EPISODE 113: Dr. Bill Campbell

Hello, everybody. It is Dr. Jamie and welcome back to the Fit and Fabulous podcast. I could not be

more excited about today's recording. I have been wanting to get this guest on here to talk about

this topic for a little while and every time he posts something about this topic, I'm like, we

got to record this. We got to do this. So please welcome Dr. Campbell. He is a professor and director

of the Performance and Physique Enhancement Lab at the University of South Florida. Florida

probably much warmer than Nebraska is today. He's authored three books on sports nutrition and

author of over 200 scientific abstracts and manuscripts on topics that are related to sports

nutrition, physique enhancement, exercise performance. He's the past president of the International

Society of Sports Nutrition. He also has this really awesome newsletter called Body by Science

and it summarizes all of this research, all of this review of research into one easy to read

format. I've seen it myself. It's amazing. You guys can find them on Instagram at billcamblephd

or billcamblephd.com. But the reason why I've invited Bill on today is to have a conversation

about menopause. His research is starting to focus on optimizing physique through lifestyle, but he

has conducted the first ever women's menopause fitness survey. And I've seen some of the results.

The survey is about women's projections and reflections on menopause as they embrace the fitness

lifestyle. He's created a free YouTube educational series about menopause and fitness. It has

lessons on exercise nutrition, hormone replacement therapy. I am so excited about what you're doing,

Bill. Welcome to the Fit and Fabulous podcast. Well, thank you very much for having me. I'm excited

to be here. Okay, so my listeners know who I am, but in case Dr. Campbell's listeners are on here,

I'm an OBGYN. I have a background in exercise science and nutrition in my adult life after being

a collegiate athlete got into bodybuilding and have competed in both women's physique and women's

bodybuilding. So as a women's health practitioner, I look through a different lens, I suppose,

when I talk about lifestyle with my patients. But what made you, Bill? You have this incredible

list of credentials and sports and exercise nutrition. But what made you start to focus on menopause?

Okay, so that's 100% was due to my wife's menopause transition. So if we were to back up five years

from today and somebody were to tell me, Hey, you're going to change your entire research program

and focus on menopause. I would have said there's no way. It was so far removed from what I was

thinking or my interest level. And essentially, so I'm a fat loss researcher exercise physiologist

by training. And my wife, um, very fit lifts weights. And then when she got to her late 40s,

she started to gain some weight. And in the past, I would always help to some extent. Like,

well, she's lucky, right? If she wants to lose weight, she's married to a fat loss researcher.

So for the first time when, when I was this, I couldn't help this time. Like, everything that we

used to do didn't help. And then, and let me also say, um, not all women are going to gain weight,

not all women that go through menopause are going to have a hard time losing it. So I don't,

it's not a doomsday scenario for everyone. But a lot of women will gain weight, especially in

the midsection. And in my wife's case, she had a hard time losing it. Um, again, I was kind of at,

you know, I was being very stressed with like, well, I can't help you. Um, and her weight gain was

not the most, she had larger problems with her menopause transition than just weight gain. But

as a lot of women who embrace a fitness lifestyle can, can empathize with, it was hard to gain weight

when she hadn't gained weight in the past. I'm really didn't feel like she changed anything

um, about her routine. Um, definitely had less energy for sure. So that is why I'm like,

hmm, I can't help you. This is a now a challenge to me. And then I started with her permission to

start talking about this a little bit publicly. And, and let me tell you the avalanche of responses

from other women who say this and continue to say the same thing. So I'm extremely, and I know

exactly why because I have your wife in my clinic every single day, every single day. I'm not

kidding. There is a woman. She's in her late 40s or early 50s and she is like, listen, Doc,

I'm working out. I'm going 40s a week. I'm doing the same level of intensity. I'm lifting the

weights. I'm eating the same diet. I am doing everything I used to do. And hey, you know, I haven't

been perfect. But 10 years ago, I used to be able to, you know, manipulate it in this way. And I'd

get the 10 pounds off and I'd get back on track. Nothing is working. I'm so frustrated. I think I'm

just going to quit doing it. And, um, you know, they're, they just feel so defeated because they feel

like they really are doing the right thing. So you've shared a few things on social media about

why this could be, right? Maybe they're not really tracking adequately. Maybe their intensity,

their workouts really isn't as intense as maybe they think it is. What was initially your theory

when your wife is experiencing this? I mean, with your science brain, like, what, I mean,

what were you thinking? What questions were you asking? So at first, I had no idea because it was

new to me. Like all of my research or most of my research was in younger, metabolically healthy

women. So mostly women in their 20s, maybe 30s. And every time we reduce calories, they would always

lose, lose, lose fat. And I also want to say that I'm, I'm what was and probably still am one of

the biggest advocates for the calories and calories out. Like there is nobody who beat that drum

more than me as a fat loss scientist. And I'm not backing away from saying, hey, yes, you

that still applies still applies. Yeah. However, now I have to have almost like a menopause caveat where

I think, or at least I'm open to the idea that some women, a small proportion of women that go

through menopause, they, the traditional or what used to work is not enough of a stimulus

for causing fat loss. When a few years ago, it used to be. So it, another way to say it is

the calorie deficits that they need to employ to lose body fat are so low and unsustainable

that it's just not healthy and more importantly, it's, or just as important, it's not sustainable.

So I didn't answer your question yet. I'm just trying to give context around this. I'm not

running away from, oh, calories don't matter. Of course they do. But why, why does it, why do so

many women claim that I'm doing the same thing and it's not working? And why do all of these women

seem to be in their 40s and 50s, early 50s, late 40s? So all's I'm doing as a scientist is, is

listening to the culture around me in this sub population of women who embrace a fitness lifestyle

and am starting to ask the appropriate scientific questions. So that's my thinking around this.

What I originally thought, and again, at first I had no idea. Everything was new to me in my wife.

We were completely reactive to this menopause thing, which was very frustrating. She suffered

a lot more than she needed to. And my wife kind of defers to me for all of the health-related

components of her life. And I defer to her on 99.9% of everything else in our lives. So she does

everything. I do the one, I go to PubMed. I'm the one who, you know, well, hey, make sure you ask

your doctor these three questions. So she's relying on me. And I didn't have any answers. So one

of the first things that started to come up was, well, what about this hormone therapy thing?

And I was like, well, I know that that can cause breast cancer. And I didn't know much. So I started

with no knowledge. And I jumped in, tried to, most of what I read is research articles. But I read

a few books early on as well. And just to now try to answer your question, what we do know with

this weight gain, it happens the same exact time that estrogen. And I'm just going to use the word

estradiol levels start to go down. So again, as that causation is a correlation, well, it's clearly

correlated. So then I'm thinking, okay, if it's, and a lot of people will point to estradiol levels

are getting lower and abdominal fat is increasing. So then I thought, okay, well, this is pretty simple.

This is a one plus one equals two. The women who take estrogen therapy, estradiol therapy,

they're probably not going to gain this body fat or they'll be able to lose it. And I,

and I can't sit here today and say, I don't think that's true for everyone. What I've learned

both in conversations with women. And by the way, as we have this conversation, I talk to through

social media a lot. I'm a sponge for knowledge. I'm, I learn, and I read all kinds of research on

this, but I don't, I don't want to discount. I'm having conversations. So what I, let me start with

the conversations in the anecdotal information. Women would tell me, oh, I started hormone therapy.

And it was great. I lost 10 pounds, feel better, et cetera. Other women would say, hey, man,

I started hormone, you know, an estrogen patch or an estrogen pill. And man, I gained eight pounds

in three weeks. And then other women are like, yeah, I didn't make any difference. So anecdotally,

what I'm learning is, boy, it's highly variable. I would think that estrogen would just

solve all of this. And then in the research, highly variable outcomes. Some studies show estrogen

therapy helps with weight loss. Other research will show it actually can cause weight gain.

Other research shows it will prevent the loss of body fat. So to answer your question,

what was my theory? Initially, it was all estrogen, estradio, and man, it was just that magic.

Yeah, it was just that easy. And now I'm left with, and this is my lab is literally, I was in

meetings with my research team for the last few hours. We're designing a study to answer the

question. Well, just a document does it exist? If it does, why? And we're not really answering the

why we're going to try to document yes or no first. But I wish it was estradio because then

there's a solution for that. But I don't know why it's so variable. So that's what I would love

to know your thoughts. Do you know why? So for my listeners to understand what's happening,

you know, we're suddenly seeing this shift at menopause. Well, what happens at menopause?

Month over month, year-to-year, in perimenopause, there is a

average lower estradio level month-to-month. And then finally, once you make this

menopausal transition, it's low. And it's just steady state low. For gestorone, same thing,

loss of progesterone. Testosterone does not fall off the cliff like estradio does,

but there is a slow age-related decline over our midlife and through menopause.

What we know estrogen does, so estrogen plays a very multifaceted approach with human metabolism.

We have known that. And it's part of the reason why a lot of people shyed away from studying

women across the menstrual cycle. It's really hard. There's not much control when you have

fluctuating day-to-day week-to-week levels of estradio. But we know that with

because of what estrogen does, we know that it does change energy balance. It changes glucose

homeostasis, so it's not uncommon in a menopausal patient. The year she makes this transition,

her A1C goes up, her fasting insulin and glucose go up. We start to see lipid metabolism changes.

Her cholesterol panel, all of a sudden, is changing. We know that estradio plays a role in human

metabolism. So what's interesting for me, just like you, okay, well, what about the HRT

users? That's probably the magic sauce. What I have found clinically, when you say there's this

variability in how people respond, is that I explain it to patients that it is like one of the

puzzle pieces. And if you have a puzzle that has 10 pieces in it and you're making Mickey Mouse,

it is an important piece of the puzzle, but it's not the whole picture. And I find that estrogen

replacement works best in patients who are doing a lot of the right things. My kind of like

mantras, these five pillars, sleep, nutrition, exercise, stress, mitigation, and kind of environment.

So I do think they were on the same page with who are these people that it works best in? How do you

select for those people? Obviously, it's always a choice to take hormone replacement. In some

patients, I actually had a couple followers messaging, can you please talk about the people who

can't take it? Like, what can we do, right? These, of course, are breast cancer patients or there's

some people that just have a risk of blood clot or whatever it is that can't take it or choose not to

take it. But when I've looked at the studies and you know this data better than I do, Bill, but,

you know, 2019 JAMA meta-analysis on like 12 studies over 4,500 patients, not much different in

skeletal lean body mass gains. So it doesn't appear to like, you know, keep a bunch of muscle

on patients. When you look at fat mass, you're right, it's all over the place. Some show they gain,

some show they lose. There is some favorability when we look at twin studies of people who took it

in people that don't listen. I'm a fan of HRT for a variety of reasons that have nothing to do with

body composition. There is less diabetes, less cardiovascular disease, less osteoporosis,

less colon cancer, and some studies less breast cancer. And if you start HRT between 50 and 59,

there's a 30% reduction in all cause mortality. So 30% less chance of dying of anything. So I'm

a huge fan of that. And the listeners know that. But let's go back to what you know and kind of

segue into this study. So Bill, if you're talking to somebody that's in their 20s, 30s, 40s, 50s,

traditionally, you would have told all these women in all these different decades that the same

principles apply if they want to improve their body composition. Because I think vast majority

of people listening aren't bodybuilders. But because I've gone through a prep before, I know that

those same principles apply if I want to lose 10 pounds before vacation or put on lean tissue.

Would you still say until we know more, until we kind of subtle the science more, that the same

principle still apply for somebody that's listening that's 30 versus 50? Yeah, I would add a little

nuance to this. And this is just based on some preliminary research that we've done in my lab.

So if I have 20, 30 year old, hey, let's do the traditional 25% caloric deficit, optimal protein,

resistance training. And for almost all of them, at least in my experience, they're going to lose fat,

they're going to retain their muscle. When we get into this, again, I'll just say a subpopulation

of women that are going through the menopause transition. So typically, it's going to be late 40s,

early 50s. And they have this, hey, it's not working. My suggestion or an option that I would

want to have with them is, okay, there could be, you just need to be more aggressive. Now, I've

spent a lot of years railing against crash dieting and aggressive dieting because that does a host

of negative things. Let's talk about them. When you diet aggressively for extended periods of time,

you lose a lot of weight, you lose a lot of fat, but you lose a lot of lean mass when you do that.

If you lose lean mass when you diet, as soon as your diet is over, you are significantly more

likely to gain back body fat. And in many cases, depending on how aggressive you were, that body

fat comes on not only rapidly, but it comes back on more and more amount than what you had before

you started your diet. So we call that fat overshoot. And that is due to a phenomenon known as

hyperphasia. So hyperphasia is basically the term refers to uncontrollable hunger or a really

strong desire to eat. And that is really tapered to lean mass changes. So my whole career has been

built on kind of, you know, been like a bodybuilding perspective, helping people lose weight, but maintain

as much lean mass so that they have a greater likelihood of maintaining that fat loss.

So there's the base. And now I'm going to sound like a hypocrite, but I'm actually not

for the women that I've had come into my lab who have claimed weight loss resistance. And this

is not published yet. We did present some of this data at a conference last year, but we don't

publish this study yet. We are very aggressive with walking and low calorie, but now here's the key.

The duration is very short. It is about, we have a four day protocol where they walk six hours a day

and they're eating about three to five hundred calories of mostly protein. So what does this do?

Well, if the theory is that what used to work never is not working, and which would be a normal

caloric deficit, but I have to have my calories so low to make the fat loss needle move. What I'm

essentially doing is leaning into that, but in such a way where the duration is so short that the

body only responds in our data by losing fat and not losing any lean mass. In fact, most of the

women we've had nine go through this protocol actually gained a little bit of lean mass. And these

are all women that are fit and many of whom just dieting is not working. So they say, so there is

something I would that possibly would be a little different between somebody who says they're struggling,

whose older, when I say older 40s and 50s compared to your question 20s and 30s. And one more thing,

I'm scared to death of publishing this data because I know what will happen. A lot of people will

say, oh, four days was great, but now let's do eight, let's do 12. And that's all of those harms

are going to now be in play. Could you, is this like they do this four days a month, four days every

two weeks? Like what do you think the optimal ratio of rest recovery is? Yes, so we've only,

we've only investigated this as a one time four day period. And we brought them back

30 days later to make sure because everybody, you know, we, they did these four days. And again,

that's that's a very severe protocol. Like if you have a normal job, it's a lot of moving and not

a lot of energy intake. Yeah, but on the energy side, because I obviously put myself through this,

and I'm a foodie, like I, I think about food all the time, like the GLP ones, like that's me,

like I'm constantly thinking of food. But surprisingly for myself, and in most of the subjects that

went through this, you're so busy walking that it really does suppress your hungry. Now I will say,

for myself, on the fourth day, I was very hungry, but the, I was shocked at how little I thought about

food during, at least the first three days of this. And importantly, we put them through the

protocol, then had them eat normal calories for three days. And then we brought them back to make,

you know, because their fluids are all messed up. So if you do body composition testing after four

days of starvation, essentially, and maybe some inflammation with all this walking, you're going

to get wonky values. So we wanted to stabilize nutrition fluids brought them back three days later.

And then we brought them back a month later, because that's where we're going to see,

did we cause harm by, if they lost lean mass, did they now get this hunger drive, and did they

gain fat? And in every situation, they all continue to maintain their fat loss, not lose any lean

mass. And we did blood work. So it was, it was, I mean, there was no harm done, at least within

the 30 days. And that's when, you know, we would see, so I'd like the health outcomes, or the body

composition outcomes without any adverse health effects. Now again, that the key here is we were more

aggressive, which I think it's probably what you need to do in menopause, maybe stay away from

the slow, long duration dieting, which again, for much of my career, I said, that's the way to do it.

I'm thinking that this should be an option. And I want to, I want to say something else.

My world and, and the women that I'm really trying to serve are those that embrace a fitness

lifestyle. If, if I have a 50 year old come to me, I'll just use my wife. If my wife said,

hey, I can't lose weight. And she's not tracking her food. And she's not lifting weights.

I would say, that's the starting point. Yes. Yeah. You're saying you can't, but how do you

know if you're not, and again, I'm not saying everybody has to track, but if you're going to claim

that nothing is working, and you're not already, you know, I have to say, buttoned up. You're not

tracking your food. You're not, you're not, you're not optimizing protein. You're not. I'm,

I don't want to say I'm not going to believe you, but I'm, there's a lot, or you're drinking a lot of

wine. You've got to have a baseline to start from. I mean, you, yes. So,

when you highlight for the listeners, though, what is the data really show with measuring and

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and happy podcast available now, wherever you get your podcasts. Oh, it's

overwhelming if you track just just calories and body weight, significant

improved significantly positive outcomes for body composition. How accurate is that for most

people? Because I have some patients that come in and they're like, oh, yeah, Doc, I've got my

app right here. This is what I'm eating. I'm not losing weight. Yeah, that can be, again,

we talked about variability. That can be highly variable as well. What I would do if I'm working with

clients, I would say, hey, great, you're tracking. But if things aren't working, let's just,

I'll, here's the example I use in my class, is like, take a picture of what you just tracked

and send it to me. So as an example, if they had a normal piece of lasagna and they say, yeah,

I tracked and it's 250 calories, no, what you just ate based on the weight and the picture,

you sent me that's closer to 800 calories. So there's a little test. So, yeah, so even then,

even if you're tracking, but yeah, that's true. We have to make an assumption that you're tracking

well and everything. A lot of people are like, well, I'm not going to count the dressing or

yeah. One thing I always tried to share with followers when I was going through my own bodybuilding

prep was like, I mean, you're weighing your food, you're measuring tablespoons. I mean, it's

it's a neurotic level of tracking when you're doing a bodybuilding competition because my calories

were dropping like 45 calories each week. I mean, that's like one extra bite of food or like one

less bite of food a day. I mean, that's like crazy. So I just want to highlight that for people

that maybe you are counting and tracking and it's just not good information. So let's talk about

another thing that comes up for menopausal women is they're like, I've heard on a podcast,

I'm not supposed to do orange theory because hit increases cortisol and I heard not supposed to be

spiking your cortisol for menopausal women. So you did walking for this study. What kind of

exercise do you think that menopausal women should be doing? Whatever they enjoy, I'm very,

if you like a certain type of exercise, do that exercise. I would really hope and encourage

people make resistance training the foundation of what you do. But if you hate that and you love

pickleball or you love cycling, I'm not going to any movement is good. So yeah, I'm I don't like

I like people to lean into what they like to do. But I do highly encourage resistance exercise

as ideally a foundational part or at least a that it occupies some time of your of your fitness

program. Do you think there's a population of women that are doing too much cardio for too long

or too much hit for too long and really creating a cortisol issue? Do you think it's even a thing?

Yeah, I so let me also say what we did in our study when they were doing these these were all

resistance trained women in this what we call a rapid fat loss protocol. We said no lifting for

these four days like this is we want you to relax try to walk outside now again depending on

if they lived in Florida careful. It it they lost no muscle even though we we again it's only four

days of of not lifting. But yeah, if I have if if I have women who are really high volume

exercises. I'm all for hey and and and they're coming to me saying nothing is working and yes,

you're tracking yes, I'm lifting yes, I'm running yes, I'm getting my steps in yes, I'm going to

conditioning classes to me. I'm like okay, I'm just listening to you and and great for you,

you're doing all of this movement, but you're also telling me that nothing like whatever you're

doing isn't working. If I get the sense that this your volume of exercise is just so high to me,

it makes sense that let's dial some of this back and let's see how your body responds and in

some cases it really helps they they bring you know they just cut everything in half and that's

a hard conversation for a lot of a lot of the women that I talk to. But you already said nothing's

working. So let's let's try something else. Is that a cortisol issue? I it could be I do know that

I don't see that in the research literature elevated cortisol. That doesn't mean it's it's not

a real thing, but I do get the sense that it's well here's exactly so I'll have women say hey,

my cortisol is really high for whatever reason and I'm like oh what were your values?

Well, I didn't actually get it measured then you don't know they have a cortisol problem.

Yeah, so that worries me. So somewhere they're getting a message that it's their cortisol.

Maybe it is. Maybe it isn't. It's not in the research literature and they're not really able

to document it when I ask that question. Yeah. What do you think? What are your thoughts on

high volumes of exercise in cortisol? Well, I mean we know like if you if you're doing like true

high intensity interval training, like you shouldn't be able to do that for an hour, like you're

totally not going to the intensity that you like think you are. But I do I mean I think it's rare

that somebody is overexercising like that they're spending so many hours on the stair mill that like

that they're creating basically too much sympathetic you know like nervous system stimulation.

I do think it's important like people need rest people need recovery like we live these

crazy jobs and careers and we're getting just stimulated all the time. So I do think sometimes people

can get so neurotic about the diet and exercise portion that it's like hey how's your sleep?

Maybe you need some meditation like maybe you need some sauna sessions like I do think there's

some women that can benefit from that but I don't think it's a you really are pumping so much cortisol

out of your trinoles that it's inhibiting your results. I mean I just don't I just don't think

that's a thing. And back to cortisol it's cortisol releases a natural response to exercise and

when I was earlier in my career I was really into overtraining and I was trying to look at all the

research on what would predict overtraining. The only thing that jumped out to me was the body's

failure to spike cortisol after intense exercise. So if the body didn't respond by releasing cortisol

after high intensity exercise that was a sign that that person was going to enter an overtrained

state. So it's something I've never forgotten relative to cortisol. Let's talk about sleep.

We know the data is very clear. People that have sleep deprivation gain weight. I can tell you

right now delivering babies that two o'clock in the morning the next day my satiety is horrible.

My hunger is up. My compliance is sometimes down. Thankfully I usually have a night of recovery

and I come back but menopausal women, perimenopausal women, they're not sleeping well either. What role do

you think that sleep plays in some of this? Well they're the only documented existence of true fat

loss resistance is it comes from a sleep deprivation study. So I'll explain this and actually we just

talked about this in my research meeting today. They had middle-aged males and females, mostly males

but a few females. They had them live in a metabolic ward, metabolic chamber,

room calorimeter, whatever you want to call it for 14 days, two different times. So what is a

what is a metabolic chamber? It's a pretty small room that tells you precisely how many calories

you're burning and it does that through indirect calorimetry which is basically measures your

oxygen consumed and your carbon dioxide that you breathe out. It is the gold standard for

measuring metabolism. So there is no better environment to test energy expenditure. They had

these subjects for 14 days all on a diet so they reduced their calories by 33%. One time for 14

days they were allowed to sleep a normal night and they averaged seven and a half hours.

Of short time later they came back for another 14 days. Same diet reduced their calories same amount

but this time they were sleep deprived by two hours. So it was 5.5 hours all randomized the same

subject. So the beauty of using the same subjects is you eliminate all genetic variability. Same

genes, same metabolism, same lifestyle you will not find a better design sleep study than this

and what they found when the subjects were sleep deprived eating the same number of calories

in a caloric deficit they lost significantly less fat. They lost 2.5 times more fat.

So I used to think now I know you don't because you see this in the real world with patients

and third shifts but I'm like yeah sleep it's important but it never really I never really cared

about it and then I've read that study and my position now is if you're at a point in life where

you can't sleep don't make that a diet phase. You are literally spinning your wheels and that is

you can't read that study and say that fat loss resistance is not real. That's a clear indication

so that doesn't mean that menopause of women have it again that that that hasn't been shown yet

but like you said which out of all the humans in the world which ones suffer from sleep deprivation the

most it would be women going through menopause so it's not a far stretch to say hey if you're

having sleep issues and you're trying to lose weight that's a reason why it might not be working

well. Yeah 100 percent so I've had so many different people on the podcast and it really was not

until my 40s that I realized sleep is like a skill like when you're a kid you just like like

down and go to sleep and then suddenly in your 40s and you're like you got this you know you got

red lights and you got a mask and you're taking you know magnesium and you got this chili pad on

your bed like I'm telling you I know what these women are doing and like they're trying a lot of

things just to get a good night's sleep. I do think that it plays a role because I hear so many of

them say they're having trouble sleeping and then they're like I can't lose weight and when people

are I think it's almost like this vicious toilet bowl that happens because they're not sleeping well

so then they're more hungry during the day and then their joints are hurting because they're

getting joint stiffness so they're not mood they're naturally just not moving as much so even though

they perceive it as like I'm doing all the same things there probably are some subtle changes

and it's not just estrogen and progesterone that go down when we don't sleep well testosterone

changes growth hormone pulsatility changes I mean there's there's more things that change you know

with poor sleep and age-related changes too. So I'm with you I think I think that's a puzzle piece

that if you're not sleeping well you got to focus on that first and sometimes it is a hormone

issue I mean if you're waking up with night sweats 12 times a night that's a problem that's a problem

and on that note just for whoever it may help my wife's she started on progesterone it immediately

I'll just say the word cured her sleep night sweats hot flashes it was I would just say progesterone

dramatically improve my wife's quality of life. Yeah the vast majority of my patients do really

well with progesterone there are a few patients that can't kind of quote unquote tolerate it you

want to take it at night 30 60 minutes before bedtime I prefer micronized progesterone or

prometrium is the trade name as opposed to a progestin yeah and that's because of the breast

cancer risk but it does it's very good for sleep and one of the metabolites of progesterone

alipregnenalone increases GABA in the brain so it's like it's really calming to the brain it helps

people sleep and even if you've had a hysterectomy you can still take progesterone you just don't

have to take progesterone if you're taking estrogen but I use a lot of progesterone impairment

before I'm actually adding estrogen yeah we don't have a lot of like robust data to even support

that but that's I will tell you anecdotally progesterone and pray menopause if you're not sleeping

well is is a is a great thing to try okay I want to touch for just a couple minutes on GLPs

you talked about this like extreme dieting really extremely low calorie diet aggressive weight

loss fast weight loss and the rebound effect that happens with weight gain and satiety we have

seen that in the GLP data but do you think that that GLPs could play a role in weight loss

resistance with menopause yes so the the the feedback that I get in the data that I have for the

women in menopause who say that they have weight loss resistance when when those women

start a GLP one treatment it's about an 80% of the time that they're saying oh this finally

helped this this worked when other things wouldn't work 20% of the time they were non-responders to

that so yeah it seems like it's very effective for for these women yeah I've seen that too

clinically and you did an initial survey and you shared some some results about women who are

taking HRT I'm just going to go we're not going to talk about GLPs we can talk about the whole

episode of that but I do I think there is some role for menopausal women but you did a survey

that compared to average kind of women only 5% we're using HRT but a fit women 55% we're we're

using HRT why do you think that is yeah and let me just let me give one caveat to that we we cited

other research for 5% it's probably a little higher than 5 let's say 10 because a lot of women

are getting compounded yeah yeah and 55% was from my and my colleagues social media that's how

we recruited so but nonetheless it was five at least five times five to 10 times higher than

the normal population so I think that women who embrace a fitness lifestyle they're already more

open to supplementation so maybe creating a protein supplement and probably even more so

they're more in tune with their bodies and if their bodies aren't performing as well they're

going to want to know why so that they are you know they're like finely tuned machines and if things

aren't feeling right I'll just like I'll just say like my mom who's not who does who did not live

a fitness baseline style I don't even know she would know if things were off she's not lifting

weights to have this calibration so I think it's the women who are used to performing at a certain

level or recovering at a certain rate it's not happening well and then they're more likely to go

to try to solve the problem yeah yeah um I think it's great that most of the women using HRT

fitness scales because like I said earlier in the podcast it's actually those patients that I

think probably get the most benefit from it yeah and and part of it in my science brain is that

we know that loss of estrogen actually changes the mitochondria in various ways and so you know

these women are they're they're already doing things to support their mitochondrial health and then

it's just like you know one it's like I tell what I was trying to break this down in a way that my

10-year-old can understand it but it's like if you had like two car engines and this one the oil's

been changed the timing belts have been going undergoing maintenance versus this one that's never

been serviced and then just try to pour premium gasoline into both of them like they don't run

the same way so so I like that that's what it showed um because I do think that people have to do

the basic things first and then I think HRT is a is a great addition but I also uh I'll contradict

myself sometimes when women aren't sleeping well and they're tired and they're fatigued and

their joints hurt and they can't comply with their diet whatever sometimes age sometimes

sometimes HRT can help them feel better and more motivated to start doing those things again

you know maybe they did it and now they've just had trouble you know maintaining because they

feel so crappy so um just something to consider okay um I want to talk about muscle so

estrogen's role in muscle uh we have estrogen receptors in our muscles when we lose estrogen we

start to lose um satellite cell proliferation we start to not turn over muscle proteins

as well I talked about the mitochondria there's more oxidative stress in the muscle

so for a woman listening that she doesn't she doesn't care about the extra 10 pounds of fat um but

she's like I want to gain muscle and now I'm you know in menopause can can women gain muscle at

any point in their life what does it look like pre-imposed menopause what do you see in the data?

Yeah so what I see in the data is pre-menopause your body responds to resistant

training better than when you're parry or post-menopause so same workout program your body is just more

anabolic response to the resistance exercise stimulus much better than when you're in menopause

now the question could be could maybe that's just aging and menopause doesn't have anything to do with

it because anabolic resistance happens in men and women I would my personal thought of reading research

and I'm gonna say once again the best research is that estrogen is anabolic so let me um the

broad research would suggest that that's not estrogen therapy estradiol therapies the one that

that I really focus on that's kind of all over the place too um in terms that sometimes women

will gain lean mass sometimes they'll maintain their lean mass but the I guess I'll phrase it as the

problem I have with all of this research all of it and I'll just I want to just throw it away

it's always in women who have not embraced a fitness lifestyle so once again the women that I'm

with I want to serve we don't have data on them uh I'll share some research that that I've read

that that has informed my opinion on this so I already said they respond better to resistance

exercise before they're in menopause another another research study gave early postmenopausal women

an estradiol patch or a placebo patch the women wearing the estradiol patch gained significantly

more muscle compared to the placebo group same exercise program so when you compare hey women

respond better when they're younger and so when they have estradiol when as women get older when

their estrogen levels are declining they're not responding as well but then we have a study where you

increased estradiol and that it was a .1 milligram patch they gain significantly more lean mass so I'm

using all of these data points to suggest as well as anecdotal um it's it's anabolic and it helps

and the other the other thing I want to say with this all of this research that shows that women

don't lose lean mass during menopause and and there's a lot of research some of it's very well

controlled but that's since that's not in women who've spent 10 15 years building it what if we tested

them do they lose more I wouldn't be surprised if they do um and again my conversations with women are

that they do so to summarize estrogen estradiol is anabolic yeah um we're at best anti-catabolic I mean

it even if you can just maintain you know what you have and not lose um but certainly yeah certainly

the more muscle you can come into menopause with your risk of sarcopenia that it's same with

bone mineral density the higher you can start on that graph even if there's some sort of age-related

decline despite whatever you're doing you're at least starting at that higher point so I always

tell my perimenopausal gals get it in order right now get it get it all you can um and we'll support

the hormones when we need to but there was an interesting mouse it's of course a rodent study but

basically saying that exercise could protect against a lot of the skeletal and mitochondrial

changes independent of local estrogen synthesis so I do think for the woman listening who cannot

take estrogen I still think they need to hear the message that these things matter how much protein

you're eating matters how much you're training and the volume of training and the intensity of

training these things still matter um despite whether you use estrogen or don't use estrogen you

agree don't you Bill oh yeah it's the foundation yep yep yep there what are the side effects of

of a fitness lifestyle they're all they're all positive I mean a little bit of your time

but I mean pay now or pay later I mean you like I'm telling you anybody that gets towards the end

of their life and has some metabolic disease cancer diagnosis like I mean something will take all

of us out but I think we just like we undervalue our health when we're young and we're so resilient

and I think we perimenopause and menopause are a great time in your life to say like I'm in control

of this and like this is worth my time and energy and effort um because health is literally the only

thing that can't be bought um and I I gave a TED talk on women lifting weights and I have three little

girls and I'm trying to set the standard that it's okay for women to have muscles but um I tell my

patients all the time that resistance training is the only not if you're want to like hate

pharma and hate drugs weightlifting is the only non-pharmacological intervention that has ever

been to consistently shown to offset age-related declines in skeletal muscle mass strength and power

so they have never come out with some magic drug GLP ones aren't great for your muscle mass I'll tell

you that um I mean unless we have some myostatin inhibitor that's coming I mean but even then

everything is gonna have a trade-off so like wait if you want a magic drug weightlifting is the

best magic that we have agreed yeah I love it I love it okay um so uh talk about creatine

somebody sent in a question can you ask Bill about supplements that menopausal that could be

beneficial to menopausal women outside of hormone replacement therapy yeah I'm creatine in my

opinion is a is a good supplement to take especially if you live a fitness lifestyle um it's the

side effects are there really aren't I mean it is the most studied diet sports dietary supplement

besides caffeine in the history of dietary supplement research so we know it's safe it's

relatively inexpensive it's not something if if somebody hasn't taken it you don't take it and you

you don't feel anything so it's not like caffeine uh but what we know that it does is it increases

power production it increases strength and lean mass and now we're getting more recent research

and I haven't read much of this literature yet but I've I'm aware enough that it's also being used

to to investigate brain function and what we know is you need higher levels so the sub you need

you need to supplement with more um about two to three times more to get potential brain benefits

of of creatine so that that's I don't take many supplements that's one that I take it's one that I

encourage my wife to take and she never listens to me yeah it's about 20 grams of creatine in the

studies on brainhouse so it has to saturate the muscle first and then it spills over into the brain

so it's you're right it's uh instead of one scoop it's like four scoops so it's it's a lot of

creatine um from a dietary perspective um talk about fat protein and carbs do you think that there is

some sort of optimal ratio amount of these things when we become menopausal?

No the the historic protein intake research would suggest and again these are these are

generally what I would call general population person but protein intakes tend to be very low

in middle aged women uh so and I think we could spend a whole another session on on this but just

increasing protein when you do nothing else no exercise if you take a a middle-aged menopausal

woman this is this research I'm citing and if they're eating sub optimal protein and the only

thing you do is increase their protein they will gain lean mass and they will lose body fat

no exercise so that's pretty powerful and that's been shown in more than one study that's that's

been shown multiple times so me being an exercise scientist former bodybuilder liking that lifestyle

I always gravitate towards a protein anchored diet so what you know I always say hey a good place

to aim is .75 grams of protein per pound of body weight or ideal body weight um in terms of carbs

and fat I again I like one of my core values is simplicity so do focus on protein and for carbs

and fat just do whatever comes natural um some people like more carbs great have more carbs some

people like more fat awesome in terms of body composition outcomes it doesn't matter protein moves

the needle um carbs generally you you want enough of them that you can train with intensity recover

from your workouts but I I like just whatever you like to whatever your dietary likes are just fill

that in get that with your natural food selection you don't have to stress about carbs and fat

yeah yeah I um my followers know I'm a proponent of the low carb ketogenic lifestyle just because of

the massive amount of metabolic disease and diabetes and things that we see but um I agree first

control the amount of energy get the protein as high as you can um we should have a whole other

podcast episode on this but Robert Sykes I don't know if you know who he is build uh he uh is a

ketogenic bodybuilder trained traditional way for many years he was my coach through both of

both of my preps but the first time that I ever did bodybuilding I actually went into it more as kind

of a student and a scientist more than anything because I took care of so many female competitors

that um became amenoriac lost their period their thyroid was crap they had no estrogen um and

I thought what if what if you in what if you maintain a higher percent of calories from fat

as you dropped your body fat solo um and kept carbs lower would it preserve you know sex hormones

that was my kind of question I mean this of course it was like an n1 experiment but um but it did

and I had the ability to check labs of myself this last show that I did like a week

before the show I clearly have an ovulation I had an estradiol level of like 376 like one week before

the show with like 13 to 14 percent body fat so my coach and I have like a lot of theories around

around women and bodybuilding that there could there could be maybe a sear a superior approach for

sex hormone preservation um and it you know time will tell time will tell and then I saw

meadow has a henselman that shared something this week about meta analysis on carbs that they're

not superior building muscles so I think it's a I think it's a fun debate because traditionally

for so many years bodybuilding has been very low percentage of calories from from fat

yeah and you exact pretty much your lifestyle or low carb lifestyle that's or just

yeah so I um I was after my third daughter was born I was diagnosed with prediabetes so I started

living a pretty low carb lifestyle got back into weightlifting and I just I just feel and

function better eating a lot of fat and less carbs trust me I love carbs but um but uh

I both of my bodybuilding preps were completely ketogenic and um it uh it was an interesting

fun experiment and I don't know I think it I think it's a great approach for women to consider

you know from a from a sex hormone standpoint but we need a lot more people we need a lot more

subjects yeah yeah I get feedback from some women where when they've switched to a ketogenic diet

or or carnivore diet that they're like hey this has been very helpful so again it's I would always

say hey if you're currently eating high carb and things aren't working for you well then let's

consider a low carb approach well I think at what it naturally does they I do think it naturally

increases the nutrient density of someone's diet when you're suddenly focusing on you know protein

and fat you're eating you know more nutrient-dense foods um because there's a lot of very

poor nutrient carb foods that yeah across this food industry has saturated our entire life with

okay um for the last bit of this bill I want you to tell people about what is what are you what are

you now studying what are the questions you're asking how can people become involved because I

know you've shared you know some surveys and things like that on your social media

yeah yes so right now we're my research team and I are planning a are designing a weight loss

resistance study in menopausal women so this would be for women who embrace a fitness lifestyle

and we're going to define that as resistance training that they have to be resistance training

but hopefully they're also doing some cardiovascular exercise as well so specifically again a lot of

people will claim I can't lose weight despite a caloric deficit so we are unapologetically

recruiting that population of fitness women so if you think that you cannot lose weight through

traditional dieting we would love for you to um be in our study it's a virtual study so

you continue you know you don't have to you don't have to come to Tampa Florida to get testing so

you continue you want to come to Tampa that you just you continue your normal exercise routine

whatever that is and we will put you on a diet and we're comparing that to women who are

pre menopausal and it's a pretty simple design um we're just going to compare hey if you're given

the same diet and you're not changing your exercise routine at all do younger women lose weight

at a faster rate and again this is in women who claim weight loss resistance that are in

peri or early post menopause so we're trying to match this with the data where this increase in

body fat occurs so the few years before menopause the few years after menopause so if any of your

listeners are interested um I'll give my email at the end um we're not officially recruiting yet

but um and we need younger women too and that that that's going to be our control group so that's um

that's the what we're really focusing on so I'm a little bit passionate about this because I know

a lot of women who say this what they're told from seemingly everybody what you're lying about

what you're eating you're you're skipping your workouts which again probably 75% are I'm I'm listening

to the women who do track everything who do measure in way who don't miss workouts and they're the

ones saying this so that's that's who I want to test and my research will um we if there is no

difference well this is a study that will say hey there is no difference so um and I also make

this a point I'm not out to um try to disprove the energy balance equation I'm an advocate

of that I'm not I'm not out trying to to validate everybody's weight loss resistance I'm just trying

to further the conversation to get data um and regardless of our outcome one study doesn't prove

anything so this is at least there's somebody studying this for women who think there might be

something that's different about their situation yeah what are the data points are you tracking body

composition dexa what are you what are the actual data points yes so that's that's hard um

with a virtual study so what we're doing we're going to take up to three weeks to to validate

energy balance so we're going to have them to eat normally weigh themselves what are your

maintenance calories then we're going to give them an eight week caloric deficit so I think it's

25% 20 or 25% caloric deficit anchoring protein like 1.6 grams per kg and we're having them use

their own scales for these eight weeks so they weigh weigh in every day track their their their

their macros so the main outcome is body weight now we do want and are asking everybody if you have

access to a research grade body composition device like a dexa like an in body bod pod

something like that we we want you to get that data because then we can actually look at fat

and lean mass yeah um I would love to be able to say hey use this home scale that measures this

they're they're I haven't I have the confidence in them so we have to use weight because that's

well one it's easy and two I trust weight but I would never do that in my own lab like we would

use our our actual ultrasound in body bod pod but when you do a virtual study we're we're we have

to use weight and another limitation of our study is we're recruiting women who claim they are

weight loss resistant so I don't I don't want them to be biased but maybe they're already biased

but the reality is they have to follow the diet we're prescribing them or we withdraw them

and we trust that they will just like we're trusting that the younger women do so

that's the that's the main study we're writing up all the studies on our menopause fitness

survey as well okay well if any of my patients and Omaha are listening I own a dexa at

upgrade performance institute so we can we can we can measure you so I love we I love having

that I think it's a good objective way not only to track you know obviously you know subcutaneous

fat and lean body mass but visceral fat um you know there's some like bit women out there that

I scan and they've got visceral fat or I do a coronary calcium scan I'm like you've got metabolic

disease you know I think you know there's some women that think they might be healthier than they

are sometimes so yes oh and real quick let me give my email now yeah yeah my university email

address if you're interested it's be Campbell at usf.edu

and we can put that in the show notes too the be Campbell at usf.edu if you guys are interested in

being in a weight loss resistance study studying menopause of women and of course we need some

younger matched controls shoot bill an email and I'm I'm I'm I'm waiting with beta breath to see

what you find and I think this is a good you know like starting point as you said on your social

media this will not settle the science but I think that it's uh that a very understudied

population and you came in into it you know on a very uh for a very personal reason which I think

is how most scientists uh come into some of these these conundrums so Bill you're such a

wealth of knowledge thank you if you guys don't follow him at bill cable PhD he has a really

amazing social media he shares really really really useful tips and tricks and research

you can sign up for his newsletter too but I really appreciate you coming on the podcast and

giving us your time yeah thank you very much for inviting me all right we'll talk soon bye