How to Eat & Workout During Your Menstrual Cycle with Dr. Stephanie Estima

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Dr. Becky Campbell: (00:03)

Welcome to the Health Babes Podcast with Dr. Becky Campbell and Krystal Hohn, where we talk everything health.

Dr. Becky Campbell: (00:14)

Hey guys, welcome to the Health Babes podcast. I’m your host, Dr. Becky Campbell, with Dr. Krystal Hohn. And today we have one of my favorite guests. She’s been on our show before, Dr. Stephanie Estima, and she is the author of The Betty Body. It’s a really great book; you have to pick it up. But we talked a lot today about our menstrual cycle, the different phases of the menstrual cycle, and what exercise and diet should look like through those phases. We also talked about the benefits of growing muscle and how much protein versus carbs you should be eating. We talked about oxalate intake because that’s a big topic right now. This episode is full of so many great things. We hope you love it. 

Dr. Becky Campbell: (00:58)

Guys, let’s welcome back Dr. Stephanie Estima to the show. She’s one of our favorite guests we’ve ever had. She’s so well-spoken. She’s such a wealth of knowledge. We’re so happy to have you back!

Dr. Stephanie Estima: (01:10)

Aw, I’m so tickled! Thank you. Thank you for having me back.

Dr. Becky Campbell: (01:14)

You’re welcome. So let’s jump in. We love how you talk about the menstrual cycle, lifting weights, and eating around your menstrual cycle. So we’re going to talk about that a lot. She’s also the author of this awesome book, The Betty Body. I have a glare, but if you’re looking on YouTube, you can see it. It’s a really good book. It’s a really easy read. It’s funny; it’s just really, really good. So I highly recommend that you get that book. But let’s talk about your journey with all this and how you got your menstrual cycle to work for you.

Dr. Stephanie Estima: (01:50)

Sure. Yes. To be very honest, I always felt like I was burdened with this curse every month and was always in quite a bit of pain at the onset of bleed week. And then, in the weeks leading up to the period, I felt tortured emotionally and physically. Sometimes we have to reach rock bottom. I had reached rock bottom in a couple of verticals in my life. I was going through a divorce at the time, and at the same time, I had a clinic that had burned down. I know—when it rains, it pours, right? 

Dr. Stephanie Estima: (02:31)

I was taking my kids on an extended vacation in Europe, and it was about three weeks long. During that time, towards the end of it, I got my period. And it was such an easy, graceful, and beautiful experience. I joke about this in the book, “Everything’s better in Italy,” right? The coffee is better. The calories don’t count. Everything is better there. But I knew that it was the same body. So even though I was in a different environment, I wanted to sort of analyze some of the things in the environment that had contributed to having such a quick turnaround. It was a really quick turnaround in terms of really enjoying my menstrual cycle rather than being holed up in my hotel room with some Advil and an eye mask on. Then, when I came back home, I wanted to deconstruct the environmental piece but also work to think about nutrition and some of the other lifestyle levers that I had at my disposal to be able to continue that.

Dr. Stephanie Estima: (03:38)

At the time, I was in private practice in Toronto, Canada, which is where I live. I was already running a nutrition program. It was a ketogenic-style diet. And I was already seeing patterns in my female and male patients. There were already differences between outcomes. Men were having great experiences, dropping weight, increasing testosterone, and sleeping like bosses. And my women were really struggling, even though they were eating the same foods. This was very apparent in our husband-and-wife couples that were doing the program together. So again, in the same environment and manipulating the same variables—they’re eating the same foods at home—the guy is dropping 10, 15, or sometimes 20 pounds in a couple of weeks, and then she is maybe dropping 1 pound. 

Dr. Becky Campbell: (04:27)

A pound. It’s always like that, yes. 

Dr. Stephanie Estima: (04:29)

Yes. So those were sort of my early guinea pigs: Myself and these women. I was starting to try to play around with their nutrition and sync it up with their menstrual cycle to see if there was anything there. The book and my body of work, that was sort of the birthplace of it—the clinic.

Dr. Krystal Hohn: (04:50)

That’s so amazing. And it’s so true with you going to Italy. You’re in a relaxed state; you’re probably sleeping and happy. Do you know what I mean? You’re out of the environment, and all things do get better. So it’s something to definitely think about: How much stress—

Dr. Stephanie Estima: (05:07)

[inaudible]. Walking after my meals. Walking to the restaurant. Smelling the food and taking your time. Like, all the things that I talk about or would talk about with my patients. And sometimes, when you point the finger… This is something that I’ve also recognized as a clinician. Sometimes when you say: “Do you know what you need, Krystal? You need to meditate. And do you know what you need, Becky? You need to walk after your meals.” It’s usually when there’s one finger pointing forward when [inaudible]. 

Dr. Krystal Hohn: (05:38)

And a couple pointing backwards.

Dr. Stephanie Estima: (05:40)


Dr. Krystal Hohn: (05:41)

Well, let’s unpack that a little bit. So let’s get into the menstrual cycle and talk about some of the different phases for those who are unfamiliar.

Dr. Stephanie Estima: (05:50)

Sure. So you can generally split the menstrual cycle up into two phases: Follicular and luteal. And when we say menstrual cycle, we’re not just talking about periods. I think that a lot of people conflate those two words. So the menstrual cycle is in totality about that 29 and a half day cycle, [including] follicular and luteal phases. Follicular is the first two weeks, approximately. The luteal phase is the latter half of the cycle. And then you can sort of further divide the follicular phase into your bleed week, which everybody knows, right? We all know when we’re on our period and then that pre-ovulatory week. So in terms of a hormonal landscape, when we are in bleed week, a lot of our anabolic or sex hormones are very low. Estrogen is low; testosterone is low. Luteinizing hormones should be low.

Dr. Stephanie Estima: (06:39)

The only hormone that we really see working or with any sort of clinical significance is follicular stimulating hormone, which is the hormone, as you might expect from the name, that is working to stimulate the follicles. So there’s hopefully going to be one follicle that develops, but that FSH is going to be higher in that first week. And then, towards the end of that bleed week, towards the end of your period week, you’re going to start to see some of these other sex hormones rise. So you’re going to start to see estrogen making her big, mighty debut. You see this very quick meteoric rise, if you will, of estradiol, [which] is primarily the estrogen that we see elevated in women in their fertile years. So that’s E2, or estradiol. And we’re also starting to see testosterone rise.

Dr. Stephanie Estima: (07:27)

And then, after we see elevated estradiol—estradiol will be elevated somewhere around 40 to 50 hours—we will see a surge in luteinizing hormone in that second week. That’s the precipice, if you will, that will allow the follicle to release the egg. And that’s ovulation—somewhere around the 14- to 16-day mark, if you will. We don’t all ovulate on day 14, by the way—that’s a fallacy. Somewhere in the middle there—14 to 16 days. If you’re tracking your cervical fluid, you’ll have a very good idea of when you ovulate because of your cervical fluid, which is… How detailed do you want to get here? 

Dr. Krystal Hohn: (08:07)

You could go into it, girl. We like details. 

Dr. Stephanie Estima: (08:10)

Okay. Some women, when I say cervical fluid, are like: “Are you talking about the stuff in my underwear?” Yes. That’s what we’re talking about—the snot in your underwear. It will change over the course of your cycle. If you’re tracking your basal body temperature, you’ll see that there’s a rise right before you ovulate, and you’ll also see a change in your cervical fluid. It’s obviously not there when you’re bleeding, but then, as estrogen is rising, you’ll see these watery secretions in your underwear that get more tacky and more opaque. It changes with age, but the last day that you see that tacky, egg whitey, lotiony cervical fluid is usually the day that you’ve ovulated. So if the next day it’s looking more watery and a little bit less opaque, then you can pretty confidently, when you pair that with your basal body temperature spike, understand when you’ve ovulated. 

Dr. Stephanie Estima: (09:09)

And ovulation brings us into the luteal phase, which is now all about, we’ll say, waiting for the fertilized egg. Whether or not you want that to be true for you, your biology works to make that happen. So we see other hormones come into play, [such as] progesterone, [which is] pro-gestation and pro-pregnancy. Progesterone is starting to rise, and we will see that peak somewhere between days 19 and 20. Progesterone also drives up appetite, slows down bowel movements, and slows down digestion. So a lot of women will report fewer BMs—fewer bowel movements—more distension, more gassiness, and better sleep as well. It does work on the brain; it works via pregnenolone and works to activate the GABA neurotransmitter, which is involved in kind of feeling chilled out. So you’ll have pretty good sleep. You should have pretty good sleep in that second phase of your cycle as well. You’ll see a second rise in estrogen. And then at some point, your body is like: “I don’t think she’s pregnant. So we’ve got to get rid of this endometrial lining and start again.” So progesterone acutely drops, estradiol acutely drops, and then we see this ischemic death, let’s say, of the endometrial lining. And then we shed it, which is what you see during your period. That blood is essentially the lining of your uterus.

Dr. Becky Campbell: (10:32)

So let’s talk about that bleed week. It’s probably one of the biggest complaints that people have. So what are some ways we can optimize our bleed week?

Dr. Stephanie Estima: (10:43)

In terms of nutrition? In terms of [inaudible]. 

Dr. Krystal Hohn: (10:44)

Yes, like, workouts, feeling better, nutrition.

Dr. Becky Campbell: (10:46)

Yes, like feeling better. What can we do with nutrition? And what type of workout should we be doing that week?

Dr. Stephanie Estima: (10:52)

Love that. For a lot of women, if you’re starting to look at your cycle as a way to predict the type of food, nutrition, and fitness interventions [you’ll need], I think this is a great place to start. The first day of bleed week can feel crampy and achy. If you’ve ever given birth, you know that those uterine contractions can feel like the early stages of labor again. Personally, I often take that first day off. I will have heating pads. I go for long walks.

Dr. Stephanie Estima: (11:26)

When you’re walking, of course—this is the chiropractor in me—we’re seeing that rocking of the sacrum, and we’re lubricating those joints. When I’m feeling discomfort on the first day or two, I usually feel it in the base of my spine; I usually feel it in my sacrum, so walking really helps me. If you feel very lethargic, the first day or two you might take it a little easy, going for some of those low-level activities like walking. I’ll state my bias here: I think that a woman should always be weight training all the way through her cycle. It’s just how we modify it to the hormonal environment that we’re living in at that particular week or at that particular point in time. So for me, when my sacral discomfort is coming down, I get right back into the gym. Especially if I’m doing a leg day—I don’t know if any of you guys notice this—if I’m pushing really hard and I’m doing a leg day and I’m on my period, I push out a lot of blood. I can see it. 

Dr. Krystal Hohn: (12:33)

Yes. It is what it is.

Dr. Stephanie Estima: (12:36)

It is what it is, right?

Dr. Krystal Hohn: (12:37)

It is what it is.

Dr. Stephanie Estima: (12:39)

So I get right back into weight training. It’s still always heavy, but I’ll modify the weight and the repetitions to match how I’m feeling. So in bleed week, it’s somewhere between eight and 12 reps. That’s sort of where I keep it. My guiding principle is that you should not be able to complete more than one or two sets before you reach failure. I say that because a lot of women will just go into the gym to do their 10 repetitions, and no matter how heavy the weight is—

Dr. Krystal Hohn: (13:14)

It’s easy breezy.

Dr. Stephanie Estima: (13:16)

Yes, it’s like, “Okay, 1, 2, 3… 10,” and then they put it down without any consideration for reaching muscle failure. I think that’s where a lot of women get it wrong. I’ll say it that way. I think that we should always be trying to lift heavy and approximate muscle failure. So if I’m at rep eight and I can do another one, I’ll do another one. If I’m at nine and I can do another one, I’ll do another one. And if I can get past 12, I know that my weight was too light, so the weight goes up for the next set. I’m always trying to max out at about eight, and if I can climb up to 12, I know that I’m going to increase the weight and come back down the ladder to eight again until I can move up to that 12-rep range again.

Dr. Krystal Hohn: (14:02)

Yes. And in that first week of follicular phase two, what are you looking at as far as macros? What should women be focusing on as far as protein and things like that?

Dr. Stephanie Estima: (14:12)

I would even say the term woman is hard to categorize because: Are you a woman with PCOS? Are you a fifty-five-year-old woman? Are you twenty-two? So there are a lot of different hormonal considerations, let’s say, and backgrounds. But I will say that generally, your appetite should be much lower. You should notice an attenuation or a pulling down of or dropping of your appetite in bleed week. If not, potentially, there may be some other deficiency. If you are going mad for chocolate in your bleed week, we may have other deficiencies. So maybe there’s a zinc, magnesium, or selenium deficiency. If you’re craving chocolate prior to your bleed week, that’s a little bit more understandable because we know that your body is actually preferentially throwing a lot of those minerals into the endometrial lining.

Dr. Stephanie Estima: (15:07)

But once you are expelling the endometrial lining and you’re still going nuts for the chocolate, then we want to be thinking about maybe some mineral deficiencies. So you should see your appetite come down. This is usually a great week to try—if you haven’t [already]—more of a lower-carb-ish diet. I talk about, in The Betty Body, a ketogenic-style diet for those who are trying to heal any type of hormonal derangement. This works particularly well for women who run androgen dominant—so for someone who has PCOS, let’s say. For someone who’s estrogen dominant—so someone who is dealing with an adenomyosis or an endometriosis scenario—a ketogenic-style diet [during] this week can work very well for them. 

Dr. Stephanie Estima: (15:52)

I do think that if you are weightlifting, you always want to be thinking about protein. I think protein has been demonized. People think that your kidneys are going to fail and that it’s going to give you cancer because you’re always jacking up growth pathways like mTOR and all these different things. And I would say that if you were trying to put on muscle, you actually do want some of those growth pathways to be activated, or else how else are you going to grow the muscle? But you can pull down on other salient activators of that growth pathway, like carbohydrates. You can pull down on your carbohydrate load, let’s say, in that week while still making sure that you’re getting in your protein requirements. And that’s going to depend on the person. But as a general rule of thumb, one gram per ideal pound of body weight is the amount of protein you want to aim for.

Dr. Becky Campbell: (16:49)

Yes. That’s what we do with our patients, for the most part. It’s interesting how women have this thing—not all, but I’d say more so in the past—about not wanting to put on too much muscle. And they don’t realize how hard it is to put on muscle. 

Dr. Stephanie Estima: (17:06)

It is still a big thing. Do you know how hard you have to work? Okay, so I’ll say there are going to be some outliers; there are going to be some genetic mutants that I just bow down to that can put on muscle just by looking at a plate. I am not one of those women. I have to work. I’ve got to w-e-r-k. I’ve got to work in the gym. And I’ve got to work for decades. And I would argue that most women—just by nature of our testosterone concentration and activity, etc.—are going to have to work to put on muscle, but it is well worth the effort. I’ve had some people just recently comment, like, “Oh, your shoulders are a little… a little big.” And it’s like, “Yeah, I’m showing you my shoulders after I’ve done a shoulder workout.” So my shoulders are swollen with blood, which is how I wish they would be. 

Dr. Krystal Hohn: (18:02)

People are nuts, Steph; that’s what it is. People are crazy with comments.

Dr. Stephanie Estima: (18:06)

I mean, I wish you had to pay for a comment. I wish you had to pay to make a comment because I feel like the comments would be so much more elevated. But I don’t have that pump all the time. And when I do have it, I’m so happy. So I’m obviously going to take a picture of it because it doesn’t happen all the time.

Dr. Krystal Hohn: (18:26)

Right. All that hard work, man. You’ve got to make it noticeable, look at it a little bit, and appreciate it.

Dr. Becky Campbell: (18:33)

Steph, do you want to talk about some of the benefits of trying to add more muscle?

Dr. Stephanie Estima: (18:38)

Oh yes, gosh. We could probably spend the rest of our time together talking about that. I’ve been speaking with a lot of people in my community recently and just getting to know people. I’m creating some plans for a select few. And one of the things that is really missing in most people’s health programs… So when I get on a call with someone, they are like: “I’m following your program. I read your book. I’m doing the keto thing. I’m doing the cycling thing.” And then they’re at Orangetheory seven times a week. And, like, no shade of Orangetheory.

Dr. Becky Campbell: (19:12)

It’s a lot on the adrenals. 

Dr. Stephanie Estima: (19:13)

It’s a lot. It’s a lot. And I feel like working out is different. It feels different. So I am also of the type A variety that likes to feel like I’ve worked. I like to feel at the end of my workout that there’s been a significant investment in my time. And I think when I first started working out with weights, and I was transitioning from being like a cardio bunny to being the step and high-low queen—

Dr. Krystal Hohn: (20:55)

Tae Bo. I think I heard you say you used to teach Tae Bo.

Dr. Stephanie Estima: (19:45)

I used to teach Tae Bo. Yes, totally. So when I was doing that and moving into more weights, one of the things I remember thinking about was, “Oh, this doesn’t feel like it’s as hard. I don’t feel as dead” versus after a Tae Bo or a step class [where] I needed a bucket [because] I had pushed myself so hard. But the adaptations that you make when you put on more muscle… I know you must have talked about this in the past, where we tend to, as a function of age, become more insulin resistant, right? So even the muscle in and of itself becomes more resistant to the mechanical stimulus. So just with that, we know that we need to be trying to lift heavier over the arc of our lives because, as we become more insulin resistant, the first place that we see insulin resistance set in, if you will, is in the musculoskeletal system. 

Dr. Stephanie Estima: (20:46)

There have been quite a few interesting studies. Dr. Gerald Shulman, I believe, has shown that just one weight training session can overcome insulin resistance in a type 2 diabetic. So you can imagine the compounding effect that might have when you’re doing that two times a week, three times a week, or four times a week, and what that does to maintain insulin sensitivity in the muscle and in the bones, which are two areas that we want to preserve as we age. We want nice, thick, dense bones—a thick cortical skeleton. We don’t want that pockmarked osteopenic or osteoporotic presentation of the bone. We also want strength and explosive power in our legs. We want to be able to get up from a seated position. One of the things I used to always do in clinic when taking a patient was, level one, “Can you get up out of a chair without using your hands?” Most people could do that if they were under 50. It’s like: “Great. Now get on the floor and do it. Stand up without using your hands.” I would say about half of the population under 50 could do that. And then to the other half who could, I would say, “Great, now lie on your back and get up without using your hands.” 

Dr. Krystal Hohn: (22:01)

I love that. 

Dr. Stephanie Estima: (22:01)

That requires core strength. It requires proprioception in the lower half of the body. You need to be able to have ankle and knee mobility. You need to be able to rotate the tibias. You need to be able to stand up, and you need to have explosive power in the glutes, the quads, and all the other things that are going to get you upright and erect. So where was I going with this? Gosh, I can’t even remember the original point I was trying to make. But what I’m getting at is that the more we focus on driving musculoskeletal growth, the better we’re going to age. So even if you’re just a vain woman like me and you just want to look good in a bikini, it’s going to make you look better in a bikini on your vacations or if you’re in the summertime and you want to wear a tank top and all that kind of stuff. And it’s going to make you a better disposer of glucose. We know that muscles are the primary glucose disposal agent in the body—just by volume. Of course, the brain is a big glucose gobbler as well. But our muscles have a larger volume than the brain. So if you’re able to maintain that insulin sensitivity, you’re going to age better. Your insulin resistance, your blood glucose markers, and how hard your pancreas has to work—all of these things are going to be better markers of inflammation. Like, all the things. All the things.

Dr. Becky Campbell: (23:27)

And you feel so much better when you’re strong. I’ve been into weight training my whole active life. I’ve always done that. But there were times when I went to Orangetheory and stuff like that. I didn’t feel well after that. It was too much. I feel really good after I weight train. I don’t feel like I need to throw up or lay down, and I’m dizzy and all that. I feel like I did work, but I feel like then I can go do more for the day because I do it right in the morning. And it just makes you feel, in my opinion, so much better.

Dr. Stephanie Estima: (24:04)

I couldn’t agree with you more. And I think, as a woman, there’s something really beautiful about feeling strong. There are so many points in our lives where maybe we don’t feel strong, [either] mentally or physically. And I think that there’s something really beautiful about getting out of your head—that’s advice that I’m giving myself as well because I can be cerebral—getting into your body, developing an awareness of the way that your body moves, and then getting to your point, where you say: “When I finish my workout, I feel like I could go and do more.” You feel like you’ve increased your capacity for life, whether you’re a mother, a wife, or you have people to take care of your work, whatever it is. I think that you just increase your cellular, physical, emotional, and mental capacity to show up as the best version of yourself in all verticals of your life.

Dr. Krystal Hohn: (24:59)

For sure. So, as we’re talking about how important muscle is, let’s circle back to those listening who really want to optimize their menstrual cycle. In the follicular phase, in that second week when we get that increased rise in testosterone and estrogen, how can we best utilize that to train? Like, what should we be eating?

Dr. Stephanie Estima: (25:20)

Great question. If you were following a low-carb-ish macro split in your first week, as you move and navigate into that pre-ovulatory or second week, I typically change the macros up myself. I like to have more protein and more carbohydrates and pull down on the fat quite a bit. So whereas in the first week, you might have been 70/20/10, let’s say, or 60/30/10, or something like that, in the second week, I will often double both the protein and the carbohydrates. Protein is about 40% of your total caloric intake. Carbohydrates, depending on your goal, will be around 20–30% of your total caloric intake. And then the remainder is going to be fat.

Dr. Stephanie Estima: (26:07)

And to your point around those anabolic sex hormones—testosterone, anabolic growth hormone, estrogen—one of the ways that we can profit, let’s say, from the rise of those two hormones in that week is to increase our protein [intake] because we’re going to be driving chemically something called muscle protein synthesis, which is just what it sounds like: You’re synthesizing new muscle proteins. You do that with an increased protein intake. When you increase your carbohydrates, you’re mitigating or attenuating muscle protein breakdown. So if the goal is muscle growth, the net amount of protein growth is what’s going to drive hypertrophy. So if we can increase muscle protein synthesis and then decrease muscle protein breakdown, then the net [effect] is going to be that you’re going to have more new muscle proteins that haven’t been degraded. So carbohydrates do help with that. 

Dr. Stephanie Estima: (27:10)

I’ll say this for all the ladies that I know are listening. They’re like: “Oh my God, she said, double the carbohydrates. Won’t I get fat from carbs?” I know every woman is scared of carbohydrates after they’ve done an intervention like keto, where the primary lever that we’ve manipulated is that we’ve pulled down on the carbohydrates, and they’ve lost weight, inflammation has improved, and they feel good. And then I tell them: “Hey, now we’re going to add in carbs.” It feels sometimes like we’re going backward. And I just pinky promise, double pinky promise, pinky swear that that’s not actually what… I promise: “You’re not going backward.” We need carbohydrates for thyroid health. Of course, I’m talking to the choir here. But you guys know that when we consume carbohydrates, that’s going to stimulate the release of insulin. And that is one of the primary drivers of the conversion of inactive to active thyroid hormone. 

Dr. Stephanie Estima: (28:05)

And that’s actually one of the things I see in women who’ve been on keto for too long: We start to see this reverse T3. So if we’re looking at her thyroid labs, let’s say, we will often see things like reverse T3 through the roof. We’ll see a 20%, 30%, or 40% reduction in thyroid output. And then what ends up happening is that the woman says: “Gosh, I was doing keto and I was doing so well, and now I feel my problem is [inaudible] back.”

Dr. Krystal Hohn: (28:35)

Going backward.

Dr. Stephanie Estima: (28:37)

“And things aren’t working the way that they were. Maybe I haven’t been doing keto enough; maybe I’ve been slacking.”

Dr. Krystal Hohn: (28:43)

But then they go harder and make things worse, right?

Dr. Stephanie Estima: (28:46)

Exactly right. What has happened in reality is that they’ve just ridden the benefit curve of keto, and it’s time to move on. It’s time for them to actually increase their protein intake and their carbohydrate intake. And hopefully, in the time that they’ve been on that therapeutic intervention of a ketogenic diet, they’ve layered in some other healthy protocols. Maybe they’ve started weightlifting. Or maybe they’ve started going for more walks. Maybe they’ve started increasing their non-exercise activity, thermogenesis, like, the stuff that’s outside of the exercise room, let’s say. They’ve just naturally increased their output. So you’re going to, by nature, need more carbs. I know after a leg day, man, if I don’t have carbs, I’m not a happy camper.

Dr. Krystal Hohn: (29:24)

You’re famished?

Dr. Stephanie Estima: (28:46)


Dr. Krystal Hohn: (29:27)

And when you say carbs too, because people get scared about that, what type of carbs are you talking about?

Dr. Stephanie Estima: (29:31)

It can be all manner of carbohydrates. So, ideally, you’re going to choose vegetables; those are all carbohydrates. You have all the polyphenols and the xenohormesis stressors that come with consuming plants. So the green leafy vegetables, the peppers, and the nightshade vegetables, if you’re able to consume those, [are beneficial]. And I would also say tubers, root vegetables, and squashes. And even—God forbid—rice, potatoes, and oats. I had oats. I did hamstrings and glutes today. I came home and had some protein. I had soaked some oats overnight with Greek yogurt and some other things, like seeds and stuff. I had some oats with protein today. 

Dr. Stephanie Estima: (30:13)

I think that I would like to remove the stigma. I think carbs in excess, just like fat in excess, just like protein in excess—all of those things in excess are never going to be good for you. But I do think that carbohydrates in particular have been demonized. And I think that part of it is because of the standard Western diet, where you’re pairing a carb with a fat, which doesn’t really happen in nature other than [with foods] like nuts. You will normally find fat and protein together, like in a steak. You’ll find carbs in isolation, like an apple or a vegetable, with maybe some minimal protein in there. But it’s really the combination of the carbs and the fat that really makes you go berserk, and it’s the overconsumption of them because you sort of hijack your own satiety signals. But vegetables are good. We should be having more vegetables. We should be having tubers, potatoes, and all the bounty that this earth provides. 

Dr. Krystal Hohn: (31:13)

We agree. Yes.

Dr. Becky Campbell: (31:13)

Steph, what do you think about oxalates? A lot of people are asking that question lately because of carnivore and all that stuff.

Dr. Stephanie Estima: (31:24)

I think for a small percentage of the population, it really does affect them. I think that there are some people who do have a hard time consuming spinach, kale, and [other] things that are traditionally high in oxalates. I think that you can get rid of probably 70 to 90% of oxalates through cooking and the heating process. So I would be cautious about individuals who claim to avoid plants. I mean, like I said, I don’t want to discount the outliers. But that is what they are. They’re outliers. For the majority of the population, oxalates are not that big of a deal.

Dr. Becky Campbell: (32:06)

Plus, there’s a lot of nutritional value, right? So it seems like—

Dr. Stephanie Estima: (32:11)

Yes. You’re missing out on the fiber, on the polyphenols, and on some of these very potent DNA methylome modifiers. I had Dr. Kara Fitzgerald on the show on my podcast, and she was talking about how you can be biologically 5 to 10 years younger by consuming things like kale and blueberries, and all of these things that some nutrition experts—which I’ve had on my show because I like to sample all the information—

Dr. Krystal Hohn: (32:41)

Oh, yes, of course. We do too. You like to hear it all.

Dr. Stephanie Estima: (32:46)

Yes. I want to hear it all. But there are some people who really believe that there are these ‘antinutrients,’ we’ll say, that are killing people. And I think that there’s a conflation there. Like, if vegetables are fried and you’re only consuming them in recycled oils, let’s say, where there’s a propensity for those oils to become trans fats, that’s the bigger problem. The problem isn’t the steamed spinach. You know, let’s come back to reality.

Dr. Becky Campbell: (33:20)

No. I agree with that, for sure. So let’s move into week three. So moving into week three, what are we looking at as far as what we’re eating and the type of exercise?

Dr. Stephanie Estima: (33:31)

Week three looks like week one. We started off our conversation by saying that estrogen is low and everything is kind of low at the beginning of week one. And the same is true in week three. Right before we ovulate, we see this big rise in estrogen, and then she drops off. Estrogen comes all the way down, and then she makes a secondary rise towards the middle of that third week. So you see a similar pattern in terms of how, right around the time of ovulation, estrogen is very low. We do see the onset, as I mentioned before, of progesterone, which is a new hormone in the cycle. And I would say that it is analogous to: If you are looking to cycle your foods and you want to change, you can bring it back to more of a low-carb constitution in the diet.

Dr. Stephanie Estima: (34:20)

If you are someone who tends to suffer from what I used to suffer from—which is more of the PMS type [of symptoms], like the angry breasts, the swollen… I couldn’t get my rings on [since] I had so much water retention, I couldn’t sleep, [my] mood [was affected], [I was] emotional, and all the commercials were making me cry—I found that returning to a lower carb constitution in my diet was very helpful physiologically and psychologically. So if you’re someone who deals with PMS, I often counsel someone to go back to a lower-carb diet in week three. 

Dr. Stephanie Estima: (34:55)

Before we go to week four, I’ll say that the way that we train is going to be similar to week one. So in week one, it was sort of a moderate 8 to 12 reps. I don’t know if I mentioned it, but in week two with the higher protein, I actually also like to go really heavy. Like, heavy as a MF, right? We’re lifting as heavy as we can, like five reps. If you have a spotter, even better for you to be maximizing…

Dr. Krystal Hohn: (35:23)


Dr. Stephanie Estima: (35:25)

Maximizing testosterone, but maximing, like, shredding the muscle fibers as much as you can, as heavy as you can, for five to six, maybe eight reps. And then in week three, it’s that return to that moderate rep range again, 8 to 12. It’s as heavy as you can go for eight. And if you can climb up to 12, you need to go heavier so that you can come back down the ladder. Start at 8 again, and then work your way back up. So 8 to 12-ish.

Dr. Stephanie Estima: (35:52)

Then the fourth week. We’ve been talking about progesterone sort of rising in that third week; it reaches a peak at about the beginning of the fourth week, so day 21 or 22-ish. And then it’s high for a little bit, and then there’s that drop-off that we described. For many years, that point in time was the worst part of my cycle. I was at peak inflammation. I hadn’t been sleeping because I felt really hot overnight. In terms of fitness, the weight will drop. We’re also a little clumsier. I also say that. We’re also a little clumsier in the second half of the cycle—in the gym or even just dropping keys and stuff. Because estrogen and testosterone are actually lower, our motor cortex, which is an area in the brain that’s towards the front—it’s in the frontal lobe—there’s not as much activity or activation in that area. If you think you’re clumsier in the second half of your cycle, you’re right; you probably are. So in that fourth week, we’re dropping the weights because we’re a little clumsier and then just increasing the reps.

Dr. Stephanie Estima: (36:52)

You can grow muscle at 5 reps, and you can grow muscle at 30 reps, right? And the literature is very clear on that. It actually doesn’t matter as long as you’re bringing the muscle very close to fatigue. In that fourth week, because you’re not really feeling as great, you can drop the weight a little bit. But maybe you’re doing 20 reps. So every time that muscle contracts, you’re releasing myokines, which are going to bring down inflammation, and it’s not as hard of a workout, let’s say. You don’t have to mentally prepare for the 400 pounds or whatever that you’re racking on your hip thruster or whatever it is. So, lighter weights, higher reps, and higher protein as well—it’s very satiating and helps with all the Häagen-Dazs cravings.

Dr. Krystal Hohn: (37:50)

Allow yourself the little cravings because they’re normal, right?

Dr. Stephanie Estima: (37:55)

And I would say increased total calories as well. Naturally, as I mentioned briefly before, your body is frenetically at this point pushing substrate into the endometrial lining. So if we were to do a blood draw for all of us in week four, you would see lower levels of glucose, amino acids, nitrogen, free fatty acids, selenium, zinc, magnesium, and all the other things that we need to create that five-star hotel—the endometrial lining—in anticipation of that fertilized egg. Your body is diverting nutrients to your endometrial lining. So, [consume] more calories because you need them. You’re creating an organ, ladies, every month. Who else can say that? So we need a bit more calories and a little more protein. I like to return to that 40/40/20-ish [ratio]. Like, 40% protein, 20% carbs, and then whatever the fill is in the fat there.

Dr. Krystal Hohn: (38:57)

Awesome. We focus so much on cycling women. And we get this question a lot in practice too: Can I build muscle while in menopause? So let’s touch a little bit on that for those who are in menopause—how important building muscle is.

Dr. Stephanie Estima: (39:13)

Well, the answer is 100% yes. The best time to start weightlifting was 10 years ago, and the second-best time is today. And it doesn’t really matter what your age is. We used to think, “Oh, all the sex hormones are low. It’s so hard.” No. You can totally do it. I’m certainly in perimenopause now; I’m 45, so I know that that is on the horizon for me. But one of the things that I think about is how freeing it will be not to be optimizing for fertility anymore. You can go hard; you can go hard. 

Dr. Krystal Hohn: (39:51)

Yes, you made it. We made it. 

Dr. Stephanie Estima: (39:54)

We made it, yes. Like, the shop is officially closed, and now I’m going to go all in on building muscle. So Absolutely. There’s a woman on Instagram, I love her. I don’t know her, but she’s one of my inspirations. I think her handle is something like @trainwithjoan.

Dr. Krystal Hohn: (40:14)

Is she Australian?

Dr. Stephanie Estima: (40:15)

I don’t know. She’s, like, a 70 year old.

Dr. Krystal Hohn: (40:18)

Okay, I know who you’re talking about.

Dr. Stephanie Estima: (40:20)

She has just, like, in the past five years, discovered weights. She looks like the bomb-dot-com. She’s so inspirational. I love her. I love her. I can see Becky is looking [inaudible].

Dr. Becky Campbell: (40:34)

I’m trying to find her.

Dr. Stephanie Estima: (40:34)

She’s amazing. She’s clearly menopausal—clearly menopausal—and looks like a bombshell. Like, she’s a goddess. She’s amazing, right?

Dr. Becky Campbell: (40:46)

I’ve seen her. I thought it might be her when you said that, but I wanted to confirm. But yes.

Dr. Stephanie Estima: (40:52)

So if you’re in perimenopause as I am or you’re full-on in menopause, there’s no bad time to start. There’s only a good time [to start] because you’re the youngest that you’ve ever been, and you’re the oldest that you’ve ever been. It’s like: Today is the day. Today is the day.

Dr. Becky Campbell: (41:13)

Yes. It’s so true. So, all right. We love you, Steph. And I love how you break this all down. I’m really glad that you came on and did this because I think that a lot of people just don’t understand anything about the menstrual cycle. And some people think when you say menstrual cycle, you’re just talking about bleed weeks. So I think for those who don’t really know a lot, or even those who don’t know some, this is going to be super beneficial because it really does matter how you treat your body and what you’re taking in during the different phases of your menstrual cycle. So thanks for being so thorough and breaking that down.

Dr. Stephanie Estima: (41:48)

Aw, thank you. And if I can add one more thing: I get messages probably every week from 40- to 45-year-olds. [They’re] like, “I just discovered you” or “I’ve just started tracking my cycle. I can’t believe this was never taught.” So if you’re in your 40s and this is completely new information for you, try not to be hard on yourself because that’s what we do as women, right? We’re like, “Ugh, how did I not know this?” And it’s like, “Well, because no one freaking taught us!” so it’s not your fault. I always like to say, “You’re exactly where you need to be. You came into this now for a reason. So if you’re just hearing about tracking your cycle or changing the way that you eat, train, or whatever with your cycle, that’s fine. There’s no shame. You’re good.”

Dr. Becky Campbell: (42:35)

It’s so true. No one talks about this. In the last two years, people have really started to talk about this more, mostly on social media.

Dr. Stephanie Estima: (42:45)

So thank you. It’s such a pleasure talking with you, ladies. Every time I get to spend time with you, it is time well spent.

Dr. Becky Campbell: (42:51)

Well, we love your podcast. We were talking to Steph before you guys were listening. I don’t listen to a lot of podcasts because I’m busy. Yours is one that I do listen to, so can you tell everybody where they can find you?

Dr. Stephanie Estima: (43:06)

Oh, thank you. The show is called Better with Dr. Stephanie. So wherever you’re listening to the Health Babes, I’m probably right beside them somewhere. It’s called Better with Dr. Stephanie. You can find it on iTunes and Spotify. And then we are paying a little bit more attention to our small but mighty YouTube channel. I realized at some point that I have 300 episodes, all videos, and they’re just sitting on my hard drive. So I’m trying to get them out onto the YouTube channel. You’ll see us every week; the YouTube episode will come out. And then we’re also releasing back episodes there as well.

Dr. Becky Campbell: (43:41)

And then on Instagram too. What’s your handle on Instagram?

Dr. Stephanie Estima: (43:44)

Yes. I’m the most active there, so it’s Dr. First name [and] last name: @dr.stephanie.estima on Instagram. I try to post clips from the podcast of what’s going on in my own life in my stories; I’m just trying to interact with my peeps there. So I’d love for you to drop in and say hi.

Dr. Becky Campbell: (44:02)

Yes. And you have a great Instagram. And don’t forget to get her book. Her book is really, really good. It’s very easy to read, it makes things really clear, and it’s funny.

Dr. Krystal Hohn: (44:12)

Actionable steps, which is amazing.

Dr. Becky Campbell: (44:14)

And go back and listen to Stephanie on our earlier podcast. That was a great episode. It’s so funny because we talked a lot about the orgasm challenge in your book. 

Dr. Stephanie Estima: (44:25)

Oh, yes. That’s right. I remember that. 

Dr. Becky Campbell: (44:26)

And we were getting people writing us— 

Dr. Krystal Hohn: (44:30)

We’re doing the challenge!

Dr. Becky Campbell: (44:32)

The nurses and all the women who work together were like, “All the girls in my unit” or on my floor or whatever, “we’re all doing the challenge together!”

Dr. Stephanie Estima: (44:40)

I love that. People ask me, “Oh, what’s your anti-aging hack?” It’s like, “Good sex.” 

Dr. Krystal Hohn: (44:12)


Dr. Becky Campbell: (44:12)

With yourself or with whoever?

Dr. Stephanie Estima: (44:40)

With yourself, with a toy, or with a person—good sex.

Dr. Krystal Hohn: (44:53)

I love it.

Dr. Becky Campbell (44:54)

It’s really true. It is. So that’s your takeaway from today: Go have an orgasm. All right, thanks, everybody, for listening. Thank you, Stephanie, for being on.

Dr. Stephanie Estima:  (45:06)

Thank you so much, guys. Thank you.

Dr. Becky Campbell: (45:10)

Thank you so much, guys, for listening to this episode. And if you love this episode, please leave a review. It only takes a couple of minutes. And you can find out more about us at And you can follow us over on Instagram at @thehealthbabespodcast, @drbeckycampbell, and @drkrystalhohn. Have an amazing day!

The Health Babes Podcast

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