
And about 70 minutes of strength training is what I recommend.
00:20:42.390 --> 00:20:45.910
And then sprinkle in some high intensity, maybe 30 minutes a week total.
00:20:46.420 --> 00:20:50.109
We need about twice as much cardio as strength training in terms of minutes.