[ANGELA FOSTER]
A common complaint I hear from my audience in addition to belly fat is I feel like I'm getting softer. I'm not seeing the same results from my training.

[ABBIE SMITH-RYAN]
When we're younger, our muscle might look more like a steak that's very lean. As we age, particularly through perimenopause, it can take on more characteristics of a rib eye. More fatty infiltration, more connective infiltration within the muscle.

PIT training is really the primary method of training that helps reduce visceral fat. We can't spot reduce, but because of the metabolic demand of high-intensity interval training, our group and others have shown a decrease in visceral fat in as short as three weeks, which can be really effective for midlife women.

[ANGELA FOSTER]
Where does Zone 2 then fit in this?

[ABBIE SMITH-RYAN]
Zone 2 training is great, but we're talking about a group of women that have minimal time to train. We're trying to see benefit, and that's where this hit comes in.

[ANGELA FOSTER]
One or two things that they should focus on in midlife, what would that be? My number one response is Dr. Abi Smith-Ryan. It's so good to have you here today.

I've been looking forward to this. I am a big fan of your content and all the science you share on Instagram. I'm super excited to have you here today.

Welcome to the show.

[ABBIE SMITH-RYAN]
Thanks for the invitation. I'm glad we could finally make it work. I'm excited for our conversation.

[ANGELA FOSTER]
Amazing. Let's kick off with muscle and specifically muscle quality. Your research suggests that one of the earliest changes through that perimenopause transition may not be in relation to losing muscle, but also in relation to losing muscle quality.

I don't think many women are thinking about this. Can you explain more about that?

[ABBIE SMITH-RYAN]
Absolutely. What we know for both men and women as we age, there is an increased likelihood to lose muscle size. Some of our early work identified that there's also a change in muscle quality.

The way I like to describe that is when we're younger, our muscle might look more like a fillet, a steak that's very lean. As we age, particularly through perimenopause, it can take on more characteristics of, let's say, a ribeye, more fatty infiltration, more connective infiltration within the muscle. Why that's important?

Well, one, I don't think a lot of people talk about it because it's very difficult to measure. Typically, we're measuring it via an MRI or a PQCT or an ultrasound. You can't look at a muscle and know if the muscle quality is changing.

However, that change in muscle quality is also often reflective in metabolic parameters. Sometimes that's blood work. Sometimes it's some other things, but that's often why people aren't talking about it.

When we have a lot of high performers like your audience, that even if we maintain our training or maybe it's an insufficient stimulus, a lot of times that muscle quality can still change with ageing. Some of it's normal ageing. Then we have seen that potentially in that perimenopause, so that early 40s into 50s, that there might be a slightly bigger increase in muscle quality or a loss of muscle quality increase in connective tissue and fatty infiltration.

[ANGELA FOSTER]
If we're getting more fatty infiltration into the muscle, will that affect our metabolic health?

[ABBIE SMITH-RYAN]
Yes, absolutely. If we think about muscle, it's an organ of longevity, partly because it uptakes and utilises glucose and helps with insulin sensitivity. If we have more of that fatty infiltration and connective tissue, so we have less active muscle tissue, less tissue that can uptake the insulin, the glucose, and even activate what we call GLUT4, being able to use glucose, it can impact our metabolic health.

I will say, and I'll have to send some papers to link, we see these classic examples of old versus young muscle or untrained versus trained. What I like to remind a lot of women, it's not dramatic. It's not, if you are training, you are still doing things to help with muscle quality, but it's part of that conversation as we might want to start changing the stimulus or even some of the neurological aspects of, let's say, power training that can help our muscle quality be maintained through that timeframe.

What I mean by that is as we age, we do tend to have, regardless if we're male or female, we have muscle fibres that become less like type two muscle fibres and more like type one with natural ageing. From a physiology perspective, if we can continue to stimulate those muscle fibres and motor units with those higher load, higher intensity, higher power, we can theoretically help maintain that quality of the muscle longer.

[ANGELA FOSTER]
Very interesting. I want to circle back to that. You were saying that you wouldn't necessarily be able to tell by looking at it.

If a woman's looking at her body composition, I certainly notice a 50 is harder, isn't it? To hold on to and to gain muscle, especially if you're stressed or you're not sleeping particularly well. Would you see less definition yourself in the mirror?

Would you find that you're kind of getting... A common complaint I hear from my audience is that in addition to belly fat is I feel like I'm getting softer. I'm not seeing the same results from my training.

Could that be down to intramuscular fat?

[ABBIE SMITH-RYAN]
Theoretically, no. You can't tell by looking at. One thing we have seen most recently is we might see and do an intervention that's hypertrophic, meant to increase lean mass.

If we're using a tool, let's say like a DEXA, it's maybe not detecting that change and increase in lean mass because it's actually improving muscle quality, which the DEXA can't measure. It tells me as a researcher, one, we need more tools and we're having conversations with new technology aspects of how can we measure this in a more feasible way. Currently, you can't tell by looking and you can't tell by like a mainstream DEXA or an in-body.

It has to be more of an imaging technique. Even with that imaging, most sites are not set up to measure quality.

[ANGELA FOSTER]
When we're looking at the inputs then, you mentioned power-based training. If we're looking at the things that affect muscle quality, I suppose if we start to understand those, then we can adapt our training to get the best quality of muscle possible. What would those be?

[ABBIE SMITH-RYAN]
I'll answer the training question. I think nutrition is also a really important conversation within that. When we look at training, another example I like to give when we think about the elements of training is if we think about an obese muscle, they have more muscle than someone that's lean, but the muscle itself has lower quality.

It's not always about the amount of muscle, it is about the quality. When we think about training, if we are doing only aerobic exercise or we're continuing to provide the same stimulus over time, it's still great. A lot of times, the goal doesn't have to be muscle building, but we want to think about how do we continue to recruit those type two motor units and those type two muscle fibres as we age.

Typically, we need to do some higher load or that power-based training. That can look a lot of different ways. It looks very different from a woman that's doing that now and adding in a day here or there, or it looks different from someone that's completely sedentary and just started to train.

It doesn't always have to be this massively heavy load or lots of plyometrics, but for the high performer, we need to start thinking about what's that added stimulus to be able to recruit those larger motor units, which can help stimulate those characteristics and help maintain muscle quality.

[ANGELA FOSTER]
Interesting. It's that type of training when you start elevating in that way also helps with overall metabolic health and fat loss quite commonly as well, and also pulling visceral fat, so many benefits.

[ABBIE SMITH-RYAN]
100%. One of my key areas of research is using high-intensity interval training. Part of why we do that, especially in a lab-based scenario, is that we have shown, first of all, it does allow for increased muscle size and it increases muscle quality and metabolic health very rapidly.

Because of not only that requirement of recruiting type two motor units, but also that metabolic demand. It's really important. I think this speaks to when we think about metabolism with high-intensity training.

During training, if it's high intensity, you're actually relying on a lot of carbohydrate, which is a good thing. We're using carbohydrate. We're requiring the mitochondria to be really active.

That's very prevalent in high-intensity interval training. Then post-exercise, specifically high-intensity exercise, what we see is what we call excess post-oxygen consumption. What we see there is this decrease in carbohydrate refuelling and increase in fat utilisation to help replenish what was lost in training.

That metabolic demand extends longer than, let's say, a long walk or an endurance bout. There's more metabolic happenings post-exercise too. That really helps us shift from carbohydrate to fat in different stages and the demand that's at need, which does help us with our insulin use, our glucose use, and our fat use.

[ANGELA FOSTER]
Amazing. For a woman listening to this who is, let's say, someone who's intermediate level. This is not beginner.

They're used to doing resistance training and maybe some HIIT themselves or classes. When you talk about your research in relation to HIIT, are these short intervals that they were doing, would they have quite long recoveries? Are they HIIT on its own in terms of a cardiovascular-based activity or are they using weights or can it be all of the above?

Are there any specific requirements we should be thinking of?

[ABBIE SMITH-RYAN]
Yeah, I love it. Thanks for bringing it back to what matters most. It can look a lot of different ways.

Typically, in a laboratory-based setting and what we leverage a lot of work on is with high-intensity interval training of one minute hard, one minute rest up to 10 times. That's kind of our base model based on several things that we've looked at. One interesting thing, we've actually looked at some genetic mice models between male and female mice.

Women and female mice respond always to this exercise approach. I say always like it's in mice, but we know that the muscle and the mitochondria are going to respond pretty quickly. A lot of this leverages some of initial Martin Gabala's work on HIIT.

It's very quick. We know that you can get an effective metabolic load and stimulus in muscle protein synthesis in just one to two sessions a week with effects we've seen in three weeks. I'll say one of the things that we've also seen is specifically related to visceral fat.

HIIT training really seems to be the primary method of training that helps reduce visceral fat. Now, we can't spot reduce, but because of the metabolic demand of high-intensity interval training, our group and others have shown a decrease in visceral fat. However, it does seem to be more effective if you have more visceral fat.

You're not going to go from zero to zero, but if you have more visceral fat, HIIT in as short as three weeks appears to decrease that visceral fat, which can be really effective for midlife women.

[ANGELA FOSTER]
And really effective for time poor individuals, right? If your time crunched one minute on, one minute off, I mean, it's a really efficient workout. Is that just literally like doing running or cycling or rowing or something like that?

Or is it for people who, let's say, for example, they wanted to do sled pulls or kettlebell swings, could they do that?

[ABBIE SMITH-RYAN]
Yeah, so typically, it's more of an aerobic-based training. Part of it is leveraged heart rate, so elevating the heart rate for an extended period of time. And so typically, it's running, biking, swimming at an intensity that you could not hold for a minute and a half, and then you rest for a minute.

Now, you could do that probably with a sled push, but if you are doing that effectively, you're not pushing that for a minute. But it can look different. It does, to me, come down to time.

You can still see benefit from a sled pull in a HIIT type of a workout. I would call that more of like a sprint interval training or a circuit training. You can see those benefits.

It's just working a slightly different energy system. If I'm going shorter, I'm not leveraging as much of my fat utilisation. I'm more leveraging things like our phosphagen system and our glycolysis, which is also helpful.

[ANGELA FOSTER]
So this tends to be specifically one minute on, one minute off?

[ABBIE SMITH-RYAN]
Yeah, and we've looked at different protocols. So for instance, if you are someone that wants to see more of those cardiovascular adaptations, then a longer interval and a shorter rest interval can be beneficial. So sometimes two minutes on or four minutes on with one to two minutes off.

You hit the nail on the head when we talk about, like, I think long, slow distance in Zone 2 training is great, but we're talking about a group of women that have minimal time to train, and we're trying to see benefit. And that's where this HIIT comes in. If you have 20 minutes, we all have 20 minutes, and even there's lower data or even more data that shows lower time is also effective.

So even if you only have time for five intervals, 10 minutes, you'll still see a benefit. It just won't be quite as large.

[ANGELA FOSTER]
Interesting. Very effective. I've also noticed that by splitting out the resistance training from the HIIT, that actually personally helps me recover faster.

When I try and mix weights and cardiovascular aerobic training together, you can end up just sort of leaving everything on the floor, and then you don't have energy for your kids and your career and everything else.

[ABBIE SMITH-RYAN]
Well, it's working different. You have different goals. So I agree 100%.

And at the same time, sometimes what I'll do is add HIIT after I do resistance training if that's like a top off or I don't have a lot of time. But you're exactly right. If you're doing HIIT and resistance training, something's going to be sacrificed.

So another word to the wise is always do the training session first that you're trying to get the most out of. And sometimes if I, you know, if my goal is to get the most out of my aerobic or cardiovascular, I'll do HIIT first and then finish up with some repetition weights. And I'd flip that if days I don't have.

So yes, if you have the option to split them, I would 100% agree it's better for training volume and outcomes. But if you are still crunched for time, then do the one first that you that you want to get the most out of.

[ANGELA FOSTER]
It sounds like you're still splitting them. So you're kind of doing resistance training though, and then HIIT as opposed to it's all muddled in together like a kind of traditional class, right, which then doesn't stimulate quite enough in anyone.

[ABBIE SMITH-RYAN]
Yeah. And one thing actually that we've done too, is used high intensity resistance training. So a lot of times people are doing a class or they're doing circuit training, which is beneficial, but it goes back to load.

And one of the high intensity resistance training methods that we've in several papers and actually recently used in our perimenopausal women is trying to do a load that you can only lift six to eight repetitions. And you do it three sets of leg press or a push, a bench press, a lunge, a shoulder press, a bicep curl, and a tricep extension. And that's done with three sets, 30 seconds in between each set, two minutes in between each exercise, all done very heavy in about 30 minutes.

And another way we see that a lot of that increases heart rate much more than let's say a traditional resistance training workout. And so it's this idea of load and minimal time.

[ANGELA FOSTER]
If you're getting value from this show, the single best thing you can do to help us keep bringing you the highest calibre guests is to subscribe or follow wherever you listen or watch. It takes 10 seconds, but it genuinely makes a difference to the quality of the guests we bring you week after week. Interesting.

So you're taking one exercise, 30 second rest between sets and then a two minute break and then you're moving to the next exercise. So, okay, I'm going to try that. Sounds quite fun.

[ABBIE SMITH-RYAN]
And it's actually, I love doing it when I'm crunched for time, but because you're going six to eight reps, you're holding or doing a weight that you can only do six to eight repetitions. So it's heavy, but you get through it pretty quickly.

[ANGELA FOSTER]
Yeah. That sounds fun. You mentioned Dr. Martin Gabala's work there and the longer intervals. So if we look at kind of the Norwegian four by four, that's typically talked about in terms of improving VO2 max with the four minutes on three minutes off, will that pull as efficiently from things like visceral fat and improve metabolic health as well as the one minute on one minute off?

[ABBIE SMITH-RYAN]
Absolutely. I just find that we've even played around early on in my career of what is the best method. We played around with two minutes on one minute off and the four by four is amazing.

It's just hard to do something that hard for four minutes, especially if you take someone that's maybe a non-athlete, whereas we have found that one minute on one minute off, you don't need any special training. You can kind of gut out for a minute on like it's, you can do anything for a minute and you know, not always the goal is, it's not always an increase in VO2 max. And so, yes, there are so many different approaches to take.

I don't know about you, but, and this is where we would say I would take a female midlife. If I told a woman to do repeated four minute protocols, they would get it done, but it would take a lot of mental, you know, you got to get yourself pumped up for that. And then it takes recovery.

Whereas a one minute on protocol, like it's just a lower barrier and you can do it on your own. And so there's just more intangibles, but yes, the Norwegian four by four is very effective. So as a, you know, one minute on one minute off, a lot of Gabala's early work was repeated 30 second bouts like wind gates.

It just requires a bit more specialised equipment to add the appropriate load.

[ANGELA FOSTER]
I found when you go on the shorter intervals, like if you're doing it, for example, in a gym on a treadmill, it's actually quite difficult to get the treadmill even fast enough to get the stimulus. So I found that like tilting, like inclining, should I say the treadmill, so you're going uphill and that also seems to help with injury risk, right? So there's other ways people can make it challenging.

[ABBIE SMITH-RYAN]
A hundred percent. And I, I love actually recommending to do something that you're not good at. Like if you're a runner, go do the rower or go, you know, swim because your heart rate gets elevated more.

You get to a point where it might not rise as much. And then the other piece you mentioned is interval training is, it does seem to be better for injury because it's lower volume. You're getting the same benefit with lower volume.

[ANGELA FOSTER]
Where does zone two then fit in this? Cause I kind of think of it more as a recovery modality. Certainly I noticed like it really helps with things like my HRV, but there's also a lot of information on the internet telling us that we should be doing hours of zone two.

It's like almost impossible for me to fit. If it was hours of zone one, that's super easy because you can walk your dogs and it's quite relaxing. But zone two is actually an uncomfortable, at least the upper part of zone two is an uncomfortable place to be in.

It's not relaxing or, you know, enjoying a nature walk. How much do we need to do for metabolic health?

[ABBIE SMITH-RYAN]
That's a great question. I don't, you know, I'd have to, to frame my, my response is it does depend on the individual. And I think some of this is someone enjoy type or zone two more than a hit type training because they can be interchanged.

[ANGELA FOSTER]
Zone two training is very individual for the person. Some people enjoy it because it's distracting. My husband's one of those.

He'll put a movie on and he's like, I just get in the zone.

[ABBIE SMITH-RYAN]
Yeah. And so I feel like some days we need that. Whereas at high intensity training adds a different element.

And so I would say from a physiological perspective, you could do no zone two and just hit not every day, but kind of strategically. However, it's better on your body and even the indirect effects of blood flow and blood flow to the brain and a number of metabolic and fuel uses. So I hate to put a number on it.

Like if I had to say, especially because someone, everyone has different time demand and goals. It really depends on the goal, but zone two, a couple of days a week is beneficial. Theoretically we could, you know, work around that.

It comes down to time and effects. One way I like to think about it, and maybe you want to answer this question too, is, you know, if a woman has three hours per week, what is going into those three hours? What would you say?

[ANGELA FOSTER]
For me? I mean, on a beginner, I would have them resistance train and walk, and then I would like graduate up from there. Then I'd include a little bit of hit and see what their tolerance is.

And then I would zone two would be the one that I would add last if they were really time crunched.

[ABBIE SMITH-RYAN]
I would do a slightly different only because I have seen sedentary, very ill people do hit and see if effects quite quickly and you need minimal equipment. And so, you know, I would add some resistance training and some early hit, and I would absolutely say zone two last. It also takes more time and effort.

And what I always tell, especially with a beginner, it takes some time to teach someone what that burn feels like, of what that zone two, you know, like what is healthy versus what's uncomfortable, you know, not healthy. And so I would agree with you. So zone two is really important, but often not the first thing I start with if it's someone that, you know, hasn't been training.

And now if it's someone that has been training, but isn't seeing results, and it's already doing resistance training, already doing some hit, but, you know, maybe they're gaining fat or not, you know, like you said, they're, they're being a little softer, feeling a little softer. I think about, okay, is there more zone two? Or is there a zone two that we could add from a different metabolic perspective?

[ANGELA FOSTER]
And what would you in that situation? How long would you add? And what are the effects on them?

Burning fat, supporting mitochondrial health? What are the benefits?

[ABBIE SMITH-RYAN]
It's such a good question. So as you noted, there's a different group of women transitioning into perimenopause, it's women that have been active. And so zone two doesn't mean go for hours, sometimes it's 30 minutes, it's high quality, and it's creating those adaptation.

The other so, you know, 30 minutes, a couple days a week is a good place to start for zone two. The other element I would say is I can't not talk about fuelling. So the same woman who is adding in zone two, a lot of times they're under fuelled around their current training.

And if you add zone two training in that doesn't necessarily it sometimes it makes it harder to get enough fuel if you're training for too long. So then a lot of our work is how do we optimise that of how do we still maintain our body composition and our health goals. And that's where some of this nutrient timing work comes in if I wouldn't, you know, a lot of times we think about zone two, my goal is to burn fat.

But fat burning is not the same thing as fat loss. And so what we've looked at a lot is actually providing some protein, not like a chicken breast, usually we're using like a whey protein or an essential amino acid before exercise is helping burn more fat during exercise. And after to help with what we call metabolic flexibility, the ability to utilise carbohydrate, but also fat for longer, which then helps with us switching between those fuel sources both during exercise and after which has a metabolic advantage.

[ANGELA FOSTER]
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In relation to fuelling, do you have like views from the science and the research that you do on whether it makes a difference if women train, fasted or fed? Like I, for me, for example, I like, I love training fast because I do it first thing in the morning and it's just super easy and it's when I fit in my day and I think I've become so conditioned to it that when I try and like train in a fed state later, I actually don't train as well. But that I think is just because that's what I'm used to.

[ABBIE SMITH-RYAN]
But what does the science tell us? It's a contentious topic, isn't it? It's controversial.

Yes. Okay. So here's what I would say is like, if you have the option to, I have to eat or train and you want to train, go train.

However, you know, especially on days that are, let's say you're doing high volume resistance training and you're fasted, we know that your training will suffer, but you know, you have a lower volume, lower effects, but the training is still going to outpower everything. Same thing. Like I like to train in the morning and many times, you know, I'm not going to eat something, but maybe what I'll do is have like a small swig of milk or, you know, something in my coffee before I go run.

However, let's say you are someone that's conditioned to fasted exercise. One, I would say, first of all, are you fasting before all training sessions? And how is that volume?

Like a lot of times you can get away with it if it's your 30 minute zone two versus your high volume resistance training or even your hit. And then let's say still your condition, you like to be fasted. Okay, great.

Then what are you doing right after? Then the window post exercise becomes really important, especially as we age, because if we've just broken down the muscle, even if it's zone two, not necessarily going to be harder to recover, but a lot of the data that we've seen is fuelling before for females helps increase muscle slightly, improve muscle quality more so than after or fasted. So it comes back to advantage and optimising.

If I want to get the most out of my training and my goal is body composition and muscle quality, then having something before is going to be helpful. Most of the time, it doesn't mean that you can ever train fast and it doesn't mean that's the only way. The second best is to make sure you're fuelling right after and that right after window depends on when was the last time you ate.

So for instance, if you take someone like yourself and myself, if we're training first thing in the morning, it's not like I had a meal two hours prior. Did I have dinner the meal before and what did that look like? And so if I'm truly fasted, then right when I finish, I want something that refuels my amino acids.

And if I've done some cardiovascular work, then I want some of that carbohydrate in there. If I've done resistance training, then I really want to focus on most of that muscle protein synthesis. Now, if we flip that, let's say I train at three o'clock in the afternoon and I had lunch at noon, then I'm not as worried about like I've had some nutrients in my system, I have amino acids in my body, then I don't have to fuel right when I finish when I leave the gym or I finish my run, I've got a little bit of a longer window.

[ANGELA FOSTER]
Very interesting because I've had different scientists on the show who've had different views or quite stark views on this on whether we should train fed or fasted and then also about that post exercise window and whether it really matters. So what I'm hearing from you, if I may summarise to make sure I have this right, is that what the research shows is that if you're doing something that's intense or you're trying to really lift, so high intensity training or lift a heavy load, your performance is likely to be better if you've had some protein, at least in the case of resistance training or in the case of hit protein and carbs on board before training, doesn't have to be a lot. And if you train true fasted, so like for example, it's the next morning, not just a few hours post meal, then you would want to refuel quite quickly after exercise to help with signalling and getting the benefits of that workout, albeit they will be slightly reduced as a result of you being fasted.

[ABBIE SMITH-RYAN]
Yeah. So sometimes we're training, not for the outcome we're training for the mental health benefits or, you know, just the other physical health benefits, which I think we forget to talk about. If the goal is optimising training, fuel matters.

That's what I would say. I would agree with your summary. I would love to hear your take.

[ANGELA FOSTER]
So in my experience, I find that I will get a better workout if I've had some carbohydrates in terms of high intensity training for sure. But say for example, because the mental health benefits are one of the major reasons that I exercise and I do it in the morning and it helps with cognition and mental focus for me. So if I'm going to do high intensity resistance training or high intensity interval training, then what I do is I make sure I have some carbohydrates at dinner at night.

So some starchy carbohydrates that tends to help me a little bit. But I do notice. Yeah.

If I go for a run mid morning, it's just that I'm then more likely to not follow through once I've gotten into my day. So there's always that isn't there because I'm not an athlete. So balancing.

[ABBIE SMITH-RYAN]
No, I mean, I think we forget that practical piece. There's not rules that everyone has to follow. It just comes down.

A lot of the timing piece comes down to really optimising and how do we see better effects? But you're absolutely right. There's a lot of intangibles we don't talk about enough when we talk about fasted versus fed exercise in the lab.

In my lab specifically, we look a lot at this because the goal is how do we see the effects of the workout with and without fuel and different types of fuel? And then how are we optimising? Or for instance, one of the things we've seen now is for instance, soreness.

Typically with age, we tend to see soreness onset longer in a couple of days after. And if that then impacts someone to exercise again, how do we help them with that? Well, fuelling either before or after can help reduce soreness.

So there's a lot of nuance that we don't often talk about, but I loved your summary.

[ANGELA FOSTER]
So that's really interesting, isn't it? Because I think that's the other thing that midlife women struggle with is that recovery, as you say. So it fuelling properly around exercise sessions, whether that's before or after or both, helps with recovery.

[ABBIE SMITH-RYAN]
Well, yeah. So if I look at midlife women transitioning right now, I'm one of them. And we grew up in this phase of eat less and exercise more.

And when you look at a lot of the survey data, more than 90% of women in midlife are unhappy with how they look. And a lot of times they're training to lose weight, which is not the only reason they train. But if you combine that with changes in our body, oftentimes we are under fuelling.

And so if my goal is body composition, or some woman's goal is body composition and their training, well, oftentimes, fasting throughout the day is one thing. But if you can maximise and shift your fuel around your training, it can actually help the training and the effects and still help with that caloric deficit. So some of it is this nuance that we forget to talk about when we're talking about a woman versus a man.

And it's intangible. It's not just, oh, black and white rules. It's like, well, what else is happening psychologically?

And even as we think, I don't know about you, Angela, but if I have a higher carbohydrate lunch, now I get even more sleepy in the afternoon. And so like, it's even our response to insulin and how that might change some of our food intake, which we're still trying to understand as hormones change and body composition changes. It's some of those nuances that I'm particularly interested in from a data perspective.

[ANGELA FOSTER]
Very interesting. And with the, I do notice that after lunch, I don't notice it at breakfast, but I guess I've trained then as well. So I'm going to be more insulin sensitive, and I've had some caffeine.

When you were talking about muscle quality and metabolic health. So that's a big one for women and the, you know, burning of that visceral fat, does the fuelling either side of training affects that?

[ABBIE SMITH-RYAN]
It's a good question. So we have data in a sample of males and females that we've published with high intensity interval training that shows that essential amino acids before training more significantly improves muscle size and quality than after or none at all. However, I will tell you, we just are analysing data in perimenopause.

So early and late perimenopause looking at fasted versus protein pre-hit, and we did not see that difference. And so I kind of showed three different studies that it was following that trend. And then in our midlife women, we didn't see a difference whether they had protein or fasted before hit.

And there's a lot that we're still trying to untangle there of what's happening, but collectively I still lean based on the data that protein prior to exercise doesn't have to be a lot. Usually what we're looking at is 90 calories appears to have a better effect on volume and then post-exercise greater calorie expenditure and greater fat oxidation, which can contribute to that greater insulin sensitivity. It flips a little bit if you told me my goal, and this is more of a, that was for more of a weight loss goal, body recomposition.

If I have a woman that's trying to maximise cardiovascular work and volume, then my pre-exercise would also include some carbohydrate.

[ANGELA FOSTER]
Okay. Interesting. And 90 calories.

So that's about 20 or so grammes of protein.

[ABBIE SMITH-RYAN]
Yeah, it's usually we've used like a protein powder or more recently have looked at essential amino acids due to the absorption and the changes in the GI that some women can't tolerate away protein. Essential amino acids are really interesting. So usually six grammes.

[ANGELA FOSTER]
So like how many essential amino acids would you have to have? Cause they're obviously six grammes.

[ABBIE SMITH-RYAN]
Well, and another thing I do, that's very interesting.

[ANGELA FOSTER]
Yeah. The other thing I do too is you've kind of encouraged me to give this a go.

[ABBIE SMITH-RYAN]
There's some interesting data on large gaps in between your meals. And most of this is in younger women. But for instance, let's say I'm going to be at the ball field for several hours.

I'll take my jug of water and add essential amino acids and a seltzer and drink that in between to help kind of maintain amino acid levels. And so then I can train later or it allows me for my next food source until I get my next meal.

[ANGELA FOSTER]
Amazing. That's going to be one I'm going to incorporate. The other thing I've noticed, right, is, and we hear a lot around the distribution of body fat changing in perimenopause and moving from the hip and thigh to the abdominal area, which we've spoken about and the visceral fat.

But what I've noticed and on my dexers is that it seems to get harder to maintain muscle and definition on my legs and my glutes. Every woman loves a good booty, right? So is this harder conceptually or like in reality or not?

[ABBIE SMITH-RYAN]
I mean, that's the million dollar question, isn't it? I think here's what I would say is right now we would train the same regardless of your age and your menopausal status. And we know like, for instance, if I take a perimenopausal woman through a progressive resistance training bout, she'll gain muscle.

I don't know if we have data that looks at, okay, does cellulite change? Does the fat mass change differently in that time frame? I mean, I think every woman would agree with you and anecdotally, yes.

But how do we measure that? And I think the other hard part is we don't have a lot of good data on women that have trained for a long time. And when we have this group of women like you and I that have trained forever and now are transitioning, how do we train differently to avoid or change, you know, not the inevitable, but mitigate those effects?

Is it diet? Is it exercise? Is it sleep and recovery?

There's an element of stress. Is it menopause hormone therapy? It's some of what we're trying to look at.

So I would say so many women feel and experience what you're saying. I don't know if I have the answers of how we would adapt differently. You know, is it more volume?

Is it recovery? I'm not sure we have the answers yet. Well, we do.

And how do you do that in a way? There's so much individual response, which I think is really important to say out loud of, even if we have data in the lab and we look at individual people or to collectively as a mean, that doesn't mean someone like you would be represented. You know, like I think sometimes we have to validate of just because you're experiencing it doesn't mean it's not true, even if the literature doesn't line up.

And then from a research perspective, that's something and why I've continued to stay in the field of how do we continue to ask these questions that have real-life effects and capture the things that matter to most women.

[ANGELA FOSTER]
I love that. I love all your work. When we're looking at menopause hormone therapy, so oestrogen, progesterone, I know testosterone isn't a standardised one.

I use testosterone for women listening to this. Does taking any of those hormones make it easier to gain muscle and lose fat, including visceral fat?

[ABBIE SMITH-RYAN]
Okay. This is, I love this question. Something that we're just starting to dabble in and there actually have, I don't know if you've spoken to Severine Lamone.

She's an incredible researcher that looks a lot at muscle changes. And here's what I would say is I'm not sure we know yet. However, the important takeaway is that any woman that's using menopause hormone therapy, any of those hormones you mentioned, it's bringing them up to normal.

It's not like a testosterone, like a bodybuilding steroid. It's bringing them to normal. And so typically, and what we're trying to explore with some of our work too, is oftentimes what we're seeing is women feel better.

These are targeting symptoms. That's why they're prescribed. And so if you are no longer so fatigued and now you can train, well, of course you're going to see better effects from your workouts.

If you no longer have joint pain and you can have a better range of motion, of course you're going to see better effects. But I would collectively say most of the literature supports indirect effects. Taking testosterone or oestrogen or progesterone is not necessarily going to massively increase muscle mass and reduce fat mass.

However, if you are now having more energy to train most days of the week, you're sleeping better, you're able to progress that volume like you did 10 years ago, then you will see improvements in muscle and body fat. But right now I would say what we're seeing is more of an indirect effect versus a direct effect.

[ANGELA FOSTER]
It's so difficult, isn't it? To kind of extrapolate these things. I was speaking to Bill Campbell and we were talking about why do we see the weight gain in women?

And he's talked quite openly about the changes that his wife was experiencing. And I was saying, but it's so hard as a woman in midlife because all these changes that happen without necessarily you intending them. So for example, for me, I noticed as my kids got into teenage years and they were doing more of like athletics and different things, I would take them to in the evening, the volume of my driving or kind of standing around like went up hugely.

So I had to be so much more intentional about my need than I did when they were toddlers and we were just moving around loads. So there's all these kind of confounding factors, right? That are so hard to separate.

[ABBIE SMITH-RYAN]
Well, there is, but I think it's such an important thing to talk about because first of all, one of the questions is, do we need to be as lean as we were? So like, is there a phase of life where our goals change slightly? And what does that look like?

And those symptoms are real. So you talk about some of the, not a symptom, but a stage of life. I think one thing I hear a lot of, I'm just so tired.

And whether that's because you're shuffling your kids everywhere or your brain is working harder, well, if you're so tired, you're not going to do that neat activity that you normally are. And so the symptom is valid and having that conversation is really important and more women talking about it. Because for instance, if I'm so tired, I'm not going to go tell someone that like, or how's a provider going to help me?

And so I think it's being more open and saying like those symptoms are valid and that can absolutely impact your body composition and overall mental health. And so I think it's more of those conversations as well of what's impacting our composition.

[ANGELA FOSTER]
That's such a great point. So important. Nutrition, you mentioned we would come onto that.

You've talked a little bit about the protein, impact of protein. Are there other things we need to be conscious of in relation to nutrition to have metabolic flexibility?

[ABBIE SMITH-RYAN]
A hundred percent. So I think everyone's talking about protein right now. It's not the only macronutrient.

So protein is helpful repeatedly throughout the day. Most of the literature suggests about 30 grammes at a minimum. I do believe based on data that having some of that protein or amino acids around exercise is important.

I think one of the most unsung heroes of midlife is fibre, not enough talking about fibre and the quality of where we get it. It's not fibre coming from a quest bar. It's fibre coming from whole foods that very much impacts satiety.

So how full we feel, but also really cool data on fibre and diet quality on lowering basal motor symptoms and reducing cancer risk. And so a minimum of fibre recommendations in the U S I wonder if it's higher there in the UK. I should have looked this up is 28 grammes, which is so low.

You're at 30. And so I would say for anyone listening, like see how much fibre you're consuming. And at a minimum, you focus a lot on protein, but can you add fibre or vegetable to every time you eat?

We could all be doing better there, especially with the changes in cholesterol as we transition into post-menopause. So I would say fibre. The other thing that I like to talk a lot about is essential fats.

So essential fatty acids, you must get them through the diet. Typically they're coming from fatty fish like salmon, herring, mackerel, sardines, and our omega-3, our essential fats and omega-6, but our omega-3 specifically helps rebuild every cell wall in the body, like our phospholipid bilayer, which impacts our hair, skin, and nails, and even our hormone production. And so if we are low fat and low essential fats, it can impact our own natural hormone production and our recovery.

And are just, I like to call it cellular repair. Omega-3 is also impact. It's like a good way to lower inflammation and our cholesterol triglycerides specifically at targets.

[ANGELA FOSTER]
I think fibre is gaining more popularity, isn't it at the moment, which is great because of the many benefits. Yeah. For people who don't have fatty fish in their diet, omega-3 supplementation can really help.

[ABBIE SMITH-RYAN]
Yeah. I mean, I don't know about you, but I like salmon and I can't eat it every day. So like omega-3 supplementation is one of those things.

It's probably a good idea. It's just hard to get enough of. Yeah.

And it's actually good for brain health and inflammation.

[ANGELA FOSTER]
I know you've done some research in relation to the benefits of creatine for women. We keep hearing a lot about creatine, the muscle benefits coming in at kind of three to five grammes, but then these higher dosages for brain health and bone health. What does the research say, Abby, what should we be doing with creatine?

[ABBIE SMITH-RYAN]
Oh, that's a good question. So I would say it does depend on diet. So if you're someone that has a lot of animal proteins, you maybe don't need the higher doses.

However, and it comes down to how quickly you want to see the results. So actually a lot in the lab, oftentimes we do do a loading phase. So 20 grammes a day to allow us to saturate muscle creatine faster.

We are about to start a study. Well, and I'll on that note, we did a study where we loaded for a week, did 20 grammes a day of creatine or placebo in midlife women, and then followed that with five grammes a day for six weeks combined with high intensity resistance training. So we did that loading followed by five grammes a day.

And early data suggests that that was sufficient. So the five grammes a day, if you take a reverse and do five grammes a day, it just takes a little bit longer to load. We have a follow-up study and most of the literature is showing in our lab and even Dr. Darren Kandel's lab, the brain benefits are probably coming from higher doses. And most of the early data was all in what I call a deprived state, a sleep deprivation, some sort of cognitive decline, depression. And that's where we see those 10 grammes a day of creatine helping alleviate those symptoms. Now, what we're seeing is, you know, how do we define suppressed?

I don't know about you, but I feel like I could always use more sleep and I'm always a little bit cloudy. And so is that enough then to see the benefits of creatine? Everything we do is a risk to benefit ratio.

And that's where we're seeing those early signals of five grammes to 10 grammes. The benefit seems to outweigh any risk. We are starting a study to look at that five grammes versus 10 grammes on brain creatine stores, particularly in postpartum women to start to ask that, like how much actually gets into the brain.

And even without that, that's one of those things I tell women of, try it. Do you see any benefits? Some people have felt it pretty acutely and others, you know, not at all and that's okay.

Then that's what, you know, even if we have data that supports it, well, how does it impact you and pay attention to those effects? So if someone's never taken creatine, I would say a five gramme dose for consistently for several weeks, usually three to four weeks is where you would see any effects. If you're really struggling from the mental piece and want to see, you know, then that 10 gramme a dose or 10 grammes a day dose seems to be more supportive for the brain piece.

[ANGELA FOSTER]
And I know you've done some content on this on Instagram as well, you've been sharing because you've done some research. What about the common complaint from women in particular around bloating?

[ABBIE SMITH-RYAN]
Yes, it's funny, actually, I was just analysing some data this morning, particularly in midlife. And interesting. So we typically will look at that loading phase, because we want it to saturate really quickly.

And we've seen bloating is quite different. So that's, you know, usually in the GI, whereas creatine pulls water into the muscle cell. And it seems to be more effective in the states that have more fluid in the cell, like the luteal phase.

We were just looking at data in that perimenopause study. And it does seem that that one week of loading increases intracellular fluid, extracellular fluid, total body water, which is a good thing. But then when that followed five grammes a day for six weeks, we actually saw no difference compared to placebo.

And so the way I see that is it almost dissipates, like you'll see it more with the loading. And then over time, it goes away, which we already knew. But it also, then if you're someone, a lot of the women will say, oh, I'm a responder, I do see that water weight.

Well, then that five gramme daily dose tends to not result in any sort of fluid shifts or not anything meaningful, but enough to still add on to the benefits of the training.

[ANGELA FOSTER]
Last question, then creatine HCL gets talked about as a way of avoiding bloating. What does the research say? When I spoke to Darren Kanda, this was a year or so ago, he said there was emerging research on creatine HCL, but not that much yet.

[ABBIE SMITH-RYAN]
Yeah. So there is one study that I know of actually by a really a great colleague of mine, Sergei. And he did the one study with creatine HCL in midlife women that showed some early benefit.

But here's what I would say is creatine monohydrate is where all the data is. And a lot of times people are saying absorption is different. When creatine monohydrate is attached to a water molecule, if I consume five grammes of creatine, I'm going to absorb about 4.9. It's very bioavailable. So head to head with creatine HCL, creatine monohydrate is still better. And I don't know of any research that goes head to head with someone that, you know, experiences bloating with creatine monohydrate and not with creatine HCL. What I would say is if a woman has used creatine monohydrate and has some bloating, we'll try creatine HCL.

It's a molecule of creatine with hydrochloride. A lot of times it's saying you need less of a dose, but that claim doesn't match up. It's one of those things of it's hard to know how everyone responds.

Generally, creatine monohydrate is the best. It's the most studied. I'm not right now recommending HCL for any different reasons.

And the data is so good in monohydrate.

[ANGELA FOSTER]
There will be a case of watching that space, I guess, to see if things change. If you could leave every woman listening to this with one or two things that they should focus on in midlife as a priority, what would that be?

[ABBIE SMITH-RYAN]
Gosh, that's a great question. My number one response is, is prioritise yourself. And I say that of like, I need the reminder to we're so busy of taking care of everyone else, which is great, but also, you know, prioritising the time that you have for you because it does make a lifelong impact.

We're not living for, you know, the 10 years later, what we do right now makes a big difference. I would also say that perimenopause is not just a reproductive transition. It's a metabolic transition.

And so, you know, a lot of times we're thinking about, oh, I have to skip this or do this workout, but it is really important for our metabolic health. And I would say, lean into your symptoms, like symptoms are really valid. And it's hard for people to either quantify them or talk about them.

Really good data on, I just don't feel like myself and taking the time to figure out why and how to alleviate that can have really good effects on your training, but also your marriage and your work and you as a person. And so, you know, this validation of figuring out why you don't feel like yourself and the more we talk about it and the more that we can get educated, it's a lot of times our own advocacy that can really help us feel better and make a lifelong impact.

[ANGELA FOSTER]
Amazing. Thank you so much for everyone watching and listening to this. Make sure you're following Abby.

I love your Instagram account. I love everything that you share. You keep it real alongside the science.

I think, you know, being among yourself, being in midlife, I think it's just so, so helpful for women listening and watching to this. Please share. How can we stay connected with you and with all the wonderful work that you're doing?

[ABBIE SMITH-RYAN]
Thank you for that. I don't have all the answers and we're just trying to figure it out as we go. So I have tried to put more on Instagram, A.

Smith Ryan. I have a website, asmithryan.com. Those are probably the best places.

And please let me know what you guys are experiencing. Angela, I actually have a new research question based on this talk. So part of why I've stayed in this space and have a lab is to really, you know, continue to generate and ask, you know, what that looks like.

So yeah, please reach out and thanks so much for having this conversation and letting me join.

[ANGELA FOSTER]
Thank you so much.

Dr. Abbie Smith-Ryan explains how muscle quality changes in perimenopause and how HIIT, heavy lifting and protein timing help women over 40 train smarter.

In perimenopause, muscle can shift from a lean "filet" toward a "rib eye," with more fat and connective tissue inside it, and a DEXA or InBody can't detect it. Dr. Abbie Smith-Ryan explains why heavier, higher power training recruits the type 2 fibers that fade with age, how 1 minute on, 1 minute off HIIT appears to reduce visceral fat in as little as three weeks, why fat burning is not fat loss, and when about 20g of protein before training helps.

WHAT YOU'LL LEARN

Why muscle quality, not just muscle size, may change first in perimenopause

How 1 minute on, 1 minute off HIIT targets visceral fat in midlife women

Why fat burning during zone 2 is not the same as fat loss

When training fasted costs you results, and when it does not