Sept. 10, 2025

Midlife Metabolism with Dr. Gillian Goddard [Ep. 160]

Show Notes
Transcript

Midlife can be the worst when it comes to weight gain. If you are wondering what the ehck is going on with your metabolism and how your hormones might play a role, this episode is for you!

I’m joined by Dr. Gillian Goddard, an endocrinologist and an adjunct assistant professor of medicine at the NYU Grossman School of Medicine. She has more than 15 years of clinical experience and a particular expertise in endocrine diseases affecting women during the reproductive years, pregnancy and through perimenopause.

She helps us understand the nuances of hormone interaction during the menopause transition (which includes all those lovely years before as well known as perimenopause!). We discuss why weight gain happens and what we can do specifically in this time to combat it.

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This is the Eat Well Think Well Live Well podcast.

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I am Lisa Salisbury and this is episode 160 Midlife Metabolism with Dr.

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Jillian Goddard.

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Welcome to eat well.

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Well, the podcast for busy women who want to lose weight without constantly counting, tracking, or stressing over every bite.

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I'm Lisa Salsbury, a certified health weight loss and life coach, and most importantly, a recovered chronic dieter here.

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You'll learn to listen to your body and uncover the reasons you're reaching for food.

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When you're not truly hungry, freeing you to focus on a healthier, more fulfilling approach to eating.

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welcome back to the Eat Well Think Well Live Well podcast.

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I am so excited to be talking to Dr.

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Jillian Goddard.

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She's an endocrinologist and an adjunct assistant professor at Grossman School of Medicine.

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Did I get all that right?

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Mostly, yeah,

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Mostly.

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Okay.

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You correct me.

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Let's, let's hear from you.

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Introduce yourself a little bit.

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Tell us about who you are and what you do.

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Sure.

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Absolutely.

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So as you said, I'm an endocrinologist and a professor at NYU.

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uh, write a newsletter called Hot Flash, which is all about women's hormonal health, not just about menopause and perimenopause, but sort of everything from puberty through menopause, and I'm so excited to be here.

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Great.

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Okay.

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Well, as a lot of my listeners are in midlife, less of us in puberty, it's like, what do people call it?

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Like second puberty or,

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Something like that.

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And sometimes if you yourself are in midlife, you live with someone in puberty, so there's lots of crossover there.

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Yes, I'm familiar with that.

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I have two, two girls, so, um, 17 and 20.

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So yeah, we are definitely in that crossover time.

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So obviously the main feature of perimenopause going into menopause is the hormonal changes.

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That's what causes all of the, problems.

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So, let's just talk about that, like a little bit of education on how those hormonal changes of perimenopause, like what happens.

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generally, and then specifically we wanna talk about how those affect our metabolism since that's, you know, a lot of what we talk about on this podcast is weight loss and, things that affect it.

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Absolutely.

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So.

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I think the best way to think about perimenopause is from the point of view of your ovaries.

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Women and girls are born with all the eggs that they will ever have, and from your first period onward, you are maturing eggs and ovulating approximately once a month, barring.

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You know, events like pregnancy, and as we get into our, typically into our late forties and early fifties, the numbers of eggs that are left in our ovaries are starting to dwindle.

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In addition to that, the way our hormonal system works is the, the, the young healthy, like best quality eggs get ovulated.

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First, and so again, by the time we're in our late forties and early fifties, not only are there fewer eggs, but the quality is lower.

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And the reason that's

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Sorry, I'm gonna interrupt you.

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The body just naturally chooses those.

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kind of.

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It's more that they kind of raise their hand,

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That's fascinating.

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I did not know that.

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Which is why we're more fertile when we're younger because of the quality of the egg.

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Fascinating.

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Okay.

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Carry on.

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So those old low quality last kids picked for the team, eggs that are left in our ovaries in our forties and fifties need a lot more.

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Hormonal drive to get them to mature and prepare for ovulation.

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Um, and the hormone that does that is called follicle stimulating hormone, FSH.

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And so you need much, much more FS, H to drive those eggs to.

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And FSH also tells the ovaries to make estrogen.

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And so what happens in perimenopause is you get these big spikes in estrogen and these big drops in estrogen.

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And that is a lot of what drives the symptoms that we are having, during perimenopause and early menopause.

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And then As the eggs get even fewer by the time you're down to, you know, under a thousand eggs at that point, sometimes it takes so long to get an egg ready to go that the wires get crossed and you have a period without ovulating.

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That's called an anovulatory cycle and sometimes you might go many months.

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Without a period because you're not ovulating.

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'cause the eggs just can't get ready quickly enough and be ready to ovulate.

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and then finally you run out of eggs essentially, and you have your last menstrual period.

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And the ovaries kind of start to say they're done and start to shut down, but.

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Our estrogen levels can still occasionally like spike up and drop even after our last menstrual period.

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And it is actually not the rising estrogen, but really the dropping estrogen that tends to create a lot of the symptoms that we have in perimenopause.

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The classic ones that people think of, like hot flushes, night sweats, and sleep disruption.

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But the other thing that happens is our estrogen levels drop and our androgen levels, those are hormones that we typically associate with men like testosterone.

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Our androgen levels oftentimes stay about the same, and so estrogen levels drop, but androgen levels stay the same.

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So the balance, the ratio between androgen levels and estrogen shifts toward androgens.

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And androgens promote weight gain in our midsection around our organs.

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Estrogen promotes weight gain around our hips, thighs, and in our breasts.

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and so we get this shift from a sort of weight gain more in the hips and thighs to this weight gain in the midsection.

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And the, that's super important for everything that happens to us metabolically after that, because it's weight gain in the midsection that changes how we metabolize carbohydrates.

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That changes, you know, How well our body is able to use carbohydrates and how much insulin we need to use carbohydrates.

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it also has some effects on muscle mass.

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So, on average women lose about a pound to two pounds of muscle mass during the perimenopausal transition.

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And if you gain fat in your midsection and you lose muscle mass, you pick up some insulin resistance and you lose some basal metabolic rate, so your metabolism slows, you're burning less calories at rest.

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and when you consume carbohydrates, you're needing a lot of insulin to utilize them, and so they preferentially get stored in your midsection, which causes more weight gain in your midsection, and then you just end up on this vicious cycle where you become more insulin resistant, you gain more weight in your midsection.

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On and on and on.

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Un until you break the cycle.

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Doesn't it sound fun?

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Okay.

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Yeah.

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Oh, dear.

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Okay.

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so I have questions.

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Sure.

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First of all, and this is actually just like a curiosity question, not really even on this topic.

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You said when you get down to under a thousand eggs, I used to think, and I I might be like, I was today years old when I learned this.

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I used to think that you had the exact, like the number of eggs and you released one per cycle.

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But I learned recently that that's not exactly true.

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'cause I'm thinking a thousand eggs, that's, you still got plenty, like that's a lot of cycles.

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But

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That's three years or something, right?

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More than,

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more, yeah.

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Way.

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So how, how many eggs do you typically release?

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Because a thousand eggs seems like still a lot left.

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So you start, most women start life with something in the neighborhood of.

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600,000 eggs, which sounds like you should be able to ovulate for like a millennium.

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But what actually happens is a whole group of eggs, start down the process of maturation.

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So at the beginning, you might have 50 or a hundred eggs starting down this process.

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But over the course of the maturation process, many of them will die off and there's a chemical process that occurs within the ovary so that some of those eggs spontaneously, like they stop growing and they, they kind of just.

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Involute and get taken care of by the, the body's system for cleaning up old cells so that you get to, you end up with a dominant follicle, and that dominant follicle is the follicle that ovulates, so you only ovulate typically one egg a month.

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There are exceptions to that.

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Sometimes some women ovulate two eggs per month, and that's, you know.

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get twins.

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Outside of IVF?

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Yes, that, that's one of the natural ways we get twins.

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but most of the time you ovulate only one egg, but many more eggs are starting down that process.

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So a thousand eggs is, you know, enough to get you through three to five years probably.

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Okay.

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Okay.

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That makes, that makes a lot more sense because I was like, but how can you release more than one egg?

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We would have way more multiple births.

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But it's not that you release more than one, it's just that, more than that there's a big Okay.

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Ghost, you, you heard her?

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I won't restate.

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So that's, that's really just, that's just interesting.

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I just like learning about the women's body.

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So, Okay, so my next question about this, like estrogen versus testosterone balance is that we have seen a lot in, You know, I'm sure a lot of my listeners are on Instagram and with a lot of menopause influencers.

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So there's a, a lot of push with hormonal replacement therapy, which I am on, and I really, I'm thriving on, especially progesterone at night.

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I love that she's nodding.

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If you're not watching video, she's nodding along so we can talk about.

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therapy is fantastic.

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Okay, but why then is testosterone?

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One of the things that I've been recommend, I, I've been on and off of it.

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I am, I'm like, I mostly because I'm not sure I'm seeing the results for the cost and because my estrogen and progesterone are like basically covered a hundred percent by my insurance.

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But testosterone, my doctor won't prescribe the, the mail version because that's an

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by her insurance, even if she did.

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Well, it's just a lot cheaper than the compounding version that I have to choose anyway, point being.

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It's a little bit of a, of a cost for me.

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And so I have been kind of on and off about it and, but what I'm kind of paranoid about, now that you've said this and I, I just think people that might be on testosterone might think, well, why would I want to be on testosterone if that's gonna cause weight gain around the middle?

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So how would that play into it?

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Why would we be, you know, recommended to be on a testosterone replacement?

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I think this confuses a lot of people.

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So I'll say a couple of things about this.

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Not everyone's testosterone stays the same in perimenopause.

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Some people's testosterone actually rises during the perimenopause.

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In early menopause, some women stays approximately the same and some women's testosterone actually falls.

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And so if your testosterone levels are very low and you're symptomatic because of that.

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then adding testosterone may be helpful.

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That said, the only thing testosterone has really been studied for in women is, hypoactive sexual desire disorder, which put much more simply is low desire for sex and difficulty getting aroused.

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Loss of libido.

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Yeah.

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Yeah.

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Not really wanting to have sex and when you do not feeling all that satisfied by it.

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And that's actually the only thing that testosterone has really been proven in the literature to do.

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but you're right, there's no testosterone that has been approved in a formulation dosed for women.

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And so your two options are compounded testosterone, which you get at a compounding pharmacy.

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The big challenge, there's two big challenges there.

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One is cost, as you mentioned, and the other is that compounding pharmacies vary a great deal in their, quality control and reliability.

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They're not, the way they're licensed is very variable.

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or you can use testosterone formulated for men and just use really tiny doses of it, which

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Yeah.

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It's messy and, and inelegant and not, but I have lots of patients who do it because it is quite a bit cheaper.

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there has been talk about getting a product for women on the market, but I think we're a long ways away from that, happening partly because a pharmaceutical would have to get behind it

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yeah.

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Yeah.

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And a lot more studies done because, so.

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studies.

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So if someone were like, okay, but I do have, you know, the loss of libido, it bothers me.

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I can't orgasm.

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I'd really like to try it.

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Are they risking midsection weight gain by using it?

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Not if you're careful with the dosing.

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So

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Mm-hmm.

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one, so one thing that can happen when you take testosterone is you can get the, make the doses very high.

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So they're higher than like a typical woman's.

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testosterone would be, and there you may get into trouble with side effects, including some weight gain.

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if you're getting, taking the levels and you're moving them from sort of low to, you know, more middle of the road for a typical female level, you don't tend to see weight gain issues with that.

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And the question is sort of why, right?

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some of this is because there's.

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Other factors at play that we're just starting to understand, around FSH and the role of FSH outside of the ovary.

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So I told you FSH tells the ovary to mature an egg and make estrogen.

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there's some.

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A growing body of literature, I think is the way I would put it.

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about FSH and FSH receptors outside of the ovary having potentially being related to metabolic changes we see.

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Women in perimenopause because what happens to FSH in perimenopause and menopause is that it can rise very high.

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and so FSH may actually be acting in other parts of our body, including in this case, importantly the adrenal gland, to have impacts on.

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Our metabolism, our blood pressure, our cholesterol, that are mitigated by that hormone directly, and not by this mismatch between estrogen and testosterone.

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Okay, so it's my understanding that.

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Menopause hormone replacement therapy or HRT or however you want to call it, is not a metabolism or weight loss fix.

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We don't get prescribed these things because we've gained weight.

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How though, could they help in weight maintenance or are they a factor?

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Because I've heard people say oh, well I'm gonna get on, HRT and try and lose some weight, and I'm like, those are two.

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Separate things, and yet our hormones are connected to our metabolism.

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So what role does that have?

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So that's actually why people got interested.

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It in, in FSH as a potential mitigating factor with all of this to begin with is people didn't understand.

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If you give women back, the reason we don't use estrogen to help women in menopause and perimenopause lose weight is because it doesn't work.

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there's lots of data to show that it doesn't work,

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And it works for a lot of other things, like

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it's great for hot licious, night sweats,

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great.

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brain fog, muscle aches, joint pain, your hormone replacement will help you with all of that, but it does not help women lose weight.

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and so the question was, well, why doesn't it?

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And, and we think that this is where FSH comes into play because when you take hormone replacement therapy, you do not typically suppress.

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Your FSH, so you don't typically get a lower FSH from taking estrogen.

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and so that may be part of the issue.

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However, I do think women who are taking hormone replacement for other indications sometimes see that their metabolic changes are less dramatic.

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and so They may not lose weight, but they also may not gain as much weight as the typical woman does in in perimenopause.

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Yeah.

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Possible though, that that could be a correlation factor because people that are pursuing HRT are also those that are living typically gonna be living a more healthy lifestyle.

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They're typically the ones that are gonna going to already be exercising and, and eating the things and, right.

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So it's, it's a confusing,

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it is, and we don't have nearly enough.

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You know, clinical trial data, like randomized clinical trial data, around any of these issues because for 20 years we didn't do clinical trials, in perimenopausal women with hormone replacement therapy, because of the women's health initiative.

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And so we're just starting to see those types of clinical trials really get going again.

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And so all we really have are observational studies from the last 20 years or so, which.

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You cannot sort out causation versus correlation with an observational study.

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Unfortunately,

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So, I mean, percentage wise, really, except for from what I, I understand the last, you know, handful of years, the percentage of women on HRT has been so low.

00:18:45.587 --> 00:18:53.762
between 19 or between 20, 24, which was the year that the Women's Health Initiative study was paused, and.

00:18:54.347 --> 00:19:02.337
Basically women throughout their HRT on, on mass, like in a single day, because of the media coverage of the study.

00:19:02.657 --> 00:19:03.738
between that,

00:19:04.292 --> 00:19:06.182
20, 24 was just last year.

00:19:06.597 --> 00:19:07.768
2004, sorry.

00:19:08.127 --> 00:19:10.738
Between 2004 and 2020.

00:19:10.738 --> 00:19:11.728
Sorry, I misspoke.

00:19:12.012 --> 00:19:12.103
okay.

00:19:12.867 --> 00:19:18.222
So in those, in, in those years between when the Women's Health Initiative study came out and 2020.

00:19:18.867 --> 00:19:22.948
Four to 5% of women were taking hormone replacement therapy.

00:19:23.607 --> 00:19:31.978
80% of women have hot flushes and night sweats, and four to 5% of women were taking hormone replacement therapy.

00:19:32.758 --> 00:19:42.117
So when people talk about like, oh, we should be using it for this and that and the other, I'm like, how about we just start by treating the symptoms that women are having that we know it works for?

00:19:42.448 --> 00:19:42.897
Yeah.

00:19:43.347 --> 00:19:52.137
Well, and another one I'm super passionate about, like all my friends know, I'm like, are, are you on vaginal estrogen though?

00:19:52.167 --> 00:19:53.728
Because everyone can be on vaginal estro.

00:19:53.877 --> 00:19:57.748
And this is kind of off topic from what we're, what you and I are trying to talk about with.

00:19:58.097 --> 00:20:00.347
you know, metabolism and, and these changes.

00:20:00.347 --> 00:20:03.827
But honestly, anytime I can plug that, like, it's so safe.

00:20:03.827 --> 00:20:06.288
It's a microdose and

00:20:06.458 --> 00:20:12.057
safe For women who have had estrogen receptor positive breast cancer, it does not affect breast cancer risk.

00:20:12.711 --> 00:20:16.642
yeah, like I just want you to say that again.

00:20:16.642 --> 00:20:21.981
Like, we have an endocrinologist here telling us it is safe.

00:20:22.071 --> 00:20:22.251
It

00:20:22.392 --> 00:20:25.241
Vaginal, estrogen is safe for everyone.

00:20:25.241 --> 00:20:32.981
We even now think it's safe for the vast majority of women who had estrogen receptor positive breast cancer.

00:20:33.731 --> 00:20:34.061
Yeah.

00:20:34.271 --> 00:20:34.662
Okay.

00:20:35.832 --> 00:20:39.882
And why would a person want to use vaginal estrogen?

00:20:41.076 --> 00:21:00.826
because vaginal dryness is very common and can lead to a whole host of undesirable symptoms, when our vaginal va vaginal lining and our vulva and the muscles that support our vagina and vulva don't have estrogen, they dry out.

00:21:01.652 --> 00:21:05.821
When they dry out, they thin and they stick together.

00:21:05.821 --> 00:21:12.031
One of my patients once said that her vagina felt like two pieces of Velcro being pulled apart when she moved.

00:21:12.481 --> 00:21:14.852
you, you can start to get atrophies.

00:21:14.852 --> 00:21:19.297
You can actually start to get breakdown of the tissues and not be able to.

00:21:20.132 --> 00:21:28.741
Insert anything in the vagina, a speculum, a finger, a penis, if that's something that you're interested in doing.

00:21:28.741 --> 00:21:31.021
So sex can become very uncomfortable.

00:21:31.491 --> 00:21:39.301
it disrupts the The flora, the bacteria that grow in the vagina so you can get yeast infections.

00:21:39.541 --> 00:21:48.632
And then my all time favorite is that the slumping down of the vagina actually pulls the anus and the urethra closer together.

00:21:48.632 --> 00:21:55.477
So it's easier to get urinary tract infections too, because you get bacteria from the anus into your urethra.

00:21:55.477 --> 00:21:56.257
So.

00:21:57.771 --> 00:22:00.531
And then your, your, I mean, I could go on and on.

00:22:00.531 --> 00:22:00.862
Your

00:22:00.906 --> 00:22:01.836
Yeah, I know.

00:22:01.882 --> 00:22:02.001
I.

00:22:02.301 --> 00:22:04.192
press on your bladder and

00:22:04.807 --> 00:22:08.017
It's, it just, it affects the entire area down there.

00:22:08.017 --> 00:22:15.817
It's not just for vaginal dryness, although that is, I, I've gotten to be almost so sensitive that I'm, I, because it's just a twice a week.

00:22:15.817 --> 00:22:20.767
And so I can tell like when it's time, like my body will tell me it's time.

00:22:20.767 --> 00:22:22.027
Don't forget your dose today.

00:22:22.487 --> 00:22:24.826
but even, you know, if, especially.

00:22:25.172 --> 00:22:25.922
It's so cheap.

00:22:25.922 --> 00:22:36.797
So if you are having trouble like with in, with intercourse and you can't do testosterone, like start with vaginal estrogen, that will increase your comfort.

00:22:37.757 --> 00:22:39.886
To the point that you, you might solve your problem there.

00:22:39.886 --> 00:22:40.876
I mean, I don't know.

00:22:40.967 --> 00:22:49.027
You know, it depends on what your problem is, but if it's just a comfort issue, start with vaginal estrogen because it's dirt cheap and, will really make such big difference.

00:22:49.027 --> 00:22:59.317
So anyway, I, I just love talking about HRT, like sometimes I think I should switch over to a menopause podcast, but I, it's just, it just makes such a difference and,

00:22:59.386 --> 00:23:00.076
big fan.

00:23:00.826 --> 00:23:08.356
So yes, we could talk a long time, but let's, let's get back to like the, the metabolic changes that we wanted to discuss.

00:23:08.356 --> 00:23:20.747
So we've got these metabolic changes and all of these hormones are kind of doing what they do in this midlife time, and we get that resulting change in body composition, so we get a little bit more fat.

00:23:21.067 --> 00:23:23.467
A little bit less muscle, one to two pounds of muscle.

00:23:23.467 --> 00:23:27.186
Doesn't sound like a whole lot, but is this happening?

00:23:27.186 --> 00:23:30.666
Like every year we're losing one to two pounds of muscle or every decade.

00:23:30.696 --> 00:23:33.277
Like, and what can we do about that?

00:23:33.916 --> 00:23:36.886
So the best data that we have around around.

00:23:37.487 --> 00:23:49.186
Body composition changes in perimenopause really specifically looks at the five years before the last menstrual period and the five years after the last menstrual period.

00:23:49.186 --> 00:23:55.237
So a 10 year time with your period, your last period, is that the midpoint of that time.

00:23:55.686 --> 00:24:01.057
And so that one to two pounds of muscle is, over that 10 year period.

00:24:02.211 --> 00:24:07.102
People do tend to lose muscle as they age too.

00:24:07.102 --> 00:24:08.781
So men lose muscle as they age.

00:24:08.781 --> 00:24:12.471
Also, not just women, it tends to be more gradual.

00:24:12.971 --> 00:24:24.971
but you, it, it only gets harder and harder to maintain muscle mass as we age because it becomes such a, again, like so many of these things, it becomes such a cycle because then.

00:24:25.406 --> 00:24:28.497
If it's hard to use your muscles, then you don't use them.

00:24:28.497 --> 00:24:31.676
And the less you use them, the less you will have.

00:24:32.007 --> 00:24:46.186
So this is where, and I know everyone's talking about this right now, but this is where strength training is so very important, for women in midlife because the best way to keep the muscle that you have and to.

00:24:46.606 --> 00:24:54.557
Keep the metabolic benefit of that muscle is to actively do things, to use it and build it.

00:24:54.656 --> 00:25:04.436
the recommendation is at least two non-consecutive days a week, doing 30 to 60 minutes of strength training.

00:25:04.856 --> 00:25:07.467
that can look like a lot of different things.

00:25:07.676 --> 00:25:10.317
It does not have to look like you in the gym.

00:25:11.037 --> 00:25:15.237
Pumping iron, although if you enjoy that, like it, it definitely works.

00:25:15.557 --> 00:25:23.116
my, I, I use Pilates as my strength training and my instructor knows that my goal is.

00:25:23.926 --> 00:25:26.297
Is to use it as my strength training.

00:25:26.676 --> 00:25:28.717
you, there's lots of different ways you can do it.

00:25:28.717 --> 00:25:31.926
You can use body weight, you can use exercise bands.

00:25:32.227 --> 00:25:35.227
You just have to be using those muscles.

00:25:35.557 --> 00:25:40.096
one of the things that's gotten very popular, is weighted vests.

00:25:40.126 --> 00:25:41.416
There's zero data for that.

00:25:42.182 --> 00:25:47.731
I wish, I wish it was so easy that you could just strap your weight and fast on and go for a walk.

00:25:48.102 --> 00:25:59.051
there's no data that it actually works and it actually misses a really important muscle group, which is like your upper core and your, and your arms.

00:25:59.152 --> 00:25:59.602
and.

00:26:00.082 --> 00:26:13.352
I can't tell you how many little old ladies I've seen who slip and fall on the ice on their outstretched hand and they break their wrist or they break their humerus or they break their shoulder, or, and awaited vest isn't gonna help you with that.

00:26:13.442 --> 00:26:13.832
So,

00:26:13.846 --> 00:26:14.957
Because you're not using

00:26:15.241 --> 00:26:20.342
'cause you're not using, you're right, you're not carrying the weight with your arms

00:26:20.747 --> 00:26:21.136
I,

00:26:21.602 --> 00:26:21.932
upper

00:26:22.156 --> 00:26:28.547
so if anybody in my own neighborhood listens to this podcast, they're gonna be like, but wait, we've seen you.

00:26:29.386 --> 00:26:32.836
I do use a weighted vest for a particular reason.

00:26:33.721 --> 00:26:50.251
And it is because I sometimes just wanna go for a long walk and be out in nature because I enjoy that and because, well, it's good for my dog and I can't get my heart rate up to the point that I want it to be at or the amount of time I'm spending.

00:26:50.281 --> 00:26:53.821
I don't wanna just go for a leisurely walk and then have to also work out later.

00:26:53.821 --> 00:26:56.162
Like I want it to be my cardio for the day.

00:26:56.162 --> 00:26:59.961
And so I use a weighted vest to increase my, my heart rate.

00:26:59.991 --> 00:27:01.701
And so I just kind of wanna like

00:27:01.791 --> 00:27:02.271
for that,

00:27:02.592 --> 00:27:03.791
Like a post-it note.

00:27:05.051 --> 00:27:05.261
what,

00:27:05.362 --> 00:27:07.551
You're like, I'm don't think I'm strength training.

00:27:07.932 --> 00:27:08.082
yeah.

00:27:09.852 --> 00:27:19.301
I, I have done, like, there's an old episode on my podcast, about rocking, which is kind of like a little bit more like a, like a lot more weight.

00:27:19.362 --> 00:27:23.652
I, I feel like that's probably a little bit different category than a, you know, a five or eight

00:27:23.842 --> 00:27:26.511
Than what you usually see people out like on your

00:27:26.711 --> 00:27:27.432
Yes.

00:27:27.461 --> 00:27:28.001
So.

00:27:28.251 --> 00:27:28.672
trail?

00:27:28.821 --> 00:27:29.182
Right.

00:27:29.182 --> 00:27:35.602
So if you are using a weighted vest to increase your heart rate, go for it.

00:27:35.632 --> 00:27:36.231
Do it,

00:27:36.527 --> 00:27:41.241
we know that increasing your heart rate is important, but it does not replace your strength training.

00:27:42.051 --> 00:27:42.442
Yeah.

00:27:42.862 --> 00:27:46.642
And also you don't wear your weighted vest to do deadlifts.

00:27:46.642 --> 00:27:47.781
Like it's not doing any good.

00:27:48.201 --> 00:27:49.041
Like, don't do that.

00:27:49.102 --> 00:27:51.652
It's not, there's no use for it.

00:27:51.771 --> 00:27:55.342
Just, just lift heavier if you need more of a challenge.

00:27:55.731 --> 00:27:56.061
Yep.

00:27:56.842 --> 00:27:57.321
Agreed.

00:27:57.801 --> 00:27:58.132
Okay.

00:27:58.582 --> 00:27:59.031
All right.

00:27:59.332 --> 00:28:07.152
So the other thing I think that's confusing about these guidelines, is when I am in the gym lifting, I take the rest periods, right?

00:28:07.152 --> 00:28:15.102
It's like my program, it's like, do these lifts and rest two minutes, but then I'm in there for, you know, 45 minutes.

00:28:15.162 --> 00:28:19.031
All of those 45 minutes count towards this 30 to 60 minute recommendation.

00:28:19.061 --> 00:28:21.761
Even though some of those minutes I'm standing around.

00:28:22.217 --> 00:28:24.797
Yes, I know it feels really weird to be like.

00:28:25.571 --> 00:28:32.981
To be like I, it's a 45 minute workout and I didn't exercise for all of those 45 minutes.

00:28:33.402 --> 00:28:42.311
I think there's a certain like subset of us who are like rule followers and wanna like get the gold star that we're like, that doesn't feel quite right.

00:28:42.912 --> 00:28:43.811
It is, it is.

00:28:43.842 --> 00:28:46.662
The guideline does not say you don't get to rest.

00:28:47.281 --> 00:28:47.491
Okay.

00:28:48.541 --> 00:28:48.842
Yeah.

00:28:48.872 --> 00:28:55.092
Well, and I think too, a lot of us come from the, little bit, you know, cardio bunny, step aro.

00:28:55.092 --> 00:29:03.192
I mean, I started working out for like, my first experience with like regular working out was like step aerobics.

00:29:03.231 --> 00:29:03.592
Right,

00:29:03.936 --> 00:29:13.807
And so, you know, it's like you're working out the whole time, and so strength training feels really strange when you've been doing that for a long, long, long time.

00:29:14.047 --> 00:29:14.557
Yeah.

00:29:14.676 --> 00:29:15.067
Yeah.

00:29:15.067 --> 00:29:17.646
And I think, I think some of that is generational.

00:29:17.646 --> 00:29:23.317
I think you and I are of the generation that was like cardio, cardio, cardio, cardio.

00:29:23.317 --> 00:29:27.967
And then like a year ago we were like, oh, maybe we should strength train.

00:29:28.991 --> 00:29:29.281
Yeah.

00:29:30.951 --> 00:29:31.521
Yes.

00:29:31.701 --> 00:29:33.781
So, okay, good.

00:29:33.781 --> 00:29:47.852
So yes, it feels like we know, we know everyone's talking about this, but it's, it's because it really is clear in the research, like it's really clear for, for midlife women strength training is key.

00:29:47.912 --> 00:29:51.362
And, and what's sad is you can't like, not do your cardio though.

00:29:51.422 --> 00:29:53.882
Like, I'm still, like, I'm still doing those long walks.

00:29:53.882 --> 00:29:56.971
I'm still like in the pool, I sw still swim laps like.

00:29:58.021 --> 00:30:02.757
So we just need to balance our cardio with some strength training.

00:30:03.211 --> 00:30:03.842
That's correct.

00:30:03.842 --> 00:30:11.281
We need cardio because we, I mean, it's really important for your cardiovascular health, for your blood pressure, and you know, your heart.

00:30:11.672 --> 00:30:13.352
It's, it's really important.

00:30:13.352 --> 00:30:17.426
And so yes, we're asking everybody to fit in an extra

00:30:18.507 --> 00:30:18.797
Yeah.

00:30:19.027 --> 00:30:19.557
more stuff.

00:30:20.432 --> 00:30:20.791
Yeah.

00:30:21.352 --> 00:30:21.711
okay.

00:30:21.711 --> 00:30:33.771
So we're hoping that this sort of mitigates the weight, the weight gain, but it doesn't really work for everyone as far as some of us are still gonna see some weight gain around this time.

00:30:34.082 --> 00:30:38.071
I can't tell you how many times I have seen a client who tells me like.

00:30:39.257 --> 00:30:41.777
Well, I guess I would say I'm about half and half.

00:30:41.836 --> 00:30:56.176
Some of my clients come to me and say they struggled with their weight their whole lives, and other clients come to me and say, I've never struggled with my weight until I turned 40, until I turned, you know, 38, 45, all of just right in this mid range.

00:30:56.717 --> 00:31:05.777
And so despite feeling like we're doing everything right, we're eating the fiber and we're, you know, counting the protein grams and all of that, sometimes.

00:31:06.352 --> 00:31:12.244
It feels like we're still gaining weight, so what are the options at that point?

00:31:12.244 --> 00:31:13.565
What are we doing wrong?

00:31:14.045 --> 00:31:18.230
And, you know, in the, like, what else can be done and, and what would you recommend?

00:31:19.109 --> 00:31:29.262
Yeah, I mean, I think one of the things that's really tricky here is a lot of the patients that I see in my office, They're pretty well educated about their diet.

00:31:29.262 --> 00:31:34.893
There may be some, some changes that they can make, but There's not any low hanging fruit.

00:31:34.893 --> 00:31:37.563
They are really doing the work.

00:31:37.923 --> 00:31:52.133
And for a long time we were taught, this is literally a board question on the endocrine boards, that if a patient is not losing weight, if they create a caloric deficit.

00:31:52.548 --> 00:32:00.347
It means that they're miscalculating their calories or lying or eating more than they think they are.

00:32:00.617 --> 00:32:05.377
And in my experience, that answer should be wrong.

00:32:06.248 --> 00:32:06.758
It's not.

00:32:06.758 --> 00:32:09.218
That's the, that's supposedly the correct answer, but.

00:32:10.212 --> 00:32:17.022
There's so much more going on that we don't understand about weight that isn't calories in and calories out.

00:32:17.502 --> 00:32:20.452
and, genetics are a huge component.

00:32:20.903 --> 00:32:23.393
and, and metabolic syndrome.

00:32:23.393 --> 00:32:27.262
And you know, we used to say, well, weight gain causes metabolic syndrome.

00:32:27.502 --> 00:32:33.722
It's becoming more and more clear that weight gain and metabolic syndrome are caused by the same thing.

00:32:33.722 --> 00:32:37.682