Diary Of A CEO Interview: w/ Dr Stephanie Estima (Transcript)

I had lost my period for 2 or 3 months before I stepped on stage. I ended up with hormonal issues. It took a long time for my period to regulate again. I gained all the weight back that I had lost, and I felt like a total failure, and I felt like the science had failed me.

STEVEN BARTLETT: And it caused you a lot of pain.

DR STEPHANIE ESTIMA: I hated myself, full stop. I looked in the mirror. I hated what I saw. I would pinch, I would pick. I was like, I wish this, I wish that, I wish, I wish.

The other thing I’ll say is the weeks before I stepped up on that stage, people were coming up to me and showering me with compliments. People were like, “Oh my God, you look amazing. What are you doing? What’s your program?” And so it’s— I think it’s so confusing for women. Maybe we lose the weight or we go on this health journey, which is often just code word for getting smaller. And we get showered with these external compliments.

At the time, I was starving because I was not eating. I was completely overworked. I wasn’t sleeping and I didn’t have my period. I was not the picture of health, but everybody was telling me how amazing I was, how amazing I looked. So I think that’s where we get it. We hitch our worth to what the outside world tells us rather than thinking about who we need to be and how we need to show up for ourselves first in order to be able to give to everybody else, but also just unhitch ourselves from other people’s expectations of us.

What You’ll Learn From This Conversation

STEVEN BARTLETT: And for the women and for all the people that have clicked to listen to this conversation right now, what are they going to leave this conversation with? Specifically, and how is that going to impact their life?

DR STEPHANIE ESTIMA: Yeah, so this is for women and the men who love them. So this is for everyone. I think for women, maybe you have been doing the good girl thing like I was doing. You’re doing the things that you thought you should have been doing, but you still don’t have the dream body or the body composition that you want. We’re going to talk through some actionable strategies on how to do that.

I think if you are in midlife, so you’re in your 40s, your 50s, and maybe you’re finding that you used to do those strategies and now they’re not working for you as well or as much as they once did. We’re going to maybe break a little bit of your paradigm and the way that you’re thinking about health.

STEVEN BARTLETT: And how old are you?

DR STEPHANIE ESTIMA: I’m 48.

STEVEN BARTLETT: I think it’s important context.

DR STEPHANIE ESTIMA: Yeah.

STEVEN BARTLETT: You’re also a mother.

DR STEPHANIE ESTIMA: I’m a mother of two.

STEVEN BARTLETT: Yeah. Of two.

DR STEPHANIE ESTIMA: Mother of two. And then I have a stepson as well.

STEVEN BARTLETT: There’s lots of things on the desk here in front of us that I’d love to go through. They’re all things that really, really interest me. We’ve also got these 5 fitness myths in this envelope here that we’ll reveal at some point, and these archetypes here. Where do you believe the best place to start this conversation is?

The Female Fitness Archetypes

DR STEPHANIE ESTIMA: I think that maybe we can talk about the archetypes because I think that it sets the stage for allowing women to identify themselves in their fitness journey, however that is.

My first is Overwhelmed Olivia. This woman wants to do the right thing. She is on social media, and within a couple of minutes of going on social media, she sees someone saying, “Plants are trying to kill you, Olivia. You should never have plants. They’re terrible for you.” And she keeps scrolling, and then she comes upon someone else who says, “Actually, plants are great for you. They have lots of fiber, they have lots of phytonutrients, et cetera.”

So she’s like, “Okay, that’s weird. Let me look up some fitness stuff.” And then the same thing with the fitness. Some people say, “You don’t want to get bulky, Olivia, so you need to do light weights, high reps.” And then there’s other people that are like, “That’s not true. As long as you’re bringing the muscle close to failure, you will build muscle.” So she’s getting what I like to call infobesity. It’s so much information, too much information, that she ends up with analysis paralysis.

This woman, I have a soft spot for her because she is so scared to start something else and fail at it, because she doesn’t want that to reinforce her own schema, her own perception of herself as a failure. So she doesn’t do anything.

When we think about Overwhelmed Olivia, we don’t want to get her A to Z. We don’t want to get her all the way to her goal. We just want to give her a couple of quick wins to start. Just get her A to B. We’re just going to get her walking. She’s just going to have a goal of racking up 5,000 to 7,000 steps in a day so she feels like she’s a winner in some vertical of her life. And then you start to layer in more things with her as she goes along.

The second one is probably my favorite, the most common woman that I see — Skinny Fat Sophia. The technical term for skinny fat is TOFI, thin on the outside, fat on the inside. This is a woman who doesn’t present as obese, but her body composition — she’s starting to see a loss of bone mass, a loss of muscle, because she is very afraid of heavy weights. So maybe she’ll do some Pilates, some yoga.

STEVEN BARTLETT: So funny.

DR STEPHANIE ESTIMA: Maybe she’ll walk. She also calorically restricts as well. This woman is personally my favorite because when we start giving her a little bit more food, and we start giving her just a little bit heavier weights than the 2-pound weights that she’s been lifting in her Pilates class — and by the way, I don’t want Pilates people to come for me. I love Pilates, but it’s just not the main strategy for muscle building.

STEVEN BARTLETT: I also love Pilates.

DR STEPHANIE ESTIMA: I love Pilates. I do it twice a week. It’s fantastic. But this woman, when she starts eating a little bit more, this is what she always says to me: “I can’t believe I’m losing fat. I can’t believe I’m losing weight by eating more. What is this trickery? What is this magic?” So I love this woman because when we get her to see the light, it’s actually just a beautiful thing to have all her schemas sort of rearranged in terms of what she thought was possible for her.

How to Actually Lose Belly Fat

STEVEN BARTLETT: This subject of fat. If someone comes to you and they say, “Stephanie, I would love to lose some belly fat because I’m skinny fat, or maybe I just have a bit too much weight on me.” What is it you say to them?

DR STEPHANIE ESTIMA: You can’t actually spot reduce.

STEVEN BARTLETT: What does spot reduce mean?

DR STEPHANIE ESTIMA: So if someone wants to reduce their belly fat, you can’t just target belly fat. The way that you’re going to reduce overall adiposity in the body is you’re going to be strength training, which we’ve talked about, but you will probably also need some kind of caloric deficit. So when we think about that very famous, somewhat oversimplified calories in, calories out — you want to be thinking about, how am I going to create a deficit? So I’m either consuming less calories on the calories in side, or I’m eating the same but I have more output. So I’m doing more cardio, or I’m doing more weightlifting, or I’m doing more walking, or I’m doing something where my calories out surpass my calories in.

STEVEN BARTLETT: Is there an easiest way to do that? Because hearing that, “just eat less” is quite—

DR STEPHANIE ESTIMA: I hate it.

STEVEN BARTLETT: Yeah, not great.

The Four Female Archetypes: Skinny Fat Sophia to Dialed-In Diana

DR STEPHANIE ESTIMA: Yeah, and it doesn’t work in the long term either. You can temporarily reduce your food, but at some point, your hunger hormones and your body is just going to drive you to consume more calories. I often find when women are like, “Hey, I want to build muscle and lose fat,” or if it’s just, “Hey, I want to lose fat,” I personally find it easier for women specifically to do more on the calories out side. So not to—

STEVEN BARTLETT: Exercise.

DR STEPHANIE ESTIMA: Yeah, so doing more exercise, more daily movement. I think that the calories in is totally doable. People do it all the time. I just find it’s hard for most women to stick to long-term, because then they have to measure, they have to do all the things. So if you can figure out what your maintenance calories are, and then you can surpass that with maybe more walking or something that’s not going to ratchet up your hunger hormones or your cortisol levels, I think that that’s often a healthier option personally, because you’re also making sure that you’re getting in sufficient substrate, sufficient calories so that you can actually build muscle, bone density, collagen, et cetera.

So, that’s our Skinny Fat Sophia. Up next, I was this woman — I sometimes still am this woman — Exorcist Emily. This is just a funny word to really describe the intensity that this woman puts out at the gym. This woman, you have no problem getting her to the gym. She is the woman at the squat rack. There’s no problem getting her to the gym and getting her to work very hard. What her issue is — and this was me for years — is that she still has some of the Skinny Fat Sophia attitude towards food. So there’s a mismatch between how much effort she’s putting out with her exercise program and how much energy is coming in with her food. She’s still undereating because she’s scared of gaining weight.

I was Exorcist Emily. I had the hoodie on, wearing the earphones — nobody talked to me with my big earphones on. This was for me after I was going through a divorce. I had very young children at the time, they were 5 and 3. So I was grieving that. And I was still adhering to this idea that I had to punish myself, that I was going to go to the gym and crush it and then follow that with insufficient calories afterwards, because I still had that “well, I can’t eat a lot, I’m going to gain weight” kind of mentality. So, Exorcist Emily, we love her.

And then the pinnacle, if you will, is the Dialed-In Diana. This is the woman who has maybe made peace with some of her demons, enjoys movement, knows that it’s a way for her to tend to herself. Food is not a punishment. She doesn’t restrict calories because she ate too much. She fuels to nourish her lifts, to nourish her recovery, and for pleasure. Because I think a lot of women have forgotten that food is pleasure. It gives us joy and happiness. My sourdough bread in the morning gives me lots and lots of pleasure, and I will not give it up for anything.

So this is where we want every woman to be able to get to. We want her to dial in both her exercise program, her nutrition program, and to give herself some effing grace with her recovery.

STEVEN BARTLETT: You can swear.

DR STEPHANIE ESTIMA: Yeah. Give herself some f*ing grace with her recovery.

STEVEN BARTLETT: We just got demonetized. Okay, but I get it. We’re trying to get everybody to become Dialed-In Diana.

DR STEPHANIE ESTIMA: Yeah. And also just know, if you’ve been listening to these descriptions and thinking, “Oh, I’ve got a little bit of the Exorcist Emily, I’ve got a little bit of that rage or grief or something, but then I also sometimes have analysis paralysis” — you will also oscillate through them. And that’s completely normal.

STEVEN BARTLETT: As well.

DR STEPHANIE ESTIMA: Yeah.

The Dark Season Behind Exorcist Emily

STEVEN BARTLETT: When you were talking about Exorcist Emily, that was not a light season of your life, was it?

DR STEPHANIE ESTIMA: No, it was very dark. And it was the lifting that got me through it, truthfully. Sometimes when we think about resistance training, it’s literally training your resistance. It’s not a question of if something bad is going to happen. It’s just a matter of when. So I think voluntarily putting yourself in a situation where you are making yourself uncomfortable, going to the gym and moving your muscles to failure — it’s not fun, it can be quite intense — but it does train your resistance, your grit, your mental capacity to withstand terrible things.

STEVEN BARTLETT: So by the end of this conversation, everybody listening is going to be a Dialed-In Diana.

DR STEPHANIE ESTIMA: That is my dream.

STEVEN BARTLETT: Okay, let’s do it.

DR STEPHANIE ESTIMA: That is my dream.

Debunking the Myths: Carbs Are Not the Enemy

STEVEN BARTLETT: First, we should start with debunking some of the myths. I’ve got 6 myths in this little envelope here.

DR STEPHANIE ESTIMA: Okay, so the first one is carbs. All the ladies who are listening — we have to heal our relationship with carbohydrates. You can restrict carbs temporarily, and for certain populations that’s a wonderful idea. If you’re a woman that has type 2 diabetes or PCOS, something like that, a temporary clawback of carbohydrates is fantastic for improving insulin sensitivity and glucose disposal. But diets like a low-carb diet or a ketogenic diet — which I am a big fan of for certain populations and even for a temporary amount of time — I think what a lot of women did with the carbs is, once they started losing weight on a keto diet or a low-carb diet, they said, “You know what the problem is? It’s the carbs. I’m never going to go back.”

And the problem with that is this: if you were sick, you had a bacterial infection, you went to your doctor, they did a swab, and they said, “You have a bacterial infection. I’m going to give you a script for antibiotics. You’re going to take it for the next 10 days, and then you’ll come back for a checkup and we’ll see how you’re doing.” You do that, you follow the protocol, you take the medication. I don’t think anybody listening is going to come to the conclusion at the end of those 10 days, “Do you know what I need to do to never get sick again? I need to continue taking antibiotics for the rest of my life.” No one is going to do that. But somehow, for carbohydrates, people made the illogical conclusion that you should never have carbohydrates ever again.

For women, what I noticed — and I’m sure we’ll talk about my first book, The Betty Body — I advocate for a lower carbohydrate, higher protein diet in there, but for a transient amount of time, right? Until you achieve the goal of reversing metabolic issues, losing some weight, improving your period. Another thing that we actually see is menstrual cycle regulation. But if you stay there too long, your thyroid — so many women—

STEVEN BARTLETT: What’s the symptom or the consequence of your thyroid malfunctioning?

DR STEPHANIE ESTIMA: You’re always cold. Your hands are cold, you’re always cold. You might have very heavy bleeding — so your menstrual cycle during your bleed week, that first 3 to 7 days when you’re on your period. Hair shedding. Hair starts to actually fall out. Hair is not necessary at all for survival. So when you don’t have sufficient calories or a sufficient balance of macros, your body is going to sacrifice the things that don’t matter at all to your survival. A lot of women will start to notice hair shedding. The classic sign is the lateral third of the eyebrow — we start to see the lateral third of the eyebrows start to fall out as well.

STEVEN BARTLETT: What do you mean the lateral third?

DR STEPHANIE ESTIMA: The outside third of the eyebrow. The tail, for most people, of their eyebrows starts to get really sparse and thin as well.

So there are lots of common signs and symptoms, but we need carbohydrates — if not for the thyroid, then for our mood, our sleep, even performance at the gym. In the vein of transparency and honesty, I don’t always get to eat before I train, but on the weekends when I do and I have some bread and an omelet or my breakfast and then go and train, it’s a fantastic performance enhancer.

A lot of women are scared to consume more carbohydrates because they think it’s going to make them fat. And this really comes down to the CIM, or carbohydrate insulin model of obesity, which has largely been disbanded. There’s not a lot of evidence to support it anymore, but there are a lot of people online that will scare you into thinking, “Well, if you have carbs, your glucose levels might spike.” And the way that it’s often presented is that that is the worst thing that ever could happen to you.

STEVEN BARTLETT: But there’s such a thing as too many carbs.

DR STEPHANIE ESTIMA: Correct. Yes. I think the problem is not that carbs were the problem. It’s the overconsumption of carbs, the overconsumption of fat, the overconsumption of total calories.

STEVEN BARTLETT: So it’s defined by calories here.

DR STEPHANIE ESTIMA: Yes.

STEVEN BARTLETT: Okay.

Myth: Women Will Get Bulky From Lifting Weights

STEVEN BARTLETT: What’s the next myth?

DR STEPHANIE ESTIMA: This one — I love this one. This one is women getting bulky. Women are still scared that if they engage in a program of progressive overload — which is to say they are lifting heavy weights, or doing more volume, meaning more sets or more repetitions — that somehow they are going to bulk up, as if to say they’re going to start looking like a physique competitor or a bodybuilder.

It is the equivalent of saying, “Well, if you drive to the store to get some groceries, you are going to be on par with Lewis Hamilton and become a Formula One driver.” It’s just almost impossible. I’m going to say 97 to 98% of women don’t have the hormonal environment to bulk. There are a few genetically gifted outliers that absolutely can, but for the most part, women cannot bulk. We do not have as much testosterone as men do. You have like 10 to 20 times more than I do. So even if we train the same way, I’m never going to be able to put on as much muscle mass as you — but a gal can continue to dream, right?

So bulking up — it’s not a thing. What I will say, though, is that some people, when they do start lifting weights initially, will start to feel a little thicker, because the muscle is a little more swollen. There’s also a layer of fat that usually sits on top of the muscle. So as you begin to lose body fat, your muscles will begin to poke through, let’s say. But sometimes that’s why people will feel bulky. They’ll say, “Oh, I started and I stopped because I was getting bulky.” It’s just a sort of swelling or inflammation of the muscle underneath.

Myth: Long Fasts Are the Key to Fat Loss

DR STEPHANIE ESTIMA: Ooh, long fasts. I will call myself out here as well. I used to believe that this was the key, and this was when I was in my Skinny Fat Sophia era, when I was in my Exorcist Emily era, where I thought that the more you could fast, the less calories you could take in, and you could lose weight.

You want to make sure that you have sufficient total calories. You don’t want to overconsume calories, but you also don’t want to underconsume them either. But fasting doesn’t actually teach you how to eat when you are not fasting. I think a lot of people overly rely on long fasts. When I say long, I would say 20 hours, 24 hours, 36, 72 — these really multi-day fasts. If I start eating a lot less calories than, let’s say, you do, I’m going to have, over the long term, more detrimental effects than you might.

STEVEN BARTLETT: Why?

Fasting, Muscle Building, and Training for Women

DR STEPHANIE ESTIMA: The female body is just more sensitive to whether nutrients are coming in or not, so that we can figure out whether or not we want to direct our energy to being able to get pregnant that month. Our ovaries, when we sort of look at the density of the mitochondria in them, it’s something like 100,000 mitochondria per oocyte, like per cell. So they’re constantly scanning the environment to see whether it’s safe for a woman to get pregnant.

And so if you are fasting all the time, you run the risk of sending a signal that it’s not safe, that these are famine conditions, and that you should not be producing an egg because that would be terrible. Because if you got pregnant, there’s not enough food to feed you or the baby.

STEVEN BARTLETT: So it shuts off your menstrual cycle as a way to stop you having a baby.

DR STEPHANIE ESTIMA: Yes. So you can still fast, but the way that I like to fast is sort of pull the food, call it 2 to 3 hours before you go to sleep. That’s when you cut off the food. You sleep for 8 or 9 hours. That’s like a 10-hour, 11-ish hour fast. And then you wake up in the morning and you eat.

What often happens is women try to push— they’ll have a cup of coffee in the morning, and then they try to push their eating window, let’s say, to 11 o’clock or noon, and that ends up— well, it becomes more difficult, I’ll say it that way. It becomes more difficult for you to get in sufficient calories, sufficient protein, sufficient carbohydrates and fats in a restricted eating window.

The “Bulky” Myth and Progressive Overload

DR STEPHANIE ESTIMA: Okay, so this is related to the bulky myth. I think a lot of women are scared of lifting heavy, partially because they’ve never done it, so it’s foreign. And I think that the other reason that women are scared of lifting heavy is they’re scared of getting injured, which, to be fair, is a valid concern.

I think that in the era of social media, which can be a blessing and can be the greatest thing ever, and sometimes it can be a vehicle for misinformation. And I think now we hear “muscle mommies” and “lifting heavy.” And I think that for women, at least in my cohort, in their 40s and 50s who grew up in the ’90s, the Kate Mosses and the— asking a woman who is very comfortable with a cardio machine as her vehicle for exercise to now move into the free weight section of the gym, the deadlifting platforms, even the machines can feel really intimidating.

So there are lots of different ways that you can build muscle. It doesn’t have to just be heavy. There are other ways that you can progressively overload the muscle, which is to say that you are applying sufficient intensity and effort every single time, whether it’s heavy weight or it’s more volume, or you’re increasing the density of your workout, meaning that you take less rest, so you’re a little bit more tired. There’s a lot of different ways that you can make a workout harder. It doesn’t always have to be heavy.

Post-Workout and Pre-Workout Fueling

DR STEPHANIE ESTIMA: This one’s good. This is post-workout fueling. We used to think that you only had 15 minutes to knock back a protein shake, right?

STEVEN BARTLETT: After you’ve done a workout.

DR STEPHANIE ESTIMA: After you’ve done a workout, because you need to replenish the glycogen and you have to start muscle protein synthesis. And I would say that this is largely false. Your muscle protein synthesis is not just limited to the 15 or 30 minutes that are immediately after the workout. Your muscles are building little protein factories over the next, depending on how trained you are, 10 to 72 hours in some cases. As long as you are getting sufficient total protein over the course of the day, total calories over a 24-hour period, totally fine.

STEVEN BARTLETT: Okay.

DR STEPHANIE ESTIMA: Oh, pre-workout fueling. I would say in an ideal world, everyone would have some food before they train. So a little bit of protein, a little bit of carbs, just to start raising some blood sugar, to have some available substrate for the workout.

I don’t do this most of the week. So when I work out during the week, I’m typically at the gym around 6-ish in the morning. And I don’t like the way that it feels when I eat that early in the morning. It sort of feels like I have a brick in my stomach. So what I typically do is I will fuel with ketones. I have ketones for my workout. And then when I get home, that’s when I have my big meal.

STEVEN BARTLETT: So you have ketones before you do a workout?

DR STEPHANIE ESTIMA: Yeah.

STEVEN BARTLETT: Why?

DR STEPHANIE ESTIMA: In the absence of food, I would say that ketones are fuel that your body already— your body produces ketones, right? It’s a fuel that your body already knows what to do with, especially when it’s a big muscle group. So if you’re doing a leg day, let’s say, or a back day, it provides you with the neural drive to continue going. So you get into that sort of sympathetic state. That’s my favorite word. My favorite flavor too is the green apple. My kids have the green apple before their soccer too.

STEVEN BARTLETT: I am a co-owner of this company, hashtag ad.

DR STEPHANIE ESTIMA: Yes.

STEVEN BARTLETT: So I have to disclaimer that. Someone’s going to come for me.

DR STEPHANIE ESTIMA: Yeah. So in an ideal world, we would fuel before we work out. But the constraints that I have in my life is that I just can’t. In the weekend, different story. I can wake up later. I can have a long coffee with my boys, have breakfast, head to the gym. And I always know that when I do have food, my performance is—

STEVEN BARTLETT: Better in the gym.

DR STEPHANIE ESTIMA: Better, always, 100% of the time.

What Women Should Be Doing in the Gym

STEVEN BARTLETT: So let’s talk about what you do in the gym and why you do it, because you clearly got a big focus on muscle being important.

DR STEPHANIE ESTIMA: Yeah.

STEVEN BARTLETT: I train with lots of women. I actually trained with a colleague of mine this morning called George. She often goes off into the cardio section and she does muscles as well, some resistance training as well. And I go off in the other direction to the stuff that men typically gravitate towards. And I’m wondering what you think all women should be doing in the gym. Like, if you think about a 7-day workout regime, what do you think is optimal in those 7 days?

DR STEPHANIE ESTIMA: Yeah, there is. I do want to call out something you just said, and then I’ll answer your question. You just said, “I go to the area that typically men go to, and I do the exercises that men typically do.” So just because squats and deadlifts, presses and pull-ups are typically done by men doesn’t mean that those are male exercises. Those are fundamental human motor patterns that both men and women can benefit from.

But to your point, there is typically more men doing those things, more comfortable doing those things, versus someone who’s like, “Hey, I can figure out how a StairMaster works. I’ll just get on this thing and I’ll be on here for the next 35 or 40 minutes,” right?

STEVEN BARTLETT: I love the StairMaster.

DR STEPHANIE ESTIMA: I love the StairMaster too. It’s a special kind of torture. It’s great. Okay, so in terms of what I think people should be doing, if she can aim for something like 3 or 4 days a week of strength training, it would be alternating upper body and lower body. And then we would be thinking about what muscle groups are we going to be working together. Is it a pull or push?

STEVEN BARTLETT: What is this?

The Key Muscle Groups for Women: Building an Hourglass Figure

DR STEPHANIE ESTIMA: This is from my book, my upcoming book called Nothing to Lose, actually, because we shouldn’t be losing, we should be trying— I’m going to try to be gaining. And these are the muscle groups that I want women to be thinking about if their goal is body composition and they are trying to build a body that has curves. You can’t spot reduce, but you can definitely spot build. You can put curves where they weren’t before.

So what I’ve done in the book is I’ve outlined muscle groups that I think women should be focusing on in order to help develop more of an hourglass figure. Starting at the top, we have the deltoid muscle group, which are your shoulders. I like to call these your “bread buns.” They’re sitting on the side of your shoulder, the lateral delts.

Below that, we’ll have the back muscles and the lats in particular. I like to call the lats our “angel wings” because it helps sort of create that V. As the back widens, you have the appearance of a slender or slimmer waist.

Moving posteriorly, we have glutes. So there are 3 muscles that make up the glutes. It’s max, mid, and min — glute maximus, glute medius, glute minimus. And then we have the adductor group.

STEVEN BARTLETT: Which is the insides of the legs.

DR STEPHANIE ESTIMA: It’s the inner thigh muscles, yep. And then the last one is the pelvic floor, or more broadly we’ll say the core muscles.

STEVEN BARTLETT: So what do I need to know if I’m a woman and I’m thinking about building these 5 muscles that you’ve highlighted here? Are there, as it relates to how I should be training and the big misconceptions about how to train to build this— what do I need to know?

Training Volume and Getting Close to Failure

DR STEPHANIE ESTIMA: For these muscle groups, you probably should be hitting something like 10 sets of exercises per week per muscle group.

STEVEN BARTLETT: Okay. So if I do 4 hip thrusts, that is 1 set of 4.

DR STEPHANIE ESTIMA: Correct.

STEVEN BARTLETT: And that’s going to help my glutes.

DR STEPHANIE ESTIMA: Correct.

STEVEN BARTLETT: So you’re saying that I should be doing 10 sets a week.

DR STEPHANIE ESTIMA: Per muscle group per week.

STEVEN BARTLETT: That’s not actually that much.

DR STEPHANIE ESTIMA: It’s not that much. No. And this is why I was saying before, the 2 times a week — the ladies that are like, “I just have 2. That’s all I can give you.” You can still have incredible results, as long as you are taking the muscle close to muscle failure, which is to say that you can no longer perform the repetition anymore. You don’t have to take it to failure, but as long as it’s 1 to 3 repetitions from failure. That’s all you need to do.

And now, it’s simple to say that’s all you need to do. It’s going to be very difficult for you to do that because you are going to start noticing your range of motion, your ability to do your range of motion, is going to be limited. You’re going to start noticing the velocity of the repetition is starting to slow down. So your ability to sort of move the weight through space is going to start slowing down.

You’re going to subjectively, even though you can see that you’re holding like a 15-pound, 10-pound weight, it’s going to start feeling like 20 or 25. Your subjective perception of the weight is going to be increasing. If you were to rate it out of 10, you would rate your effort like 8 or 9 out of 10.

Male vs. Female Anatomy in Training

STEVEN BARTLETT: And men and women, because they have different anatomies, should be doing slightly different exercises?

DR STEPHANIE ESTIMA: I think that that’s more a matter of preference and goals.

STEVEN BARTLETT: But is my anatomy and your anatomy the same?

Female Anatomy and Movement: The Q Angle Explained

DR STEPHANIE ESTIMA: Our anatomy is not the same, no. So when we think about the way that we move through— let’s say if you and I were to squat together, or you and I were to lunge together, there’s going to be some differences in terms of how we look. And so we’ll pull up some props here if we can.

So this is a female pelvis, and this is— this little guy who doesn’t want to stand up today— is a male pelvis. So when we sort of look at the difference between them, the female pelvis is wider and it’s more shallow. The male pelvis is more narrow. And the reason that we have more of this sort of— if you sort of look at the two, this looks like a little bit more like a heart shape, and this looks a little bit more like an oval shape. And the reason for that is to allow a baby to pass through.

Why this is so important is this is going to shape the stressors that happen in our knees and our ankles. So in particular, we have something called the Q angle, which I believe— I believe I have a— yeah, I have something. Yeah, yeah. So here is the Q angle.

So what a Q angle is, is basically you take a measurement from the hip and you draw it all the way down to the kneecap or the patella, and then you take another little line from the tibial tubercle and draw it upwards. For all the nerds that are listening, if you want to measure this, it’s the anterior superior iliac spine all the way down to the patella and then the tibial tubercle.

And what you’ll see for women here in pink, because the pelvis is wider, the femur has to more aggressively come in medially. It has to come more to the center. So this makes women, when we compare women and men, it makes us more knock-kneed, which just means that the knees are coming more together. So this is going to impact literally every— how we move. So it’s going to affect how we walk, how we jump, how we squat, how we lunge, how we run.

And so it’s important for women to understand how we’re different, because often the cueing and the instruction that women get are sort of very— they’re based off of a male pelvis, let’s say. And so we can run into feeling like squats are not comfortable, that lunges are not comfortable, or we start to even shy away from some of these motions because we don’t think that they’re meant for us. You just need to know how to adapt your training so that you can support some of those shear motions as you’re moving.

Because what ends up happening for women is, as we are, let’s say, lunging or squatting, as the knee comes down, we will start to see more shear forces being placed through the medial or through the inside part of the knee. So that puts us at a greater risk for ligamentous injuries. So in the knee, the big one is the ACL that we often worry about. So as you’re getting tired, you need to be aware that you’re going to have a tendency for that knee to come in. And there’s nothing wrong with the knee coming in as long as you have muscles that can kind of support it.

If I were to grab this back here so we can sort of think about superimposing it— if we were to look at the leg here, the muscles that are going to be helping to control the way that the hip moves are the glutes. So you have the glute max, but in particular, the glute medius, which is often called the upper shelf muscle, that’s actually going to help the femur or counteract the femur being pulled inwardly.

So we do have different anatomical differences that women need to be aware of so that we can bias training that will provide mobility and stability for us. That’s another reason why— I mean, yes, glutes look amazing in jeans, but it’s also because they are providing such a driving force of stability for the spine, for the knees, for the ankles, literally for the entire body.

How Men and Women Should Squat Differently

STEVEN BARTLETT: And so with squatting, men and women should squat differently?

DR STEPHANIE ESTIMA: Yeah, not all women and men should squat differently. There are women that can squat in the sort of traditional cueing.

STEVEN BARTLETT: Can you show me this?

DR STEPHANIE ESTIMA: I can, yeah. I’ll have to take my heels off, but I’m happy to. Yes. Do you want to do it now?

STEVEN BARTLETT: Sure.

DR STEPHANIE ESTIMA: Yeah. Okay, let’s do it.

STEVEN BARTLETT: So tell me how the anatomy of a woman and a man determines how we should be squatting.

DR STEPHANIE ESTIMA: So I’ll say first that you have to play and see what feels good for you. So there’s going to be some women that are going to be able to squat just like the traditional cues that I’m about to give you. Most women prefer a little bit of a wider squat, and I’ll show that.

So the typical squat— the way that we’re often cued is feet are hip-width apart, toes facing forward, and then we’re going to come down. And then I’m just like, I can’t actually get— I’m trying, I’m collapsing my chest at this point.

So for women, what a lot of women find is more comfortable and they can actually get the range of motion that you just demonstrated is taking your feet a little bit wider and then you’re going to turn the feet out. So because the female femur tends to sit a little bit more spun inwards or internally rotated, now with this external rotation, we can actually just get by all of that and we can come all the way down into a squat. And we can hang out here— like I can, we can probably do the rest of the podcast like this if you’d like.

STEVEN BARTLETT: I’d rather not. I’d rather not.

DR STEPHANIE ESTIMA: Yeah.

STEVEN BARTLETT: So that’s the squat. Is there anything else I need to know about the squat? The variance between men and women with squatting?

DR STEPHANIE ESTIMA: The other thing that you can think about, whether it’s a squat with 2 feet or a lunge or a split squat with 1, is with a woman, when she’s coming down, when she’s decelerating— like she’s coming down into the lunge or into the split squat— everything, and this is true for you as well, everything is going to be internally rotating. So the femur, the leg bone is coming in, the tibia is coming in, the foot on the inside, you’re actually rolling onto the— you’re flattening out the arch, it’s called pronation, which everybody says is a bad thing by the way, but you need it to be able to load the spring.

And then for women, like if you and I were to squat with the same leg forward, you’ll probably be able to see that as I’m coming down, my knee tracks a little bit inward versus yours stays a little bit more straight. There’s nothing wrong with that. It’s just a matter of whether or not I have sufficient control with my hip stabilizer muscles in order to make sure that I’m not putting excess shearing forces on the knee.

STEVEN BARTLETT: So you need to strengthen your hip stabilizer?

DR STEPHANIE ESTIMA: Yep.

STEVEN BARTLETT: Okay.

DR STEPHANIE ESTIMA: The peach.

ACL Injuries in Women: Why They Happen

STEVEN BARTLETT: Because I’ve read something about, I think it was about the World Cup, the Women’s World Cup, where they said that something like 12 women had got ACL injuries in the lead up to the World Cup.

DR STEPHANIE ESTIMA: So when we’re thinking about why that happens, it usually happens when the athlete is tired. So if it’s leading up to the World Cup, they’ve probably overtrained, they’re not recovering. And then it can be just that they’re training one day and she takes a weird step, the shearing forces happen just before her ligaments and her tendons are able to stabilize it and you damage it.

STEVEN BARTLETT: And is that true that there’s a connection between your brain and your mechanics that often result in injury? Like, I can’t remember what it was, but I think someone— it was a sleep doctor telling me that when you’re underslept, one of the reasons why you get so many injuries is because when you do a jump, your brain and your—

DR STEPHANIE ESTIMA: The reaction time is slow. Yeah.

STEVEN BARTLETT: And you see a lot of athletes doing this before games because they’re almost like practicing landing.

DR STEPHANIE ESTIMA: That’s actually a little bit of deceleration. So what that is, is basically a stick and land, right? So they’re jumping and they’re holding it so that the forces are not dumped into the joints, but rather absorbed into the connective tissue. So the ligaments and the tendons.

STEVEN BARTLETT: And why is deceleration important even for everybody, even non-athletes?

DR STEPHANIE ESTIMA: Well, if you are not an athlete and you’re just somebody who doesn’t want to fall and break a hip, I think that that’s really important. If you’re thinking about falling, what you need to be able to do is get the hip flexor up in front of you and then stop the fall.

So there are a couple of muscles. We have the hip flexor muscle that has to come up quickly in order to get ahead of the fall. We have the tibialis anterior, which is just this muscle in the front of the tibia that is involved in what’s called dorsiflexion, which is just nerd speak for toes come up. So you need to be able to clear the floor, and then you need to have the gluteus maximus— the glutes— to sort of absorb and brake.

And then we were talking a little bit about the hourglass figure before when we were talking about the adductors or the inner thigh muscles. One of the things that the inner thigh muscles will do is they’ll actually pull the leg back underneath you. So they’ll also help to stabilize that fall. And the abductors— the outside muscle group, like the side of the glutes— they’re also going to help brake.

So when you’re falling, it’s like you’ve got to get the leg up, you’ve got to have the toe clear the floor. And then if you’re falling off to the side, you need the adductors and the abductors to be able to stabilize so that you don’t trip over it.

Supplementation

STEVEN BARTLETT: So let’s talk about supplementation. Do you take supplements?

Supplements for Women: A Tier-1 Guide

DR STEPHANIE ESTIMA: I do. I’ll pre-frame this by saying that I am a special category of nerd. So I take a lot of the foundational supplements, and then there are other ones that I take because I’m just very, very interested in the research, and the research excites me.

But I would say for the general population, for women that are listening, if they’re thinking, “I got to supplement,” there’s a couple of tier-1 supplements that we want to be thinking about.

So I will find my magnesium first. This is our tried and true bestie, okay? So I love a magnesium glycinate. There’s lots of different kinds, but glycinate’s just the easiest to absorb for most people. Tends to help with relaxation, helps with sleep, helps with muscle recovery. So this is something that I love. I’ll usually take one, like 250 mgs at lunchtime, and then another one in the evening. So magnesium for everyone.

STEVEN BARTLETT: How do you remember to take them?

DR STEPHANIE ESTIMA: I tend to habit stack them. So I always know that when I’m preparing my lunch, I actually keep my magnesium right beside my salt and my pepper. So as I’m salting my food, I’m like, “Oh yeah, there’s the magnesium.” I take it. And I have another bottle upstairs in my bathroom. So as I’m getting ready for bed, I’m putting up my hair, I’m doing my skin, whatever, I will take one there too.

STEVEN BARTLETT: So you put it in the way of other habits.

DR STEPHANIE ESTIMA: Because otherwise, if I put it in a really beautiful supplement closet, it’s just going to—

STEVEN BARTLETT: Yeah, same.

DR STEPHANIE ESTIMA: —stay there.

STEVEN BARTLETT: I have to put it on my desk. And also when I travel, it’s on the hotel desk. Yeah.

DR STEPHANIE ESTIMA: You’re already doing something else. So just put the thing next to the thing you’re already doing, and your compliance and your adherence is going to go up, right?

What else do we got in here? Ooh, omega-3s. Okay. These are so well established in the literature. They reduce inflammation. They help with cognition. Something like 2 to 4 grams a day.

STEVEN BARTLETT: I didn’t know you needed to keep it in the fridge. I’ve been keeping it in a hot cupboard for the longest time. Apparently it spoils.

DR STEPHANIE ESTIMA: It just, yeah, it just helps with spoilage. So you can pop them in the fridge and then same kind of thing, like habit stacking. So as you’re opening up the fridge, put it in front of the thing that you would most commonly reach for. So you go for fruits in the morning, you put them right beside your fruits.

What other goodies do we have in here? Vitamin D for sure. D3 with a K2, 4,000 IUs minimum per day. I would say most people should be taking that. They call it a vitamin, it’s not really a vitamin, it’s more of like a pro-hormone or a pre-hormone. So this is really important for sex hormone, reproductive hormone production, again, inflammation, cognition. Every day. Every day. Every day.

STEVEN BARTLETT: Yeah, every day. I went to the doctor and he said I was deficient in vitamin D and omega-3. So those—

DR STEPHANIE ESTIMA: You know how many people, even if you live in a sunny— I can’t tell you, I’ve had patients who live in Florida, let’s say, where you think that you’re getting a lot of sun exposure because the temperature is amicable to that, and you run their vitamin D and— it’s crazy. Crazy.

Creatine: Not Just for Bodybuilders

DR STEPHANIE ESTIMA: Ooh, I’m so happy you have this one here. Creatine. I know you just had Dr. Darin Kandow on the show. He was actually on my podcast as well. For women, I think creatine used to be this bro supplement, like these bodybuilders with the scary noises and the weird t-shirts and stuff. Creatine is really, really important for women.

The way that Dr. Kandow described it to me was he said, “Lifting weights builds the cake and this is like the icing on top of it.” So you’re not going to enhance performance, you’re not going to build strength if you’re just doing the creatine. You have to be pairing it with the mechanical signal of resistance training. But I think every woman can be taking 3 to 5 grams of this every single day.

STEVEN BARTLETT: How much are you taking?

DR STEPHANIE ESTIMA: 5. Sometimes I take a little bit more than 5. So when you have been — and this is the little perimenopausal hack because I am fully in the throes of it right now — there are nights where I don’t sleep well. So taking a higher dose of creatine that day will help with your cognition, your awareness, and your alertness. So something like a 10-gram dose, because my understanding of it is it’s harder to get across the blood-brain barrier, so you need a higher dose in order to facilitate that. But yeah, 10 grams.

STEVEN BARTLETT: And what impact has it had on you? Have you noticed an impact?

DR STEPHANIE ESTIMA: When I haven’t slept well, yeah, definitely. If I take it in the morning, it definitely wakes me up. I would say that when I am not taking regular, like I’m not taking the 3 to 5 grams, or for some reason I start forgetting, muscles look a little less swole, look a little less full. Don’t have as much energy in the tank when I’m doing a really intense workout. There’s a performance degradation when I’m not on it.

Collagen, Electrolytes, and Vitamin C

DR STEPHANIE ESTIMA: And then collagen. I love this one because it gets so much hate online. So we’re going to go against the grain and talk about how great collagen is. A lot of the criticism for collagen often comes from this idea that, “Well, it’s terrible, it doesn’t have any leucine,” or it has less than 3% of leucine, which is an amino acid that stimulates muscle protein synthesis. And yes, that’s true, it is a terrible driver for muscle protein, but that’s not the whole goal for women — it’s not just muscle, right?

We have other tissues that go to the gym alongside our muscle that train, like our tendons, our ligaments, our joints. And collagen, just like muscle, is a very expensive process from a mechanistic point of view to create. So taking collagen is great for what I like to call the JTL — your joints, your tendons, and your ligaments. So I will typically take something like 10 to 15 grams of this a day. People will probably come at me — I put this in my coffee sometimes, which I know the heat, I get it, but if I don’t, I won’t take it.

STEVEN BARTLETT: There’s so many collagen products out there at the moment, isn’t there? Collagen drinks, collagen’s in everything. Someone’s going to figure out how to put it in the air or something.

DR STEPHANIE ESTIMA: Yeah, right, yeah.

STEVEN BARTLETT: Is that all a fad? They’re saying it’s good for skin, it’s good for nails, it’s good for hair, it’s good for everything. It’s good for fascia.

DR STEPHANIE ESTIMA: I mean, collagen is the primary compound in joints, tendons, ligaments, fascia, skin, hair, and nails.

Do you take a particular type of collagen? Hydrolyzed, hydrolyzed type 1, 2, and 3, yeah.

What else? Electrolytes. I take electrolytes not as consistently. Again, in the vein of transparency and honesty, I typically will take this on a very heavy cardio day. So I have recently taken up tennis. I’m terrible at it, but being outside, tennis, you’re in the heat, you’re running left and right, and you’re doing it for hours on end. When you’re sweating a lot, electrolytes are really great. So electrolytes — don’t take them all the time.

And with our last one here — oh, vitamin C. Vitamin C, I actually like to take with the collagen because it can enhance its absorption. And then this is just a general antioxidant. There’s no harm in taking vitamin C, right? It’s water soluble. You take too much, you pee it out. But good as an antioxidant, good as an anti-inflammatory, helps with the absorption of collagen as well.

Protein and Cardio

STEVEN BARTLETT: What about protein? How do you think about protein? Do you take protein shakes or anything?

DR STEPHANIE ESTIMA: I do when I’m traveling. So typically, in my day-to-day diet, I don’t take protein shakes. I will if I’m falling a bit short, but for me, most of my protein is coming from whole foods.

STEVEN BARTLETT: What about cardio? Because we’ve talked a lot about doing resistance training and the importance of building muscle. Where does cardiovascular exercise — running, sprinting, stairmaster — fit into all of this?

DR STEPHANIE ESTIMA: It’s life, it’s everything. Cardio is fantastic as well. I think that again, when I think about my overwhelmed Ophelia, she’s online and she has people that are saying things like, “You should only lift weights and walk,” and then there’s other people that are doing the chronic cardio and overdoing it, and not doing enough weights. I sort of think about her as we start this discussion.

So we want to be thinking about cardio not as a punishment for what you ate and not because you’re trying to get skinny, but because we want to have other goals around our healthspan and our lifespan — living a longer life and spending more of those years healthy.

PCOS, Cortisol, and Exercise

STEVEN BARTLETT: A lot of women have PCOS, including my partner. And I was looking at the comments on one of your interviews you did, and one of the top comments from a woman was, “For women with PCOS or insulin resistance, sprint training, HIIT, often backfires because it spikes cortisol and insulin. Many of us do better with strength training plus zone 2 until hormones stabilize. I would love to hear more tailored guidance for PCOS.”

DR STEPHANIE ESTIMA: Yeah, so the first thing I want to dismantle in that comment is that cortisol spikes are bad. Context really matters. So I’ll just say it this way — without cortisol, you won’t wake up in the morning. We need cortisol. There’s something called the cortisol awakening response where it tends to peak somewhere right around the time that you wake up, and then it sort of looks like a ski slope and it gradually exits the chat, right? So cortisol is a normal process. A cortisol spike is a normal process, just like when you train.

So when she was saying, “When I do resistance training,” if she were to be monitoring her hormones, she would see both a glucose spike and a cortisol spike when she’s training. Because to be able to train with enough intensity and effort, you need to get into something called sympathetic drive. You need to be in stress physiology. So her cortisol is spiking when she’s training as well. So I want to really caution women away from being scared of normal and predicted spikes — glucose spikes, cortisol spikes. So that’s what I would say just to start off that conversation.

Women with PMOS — it used to be known as PCOS, now it’s polyendocrine metabolic ovarian syndrome — her body typically behaves more like a man’s body, or someone who is diabetic, like a type 2 diabetic, where she has issues with glucose disposal and issues with insulin sensitivity.

So specific recommendations for someone who has PCOS: absolutely she should be training, because every time she’s contracting her muscles, she’s actually helping, whether insulin is present or not, for her to pull that glucose into the muscle cell and to be able to make energy. So that’s really fantastic.

I also think that whether you have PCOS or you’re type 2 diabetic, zone 2 cardio is fantastic, again, for endurance. But you can also benefit from very high-intensity cardio that might be categorized as high-intensity interval training, or HIIT, or sprint interval training, sometimes called SIT. SIT is basically like 10 to 20 seconds all out, ovaries to the wall, 100% effort, and then you recover, and then you do that 4, 5, 6 times if you’re feeling particularly energetic.

And that stress, that cortisol spike, and all the physiological cascade that happens from that is going to make you stronger and a better glucose disposal agent — which is what she wants if she has PCOS over the long term.

Why You Should Never Stop Sprinting

STEVEN BARTLETT: Are there any particular exercises that women and people generally tend to stop doing as they age because it becomes harder, but they should definitely not stop doing? Like, what are the ones where we all kind of stop doing it, but it leads to a downward spiral?

DR STEPHANIE ESTIMA: Sprinting, 100%. I think that everybody should be sprinting. Why? You are going to be increasing something called your VO2 max, which is just, again, nerd speak for how much oxygen can you take into the lungs and distribute to the cells, right? That, along with — we’ve all heard the stat — muscle declines 1% per year if you’re not doing anything. VO2 max is the same. So you will decline your VO2 max capacity 10% per decade if you’re not actively working on it.

STEVEN BARTLETT: I’ll put some graphs on the screen that show that decline over time.

The Norwegian 4×4 and VO2 Max

DR STEPHANIE ESTIMA: Yeah, great. I can think of family members going up the stairs or down the stairs or trying to get groceries and bringing them into the house that are huffed and puffed, right? That they’ve lost their breath from going up a flight or two of stairs.

STEVEN BARTLETT: But they think, they say that that’s just getting older.

DR STEPHANIE ESTIMA: Absolutely not. It’s absolutely not a function of aging. It’s just a loss of capacity. Can you sprint? I sprint all the time. Yeah. But there’s— so what I wanted to say was there’s a couple of different ways that we can sprint. So you can sprint on a track. I used to be a track sprinter. So that’s like my love. But you can also sprint on a cardio machine in the gym. So in the wintertime, I live on the East Coast where I can’t always sprint on the track. So I will take my sprinting indoors and I will do something called the Norwegian 4×4 on a bike. Have you ever heard of a Norwegian 4×4?

STEVEN BARTLETT: I have heard of it, but please do explain.

DR STEPHANIE ESTIMA: Yeah, it’s a special kind of torture. I hate it up until the moment I get on the bike, and then when I’m doing it, I’m like, okay, I’m going to do this. And then when I’m finished, I’m like, I’m so proud of myself.

So a Norwegian 4×4 is basically 4 minutes. In my case, I do it on the bike, but it can be done on treadmill or any cardio machine. 85 to 95% of your heart rate max. So you need to know what your maximum heart rate that you have ever achieved, 85 to 95% of that for 4 minutes. It’s a long 4 minutes. And then you take a 3-minute break and then you do that again 4 times, hence the name, 4 minutes, 4 times.

Lots of really cool studies on looking at VO2 max capacity. There’s one that I’m thinking of where they looked at women. The average age of the women were 58. So a lot of them were in postmenopausal, let’s say, and they put them on a sprinting protocol. What they found was that in a period of 8 weeks, they were able to increase their VO2 max by 10%. In 2 months, which is wild when you think about how quickly you can lose it. And you can get 10% back in 2 months, which is phenomenal.

And the other really cool thing about that study was they actually took that cohort — we’ll call them the well-lived or the older cohort, let’s say — and they compared it to 18 to 30-year-olds. And they found that the gains that happened in the older cohort had mitochondrial efficiency improvements of 69%, whereas the younger cohort’s mitochondrial gains were 49%.

So all that to say, a lot of people will frame aging as, “Well, now you’re getting wrinkles, now you’re getting old, now you’re over the hill, it’s past your prime.” These women had so much more upside to gain, right? Which makes me so excited because it’s never, ever, ever too late. The best time to start was 10 years ago. Fine, but the second best time is today. You’re not behind. You can totally do it now.

Jumping, Bone Density, and Plyometrics

STEVEN BARTLETT: One of the top comments on your recent video was someone saying jumping or hopping is a good way to strengthen your bones and knees. You should not stop doing that as we age. True. Because a lot of people start thinking, “Oh, I can’t run anymore because it’s not good for my hips and my knees.” I’ve had injuries and stuff like that. So running is one of those things that people stop doing because they’re scared of joint issues.

DR STEPHANIE ESTIMA: Yeah. I think the old adage of “use it or lose it” is really, really key here. If you stop doing it, you’re going to definitely stop your ability to do it, right? Your body is going to prioritize the things that it does. So if you want to be able to jump, you want to be able to sprint, you want to be able to squat, age is absolutely inconsequential to that.

So in that particular comment, if somebody wanted to improve their bone density, yeah, for sure, you can strap on a weighted vest, do some plyometrics, add some weight to your jump. That’s going to increase that strain magnitude and strain rate on the bone, which is going to drive that positive bone reformation. That’s awesome. But yeah, if you don’t jump, you’re going to lose your ability to jump. Do you jump? I do it all the time. Well, sprinting is jumping, right?

STEVEN BARTLETT: Do you do like— is there such a thing as jump training?

DR STEPHANIE ESTIMA: Like plyos, plyometrics. 100%. And you do that? Yes. Even if it’s just isometric holds, let’s say. Maybe somebody can’t jump, but they can stand with their heels elevated so that the Achilles tendon and the calf, the gastrocnemius, is contracting.

Just to give you a little bit of a visual here — one of the most famous tendons in the body is the Achilles. It is the extension of the calf muscles, and then it sort of wraps around the heel and attaches into the inferior part of the calcaneus, which is just your heel bone. So maybe you can’t quite jump yet, but you can actually — this mannequin is doing a really good job — just come up on their toes, contracting the gastrocnemius, and this is called an isometric hold.

So that tension in the muscles and in the tendon — we have these little mechanoreceptors that detect stretch — they will detect whether something’s being contracted or whether something’s stretching, and they will say, “Oh, we need to remodel in order to meet the demand of this activity.” And then you can progress to doing little hops, you can progress to doing jumps, et cetera.

Deceleration and Mobility

STEVEN BARTLETT: Very easy to do. You don’t need a gym or anything like that. Not at all. I’ve heard you say that deceleration is important for mobility.

DR STEPHANIE ESTIMA: Yeah, deceleration is the opposite of acceleration. So we think of acceleration as speeding up and getting fast. Deceleration is coming to a stop. So in order to come to a stop without dumping all of the forces in your joints, the tendons and the ligaments need to be able to absorb that kinetic energy.

And from a sport perspective, your ability to decelerate — coming to a complete stop and then changing direction — change of direction training, is actually more predictive of whether you’ll go pro than your vertical jump, your acceleration speed, or if you’re doing things like beep tests or whatever.

It’s also really important for us as we age. You might trip on the floor or the corner of a rug, or you might lose your footing on the stairs. You need to be able to get your foot in front of you and then be able to stop the motion before you fall.

Simple Exercises Without Equipment

STEVEN BARTLETT: Are there any other exercises that are really, really simple and underrated that one can do without equipment?

DR STEPHANIE ESTIMA: I have so many to show you. So the one that I love — this is almost like a diagnosis, but then the diagnosis almost becomes the plan, the care plan. Something that I just call the X plank. It’s very difficult to do, but it is a test for stability and mobility of the hip. So we were talking about the Q angle before. This is directly challenging the muscles on the side of the hip and whether or not you can stay stable. So this is a great exercise. Yeah, I can show it to you. So it’s the test, but then it also becomes the care plan. So maybe what we’ll do — I’ll show it to you and then maybe we’ll have you try it.

STEVEN BARTLETT: Yeah, you show me. I’m going to be over here.

DR STEPHANIE ESTIMA: Yeah, okay. So you’re basically going to come into a side plank, so where your wrist and your shoulders are all aligned, toes are facing forward, hand comes up, and then you’re going to lift the arm up, and you’re going to try and see if you can hold this for 30 seconds. It is not easy, and so this is really testing the stability and the mobility of your hips. It’s also testing the integrity of your ability to stay abducted, which is what my leg is doing right now. So if someone has a timer — hopefully I’m close to 30 seconds — probably about 30 seconds there. So that’s a really great test for anybody to do. And there’s core work, there’s shoulder work. It’s a really whole body workout.

STEVEN BARTLETT: Okay. Yeah, my turn. Why don’t you try?

DR STEPHANIE ESTIMA: Yeah, see. Okay. So on your side. Toes stacked on top of each other, wrist is kind of tucked under the shoulder. Yeah, hands waving hello. And now try to lift your top leg.

STEVEN BARTLETT: Oh gosh. Okay. Let me just call somebody. I’m just—

DR STEPHANIE ESTIMA: Let me phone a friend.

STEVEN BARTLETT: Okay, I’m going to tuck my— My feet hurt.

DR STEPHANIE ESTIMA: So in this case, if you’re not able to do it, this becomes the thing that you train.

STEVEN BARTLETT: I mean, the pressure of putting my foot on my other foot and putting all the weight on this foot here. Okay. Maybe I’ll put my foot on the mat.

DR STEPHANIE ESTIMA: Yeah, maybe you need a little bit of grip.

STEVEN BARTLETT: Yeah, we go. That’s no better. I think it’s actually just me being weak. Okay, so like this? Yeah. And then lifting this leg up?

DR STEPHANIE ESTIMA: Lifting the leg up. There you go. Okay. Yeah. So now you’re just going to work yourself up to 10 seconds, 15 seconds, 20 seconds, and over time you’ll just be doing this in the air. Where does this arm go? Just on top. Anywhere? Yeah, just on top. Yeah.

STEVEN BARTLETT: I think I’ve got more of a balancing issue.

DR STEPHANIE ESTIMA: Yeah, it’s also a really strong balance test. This is one of those exercises that literally tests almost every system in the body. So I love it as a diagnostic.

STEVEN BARTLETT: Is there like an entry to this exercise that’s a little bit more amateur?

DR STEPHANIE ESTIMA: For sure. Well, if you want, instead of doing it on both feet, you can maybe do it on your knees. So I’ll demo that real quick. So you’re stacking the knees on top of each other, and then you can do it this way. So you’re still having to recruit the glute med here, but it’s just less stress.

STEVEN BARTLETT: Okay.

DR STEPHANIE ESTIMA: You want to try that? See how that one feels.

STEVEN BARTLETT: I got it. Yeah, you got it. I got it. Is there anything else that you can show me that you think is pertinent to the conversation we just had?

Sitting on the Floor and the Sit-Stand Test

DR STEPHANIE ESTIMA: Well, yeah, this one actually relates to mobility a little bit, which we did talk about. So in cultures where people sit on the floor, they eat on the floor, they toilet on the floor, their fall risk is literally almost zero. So I think as North Americans or Westerners, we can do more sitting on the floor.

So one of the big tests — I usually won’t start on the floor, but if it’s an elderly person, maybe they’re sitting on a chair — can they stand up unassisted, like without using their hands? And this is the hardest part of the test. So what you’ll do is your feet crossed, and we’ll do it with both feet, to see if you can get up without using your hands. You can use a little bit of momentum if you want, but you’re going to see if you can get up without using your hands. There you go. Oh, that’s awesome. Nicely done.

All right, let’s get back down. Let’s try to cross our feet the other way. The other way? Yeah. Because you always typically cross your feet one way, right? So I don’t do this one as well as I do the other one, so I’m working on it as well. So again, no hands. You can use a little bit of momentum if you want, and you’re going to come all the way up. That one was not as pretty. Yeah, there you go.

STEVEN BARTLETT: What is that? What muscles am I using there?

DR STEPHANIE ESTIMA: You are recruiting mobility in your ankles. You are recruiting your quads to be able to extend your knee, your glutes to extend your hip. It’s the whole leg. Great. Thank you so much. We’re done. Yeah, awesome. Thank you.

STEVEN BARTLETT: Any others that you love? That you can do without equipment at home?

The Pelvic Floor and Postpartum Fitness

DR STEPHANIE ESTIMA: Push-ups, bodyweight squats, which I think you should eventually progress to weights, but so many people have terrible technique, so you can actually have a fantastic workout with just your bodyweight. Glute bridges, I think, are fantastic. So many. You can pick up a big bag of cat food or dog food and do walking lunges down your, you know, wherever.

STEVEN BARTLETT: One of the— I mean, I looked at lots of the comments and a lot of them also talk about the specific issues mothers face after they have a child. I saw comments about prolapse and pelvic floors, etc. You’ve had 2 children. What are— and you speak to many, many mothers. What are the specific issues that mothers face as it relates to fitness, their workout regimes, their goals, resistance training, etc., that I wouldn’t be aware of? As someone that’s not given birth to a child.

DR STEPHANIE ESTIMA: So we talked about how the hips are different for men and women. The pelvic floor is also very different for men and women as well.

STEVEN BARTLETT: What is the pelvic floor?

DR STEPHANIE ESTIMA: The pelvic floor is like a hammock of muscles that goes from the pubic bone. So if we were to think about, so here is the female pelvis, we have the pubic bone here, and then it’s like a sling of muscles that come around and then attach to the coccyx, or what’s known as the tailbone. And these are called the pubococcygeal — so pubic coccyx — pubococcygeal muscles, or PC muscles.

And they’re different than, let’s say, your quadriceps or your glutes, because they are literally working all the time. They are working to keep your organs in the pelvis so that they don’t just fall out.

And for women, this is another area where we are different, because we have more — I mean, first of all, we have more openings, right? So if you think about the sling of muscles for a woman, you’re going to have a hole at the urethra, at the opening of the vulva into the vagina, and then also the anus. So there’s 3 holes. And so already you have less surface area for those muscles to be able to contract and support, right? Versus a male, those PC muscles just have to deal with one. So it’s mechanically much simpler for a man.

And then you layer on hormonal fluctuations over the course of a woman as she’s menstruating, if she becomes pregnant, under the influence of different hormones like relaxin, the weight of the baby constantly pushing down, and then birth — as I’ve mentioned before — these can significantly alter the strength and the ability for the PC muscles to absorb load appropriately.

So for women who’ve had babies, first you have to obviously be working with your OB-GYN or your midwife or whoever is managing your care plan to be able to clear you for exercise. And once they do, you don’t want to necessarily go back to extremely heavy loads with lots of intensity right away, because you haven’t necessarily yet completely healed, right?

So this is where we get into thinking about, okay, so what are some ways that we can connect with the pelvic floor? So the famous exercise that everybody has probably heard of is Kegels. You’ve probably heard of Kegels. So those are wonderful if you’re someone who has a weak pelvic floor, not so much if you—

STEVEN BARTLETT: You just sit and contract in your seat.

DR STEPHANIE ESTIMA: Yeah, it’s literally like — for men, the way that I’ve often cued men is like, imagine you’re zipping up a zipper, like you’re just kind of coming up and you’re sort of holding it and then you’re relaxing. You don’t necessarily have to move and jump, but you’re literally just sort of connecting as much as you can. It’s hard because our neuromuscular connection to the pelvic floor sometimes is not really strong, but often just closing your eyes and just think — just coming up, holding, and then coming down. And you can do these all day long, free, no one’s going to know that you’re doing it.

So that, if you have a weak pelvic floor, that would be something that you might explore. A pelvic floor physiotherapist would be someone who’d be able to diagnose that and give you a bit more counsel there. But weak pelvic floor, Kegels are great. If you have a tight pelvic floor where you actually have trouble relaxing, Kegels can actually make things a little bit worse for you.

The Betty Body: Women, Sex, and Hormones

STEVEN BARTLETT: On your book, The Betty Body, the last word on the subtitle is the word “sex.” A Geeky Goddess’s Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex. Why did you include “transformative sex”?

DR STEPHANIE ESTIMA: I included it because I think just like all of the myths that we’ve been talking about today about bulky and carbs, I think that the other thing that has been really taboo for women is women who enjoy their sex life. And so I was hoping in that first book to give women permission to want to desire it, to figure out — if there was low desire or low libido — what maybe some of those causes were, and what are some of the ways that we can learn more about ourselves.

I’m thinking of this one patient that I had. And she actually was part of the reason why I included it in this first book. She had come into my clinic for low back pain. It was like the most typical mechanical low back pain, right? And so we were giving her adjustments, we were giving her strengthening exercises, we were doing the rehab, all the things, nothing out of the ordinary.

At her reevaluation appointment, she said, “Dr. Steph, I want to talk to you privately.” I was like, okay, fine. Let’s go into this room, close the door, all the things. And she said, “Do you know the real reason why I came in to see you?” And I said, “Yes, it was mechanical low back pain.” And she said, “No, it’s because when I was with my husband, getting on top of him while we were being intimate was really hurting me. My back was killing me, my pelvis was killing me, my joints felt like they were rubbing on top of each other.”

I mean, I was lucky enough that this patient trusted me enough and we had enough rapport for her to basically say, “Yeah, I want to ride my husband and I can’t. I couldn’t before, and now I can.”

And so I think that there is a quiet taboo around women not enjoying sex, and I want to give women permission to. So whether you have low back pain and that needs to be corrected, if there’s a hormonal input to that, okay.

GLP-1s, Hormone Therapy, and Lifestyle Medicine

STEVEN BARTLETT: Stephanie, what’s the most important thing we haven’t talked about that we should have talked about?

DR STEPHANIE ESTIMA: Oh my goodness.

STEVEN BARTLETT: Well, we didn’t talk about GLP-1s. That’s all the bloody rage at the moment, isn’t it?

DR STEPHANIE ESTIMA: Yeah, GLP-1s are interesting for sure. I do think with all medications — and I am including hormone therapy in here as well, at the risk of getting shot down by some people — is I think that we often marry ourselves to what we feel the benefits might be, and we will divorce ourselves from the possible side effects, right?

Hormones are going to help with your sleep, your mood, if you’re experiencing some of the thermoregulatory problems like the night sweats and the hot flashes and all the things. But it’s not going to go to the gym and lift weights with you. It’s not going to build a healthy plate. It’s not going to set boundaries with your boss. Those things, you have to do those things, right?

So there’s this beautiful opportunity where we see more women taking MHT — or hormone replacement therapy, menopause hormone therapy — to blend that with lifestyle medicine. There’s no easy button here. You have to also put in the work.

STEVEN BARTLETT: And lifestyle medicine meaning training, managing your stress, recovering, doing the cardio that we’ve been talking about. And that recovery point you just said — what are the recovery protocols that you think all women should be doing?

Recovery Protocols for Women

DR STEPHANIE ESTIMA: The best one that I can tell you is sleep, which can be a challenge in perimenopause, I understand. But that is where you have things like growth hormone and IGF-1 tend to surge. Muscles grow when you’re sleeping. The brain cleans itself up. Sleep is the number one thing that everybody should be prioritizing. That’s like an S tier — if there’s an S tier, sleep is it.

Under that, I would say, if you have access to something like a sauna, that might be something that you can think of for recovery, whether that’s an infrared sauna or a traditional Finnish sauna. I often call it lazy cardio. So if you don’t feel like doing a really intense cardio session, get yourself into a sauna if you have access to one. Not necessary, but there are a lot of really cool studies that have come out of Finland — which, by the way, “sauna” is the only word in English that we’ve borrowed from Finnish. Just a fun little tidbit there.

But electrolytes — we’ve talked about those. I think that if you are really pushing yourself and you’re sweating a lot, helping to recover and replenish those is important. As we lose estrogen in midlife, our ability to regulate salt also starts to decline as well.

Joints, Tendons, and Ligaments: The Forgotten Foundation

STEVEN BARTLETT: So what should we have talked about that we didn’t talk about as it relates to the most pressing questions you get asked by the people that consume the content you make?

DR STEPHANIE ESTIMA: The only other thing I would say that we didn’t really go on a nerd safari on is the joints, tendons, and ligaments — the connective tissue capacity. We’ve talked a lot about muscle. I love muscle. I train muscle. Muscle is like the popular girl at the party. She gets a lot of attention.

If you think about a superstar, like Beyoncé or something, right? She’s beautiful to look at. The pomp is great, all of that. But if you put Beyoncé on a rotting stage, or you put her on a stage that can’t handle her, she’s just going to fall right through it, and then you have no concert, right? So I think that the forgotten tendons and ligaments and joints — we have to be thinking about those as we age, because you can’t squat if you don’t have good knees.

STEVEN BARTLETT: How do I get great ligaments and tendons?

DR STEPHANIE ESTIMA: So the way that you encourage them to become stronger over time is how you train in the gym. There are a couple of different ways that you can bias for more tendon strength and more ligament strength. One of them is when you are lifting, you can bias what’s called the eccentric portion of the lift. So concentric — muscle gets shorter, bones come together. Eccentric is stretch. When you start stretching the tendon, the tendon is like, “I’m being stretched. Okay, we have to now create more tensile strength to be able to meet that demand.” So stretching under load. Not just stretching.

STEVEN BARTLETT: Pilates?

DR STEPHANIE ESTIMA: Not Pilates, no. So Pilates — again, love Pilates, do it twice a week.

Pilates, Skincare, and the Bigger Picture

STEVEN BARTLETT: You really got to be in your bonnet about Pilates. You really don’t like Pilates.

DR STEPHANIE ESTIMA: Do you know what it is? No, no, no, it’s not that. It’s people confuse muscle endurance. So in Pilates, you often have very high reps, the muscle burns. It’s fantastic for the pelvic floor that we were talking about before. Phenomenal for women’s health, for pelvic floor health, posture.

STEVEN BARTLETT: You’re saying Pilates isn’t enough to build sufficient muscle mass.

DR STEPHANIE ESTIMA: That’s the main point. And that’s where I think that people were like, “How dare you talk about this? I love Pilates. I do Pilates. I’m probably in your Pilates class.” However, I also am training 4 or 5 times a week. I’m also sprinting 1, sometimes 2, but mostly 1 time a week. I’m doing tennis. I’m doing all of these other things. And Pilates brings me a lot of joy. I always say I feel so happy after Pilates. I don’t know why. It makes me really happy.

But some people are doing just Pilates. So if you are just doing the Pilates, that’s where I fear that you’re like, “Look at me, I’m slim. I’m able to fit in this dress now.” But then what you’re not doing is you’re not loading your bones appropriately. You’re not building sufficient muscle. Your tendons and your ligaments are weak, and you’re going to end up with bone disease or a loss of load capacity when you’re older.

The Most Popular Question Women Ask

STEVEN BARTLETT: What’s the most popular question that women message you with on Instagram?

DR STEPHANIE ESTIMA: Usually it’s, “Tell me about your skincare. Tell me about what you do with your hair, or what your workout outfit is.” All those little questions. But it’s “How do I gain muscle and lose fat?” That’s the big one.

STEVEN BARTLETT: So tell me about your skincare routine then.

DR STEPHANIE ESTIMA: Yeah, it’s pretty basic. I learned this from my dermatology friends. So some vitamin C in the morning, some SPF, and in the evening there’s some kind of vitamin A. I actually really like NAD+. I use another company, it has something called Urolithin A in it, which is supposed to help get rid of senescent cells in the body. Which are like dead cells, right? Which are — yeah, that’s like the zombie cells that sort of hang around and just create inflammation everywhere. You’re almost 50? I’m almost 50, yeah.

STEVEN BARTLETT: You feeling good?

DR STEPHANIE ESTIMA: I feel great. I feel like I inhabit my body now in a way I wish I did in my 20s. I was so punitive and I was so terrible to myself. The things I would say to myself and call myself when I was 20, 30, I would never say that out loud to anybody else.

And so now I feel really proud of myself. I got into weight training just like a lot of women who are watching. They want to look better, build muscle, lose fat. That’s why I got into it as well. But I stayed with it because it provided me a way back home. It taught me how to love myself. It taught me how to be patient with myself. It taught me how to forgive myself when I felt like I had failed. It reimagines your relationship with failure, which I think is like a really big F word for women.

Do You Believe in God?

STEVEN BARTLETT: Dr. Stephanie, we have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they’re leaving it for. And the question left for you is —

DR STEPHANIE ESTIMA: What’s your skincare routine?

STEVEN BARTLETT: No, I’m kidding. Do you believe in God and why or why not?

DR STEPHANIE ESTIMA: Oh, I do believe in God. I believe that there is a force greater than us, greater than we will ever be able to explain, that protects us, that gives us the lessons that we need to learn, and it will continue to present the same lessons to us over and over and over again until we are willing to surrender to learning the lesson.

What Would Make a Life Well Lived?

STEVEN BARTLETT: When you’re on your last day and you look back at your life and you go, “Do you know what, I did it.” What would warrant you being able to say that?

DR STEPHANIE ESTIMA: That my family is around. I’ve met my grandchildren, maybe even my great-grandchildren, that they’re all around my bed telling me — oh, you’re going to make me cry, Steven — that they’re telling me all the ways, all the things that they have learned from me and that they’re going to take on to future generations in my lineage.

STEVEN BARTLETT: Why is that so important for you?

DR STEPHANIE ESTIMA: I think all the reasons why I do what I do is it’s for my kids. I want my kids to have a better life. I want to shortcut some of the learnings for them that I had to learn the hard way. And that’s not to say I want to deny them of their own learning opportunity, but I want to be able to pass on what I feel are important values that I think make the world a better place. I just want to leave the world better than how I found it. And the way that I want to do that is through my family and the work that I do here.

Closing Thoughts and Where to Find Dr. Stephanie

STEVEN BARTLETT: Thank you. Thank you for doing all that you do. I think it’s incredibly important for so many reasons. I mean, it kind of says on the back of your book here, The Betty Body — through time people have thought that women were little men. And that’s what you write on the back of your book. It says, “Women are not little men, but that’s how we treat our bodies.”

And it’s great to have voices like you that are so backed by science, so eloquent, that are out there demystifying what is an incredibly complicated world of health information and conflicting information. And I know it better than anybody because my audience will often say to me that I relate to all of the personas that you highlighted there. What was it? Overwhelmed Olivia.

DR STEPHANIE ESTIMA: “Where do I start? Yeah. Where do I start? Because I don’t want to fail again.”

STEVEN BARTLETT: Yes. So many overwhelmed Olivias, in part because one of the upsides of there being so much information out there now is that people are getting — they’re not having to go to some expensive doctor and they can go on an AI, they can go on a podcast, whatever. But with science evolving over time and with lots of different voices, people are often feeling more overwhelmed than ever with what they consider to be conflicting information.

And I think you do a wonderful job of demystifying that. Thank you so much. Because it’s nuanced, it’s very human, it comes from lived experience, and it comes from, as you said, you’ve sat with tens of thousands of patients through your career in practice. And things aren’t always so simple. They’re not always as simple as they are easiest to sell. And I think things that sell are often simple and reductive. But the truth is often complicated, personal.

DR STEPHANIE ESTIMA: And it doesn’t exist always in a lab. You can’t always replicate it in a lab.

STEVEN BARTLETT: And one of the things I learned from your work as well is that it changes through time. For me, what’s true for me now at 33 years old as a man, this stage of my life with the hormone complexion I have and the goals that I have, one thing can be true. But maybe when I’m 55, a different set of things are going to be true. And I think that nuance is super, super important.

If people want more of your work, I know you’ve got a book coming out at the top of the year next year called Nothing to Lose: Build the Dream Body You Want Today, Gain the Strength and Mobility You’ll Need Tomorrow. And you’ve got this current book here called The Betty Body, which I’ll link below, subtitled — you use the word geeky a lot. A nerd. A nerd safari.

DR STEPHANIE ESTIMA: That’s an interesting phrase. Used to be sort of a terrible word to use. I’m like, no, I’m a total nerd. Yeah, special category of nerd.

STEVEN BARTLETT: A Geeky Goddess Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex. Where else do people find you if they want to learn more, message you, or get in touch, or come see you?

DR STEPHANIE ESTIMA: My podcast. Not quite the reach that DOAC has, but we are — I have a podcast called Better with Dr. Stephanie. So I do solo episodes there where I go on my little tangents about tendons and ligaments and all the things. And then I also interview what I would qualify as the world’s thought leaders in science and health. And we try to distill what it means to have a well-lived life. So podcast, it’s free, probably where you’re listening to this, YouTube and all the places. And then you can head over to my website, drstephanieestima.com.

And I would say for the woman listening — my overwhelmed Olivias who are feeling that they don’t know where to start, or my skinny fat Sophias who are scared of lifting weights and eating like a bird, or my Exorcist Emilys who are still exorcising their demons — you’re not behind. You are absolutely enough. And don’t be so hard on yourself.

STEVEN BARTLETT: Thank you.

DR STEPHANIE ESTIMA: Thank you. Thank you.

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