[Bill Campbell PHD] (0:04 - 0:14)
Why is it that some women in midlife gain weight and some women find it hard to lose weight, but not every woman?

[Angela Foster] (0:14 - 1:34)
That's a really good question and so far what my research has been able to do, mostly through survey-based research, is identify the number of women who make the claim that it's very hard to lose weight versus the number of women who are going through menopause who say, yeah, I haven't really gained much weight or if I try to lose it, I can. So let me start with those numbers and then we can get into, well, why is this happening? So it seems that about 15% of women don't have that problem.

So 15% of midlife women who go through menopause, they just don't have a real bad experience. They haven't gained a lot of weight or if they try to lose weight, in their experience, they don't really have a problem. So the normal calorie deficits or doing more exercise seems to work for them.

And I also want to say that the women that I'm talking about are women who already embrace a fitness-orientated lifestyle. So that's who I like to study. So women who lift weights, who do some type of conditioning.

So that's the context for everything that I'm going to talk about, at least related to my research.

[Bill Campbell PHD] (1:34 - 1:55)
So just to be clear then, so all the women that we're talking about are women who exercise and of those, and I guess pay attention to their diet and things like that, and of those women, around 15% of them will not experience weight gain or if they have had a bit of weight gain, they find it easy or easier to lose with normal calorie deficits or increase in physical activity.

[Angela Foster] (1:56 - 1:57)
Exactly. Yep.

[Bill Campbell PHD] (1:57 - 1:58)
Like a small percentage.

[Angela Foster] (1:59 - 5:09)
Yeah. Yeah, it is. And it's self-reported.

So it's not like we validated this in the labs, but it's self-reported. So now let's look at the other women to differing, you know, to different degrees. They gain weight, sometimes a little, sometimes a lot, and also would suggest, Hey, the things that used to work five years ago, 10 years ago, don't seem to be working as well.

So what you asked is what I would say the, the, the question to ask, why is this happening? I, I, I, my thinking, and this is hard to, to prove because it's one, we have women that are ageing as they go through menopause. So some people say, Hey, and even some research reviews suggest, Hey, there's nothing special about menopause here.

This is just the act of ageing. Of course, people gain weight when they age other research reviews or longitudinal studies would say, no, it's not just ageing. It's menopause specific.

And as a researcher, it's very hard to separate them because you can't separate going through menopause with ageing. Everybody that goes through menopause is also ageing. Every woman that's ageing at some point is going to go through menopause.

So we can get into the nuance of how best to study that. But I think the, what most people will attribute this increase in weight gain to, and what research shows is associated with this is the change in the hormonal environment. So specifically we know that oestrogen estradiol in particular is decreasing during this time when research has reported that women are gaining an accelerated rate of fat gain.

So estradiol levels are going down at the same time. FSH follicle stimulating hormone levels are going up and we also have declining progesterone levels. So I think the most common explanation as to why this is happening is it's the change in hormones.

Now, one other thought to this, if that's true, one would think, or I would think, well, let's just give hormone therapy as soon as we start seeing this, and that should, that should lessen the amount of body fat. And that's not always what we see with oestrogen therapy. Sometimes we do, sometimes that has no impact.

And sometimes there's actually weight gain or fat gain with oestrogen therapy. So when I first started looking at this, I was all excited. I'm like, well, this is great.

This is pretty, you know, if it's the hormones, we can address that. Let's just give hormone therapy. And to my surprise, it doesn't seem as though that consistently solves this issue, but nonetheless, it is the change in hormones that seem to be highly associated with the changes in body composition.

[Bill Campbell PHD] (5:10 - 5:22)
Interesting. So what you're saying there is some women who then go on to have menopause hormone therapy that helps improve body composition or improve the results that they're getting, but it doesn't seem to universally do that in all cases.

[Angela Foster] (5:22 - 6:54)
Let me discuss that from two perspectives. I communicate a lot with women, like I'm, I'm, I'm loving the learning environment that I'm in right now. Cause I have, I wasn't doing this research five.

I mean, I've always been doing body composition research, but not historically, um, as it related to menopause. So one of the things was I keep getting feedback. Some women, oh my gosh, I started hormone therapy and I lost all this fat and I, um, gained muscle, lean, lean muscle mass.

And obviously a lot of women feel better. That's pretty universal. Other women would say, yeah, I started it.

I didn't really notice any changes in my body composition, like whether I was on it or not. And then I even have other women who communicate with me. Like I gained more weight when I started.

And then I started looking at the research and it really matched the variability of the personal stories that, that, that women would give me some research HRT. Again, I'm going to usually go to estradiol therapy as the main mover reduces body fat. Some research has suggested that it actually prevents the loss of, of body fat.

Like you, it's harder to lose it when you're on estradiol. So to my dismay, there's a, there seems to be a lot of variability around the, the, the effects of hormone therapy on body fat changes.

[Bill Campbell PHD] (6:54 - 7:34)
It's interesting, isn't it? Cause I, I love following your content on Instagram and when you sort of poll women and ask them questions as well. And it's interesting, I think I saw this was maybe even a couple of months ago when you were sharing a post around the percentage of women that use hormone therapy like just general population versus those women who are working out.

And it was much higher in that sort of category, if you like of women, when you're looking at hormone therapy and you see that the results that you're speaking of does testosterone play a part? Cause I, I mean, I imagine as well that the percentage of women that actually use testosterone is even obviously a lot smaller than the women who are on estradiol and progesterone.

[Angela Foster] (7:34 - 9:10)
Yeah. So that's, that's very interesting. And that's part of what we asked in our survey.

Now, the data that you just mentioned was specific to oestrogen and progesterone hormone therapy. So it was like 10 times higher than what the research has reported. Now, two things.

One, there was likely some, what we call bias or selection bias. So we advertise this survey through my social media, through other people's social media. So we're getting people that already follow my content and I'm not overtly, um, at least not yet.

I'm not telling women or suggesting, Hey, you definitely have to go on hormone therapy. Now, I always say you should always put it on the table, but that's a conversation between you and your evidence-based physician. But testosterone was not part of that question.

We did separately ask testosterone, what percentage? And unfortunately I haven't analysed that data yet. We will be getting to that, but I don't have a number, but it will be much lower.

And one thing we know about testosterone, it does, obviously that helps with lean mass. And in this population of women, they're already lifting weights. So I do think we'll see much higher rates than what other research has reported in, you know, in what we, what I would call a general population.

So women who aren't lifting weights, who aren't living in a fitness orientated lifestyle, but I don't have that data yet to share.

[Bill Campbell PHD] (9:15 - 12:27)
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I mean, I can share some of my own personal experience as a midlife woman here, right? Um, because I've been thinking about that and it just feels harder. So I haven't, when I look at my dexter, for example, when I three years ago, I'm 50 now.

So if I look at four age 47, and then I look at myself now, not much, very much changed. So body fat very slightly. I think like half a percent, um, change, um, muscle mass didn't really change.

Um, I started taking menopause hormone therapy. I want to say 15 months ago or so, uh, and then added in last July, some, uh, female testosterone. What I noticed was, um, when I got the right combination, my energy improved.

And interestingly, when I looked at my lab work, so some of my cholesterol markers that were going a little bit off, came back into a really good range. So I noticed that, but I don't notice that I'm gaining muscle more easily. In fact, I would say that my workouts just feel harder than they used to.

That's sort of a consistent thing. And it's interesting as well, because I do wonder how inflammation plays a part in this. So what, as part of all the testing that I've been doing, I did a biological age test with glycinate, um, which looks at the inflammation of the immune system, inflammation, kind of an immune system ageing.

Um, it looks at both and that had shifted. Although my biological age was way, way younger, decades younger than my actual age that had shifted a little bit in the wrong direction. But before I, once I haven't retested since now taking hormone therapy.

So it's really interesting because what I've been trying to sort of understand with all of this is there are variances between women, but there are also a tonne of things that are going on in a midlife woman's life. Right. So, and we know some of those are driven by hormone changes.

So inflammation, for example, I think increased cortisol, but then so is her stress load often increasing in midlife. Um, so there's sort of all these things that are going on at the same time. It must be very difficult to distinguish what's, what's actually driving it.

[Angela Foster] (12:27 - 12:38)
Yeah. It's, it's, it's very hard. Like you said, just life circumstances are highly variable as well, but I love the fact that one that you you've been doing DEXs and it seems like every year.

[Bill Campbell PHD] (12:38 - 12:58)
I did in body scans in between. So I did my DEXs three years apart. I will now do them more regularly.

Um, so they were three years apart by the same clinic, uh, and not much had changed, but the in body scan that I did in between is a different result than the DEXs. Uh, and I find that wildly variable between machines.

[Angela Foster] (12:58 - 14:38)
Exactly. Yeah. And I would, you just said it, but I'm, I would just say, be very careful.

Um, cause I get a lot of questions and a lot of times, um, women are like, nothing's working. I just got this scan and it's like, well, first of all, let me find out about the scan because DEXA and in body. And I like both.

I have, um, I don't have a DEXA in my lab. I have a bod pod, but I have, you know, in body or, or BIA assessments. And I'd like, I'd like all of them, but when you start to mix and match different measures, you're going to get very different numbers.

So what I always try to say is whatever method you use, always make sure you do it under standardised conditions. And that's pretty simple. It means you should do it first thing in the morning after an overnight fast, use the same machine every time don't do a DEXA at one location and then a DEXA at a different location or an in body, um, at one place and then another.

And, and then the best thing to do is if you're getting these every year, just look at the changes, the trajectory of our things going up or things going down. And in your personal experience using the DEXA three years apart. So let's just use that as our reference point.

The fact that you didn't lose lean mass, that's there's some research that I'm going to, I'm thinking of the best research in this area that has, that has studied women over the years as they go through menopause. Some research says that there is a slight decrease in lean mass. Other research says there is not.

And you would fall into this area of.

[Bill Campbell PHD] (14:38 - 15:01)
I had a slight decrease. Yeah. I was discussing this with Stu Phillips, so a slight decrease and a slight increase, but it's quite marginal in, uh, in, um, body fat.

I would say it was my leg mass. That was what seemed to be decreasing the most, not my upper body. It was actually my lower body.

But he was saying that's actually quite a result in three years as a midlife woman to not significantly lose.

[Angela Foster] (15:01 - 15:07)
So can I ask, are you post-menopausal yet? Or are you, do you think you're perimenopausal?

[Bill Campbell PHD] (15:10 - 15:12)
Perimenopausal, yeah, at the moment.

[Angela Foster] (15:12 - 17:56)
So that's always a very important characteristic to define. So if let's just say I have a 48 year old, a 52 year old and a 56 year old, they could all be premenopausal. And a lot of people don't appreciate that.

So whenever I'm looking at research, I always want to look at, did the studies identify something that's called the FMP? And that's, that stands for the final menstrual period. So what that tells us is once a woman has had her last menstrual cycle, 12 months later, she is now post-menopausal and will be post-menopausal the rest of her life.

That's really the key marker that we want to use to interpret any of these body composition changes. Because what the research tells us is body composition is not changing based on a specific chronological age. When things are changing rapidly, it's about two to three years before the final menstrual period.

So let's just say about three years before being classified as post-menopausal and then about a year, year and a half after being post-menopausal. So it's this really short window. So in your case, and again, you may just cruise through this phase of life and not lose muscle, not gain weight, and that would be awesome.

But I do get a lot of, a lot of feedback where women are gaining a lot of excess weight in a very short period of time. And the research would suggest that this accelerated rate of fat gain is happening in this truncated window, which is again, about two, two and a half years is where we start to see this spike in excess body fat gain before being classified as post-menopausal. And again, the other thing is you don't know you're post-menopausal until you're post-menopausal.

It's not like you know where you're at. Some women are in perimenopause for a year, some are in it for four or five years. So there's so much more variability going on here.

But knowing this anchor point is very important. And to that point, when we have research that says, hey, menopause isn't causing any changes in body composition, I've yet to see any of them that have actually identified the final menstrual period. In the studies that identify this, they're the ones reporting, oh, yeah, we now we see this spike in excess body fat gain.

Not everyone, but more likely to happen. The best design studies are the ones where we see this nuance.

[Bill Campbell PHD] (17:57 - 18:14)
That's very interesting, right? So there's a kind of n of one, we almost need to track what happens to me over the next five years, right? And repeat the dexes and see what happens until I finally make that transition and see have I gained body fat?

Have I lost muscle and bone as is also relevant here?

[Angela Foster] (18:15 - 20:06)
Yes. Yeah. And then relative to bone and even muscle again, my population and you would be in this like you living a fitness lifestyle.

So we don't really have any longitudinal data on that. I think none, zero. Let's just look at the muscle aspect of this.

And I'll use an n size of one for my wife because my primary education was my wife's journey through menopause. And it was not a good journey to unfortunately, much better now. But she lost a lot of lean mass during this phase and she kept lifting throughout this phase of life.

I would just say theoretically, if women are lifting weights and they and they build more muscle, do they suffer more through this phase of life? And I'm going to say without oestrogen therapy in this case, because they have more to lose. Now, one thing the research is pretty consistent on is estradiol therapy in particular is anabolic for women.

It increases lean mass. Now, again, anecdotally, my wife, I lost all this lean mass over the last two or three years. And that's where I wish we would have been getting dexes on her about every year.

Then I would have, I'm a scientist, so I see numbers and I would have been, oh, wow. I mean, that might have jumped out and we would have gotten her treatment earlier. As soon as she started estradiol therapy, she takes it, she wears a patch.

She's like, oh my, I'm definitely stronger. I'm definitely gaining muscle back. And then again, I'm always matching my wife's experience and all the other women that I communicate with, with what does the research say?

And again, the best design studies, estradiol therapy, while highly variable with body fat, seems to consistently result in gaining lean mass.

[Bill Campbell PHD] (20:11 - 23:55)
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Just head over to Timeline.com forward slash Angela and enter code Angela for your exclusive discount. This is your chance to feel the shift in your energy, your skin, and your vitality from the inside out. Head over to Timeline.com forward slash Angela and enter code Angela to get your discount. I'll also put a link with the discount code in the show notes below. Interesting. So I'm going to track that now on my Dexa because the thing with, and I think for women listening to this as well, right, it's something to appreciate is that women absorb at different rates.

So in my own case, for example, I was using a gel and I wasn't really seeing very many results with that. And then when I switched to a patch, I felt markedly better. And even within different patches, for example, I can notice a difference.

So now I'm kind of wedded to one that I know I feel good on. And I think that does make a difference. So I'm quite excited actually to track those changes.

The other thing that I think I'd love to hear from you, whether you think this is making a difference is when I was sort of studying it, there's a, as I understand it, a kind of two way relationship between oestrogen and mitochondria. And obviously your mitochondria affect how you feel, how energised you feel and how much you move. And I was reading something that was basically suggesting that women start to move less because their energy is lower.

And we know that that kind of that neat activity, if you like, also has an impact, right, on how many calories you're burning a day. How much do you think the lowering of their energy levels is playing a part in this increase in body fat?

[Angela Foster] (23:55 - 25:37)
Yeah. So that's definitely a factor. So literally it's morning for me before, before we started this, I'm reading a study, a 2008 Lovejoy study.

They, they reported exactly what you're saying, the amount of activity. So overall daily activity. And they measured this with a, an, a triaxial accelerometer, which basically these women wore four days each year as they went from pre to peri through post menopause.

So four days, I mean, there's limitations to that, but at least it's something it's more than what we have from all the other studies, but there was a definitive drop in total movement as they went through this. So obviously if, if all else is equal and all of this excess activity or movement declines, well, that is a, that, that will cause an increase in body fat. So how, you know, so it's clearly, and that's not the only study to report this.

There's other research as well. Now in this particular study, and again, I'm still reading through this and, and, and, and analysing it, they matched this decrease in energy also by decreasing their calories. So when I say I'm still analysing this, I have to, I want to go in and say, okay, did they match it directly or did their movement surpass the amount that they decreased their calories?

So both things happened in this study. I'm still reading through the results to try to get a handle on this, but overall, what you, what you just said about activities declining, yes, very common.

[Bill Campbell PHD] (25:37 - 26:09)
And then we have to fix the other things, right? So like, if they're not sleeping well, then they're also going to move less because now they feel really, really tired. I also think like you and I were speaking a moment ago there around lifestyle, just how much that indirectly plays a part, because I've noticed that with teenagers, they need driving around to various places so much that also makes you sedentary.

Do you know what I mean? There's certain things that you're doing that when you had really young children, you were just moving around loads more. Now you're sitting in a car.

I just think there's so many confounding factors that are taking place at this time.

[Angela Foster] (26:10 - 26:49)
I've never considered that, but what you, that is, that is a great insight. Yeah, that's exactly right. And, and again, that could be pretty significant depending on how many children, how many activities.

And I'm just thinking to when my daughters were younger, yeah, you're, you're running around after them. You're picking up their, you know, their, their toys, walking them down, you know, going to the park. So yes, that's a, that's, that's a very good insight again.

So I, this is what I love. I love learning. So thank you for one, for inviting me on here and now teaching me or making me think about things.

I love this.

[Bill Campbell PHD] (26:49 - 27:37)
Well, thank you. I'm excited to have you here because I love learning from your content. I am, I'll tell you how I noticed it was just looking at my step count.

I would see that it was, you know, I was always the type of person who'd get kind of 15,000 plus steps a day so easily. It was never a problem. And then more recently as the kids have grown, I feel I have to work harder to get to 12,000 steps.

Do you see what I mean? And that's when I noticed it. And then if I don't work out that day, or I haven't been out for a run or something like that, I'm like, Oh my God, I'm knocking around below at like eight and a half thousand.

And when you compare those activity levels, that can be quite a big drop on some days. So that's where I just noticed it. And I was like, yeah, it's because I'm spending, you know, an hour in the car here and hour there, and there isn't as much time to move around.

And as you say, they're not leaving toys and Lego all over the floor that you're kind of clearing up.

[Angela Foster] (27:37 - 27:59)
Yeah. It's like, you have to be a lot more intentional about getting what you didn't used to even have to think about. And being intentional is hard.

It's, I mean, now you're losing all that time driving everywhere. So that's time that you don't have that you used to not, you know, again, that you used to use for the activity that was unplanned.

[Bill Campbell PHD] (27:59 - 28:23)
Exactly. Yeah. Which was physical.

The other thick question I have is around when you look at body types, right? So people have varying body types. Some people find it, I think they call it mesomorph.

They find it easier to gain more muscle. There's ectomorphs who kind of find it harder to gain muscle. Do we see variances in that in terms of someone's body type and then how that menopausal transition affects them individually?

[Angela Foster] (28:24 - 30:05)
So we haven't looked at or asked any question about body types. Now I find it interesting when looking at this. So, and let's see, endomeso and ecto.

So the more round shaped body type. So I think that's an endomorph. I would, I know from experience, so I'm going to say things that are going to be seemingly contradictory here.

That body type just has to work harder. Even, not even menopause, male, female, 20 years old, 40 years old. If you have that body type, an endomorph, it's getting, it's more like rounded face.

Just, just seems to have a little more body fat and rounded appearance. In my experience as a body composition researcher, fitness professional trainer in the past, they have to work harder than people who are mesomorphs or even ectomorphs when, when, when trying to lose body excess body fat. So while that's true, it's not like there's any, any difference in the strategies that I would recommend for such a person who is an endomorph.

It's like, well, if you're, if you're an endomorph, let's, let's have you increase your calories or let's have you do yoga instead of, you know, zone two or whatever, whatever the exercise is. So I'm not convinced that anything specialised is needed. The same levers need to be pulled for, for people of a certain body type.

It's just that those levers need to be pulled harder, in my opinion.

[Bill Campbell PHD] (30:06 - 30:45)
And they have to be more disciplined probably with their diet as well. When you're looking at pulling the levers for exercise in particular, so if we look at resistance training, when someone is working out and they're thinking about what reps and sets to select, in my experience, obviously you go a bit higher reps, kind of 10 to 12 reps, it's just more metabolically demanding, right? It becomes a little bit more conditioning in there than if, for example, you are doing five reps, which is much slower, much heavier.

What have you found in terms of women who they want to maintain muscle, but fat loss is a goal in terms of structuring that workout?

[Angela Foster] (30:45 - 34:14)
Yeah. So I get very philosophical on this. So let's start with saying, there's, let's start by what the science tells us.

So there's two main goals for people when they lift weights. One would be to build or maintain muscle. And the other one would be to increase or maintain strength.

If we're talking about just building muscle, it really doesn't matter if you lift heavy, if you lift moderate, or if lift light, as long as you take each set to near failure. So as long as, if you can do eight reps, as long as you lift six or seven, you're going to have a stimulus to maximise muscle growth. Same thing if you can lift a weight 20 times, as long as you take it to about 18 or 19 reps, you'll get the same stimulus to build muscle.

So lifting heavy or light really doesn't matter if you're trying to build muscle. So with that, I usually tell people, do what you enjoy. If you like lifting heavy, lift heavy.

If your joints can tolerate it, awesome. If you like lifting lighter weights, as long as you take it to where you really can't do many more reps at the end of that set, then do that. I don't want to tell you to do something that's less enjoyable if it doesn't matter.

Now, where it does matter is if you're trying to increase strength. The only way to maximise strength is to lift with heavier weights. So lifting with lighter weights does not do much for strength enhancement.

So with that, I would always ask, what's your goal? And then back into that goal. So there's the first thing.

Now, where I get philosophical about this question is I do not, I like to look at resistance training as a path towards an anabolic stimulus on the body to increase muscle and strength. So I don't like thinking I'm going to go into my lifting weights as partly a calorie burning exercise. And the reason I don't like that is because when, when, when we start lifting weights as a conditioning or as calorie burning, we start to make decisions about how we would do structure our programmes in a way that doesn't give us good outcomes.

And what I mean by that is if the primary goal is to be anabolic, we want to lift weights close to failure and not do tonnes and tonnes of volume hours and hours of work, go in, do your lifting, lift hard, whether it's heavy, moderate or light weights, and then get out. If you want to burn calories, or you're trying to be in a calorie deficit for either to lose excess body fat, to lose weight, then I would say the correct levers to pull there are diet. So reduction in calories or aerobic exercise.

But as soon as we start looking at our lifting programmes as a way to burn more calories or to do conditioning, that's when we start to say, Hey, I'm going to lift for two hours and I'm just going to do a bunch of sets. And those sets usually tend not to be very high quality. So to me, the lifting is one purpose.

Burning calories is another.

[Bill Campbell PHD] (34:15 - 35:01)
That makes a lot of sense. So if you, if you try and burn calories through your resistance training deliberately, you're going to compromise your efforts in terms of building strength and muscle. Just to clarify, then for people, you were you were drawing a distinction there between muscle and pure strength, and how strength needs to be much heavier, so lower reps.

So if we take a, for example, let's take a move that many women find difficult, right, which would be a pull up. So if a woman wants to progress to an unassisted pull up, to build that level of strength, are they better off than, you know, having a little bit of resistance, but going lower reps to build that strength up in order to get to the final stage of doing a pull up than doing, for example, 10, 12 reps with assistance?

[Angela Foster] (35:02 - 36:02)
I would use like a progression. So like, again, I would just, let's do the pull up movement. If the goal, if the end goal is to do one unassisted pull up, and I love that goal, let's start with using band assisted pull ups.

So are you familiar with that concept? So that way you're actually practising the movement that you want to be able to do. And yeah, so the band might allow you to do four or five or eight, and then you just keep reducing the tension on the band so there's more on your muscles.

So that is, that's personally how I would help somebody with that specific goal. So yes, doing more reps initially with assistance, and then just keep pulling that assistance away. Another thing that I really like about pull ups is just, just lowering yourself.

So you're, you start here and then you just lower yourself. That's like an eccentric portion. That's a great way to gain strength as well.

And what I love about it is again, it's, you're actually practising the movement that you want to be able to do eventually.

[Bill Campbell PHD] (36:03 - 36:13)
Yeah. A hundred percent. That, that, that move actually was the one that really helped me master pull ups, uh, unassisted.

Yeah. I was doing that eccentric lowering for quite some time. Yeah.

And then got it.

[Angela Foster] (36:13 - 36:17)
So where are you at now? Or how many, you can do one completely unassisted?

[Bill Campbell PHD] (36:17 - 36:22)
I can do about five or six pull ups now. Yeah. Wow.

That's exactly about what I can do.

[Angela Foster] (36:23 - 36:30)
Um, I'm not good at, I mean, I wish I could do more and I do them several times a week, but that's.

[Bill Campbell PHD] (36:30 - 37:17)
The thing I found is that you like, do you not find that with pull ups, you have to keep doing them. That's what I find. I mean, I suppose it's true with all ways, right.

But it's like, I don't like them. And so if you fall out of them, then you're not going to be able to do them for a bit. You kind of have to keep doing them if you see what I mean, which makes sense.

Cause I guess with a deadlift or if you didn't deadlift for months at a time, you're not going to walk up to the bar and be able to lift it as heavy. Um, but I think you kind of just wish don't need that at any point in time, you can just go up and pull out a whole number of pull ups. Uh, but it's not that easy.

Yeah. Um, I want to talk to you about protein because this makes a big difference as well. And I think I'd heard you speak about the fact that protein in itself can also help with fat loss.

Um, what should we know about protein for our muscle goals and also fat loss?

[Angela Foster] (37:18 - 40:21)
Yeah. So to that, to that statement, there's several studies showing that menopausal aged women do not consume enough protein. So like deficient levels.

Um, I think the average was like 70 grammes per day. And one study in particular when researchers gave, and these were not training women. So just your average sedentary middle-aged menopausal aged women.

When the only thing they changed was to increase their protein. That was it. They weren't no more exercising that in increase carbs or fats, just the act of increasing protein resulted in a significant gain of lean mass and a significant loss of body fat.

So that's pretty powerful because again, that is an exercise response, but we're not doing that through exercise. We're doing that through just increasing protein. Um, so oftentimes when, when I will help someone male or female who has the goal of, Hey, I want to, um, I want to lose body fat instead of going right to, well, let me decrease your calories.

Cause as soon as least for myself, if I reduce my calories, well now I'm hungry. Now I'm more grouchy. I don't like life as much.

So if I can get an outcome that doesn't involve reducing calories, that is an awesome approach or an awesome strategy. And again, that's been, we have research. And again, I used to be a, um, uh, personal trainer, uh, professional fitness trainer earlier in my career.

And I did the same thing and salt and salt again, anecdotally the same outcomes. So protein is anabolic and for, for muscle. And it happens to be catabolic for fat.

Um, and again, that's not just one study there. There's multiple studies showing that optimal protein. Now, on the other side of this, you don't have to think, Oh my gosh, I have to eat so much protein because protein's hard.

If, if you try to get, let's say, um, 2.2 grammes per kg, that's very difficult. It's hard. The only way I do that is if I take protein supplements.

So a good goal in terms of the amount, which there's, there's research to suggest this is all you need for optimising lean muscle mass is 1.6 grammes of protein per kilogramme of body mass per day. And for our American listeners, that's 0.75 grammes of protein per pound per day. So yes, that can be a lot for some people.

And let's just say that's, that's too much. Well, if you're currently eating, let's say one and I can get you to 1.3 grammes per kg. Yes, it's not reading the 1.6, but it's still better than one you're eating now eating 1.3. There's still a lot of benefit just by approaching this optimal threshold for protein intake.

[Bill Campbell PHD] (40:22 - 40:36)
And when you talk about the optimal threshold, so if someone gets to the point where they're one gramme per pound of body weight, um, do the results in terms of the fat loss and the muscle gain then start to top off? Like, is there any benefit to going over that?

[Angela Foster] (40:36 - 42:03)
Um, very little. So after you pass 0.75 grammes per pound, just as you said, the, you still, there is still an, a, an anabolic benefit, but the more and more you eat, the less and less that benefit becomes. And we see that at the cellular level with muscle protein synthesis studies.

And we see that at the whole body level with let's say DEXA scans. So the more and more you eat, the less and less of a benefit there is. Now I w I w I want to, I want to make sure I say this as well.

Um, and I'm sensitive to, again, not telling people you have to eat so much protein that it's just, it's not sustainable, not enjoyable. So I get that. And that's true for most people, but I've been doing body composition research, my entire professional academic career and the leanest women that I've noticed in my, in my career, they always eat a lot of protein.

And again, the ones that stick out to me, they're usually in their forties or fifties, and they're just really lean and they're eating a lot of protein. So a lot of times even more than a gramme per pound. Now I don't have research that this is just a personal observation.

So I don't want to say don't ever eat more than 0.75 grammes per pound. Research says, yeah, it's less and less of a benefit, but also observationally there's something about the higher levels that, that does seem to cause a lean physique.

[Bill Campbell PHD] (42:03 - 42:30)
Interesting. You say that because that's what I've noticed myself. So if I'm not, if I don't pay as much attention and I eat about say 105 grammes of protein a day, that's different.

I will feel and look leaner, like I prefer it. Uh, when I'm eating around 120 grammes a day, there's this, it's just a subtle difference. It's like that extra dose, if you like in the form of a snack or something of protein that just makes a difference to the way I look.

[Angela Foster] (42:31 - 45:43)
Yep. Yep. So you, you notice in yourself what I've noticed in my career.

And again, I, I test a lot of body composition. So I'm, I'm very attuned to, to these, to these observations. And I ask a lot of questions before I forget, you had mentioned something earlier that I think is extremely important in the menopausal body, body fat outcomes.

So they, there was a study and this was in younger people, and this was a sleep study. So you mentioned sleep. And again, I, I look at sleep as lifestyle, and this is a documented case of, of literal weight loss resistance.

So they had younger men and women live in a metabolic ward. I think it was for two weeks. So a metabolic ward or room calorimeter or respiratory chamber, this is where you live in basically a fairly small box, but you can use, you can eat your food.

Sometimes they put a little exercise device in there, go to the restroom, sleep. So you're, you're confined to this room calorimeter, which precisely measures your total calories. So there is no better controlled research than this in terms of how many calories are going into your body.

Cause the researchers know exactly what you're eating. And then this specialised room measures how many calories you're burning and what they did in this study under two different periods, a two week period where they reduced the calories of the subjects. And, and one time they were sleep deprived.

Then they came back and another two weeks, they reduced their calories again, but they, they were not sleep deprived. They were allowed to sleep, you know, the typical eight, eight hours a night. And what they found was when they were sleep deprived, eating the same number of calories.

So 25% lower, I don't remember the exact how many calories it was lower. They lost significantly less body weight and body fat. So, and again, you won't find a better design study.

So we know that sleep disruption or being sleep deprived literally makes you have, you're going to work just as hard and you're not going to get the same body composition outcome. Now, this was not conducted in middle-aged women, but of any human on the planet, which group of, of, of humans suffers from sleep deprivation or sleep disturbances the most and at what phase? And I think most everybody would agree it's women going through menopause transition that lacks, you know, that have much greater sleep disruptions.

So it's not too far to suggest that if you are having sleep problems, you're not getting adequate sleep. There are going to be body composition repercussions from this.

[Bill Campbell PHD] (45:43 - 46:42)
And this is that you will gain muscle tissue less easily and you will find you have more weight loss resistance. It's kind of a double whammy here, right? I mean, that's making it really hard.

Here's another lifestyle observation that I've noticed because there's sleep disruption, which obviously you have during pregnancy and then with toddlers as well. And then again, women, particularly if they're not taking hormone therapy, they can have it in midlife, but there's also again shifts, right? So for me, for example, I've always been an early morning person.

I love going to train at half five in the morning. Now that I have teenagers, they go to bed later. So if I wanted to go to bed at like nine 30, 10, then I would be going to bed ahead of teenagers.

And so if you want to spend time with your kids, you end up shaving a little bit off your sleep as well. So there's another kind of factor, if you like, that for me, certainly, and I guess for a lot of women who do wake and rise early, maybe they're just cutting off an extra 30 minutes as well without necessarily meaning to.

[Angela Foster] (46:43 - 48:02)
Yeah. So again, I love these observations that you're making. Let me just, let me expound on that.

So we have two teenagers in our home. Uh, one, my older daughter, um, is, is at college, but she comes home sometimes. So exactly this.

So my wife just wants to spend time with her. Sometimes the best time is at night staying up later. My younger daughter gets up five 30 to get ready for school.

She has to catch the bus at like six 30. So my wife is helping her get ready in the morning. So, and that, yeah, I mean, other than the infant years, you know, nursing, I'm sure my wife was going to bed earlier and probably not getting up at five 30.

So yeah, that's you can, and now you're starting to make me appreciate there's almost like this stacking effect. So the S the sleep is being truncated the more time in a vehicle, less time just doing natural movement. So yeah.

How much are these things, um, impacting body composition changes when again, a lot of people, including myself would say, I think it's mostly hormones. Well, maybe not when we control for these other variables.

[Bill Campbell PHD] (48:02 - 48:52)
That's the thing, isn't it? I just noticed there's so many changes. And then for example, like ageing parents, so like my mother has dementia.

And so that's another thing, right? It's another level of stress that's impacting everything. I just feel like there's so many, it's like a perfect storm.

Let's put it that way in midlife at the point at which menopause occurs, um, that all these things are going on. And the thing is we can't carry out a second group. Can we, where we say, Hey, we're going to give you all these changes at this point of midlife with no menopause, because we just can't do that.

So there's, we almost can't study the variables independently. It's kind of difficult. Um, when we look at protein, our question for you is, is it true that women need to have a bigger dose, um, to stimulate muscle protein synthesis, um, that they need kind of 30 to 50 grammes?

Um, is that, is there a dose that they need in one serving?

[Angela Foster] (48:53 - 50:59)
My interpretation of the research is the most important thing when you're, when you're thinking about protein, that's that the, the one thing you want to do, put your focus on is your total daily amount. So whether you eat, let's just say a hundred grammes is ideal for someone just to make the math easier. The most important thing is that by the time you, you end your day, that you're getting a hundred grammes.

The next most important thing, which is where you're going is we, we, in terms of building muscle, the next most important thing after getting your total daily amount is to approximately evenly distribute that hundred grammes or that protein across the day. And what makes sense is about three to five feedings, three to four feedings throughout the day. And again, I said approximately evenly distributed.

So you got breakfast, lunch, dinner, there's three, and then maybe a pre or post workout protein feeding. So by, by when you look at it like that, you are going to get away from these very small dosages and probably will be in this 20 to 40 grammes of feeding per, per protein feeding per day. But let's just say you only could eat once a day, or that's what you wanted to do.

You could get all 100 grammes. And we have research on this. This happened to be in males, but there would be no difference in females that I'm aware of.

And I know you had Dr. Phillips on he's, he's like in my world, he's the protein expert. So I love learning from him, but even when you give a hundred grammes to people and that's all they eat, they still, they have their muscle protein synthesis will go on for hours, like up to 12 hours. So why I don't, it's not ideal.

As long as you get the total daily amount that's most important and then try to divide that up evenly throughout the day.

[Bill Campbell PHD] (50:59 - 51:40)
Makes sense. And what about fasted training, this perennial question over whether it is or isn't catabolic? Because when I've looked at quite a bit of the research, there doesn't seem to be necessarily differences between men and women.

Although I do hear of, and you know, I've had scientists on the show who've talked about the sex differences. I've always trained fasted. It doesn't seem to have made a difference, but then I guess I don't know because I train in the morning.

I don't know the full results I would get if I was pre-fuelling. Have you seen in your research or other research anything to suggest that we must, we must train in a fed state?

[Angela Foster] (51:40 - 53:33)
No, I haven't seen that research. And I have not personally done research on fed versus fasted training, but I have, I think I've read all of the human studies. So I'm well versed on the outcomes.

And I go back to whether you train fasted or fed relative to let's say fat or even muscle. It doesn't matter as long as you are training and your calories are the same throughout the day. So, and again, you will find some research, generally not the best research though, that there's lacking a lot of controls that actually said that fasted training is better for fat loss, but the higher quality studies, it doesn't make a difference.

So if that's true and that is my interpretation, I go back to like in your case, if you're, if you want to train in the morning, let's say early, and it's not convenient to eat food before you train, then don't worry about it. Just train fasted. Now you can get theoretical and start saying, Hey, in the cell, we see this.

So you can make arguments that fasted training is not ideal, but I think that's a little more theoretical and not based on the outcome data that I've read. And again, my research is, is really focused on body composition. So I'm speaking in terms of, is it better to lose fat or to, to, to lose muscle?

If you've trained fasted, there may be other reasons, circadian rhythms, metabolic health, like there may be other things where fasted is better or worse, but I'm not speaking to that because I don't, I haven't read that research. I'm not aware of that. But body composition, just do what you prefer.

If you prefer to eat exercise in the fed state, great, do that. If you prefer to do it in the fasted state, great, do that.

[Bill Campbell PHD] (53:34 - 54:04)
And what about when you finish the workout? So I'd read that if, for example, someone who has a really high training volume, maybe they're training sometimes twice a day or they're training every day, the faster that you refuel that can help facilitate a faster recovery. Um, is that true?

And does it make a difference, for example, to your results in terms of gaining muscle or strength, whether you refuel within an hour or so post-workout or whether you move it by a few hours?

[Angela Foster] (54:04 - 55:48)
Let me answer this with, with, um, some theoreticals. If I'm working with someone, and this is usually more true in women, at least that I've worked with, and they're perpetually dieting, they're perpetually under eating, then I'm going to, I'm going to kind of leverage and say, Hey, let's make sure that we get you some calories, some, some refuelling immediately after your workout, because I know that they're prone to under eating constantly. I would say, yes, let's get you refuelled, uh, recovering better.

But my analysis of the research is, as long as you're going to get the same number of calories and protein and carbs over the course of a day, and you're going to do the same thing tomorrow and the next day, there doesn't need to be an undue amount of attention put on the post-workout meal, um, for, um, body composition outcomes. Now I, I am aware of some research where performance outcomes, so strength does seem to be, I read a recent study, and this was in younger females, post-workout feeding did seem to be better for performance. So all of that, my, my thinking is, it's never a bad thing to eat right after our workouts.

There's no harm. And in fact, it may actually be better. But if somebody says, Oh, I'm just not hungry, or it's not convenient, then I'm not going to force, I would say, Oh, you have to, the research is overwhelmingly clear.

You must, I can't say that, but in my own life, I think it makes sense to, to, to refuel after our workouts. And again, I just make sure that's part of my day's plan of nutrient intake.

[Bill Campbell PHD] (55:48 - 56:27)
Even I guess, right from an, just an overall energy perspective. I know, for example, when I shifted mine, so I used to like go work out in the morning, then I'll come back shower, get ready, organise the kids' breakfast. Then I do a drive on the school run.

Then I go walk my dogs for an hour, come back. By which time it's like, you know, you've been up since five, you're not eating till 10. I was, I found that I was, I guess my attention and focus was less, right?

Because I was tired. I'd put in a lot of effort. Whereas when I then shifted that, and I came back and I was like, right, I'm going to, you know, have a quick shake with some blueberries, just get a bit of fuel on board and then go and do all of the other things.

I had more energy. So I guess that's also individual, right? Person to person.

[Angela Foster] (56:27 - 56:42)
Yeah. And again, that makes sense. And again, I think for you, it was a better decision to, Annie, if you can make that smooth, that whatever the berries and shake 10 minutes, five minutes, it wasn't a huge planning.

Yeah. That makes a lot of sense.

[Bill Campbell PHD] (56:42 - 56:49)
Is there anything that we haven't spoken about in relation to fat loss or muscle gain for women that you think you should mention?

[Angela Foster] (56:49 - 58:51)
Yeah, we did mention it, but I want to reinforce it. There's a lot of horror stories about, Oh my gosh, I'm a 43 year old woman. And I hear all these horror stories.

And I, I hear Dr. Campbell talking about all this fat game that that's going to happen. And that that's, that may not happen. So I, I don't like, yes, I do research this in the evidence that I rely on says that a lot of women will gain body fat, but it doesn't happen to everyone.

So I wouldn't want somebody to stress over what may happen when in fact it might not happen. So a lot of the train wreck stories might not happen to you. The other thing is while I'm a body fat researcher, there's more to life than just my body composition.

So let's just say, let's just look at a situation where someone is gaining body fat and it's very hard for them to lose. And I, and I know that I hear this a lot, like why do I even bother? Why am I still lifting weights and doing conditioning because nothing's working?

Well that, and I want to be, I want to have empathy and acknowledge. Yeah, I know that's frustrating because you're trying to lose body fat, but if the alternative is you're just going to stop trying, what about all of the other benefits that your lifestyle is giving you that you can't see on a scale or you don't see in a mirror like bone mineral density, mitochondrial health, lessened anxiety, having more energy. And again, a lot of women really struggle with energy, but it could be worse potentially if they're not doing any of these things.

So I, yes, I'm focused on body composition. That's, that's what my skill set is, but I don't want to discount a devotion to a fitness lifestyle is giving you, giving all of us a lot of benefits, which we don't immediately see or feel. So let's not forget about those things as well.

[Bill Campbell PHD] (58:52 - 59:38)
100%. I'm so glad you said that because I think it's so important and you can't account for what things would look like, right. If you weren't putting in that effort, as you say, and also brain health, there's more coming out in terms of how we protect our cognitive health with exercise as well.

I just think it's just so transformational. It's definitely been the thing for me as someone who struggled previously with mental health, just daily exercise movement of some description. It doesn't have to be an intense workout has been the biggest mood stabiliser ever.

It's just, I think, incredible. Dr. Campbell, I want to thank you for all your work and everything you share. I know that you have, you share articles.

I believe every single month you run workshops for people where they can go deeper into this. And you also share a lot on your Instagram. I'd love for you to share how people can connect with you and continue to learn from you as I am.

[Angela Foster] (59:39 - 1:00:31)
Yeah. Yeah. Thank you.

So I publish a monthly research review where I summarise the latest and best research on body composition. So how to lose excess body fat, how to build muscle. And a lot of, because my research interests now and personal interests are in this menopause phase of life.

So a lot of the articles that I'm summarising are about menopause. And if anybody's interested in that, and like you said, I also do live lectures as part of that subscription. So it's $7.99 per month. So pretty low cost. I try to deliver a tonne of value through that. If anybody's interested, my website is BillCampbellPhD.com.

I'll send you some free issues so you can see if it's something that you might like. And in terms of following my content, Instagram is the best place. My handle is BillCampbellPhD.

[Bill Campbell PHD] (1:00:31 - 1:00:42)
Amazing. Thank you so much. Thanks for your time today.

We will link to all of that in the notes below this episode as well. Thanks for coming on. It's just been fascinating talking to you and learning from you.

[Angela Foster] (1:00:42 - 1:00:44)
Yes. And likewise, love learning from you as well.

If you’re in midlife and suddenly feel like fat loss has become harder overnight, despite training, eating well, and doing what used to work, this episode is for you.

Today I’m joined by Bill Campbell, PhD to unpack what the research actually shows about menopause, body composition, and “weight loss resistance”. We explore why some women gain body fat during this transition while others don’t, why hormone therapy isn’t a guaranteed fix, and the small but powerful lifestyle factors (movement, sleep, protein) that can quietly shift results.

This is a practical, evidence-based conversation for women who lift, care about their health, and want clarity; not clichés.

WHAT YOU’LL LEARN
• Why menopause-related fat gain doesn’t happen to everyone
• The 2–3 year window where body fat gain seems most likely
• Why hormone therapy helps some women but not others
• How daily movement (NEAT) drops in midlife without you noticing
• The difference between training for muscle vs strength
• Why lifting shouldn’t be treated as “calorie-burning cardio”
• How much protein is actually supported by research (and why many women under-eat it)
• Why poor sleep can create real weight-loss resistance
• Whether fasted training makes any difference for body composition

Disclaimer: The High Performance Health Podcast is for general information purposes only and do not constitute the practice of professional or coaching advice and no client relationship is formed. The use of information on this podcast, or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for medical or other professional advice, diagnosis, or treatment. Users should seek the assistance of their medical doctor or other health care professional for before taking any steps to implement any of the items discussed in this podcast.