Creatine, Muscle, and Female Metabolism: Why Women’s Fitness Advice Was Built Wrong | Dr. Abbie Smith-Ryan
Women’s health and performance science is finally catching up—but for decades, much of the research guiding training, nutrition, and recovery was built primarily on male physiology. That mismatch has left many women feeling like they’re doing everything right—training hard, eating “clean,” tracking their metrics—yet still struggling with energy, metabolism, recovery, and body composition.
In this episode of the Crackin’ Backs Podcast, we sit down with Abbie Smith-Ryan, one of the world’s leading researchers in female metabolism, performance physiology, and body composition, to explore what happens when we finally study women’s bodies on their own terms.
Drawing from hundreds of peer-reviewed publications and years of clinical and laboratory research, Dr. Smith-Ryan explains how women’s hormones, metabolism, muscle physiology, and fueling strategies influence everything from athletic performance to long-term health and longevity.
In this episode, we explore:
Why much of the traditional fitness and nutrition advice for women was built on male data
What actually happens to metabolism and body composition during perimenopause and menopause
Why many active women are chronically under-fueling without realizing it
The growing research behind creatine for women’s health, muscle, and brain performance
Why muscle may be one of the most powerful longevity organs
The role of strength training vs cardio in women’s long-term health
The pros and cons of wearables, hormone panels, and optimization tools
The highest-impact habits women can implement without expensive testing
Dr. Smith-Ryan also discusses the future of women-specific exercise science, why we may need to start these conversations much earlier in life, and what she hopes women ultimately believe differently about their bodies.
This episode is essential listening for anyone interested in:
women’s health
female metabolism
strength training for women
creatine supplementation
menopause performance
body composition science
longevity and muscle health
About Dr. Abbie Smith-Ryan
Abbie Smith-Ryan is an internationally recognized exercise physiologist, researcher, and professor at the University of North Carolina–Chapel Hill, where she directs the Applied Physiology Laboratory.
Her research focuses on female metabolism, exercise performance, body composition, sports nutrition, and dietary supplementation, with particular emphasis on women across the lifespan—from athletes to women navigating menopause. She has authored hundreds of scientific publications and is widely recognized as a leader in translating complex metabolic science into practical strategies for real-world health and performance.
Her work has been featured in major scientific journals and global media outlets, helping shape the modern conversation around women’s physiology, muscle health, and metabolic resilience.
We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.
Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast
Dr. Spencer Baron (00:01)
Women's health is finally having its moment. From cycle tracking apps to hormone therapy to wearables promising to optimize every workout, but there's a problem. Most of the science, the algorithms, and even the fitness advice were originally built around the...
male physiology. Today we're joined by exercise physiologist Dr. Abby Smith Ryan, one of the world's leading researchers in female metabolism and performance. To explore what happens when we finally study women's bodies on their own terms and how simple lifestyle strategies may outperform the expensive hacks everyone's chasing, welcome to the show Dr. Abby Smith Ryan.
Abbie Smith-Ryan, PhD (00:46)
Thanks
so much for having me. Excited to be here.
Dr. Spencer Baron (00:50)
That's great. great. We'll hope you still feel that way after our times of question. ⁓
Abbie Smith-Ryan, PhD (00:57)
I did notice
that you both have the doctor in front of your name and then I put my credentials at the end of my name and we could always start with a little healthy debate. I always say I'm the wrong kind of doctor, but I know it's going to be fun. I'm not going to have all the answers, but.
Dr. Spencer Baron (01:11)
No.
Well, no, actually, you know, it's funny is it I've noticed that because we're chiropractors, but we're our specialties in sports. We always have to throw that doctor on the front end to carry some weight there. So I don't know. Well, we'll we'll let we'll let the audience be the judge of how smart we are. Here we go. All right, Abby, let me ask you just to start. You know, for decades, women have been really been told that follow the same training diet and recovery advice that we didn't realize until
Abbie Smith-Ryan, PhD (01:19)
Yep. Yep.
I'm sorry.
Dr. Spencer Baron (01:43)
recently that is for men, by men, and so on. But it's just scaled down. But what does that really mean? Is there one myth about female physiology that you wish would disappear tomorrow? And what would it be?
Abbie Smith-Ryan, PhD (02:00)
Yeah, I I think I love science and the foundation of science and it was largely built on male physiology and I think we can draw a lot from that.
But I also would love us to have a better reckoning that there are key differences between males and females in our physiology. Not everything is different, ⁓ but there are key things that do impact performance, recovery, how we feel mentally, physically, emotionally, and that awareness can be really powerful. That doesn't mean we have to change every approach that we've always done. ⁓ But yeah, I think having those direct conversations about what is different and how might that
change how we approach things is really important. ⁓
Dr. Spencer Baron (02:42)
Are there
any things that really get you going from the start or maybe questions that you've been asked often?
Abbie Smith-Ryan, PhD (02:51)
gosh, so many.
But one of the things that I think is the most clear in the literature, I'll just give you this example. ⁓
we know that the way a man's vessels dilate is very different than a way a woman's vessels dilate. And so what I mean by that is blood flow and vascularity and delivery of nutrients and removal of nutrients. And so as someone, as a physiologist, when we think about vessel dilation and getting blood to certain tissues, and then I also study sports supplements, think about all the supplements that are claimed to increase vasodilation and
vascularity, they will work different for males and females and even recovery, etc. And so that's just a true example of we might need to think about all this foundational work that we've done on the vascular system and how then things like exercise and nutrition impact that not only across the menstrual cycle but then also as women go into peri and postmenopause and those hormones change. And so that's just one example of
key foundational physiology, then that leads to more questions that we really need to understand now that we understand the hormonal influence.
Dr. Spencer Baron (04:09)
Hmm. Go ahead, Terry. I was just gonna make a crack a joke, not a joke, but okay, because...
Abbie Smith-Ryan, PhD (04:15)
I think you should.
Dr Terry (04:17)
Okay, well now you opened the door, right?
Dr. Spencer Baron (04:19)
Yeah, yeah, because I
got to tell you that it wasn't too long last year. was walking into the gym and one of my ⁓ training partners found a box of or an empty box of Viagra in front of the gym. we got I go, what? He goes, look what I found. go, well, he he actually took a picture of it and pick it up. And he and I find out that that's something that bodybuilders do because that it opens up the blood vessels. Now would.
Abbie Smith-Ryan, PhD (04:46)
Mm-hmm.
Dr. Spencer Baron (04:47)
That's not something women would do, I would imagine.
Abbie Smith-Ryan, PhD (04:50)
I mean,
not Viagra, but we could talk a long time about conversations about the women, like women needing something like that that's not available. ⁓ But.
Dr. Spencer Baron (04:58)
something.
Abbie Smith-Ryan, PhD (05:01)
If we look at it slightly different, if you look at anything that increases blood flow, it's still going to increase blood flow for a woman. It might just work slightly different. It might need a higher dose or a lot of times women's vessels are smaller. So things like I think about even bodybuilding, ⁓ like what you might do to increase vasodilation. Well, exercise works better than anything, but then you might add, think about like some alcohol would increase vasodilation, caffeine, maybe some vasodilation to some areas of the body. ⁓
the degree and the impact can be different between men and women.
Dr. Spencer Baron (05:35)
Is that something that is important not just for training, but for anti-aging and longevity to increase dilation of the... Isn't it transient ⁓ if you take a supplement and it only happens for a short time or is that something that someone or a woman would do on a continual basis?
Abbie Smith-Ryan, PhD (05:59)
Yeah, I mean,
it's, I think the other thing we know very well is that one of the key things that happens to women in perimenopause is...
pretty significant changes to cardiovascular health and the cardiovascular system really relying on vasodilation and vascular changes because of the hormonal aspects. So yes, you can't just exercise once and I mean you'll get some acute effects of vasodilation or just you know, take one beetroot supplement. You'll get those acute effects of vasodilation, but it's really that chronic lifestyle that helps with vasodilation and capillaries.
and oxygen delivery, CO2 ⁓ removal, that is a key foundation of why we exercise for, maybe we could discuss this term, longevity, but why we exercise for health and applications of that.
Dr Terry (06:53)
you know, on that note, I have patients come in, women wearing wearables now, right? They have the Apple Watch, the rings, and everything like that. And they're listening to their wearable or they're paying attention to that more than how they feel. And I have women going, I have a sleep score of 92, and my HRV is fantastic, and I like it, how do you feel? She goes, like shit. You know, so, and I feel sleep deprived, but my sleep score
Abbie Smith-Ryan, PhD (07:09)
Mm-hmm.
you
Dr Terry (07:23)
It's great, it must be something else. What's your answer when people, especially women, start talking about wearables?
Abbie Smith-Ryan, PhD (07:32)
I mean, think wearables are a powerful tool, especially. mean, think that is one. Men use wearables too, but I do feel like there's data that women really want that data. They want to understand. There is some empowering. ⁓
kind of element to it. And we use wearables all the time. But what's really interesting, and I'm a quantitative researcher, and wearables are quantitative, but what I continue to see is like performance outcome numbers, wearable numbers, often aren't detecting any changes, let's say with across the menstrual cycle or with hormones, but those qualitative, how do you feel change? And as someone that is very data-driven,
to adapt a bit and say like, it does matter. We have to capture that qualitative how do you feel because that indirectly impacts a lot of things. It might not directly and I always say that of like no matter what we know about the physiology, a woman she can perform at any given point in the cycle and she will perform. However, based on some of those feelings like if she's feeling like shit she's going to show up but then she might need to recover different or we might need to modify her you know her sleep habits
that day or her nutritional intake that day. so wearables are good, but I actually find the opposite. ⁓ It'll say like, I, you know, it'll tell me like I suck. I need to sleep more. When in reality of like you have, like I don't need the negative feedback. I think the positive feedback can be helpful, but I love to use wearables as a way to inform men and women about, okay, well actually what do we need to do? Do we need to look at training or use it as a tool in the toolbox?
Dr Terry (09:14)
So as wearables, is there any style you recommend, the watch versus the rings or stuff like that? Is there anything in your research that you find is better and which one do you feel does one thing better and which one feels like you do another thing better?
Abbie Smith-Ryan, PhD (09:31)
That's a good question. think a couple of the wearables are working really hard to be integrated where it's not just one thing and consistency is going to help with a lot of things. Like what does it show for you? ⁓ I'm going to talk about something, it's not a wearable, but what I think is cool. Like we've used aura and whoop and ⁓ you know, Garmin and Apple and all the things. And it really just depends what you want. And most importantly, what will participants use and wear all the time? And you might use one
for sleep and one for temperature or something like that. But we've actually started using at home urine trackers that were meant for fertility, but use it as a way that we can capture hormones every day of a cycle or two. And let me tell you, it's really empowering to say like, well, no wonder I feel like shit today. My estrogen is low and my progesterone is high. Or no wonder my sleep, I had a hot flash. Especially in that perimenopause,
really variable. The other thing that we're seeing that maybe you guys see is there's this group of women that are very active and they're you know Title IX, they're training all the time and they're late 30s early 40s and it's a mix of hormones and it's a mix of I wouldn't say over training but like training and maybe not getting the most appropriate fuel.
And so hormones are low, and they're getting symptoms of perimenopause, but it actually may be more low energy availability. And these urine hormone trackers can be really helpful of like, OK, there's a reason I'm really tired, or like, I felt really good. So that's not a wearable, but I think tech is really interesting and enhances our ability to translate to people's lives. That doesn't happen in a lab or having a ton of resources.
Dr. Spencer Baron (11:24)
Wait, I gotta ask. This urine track, this is, see, I love this stuff, because nobody knows about this. Nobody should, and people should. So the urine trackers, is this the same thing that my ex-wife used when we were trying to get pregnant? I mean, we have two boys now, but at the time she would go, okay, it's time, we can have sex now. Is this the same thing?
Abbie Smith-Ryan, PhD (11:31)
Oof.
Kind of. Well, so
like it used to like there's still ovulation that usually is like you you an ovulation stick and when you ovulate you're the most fertile and now they have them like they it started in the fertility world. So like you could track for more than just those few days. ⁓ And now though they are tracking more than just estrogen progesterone. A lot of times we're getting LH, FSH ⁓ at home. You I don't have one up here but in the lab it's it's you just like
read a QR code after you pee on it. It's very cool. Yeah.
Dr. Spencer Baron (12:19)
So,
where can we, where can we, I mean, where could they get this? No, no, no. It'll come back saying reject. What are you talking about?
Abbie Smith-Ryan, PhD (12:23)
Yeah, well you could get a two. I actually think you should pee on a stick.
Dr Terry (12:24)
He's gonna be peeing a stick every morning. He does. No he won't. He watches
Barbie. So he'll measure his estrogen and it'll totally work. And we'll probably find out why you're more sensitive than me and we'll balance it out.
Abbie Smith-Ryan, PhD (12:35)
⁓ You do have estrogen, so ⁓
Dr. Spencer Baron (12:38)
That is true.
So it would work if I did it?
You
Abbie Smith-Ryan, PhD (12:51)
That actually would be quite hilarious.
Dr. Spencer Baron (12:51)
was Abbey talk, man. I don't want to hear that.
Abbie Smith-Ryan, PhD (12:54)
You know, maybe we just found the thing that is more supportive for women than men. You guys don't have an at-home urine tracker for testosterone, and maybe we need that.
Dr. Spencer Baron (13:02)
No!
Dr Terry (13:05)
Actually,
that's not bad idea. Tell ⁓ me.
Abbie Smith-Ryan, PhD (13:08)
Bye!
Dr. Spencer Baron (13:08)
be awesome. I would love to know. And you know it's funny because
you know I often tell patients that do you know that especially the females that get you know they get their testosterone, estradiol and all that and progesterone tested I go that's just a snapshot that's not a movie we don't really know. And so what you're saying is...
Abbie Smith-Ryan, PhD (13:21)
Yes. Yeah, which is what we're trying
to do. Yeah, so you can get them over the counter and like we've used, there's a couple different brands. Anita, we've used in the lab. Mira, we've used in the lab.
There's all sorts of them on the market and ⁓ they all have a similar technology. Some of them have different hormones per stick, but it's, I mean, it obviously is a cost, but I agree. Like my hope is that in the future, when someone goes on hormone replacement therapy or is having some hormonal changes, instead of just saying, take it one time, we can allow more of this tracking to understand what's really happening.
Dr Terry (14:05)
I'm going to ask a question. Have you seen any integration between this stick that we're talking about and can you upload that data to your wearable ring so it can actually start correlating the two?
Abbie Smith-Ryan, PhD (14:17)
They're trying, yes. So I think absolutely. I don't see why we're not at this point. ⁓ But over the last, like we've been using them for the last two years and I know there are a few groups that are definitely trying to do that. Yeah.
Dr. Spencer Baron (14:31)
Interesting. Really, this is actually fascinating because I'm immediately going to tell several of my female patients that that would be a great tool to use to identify what you're really feeling versus maybe your R.R. ring or what have you. you know, you actually.
pretty much answered one of my questions regarding energy or the women feel like they're under fueling and then they get all these different, ⁓ you need to add more calories and they're afraid because they're gonna get overweight or what have you. And you hear so many things, especially from the influencers that think they know what they're talking about. So what...
Abbie Smith-Ryan, PhD (15:05)
Mm-hmm.
Dr. Spencer Baron (15:12)
This could be a way to identify the reason why you're not having energy is based more on something objective like your hormone levels, because that could make a huge impact. Now.
Abbie Smith-Ryan, PhD (15:26)
100%. And
I think it's indirect and direct, but absolutely. Like if you have very low hormone estrogen, progesterone, obviously testosterone, we don't have on a stick yet. ⁓ But that absolutely can impact energy.
Dr Terry (15:43)
You know, can I interject something really quick that kind of ties into this? know, for a lot of the lay listeners, the doctors understand, but a lot of the lay listeners will say, women, feel like everything breaks in their 40s and 50s. Can you kind of tie this in and educate the listener what's really happening in this transition? And is it a hormone thing? Is it a training thing? Is it diet? mean, it's kind of tying this in, but I want the average listener who doesn't really
Dr. Spencer Baron (15:43)
So, yeah.
Dr Terry (16:13)
understand this to go, what is really happening so they understand when they pee on a stick what a hormone is telling them.
Abbie Smith-Ryan, PhD (16:19)
Yeah, and I mean, this is a key area of my research is to try and figure out what is happening. And so the first thing I'll say is every woman has different symptoms and it's hard to know what is happening. And really, essentially what's happening is ⁓ you're producing lower amounts of estrogen and progesterone. And ⁓ FSH is often an indicator identifying when someone is in perimenopause. But before
⁓ perimenopause, not most, but cycle. It's cyclical where our hormones are low and they peak for ovulation and then luteal phase becomes much higher, preparing for fertility. And essentially rolling into midlife, ⁓ we no longer have eggs to ovulate. So ovulation goes down, our hormones are low. Well, what happens in perimenopause is it's often up and down, up and down, up and down. It's no longer like a nice cycle.
into post menopause, ⁓ often women feel better because the hormones are more stable. They're less variable. And so why I am kind of not avoiding your question, it's if a woman is in perimenopause, first of all, it's often a slow transition and they don't understand what's happening. so they may, someone may get hot at night. Someone may have brain fog. Someone may be tired. ⁓ I posted this thing and I was like, I'm playing a
fun game as a midlife woman. Am I dying or is it perimenopause? And ⁓ all the women wrote back is like, I play a game. Like, am I pregnant or am I perimenopause? Am I crazy or am I perimenopause? ⁓ And so there's lots of different.
side effects per se, ⁓ and it is driven by hormones, but I think the other piece is the indirect. And so one key takeaway that is consistent in the literature is like there are body composition changes, there are brain changes that tend to stabilize into postmenopause, but you know what is really helpful? Consistent exercise.
fueling yourself, sleep, ⁓ and that's often hard. So then that's where the indirect piece, like if I'm really tired and I don't have any energy, well then am I going to train? And so we need to lower the barrier. It goes back to how we started this session of like, I tell women in this life, just do something, just do something that you can do every day and take care of yourself. And then if we go back to like vasodilation, we are finding that women that exercise consistently,
they're not the ones that are having a lot of hot flashes. Their bodies are used to kind of that cooling and that vasodilation. So that's really what we're trying to also understand is how do you feel better during this life space and like really being powered to take some action.
Dr. Spencer Baron (19:19)
So let me ask you, a lot of my patients that, actually a lot of our patients that are into a healthcare that's void of medication and surgeries and all that, they're turning to nutrition and peptides. Peptides is a big one nowadays. Would that be a good tool, the urine hormone stick, to identify how some of the peptides that do enhance, would you? ⁓
Think that you know in your best guess would that be something that? Could be a good way to monitor changes because some people aren't sure if peptides are working or not or the ones that enhance some of the hormone like growth hormone or what have you
Abbie Smith-Ryan, PhD (20:04)
Yeah, I mean, I think I don't
But for the peptides that I'm aware of, ⁓ I think some better tracking tools would be some simple strength outcomes, like what are some peak strength changes. You're not going to get that in urine hormones, but I think any time you can do some measurements of tracking, it's really helpful. So whether that be, if the goal is to get stronger, ⁓ we'll then do some strength outcomes. If the goal is to lose body fat and increase muscle,
do those measures to see. And I think on the opposite end is true. And that's where I spend a lot of my time is ⁓ understanding those body composition changes and actually measuring it. So like a classic example I have with midlife women is let's say we just finished a big study looking at twice a week, heavy resistance training with creatine or without. And a lot of these women, yeah, and that's a hot topic. A lot of these midlife women ⁓
Dr. Spencer Baron (21:00)
Yeah.
Abbie Smith-Ryan, PhD (21:03)
didn't change a whole lot of weight or gained weight in the six weeks. But when we looked at their body composition, there was some really fascinating body recomposition happening, a decrease in fat and an increase in muscle size and quality, which we never would have known if we only looked at body weight. And so it's just very telling during a time when weight changes across the cycle and into perimenopause.
Dr. Spencer Baron (21:27)
Abby, could you just, would you mind just mentioning, because I get asked the question all the time about creatine, ⁓ a dosage for women? Is there a formula?
Abbie Smith-Ryan, PhD (21:37)
Yes. So
funny. Okay. So I think it's okay. Two things. How I know. And I just want to I don't know if people realize this, but have you seen the creatine sales? It's like projected to be like, it's like triple of what it has been. And
Dr Terry (21:41)
By the way, did you see how he went all excited? did.
Dr. Spencer Baron (21:43)
I actually break out in a sweat. don't know.
What's up with that?
Abbie Smith-Ryan, PhD (21:59)
The
Dr. Spencer Baron (21:59)
Yeah.
Abbie Smith-Ryan, PhD (21:59)
cool thing I don't think people are realizing is it's because it's not just men buying it anymore. It's women and, you know, just active individuals. And so to me, that's a really empowering like if if you give those people education, they will help with the market. ⁓ But from a science side of things like I've been studying creatine since I was in grad school. And yeah, for dosing, what I always tell women is like if you want to short like if you want to know if it's working for you,
⁓ A loading dose is something that will get you there faster and a loading dose is ⁓ five grams four times a day for about five days.
Now, I'm not saying that you do that, but like if someone's like, ⁓ I'm really fatigued. I want to see if it impacts my exercise. I want to see if it impacts anything. A loading dose just gets your muscle saturated more quickly. So in about five days. You also then can see if there's any, I mean, there's not really any side effects. We can come back to that.
The other approach is to do ⁓ five grams a day every day for three to four weeks. And I would start with that to see everyone responds differently. But five grams over three to four weeks would result in a similar muscle saturation to the 20 grams a day. ⁓ But new research also shows that 10 grams a day can help with more of the brain and cognition ⁓ and maybe slightly better effects. But if someone's just
starting, I would start with five grams. If someone's been taking it a while and wants to see, like the theory is that once my muscle is saturated, then it will go to my brain. And we're about to look at some of those dosing differences in women.
Dr Terry (23:48)
So I got a quick question.
Dr. Spencer Baron (23:48)
Okay, wait.
No!
Dr Terry (23:49)
got the people to say if 10 is good, 100 is better.
Abbie Smith-Ryan, PhD (23:54)
Yeah.
Well, so couple of things to think about. You don't want to take it all at one time. But for me, ⁓ for example, like if I, let's say I have to give a talk and I'm traveling across country or like overseas or like whatever, I'll take, you know, 10 to 15 to 20 grams in those days, even though like I take it every day, it gives you that boost. And so there's cool data up to 30 grams in concussion, post concussion. ⁓ So there does seem to be a higher level
needed for brain targets. And there are very minimal side effects. I think the one thing that people don't talk about is you do need to consume more water because it works by pulling water into the muscle. And so one, if you're dehydrated, ⁓ you won't see effects. And then if you're drinking more water and it's pulling more water into the cell and you're having high doses, you're going to hold on to some water weight short term. ⁓ We don't see it as much in women, but again, those are those higher doses.
and we can talk about weight gain, etc. ⁓ But that's yeah, 20 grams ready. Yeah.
Dr. Spencer Baron (24:58)
Okay, ready?
Powder or capsules?
Abbie Smith-Ryan, PhD (25:05)
I thought you were or okay, so totally biased here. I help accompany with gummies. ⁓
And gosh, did you see? So I like the powder, ⁓ plain creatine monohydrate powder for my daily dose. But then I like the gummies as a travel or like I'll grab a couple as like my second dose. So I'll do five grams in a powder, whether it's in my shake or my coffee or whatever. And then in the afternoon, like before I go teach, I might take, you know, a couple gummies, get another five grams or throw them in my bag.
Dr. Spencer Baron (25:13)
I was.
Okay, this wasn't gonna be a question because we don't like to promote anybody on the show, but I do wanna know what company the gummies or the creatine powder comes from. Did you say monohydrate? Creatine monohydrate, is it?
Abbie Smith-Ryan, PhD (25:49)
Creatine monohydrate,
yeah. then what I always say, like, so creatine monohydrate, all types are very bioavailable, absorbable, meaning if I take five grams, I'm going to absorb 4.8 grams. So creatine monohydrate is what I would recommend. And then ⁓ if I have someone that, like, sometimes some people might get some bloating or digestion issues, and it's very rare, but it's usually what they mix it with. ⁓
And then for the gummies, the only thing that I would caution and say is like many companies are making gummies, but not testing them to make sure the creatine is still in there. And the one that I helped does it's NSF certified and they test it to make sure that there's actually creatine in the gummies. well, I don't want to promote and it's not like I make money on it. I'm a scientist.
Dr Terry (26:38)
And the name of it.
Dr. Spencer Baron (26:38)
I gotta ask, give us the name of the company. I'm good with it.
Abbie Smith-Ryan, PhD (26:44)
Yeah, so
Dr. Spencer Baron (26:44)
Terry.
Abbie Smith-Ryan, PhD (26:45)
I helped create gummies. They were like the first gummy on the market.
Dr. Spencer Baron (26:49)
C-R-E and the number eight, create. Oh, create, oh, the real, okay, create. All right, all right, thank you. Wait, I still got more. How about, okay. So five, five grand, that's women, yes, women. What about dudes? Same, same? Okay.
Dr Terry (26:49)
What's it called again?
Abbie Smith-Ryan, PhD (26:51)
C-R-E-A-T-E, create. Yeah. Yeah.
Dr Terry (27:00)
No, you're good.
Abbie Smith-Ryan, PhD (27:09)
Same. So it's the same
creatine, same dose. I think the dosing differences come. And I have this debate a lot of people like, well, should you take it per pound? Like, obviously, I'm assuming you're bigger than me, but maybe not. I got a lot of muscle. ⁓ But what are we talking? We're talking about ⁓ a gram difference? Like, I'm going to see the same benefits.
Dr. Spencer Baron (27:20)
That's what I was.
Abbie Smith-Ryan, PhD (27:35)
There's no point in doing that research because we know it works and the dose is going to be so slightly different. I think that the difference is, ⁓ you know, what's the goal? Are we trying to like saturate it quickly? That dose might needs to go higher. we trying to, we're really trying to understand the impacts on brain that might need to be higher depending on how much muscle, also depending on how much meat you have. So I would still right now make that blanket ⁓ gram dose. There are some gram per kilogram, but it's really not that much
different. We're talking about a couple grams.
Dr Terry (28:06)
I gotta
Dr. Spencer Baron (28:06)
before
Dr Terry (28:07)
ask one thing. Okay, go ahead. Go ahead, sir. Yeah, okay.
Dr. Spencer Baron (28:07)
or after a workout? No, no, it could be a one word answer. Hold on, before or after a workout.
Abbie Smith-Ryan, PhD (28:13)
Most important is that you take it every day.
Dr Terry (28:16)
Okay, what would a person that loves data that looks at their watch or their ring, what can they expect to see when you start adding creatine?
Dr. Spencer Baron (28:16)
Go Terry.
Abbie Smith-Ryan, PhD (28:27)
That's a great question. So a watch is not going to pick it up. ⁓ The effects that you might see are indirect.
So the way I describe creatine is it will help with your training volume. You might be able to do a few more extra reps. You might be a little bit stronger. That's not gonna show up on a watch. However, if you are able to recover faster, that might over time show up with a lower resting heart rate or your recovery heart rate. But again, indirect effects because it's now allowed me to train harder or recover faster. There's some early data we're actually trying to dial into this.
sleep. Some early data that on training days it might be helpful but honestly we just saw some opposite I think.
it allows you to train harder. And so sleep is worse. And we want to look at a couple of days after. like, you know, like that recovery piece. ⁓ The interesting thing that we like might be relatable to your listeners is we're seeing some really cool effects on fluid distribution and like cell integrity. So if you have someone that has a home scale, like a bioelectrical impedance analysis,
⁓ Creatine works by bringing fluid into the cell. And we actually saw this across the menstrual cycle. ⁓ So in the luteal phase, women tend to have more fluid extracellularly. They're like puffy, gain some extra water weight. And creatine supplementation appeared to make it go more intracellularly, which then if you have more water intracellularly, that's also a prime for greater muscle protein synthesis and, you know, nutrients, et cetera. So that fluid change you might be
able to detect on like a home scale depending on how good it is.
Dr Terry (30:10)
What about for injuries?
Dr. Spencer Baron (30:10)
Let's go.
Abbie Smith-Ryan, PhD (30:12)
Yeah, injury data is very interesting. Creatine is not magic, and people talk like it is. But with injury, it's pretty interesting. If you ⁓ supplement with creatine either right after injury or surgery and with PT, there's really cool data that shows that it helps you get back stronger faster compared to not.
Dr. Spencer Baron (30:38)
That is golden. I didn't even think about the injury part of it. I'm only thinking about training, you know, post training repair, you know, but that is fantastic. Yeah.
Abbie Smith-Ryan, PhD (30:39)
Yeah.
Mm-hmm.
When someone in my family has a surgery,
one of the key things I send them is creatine. I send them, you want to know what else I send them? ⁓ Omega-3, if they're not taking it. It helps with inflammation, healing, and then usually some sort of essential amino acid to help with amino acid availability in between meals. Accelerates recovery, repair, protein synthesis.
Dr. Spencer Baron (30:56)
Tell me, tell me.
a combination of essential not one in particular, not any in particular, just the compensate composition. You know, just I'm curious because I did creatine many, probably 20 years ago when it.
Abbie Smith-Ryan, PhD (31:18)
a cloud area.
before I was born. I'm just kidding.
Dr Terry (31:32)
That was awesome! I didn't even know they made Create Team back then.
Dr. Spencer Baron (31:35)
Terry, she is perfect for this show. Did you tell?
yeah, well, yeah.
Abbie Smith-Ryan, PhD (31:51)
I'm done.
Dr. Spencer Baron (31:53)
All right. I have no comeback for that one. ⁓ hell. All right. Back to the. I forgot what I was going to ask. yeah. Yeah, I need I need it bad. ⁓ so. ⁓
Abbie Smith-Ryan, PhD (31:55)
Hahaha! ⁓
No.
Dr Terry (32:05)
He needs creatine for his brain.
Abbie Smith-Ryan, PhD (32:08)
What
do you mean?
Dr. Spencer Baron (32:12)
some time ago when I first started creatine. All right, try it. There was a company ⁓ by a guy named Bill, well, Bill Phillips came out with, Bill Phillips, right? Yeah, yeah.
Abbie Smith-Ryan, PhD (32:13)
Hahaha!
Go Phyllis! Yeah, eight ball nutrition, right? I love eight
ball.
Dr. Spencer Baron (32:26)
So so he when he had bought the company EAS many many years ago There was this whole you know challenge that he came up with but I thought creatine Well, creating was an integral part of it I tried the creating but it had so much sugar sweetener or sugar in it that I became terribly hypoglycemic because I would train and then take it and then and I stopped after a week because I would be miserably tired now I imagine creatine is a little
Abbie Smith-Ryan, PhD (32:31)
Yes.
Mm-hmm. Yep.
Dr. Spencer Baron (32:57)
more advanced now that you know powders don't have as much sugar or sweetener.
Abbie Smith-Ryan, PhD (33:03)
Yeah, I mean, way back then, I'm just kidding, they used to think that you had to take it with sugar.
Dr. Spencer Baron (33:05)
⁓ you got to rub it in.
Abbie Smith-Ryan, PhD (33:15)
could be absorbed to be up. And it does help. Like if you take creatine with some sugar, it actually really helps with ⁓ carbohydrate, like glycogen recompensation. But you don't need the sugar. Like we know it will absorb anyway. So I think that you can take a plain creatine monohydrate now and it's unflavored and it will still work. Now a little bit of sugar can help, but you're right. Like the old products, it was mixed in a lot of sugar or mixed with a lot of things. ⁓
Dr. Spencer Baron (33:15)
⁓ yeah.
Yeah.
Abbie Smith-Ryan, PhD (33:44)
Some people, it goes back to your question about before or after exercise. I once did a study and we were looking at a pre-workout and it had creatine in it and we'd have to get them to take it and then get a bathroom break before they did their intervals on the treadmill. And it wasn't just from the creatine, but if you mix a bunch of stuff before you go train, so you know, if you're sensitive that way, otherwise like post exercise, I always say is a good time to take things because your muscle is like a sponge. You've just rung it out.
Dr. Spencer Baron (34:05)
Mm.
Abbie Smith-Ryan, PhD (34:14)
and if you add things like sugar and creatine and amino acids it's just going to get there faster but you you don't have to take it then.
Dr Terry (34:24)
If you're going to take it daily, is there a time of day that just for the average person is better morning, noon, or night if you're just trying to do that stacking thing?
Dr. Spencer Baron (34:24)
I have...
Abbie Smith-Ryan, PhD (34:34)
Yeah, so I would say ⁓ just pick a day that you can do, pick a time that you can do it every day. I like to do mine in the morning. I do think I see like a bit of a brain effect. And so I like to either do mine in the morning or in that like afternoon slump.
Dr. Spencer Baron (34:50)
I'm so going to do that. I know I'm glad I clarified that because I had this fear that it was still made the same way. Because back then when I would crank up that Model T Ford, you know, I would get a pump in my arm. All right, never mind.
Abbie Smith-Ryan, PhD (35:00)
Yeah.
You're probably
Dr Terry (35:05)
in my way.
Abbie Smith-Ryan, PhD (35:06)
taking NO explode too at the same time or you could talk about peptides. I'm sure you were taking peptides then, huh?
Dr. Spencer Baron (35:11)
yeah.
yeah, sure. Back then it was all
out, man. You could go into a pharmacy. No lie. We did bodybuilding back then. In South Florida, where I'm from, where I'm here, we could go into a pharmacy in, it was Miramar Pharmacy. You could ask for a testosterone or any kind of steroid and they would give it to you over the counter. It was shocking. That's how long ago this was. Yeah.
Abbie Smith-Ryan, PhD (35:36)
That's crazy. Yep, exactly. ⁓
Dr. Spencer Baron (35:41)
Terry quick, ask a question so I can recover. While I can recover. I'm sweating.
Abbie Smith-Ryan, PhD (35:44)
I made you blustered! Look at that!
Dr Terry (35:48)
Yo Abby, I
hope you're going to clear your schedule because I'm gonna have you on once a month just for that.
Dr. Spencer Baron (35:55)
Yeah,
yeah. We call it cracking backs comedy central. That's what it'd be. ⁓ man. ⁓ yeah. I'm having a hot flash. Sorry.
Abbie Smith-Ryan, PhD (35:58)
I got more. I got more. can keep going. Hot Flash! I know! You could
Dr Terry (36:06)
All right, yeah.
Abbie Smith-Ryan, PhD (36:11)
see it happening.
Dr Terry (36:11)
All right, and thank you for really diving into the creatine, because that's such a hot topic right now. But the other hot topic is hormone replacement therapy. And some of that stuff is so expensive. And some of our patients listening going, you know, is this something I need to take? Do I put the patch on? Do I do the pellets? Do I do that?
Dr. Spencer Baron (36:16)
Yeah, big time.
Dr Terry (36:35)
then it's expensive. So what are some things that, like three highest impact habits that you can do when you start in that perimenopause stuff, or you just, and then I have other people going, I'm just gonna let nature take its course. So what are some of your advice? ⁓
Abbie Smith-Ryan, PhD (36:53)
Yeah, it's a really good question. And I am not a hormone replacement expert. ⁓ do like a lot of our work is really focused on one, what if you don't want to take it and or can't take it? Some women, you know, it puts them at greater risk. And more importantly, too, of like even if you're taking or provided with hormone therapy, you still need these lifestyle changes to ⁓ and lifestyle habits to be really healthy and have an impact. And so I
will also reframe this. There's nothing that you need to take. Hormone therapy is often ⁓ prescribed to treat symptoms. So I would say if someone is really struggling with symptoms, that would be something to advocate for. And so like I know a lot of women with really bad joint pain or you know mood disorders or ⁓ you know they can't sleep at night or really fatigued. It's like those like let's leave space like a provider really should help you.
And
a lot of providers don't know how. And so it's very dismissive. And same thing, ⁓ insurance doesn't often cover it. But if you find a provider, it's managing symptoms. So that's one thing. Now, if we look at some of the other things that hormone therapy is being touted for, it's not going to give you massive amounts of muscle. It's not going to make you lose a bunch of fat. It may make you feel better, and then your workouts are better.
Dr. Spencer Baron (37:58)
you
Abbie Smith-Ryan, PhD (38:23)
the energy to do your workouts. ⁓ But you know, this is has not been studied yet. ⁓ I have a feeling that as we see this hormone therapy increase and then you have all these active women, you have like a different group of women going into perimenopause. They've been active their whole lives because of Title IX and then they crank up their training. We're going to see there's differences in how the muscle and tendons adapt and so will we see greater musculoskeletal injury maybe?
And so like I think there's a lot we need to know on the back end and and so what advice I would give is one if you have symptoms Definitely get a provider that can help you It's very dismissive and very hard to find someone that can help you on the reverse. It goes back to consistency And I'll give you two two thoughts here like I hear from a lot of women that are like I've been doing the same thing as always and I'm training hard, but I'm gaining belly fat And so in those scenarios, I always say like that's that's exercise metabolism
for you, we train to become really efficient. So go do something you're not used to or add some intervals. If you run all the time, go swim. ⁓ know, obviously lifting weights, you can do more progressive or do some more power training, kind of switch it up so that your mitochondria are being kind of targeted, et cetera. And then from the nutrition side, it's also about consistency. And the one thing too, I see two things. Women are under fueling because they're trying to lose
fat, so therefore they're not eating and that's not causing, that's causing more fat gain over time. Or they're avoiding certain food groups like carbohydrates or fiber or some of those things. And so like another thing that's pretty rooted in science is kind of modify your carb to protein ratio. So one and a half to one carb to protein ratio per meal and per day. So what that would look like is maybe I'm getting, you know, 50 grams of carbohydrate and I'm getting 35 grams of protein and then add in a vegetable
or a fruit, some sort of fiber, really important. And do that a couple times a day, like kind of keep it simple, keep it fueled, and keep it consistent. It's going to be really the most helpful things. And then another really, I think, thing that impacts the whole body. I'm not a sleep researcher, but so much data on sleep and sleep habits going into bed. And then the other thing, women wake up, like I always joke, I have like 25 squirrels in my brain, and once they're up, they're ready to go. And so like even
those sleep habits can have a pretty big indirect effect on body composition and microbiome and all of those things. ⁓ to sum that very long response up is take care of yourself and find like consistent habits to do and if it's not working then do something slightly different that your body's not used to.
Dr Terry (41:12)
So on that note, have people, libido is a big topic, especially when it comes to paramodipalism and all that. So a lot of women.
Abbie Smith-Ryan, PhD (41:20)
Yeah, how did I forget
that important symptom? Maybe because we talked about that.
Dr Terry (41:23)
I have no idea. You got stuck
in the black and white movie from my partner. ⁓ Where the couple slept in separate beds on TV. and libido. You have research, you're exercise scientist that says exercise, maybe even creatine, strength training can increase libido and then women being driven into taking all this hormone replacement can eff their body up.
Abbie Smith-Ryan, PhD (41:29)
Yes. Yes.
Yeah.
Dr Terry (41:53)
the research to compare the two of what works better if they just get into a strength exercise lifestyle program versus going the hormone replacement?
Abbie Smith-Ryan, PhD (42:03)
I don't think head to head, but if we just think about this. So libido is one of those first symptoms ⁓ that women complain about and that is treated, people will treat that. But you're right, if you think about all exercise, exercise is the best way to cause vasodilation and that's blood flow to your muscle or your sexual organs. It's very healthy and that's a key part. So blood flow is one thing. The other thing is,
every muscle like if you think about a valsalva maneuver a valsalva maneuver that you do for a squat or a deadlift that's making your vaginal wall stronger and it's going to have that experience be better and so but it's those things that aren't necessarily like again
How are gonna research that and is it worth the funding and et cetera? So like I'm not sure there will ever be a head to head because no one cares about women's sexual health enough. I think yes, like an active lifestyle, like your sexual organs are a muscle and they need to be moved and it's not just, you like you can do that in the gym. It's all supportive muscles. And then another key thing is hydration.
All these principles of active lifestyle have a direct impact on libido and sleep, which sleep impacts libido, et cetera. So absolutely. Now, there's no head-to-head and I don't study that, but I'll have to go look.
Dr. Spencer Baron (43:31)
Okay, so strength training, just to be specific, because women often complain or comment on they don't want to look pumped up, or they don't want to get big muscles or anything, but when you say strength training, do you have a suggestion?
Abbie Smith-Ryan, PhD (43:43)
Mm-hmm.
Yeah, I mean, I've been trying forever to get pumped up, so it doesn't work. And so.
Women are never going to naturally gain a lot of muscle. they have, you know, even if you take testosterone, it's not going to have massive body composition changes. It's just to get you to normal. So when I say strength training, I really, it's really a stimulus above normal, some sort of push-pull, most muscle groups. ⁓ Now, if someone like one approach, I'll just use an example. If we're trying to have pretty important effects in a short period of time,
⁓ We will often use progressive resistance training and what that means is that you are adding in weight as you get stronger and you are pushing the intensity a little bit. ⁓ And most women, like right now, and I'm sure you talked with Stacey about this, a lot of people right now are saying, you need to lift heavy weights and do a lot of jumping.
Like, yes, that's true if you've been jumping and already lifting, that's great, but that's not the only way you can do it. Like, what you need to do is stimulate the muscle with ⁓ a load that you're not used to. So if you've never done anything... ⁓
stimulate the load or the muscle with some resistance bands and as that gets easier add load. And then the opposite true is like you don't necessarily have to lift heavy. If you're not going to lift heavy then you need to do more repetition so that your time under tension is there so that you're really ⁓ basically building up and breaking down the muscle is really what you want and you can get there in a few different ways.
Dr. Spencer Baron (45:27)
That was great. I was always curious about repetitions, but you made a good point in saying it, know, just progress from where you're at now and then move into a heavier or more or greater resistance.
I was just, I think even Stacey had mentioned something like, know, even bring it down to four repetitions after you've done enough of a warmup, which most women wouldn't imagine that would be a thing. But hey, strength training is probably one of the, the, the best researched items for, or activities for longevity that there is. It's indisputable.
Abbie Smith-Ryan, PhD (46:01)
Well, longevity,
and when you say longevity, think the organ of longevity is muscle.
And the way we know that stimulates muscle is resistance training. And that doesn't have to have a lot of rules. Now the rules come around preventing injury. And then a lot of my research is around like timing. How much time in the day you have? I don't have two hours to train. I need to be in and be out and make it work for me. And so like that's where some of the heavy shorter like it's it's how do we match lifestyles? Depending, you know, when I was younger versus I'm
sure at your age you have lots of time to train.
Dr. Spencer Baron (46:41)
You know, I almost brought it up before you said it. But.
Abbie Smith-Ryan, PhD (46:42)
you
Dr. Spencer Baron (46:47)
Back in the day, the old guys would come up to me when I was a 20 year old and say, how long do you train in the gym? They would measure your intensity by the amount of time. I'd go, oh, about an hour. And they go, oh, that's not training. What? They would spend two or three hours. And I would look at my dad, and my dad says, that's because they talk most of the time. So I'm in. Yeah.
Abbie Smith-Ryan, PhD (46:59)
Yes.
Yes.
Yes, yes. They have time. They chit chat. yeah.
Dr. Spencer Baron (47:15)
No, I'm in for a half an hour. Hello. And I get a good workout. ⁓ I'm teasing. That's fine. But the
Abbie Smith-Ryan, PhD (47:17)
Okay, okay. You're not that old. I'm just kidding.
Dr. Spencer Baron (47:23)
the other the other thought was ⁓ so strength training. No, I appreciate that. But if you're a runner and you like doing endurance now, you started to mention or you did mention something about more, ⁓ you know, cardio, cardiovascular. Do you have any suggestions in that area?
Abbie Smith-Ryan, PhD (47:40)
Yeah, so even now the message to a lot of people is, well, endurance exercise makes you fat, or don't do that, you need to lift. ⁓
Which is not true. ⁓ It's really like, what are you spending your time doing? If you want to be really good aerobically, like you need to do aerobic exercise, ⁓ you absolutely do need to include strength training. It's just different goals. And so like I was a collegiate runner. I love to lift weights and even as a runner I did, but I'm not going to go lift for repetitions. I'm going to make my resistance training more injury prevention and slightly higher repetitions to help with that. And I will overemphasize
like the importance of aerobic exercise as we age, particularly for women, because of the cardiovascular changes that we see, we know that aerobic exercise is a huge stimulator for cardiovascular disease risk that you don't necessarily get with resistance training. You get some of it, ⁓ but the only way to get some of the mitochondrial and vascular changes ⁓ is from aerobic exercise. I just, if you want to run, ⁓ one thing would
be integrate some intensity. some, lot of my work is around high intensity interval training. Not that you, you shouldn't be able to do that every day, but instead of walking for two hours, maybe what you do is take 20 minutes and do an interval style workout.
or instead of running for eight miles, again, maybe it's more of a fart lick or you're adding some of that intensity in there. And some of it as we age, just the repetitive nature, people don't often talk about the negative sides of exercise. Like as a runner, likely gonna have to have some joint replaced, but as I age, I do it smarter. I don't need to, depending on what you're training for, if you are doing a long volume, then make sure those muscles around those knees and hips are also supporting those joints to prevent
of that. So it really is dependent. But yes, we need aerobic exercise and we need resistance training.
Dr. Spencer Baron (49:41)
familiar with there was a conversation some time ago about the you know over 50 if you can run a mile in 10 minutes you're in a you're you're fit but if you can run it in nine minutes you're fitter and if you can run a mile in eight minutes you're at the fittest level over age 50 have you heard anything about that I've been using that as a guide no okay
Abbie Smith-Ryan, PhD (50:04)
Hmm. I have it. I
have it, but I'll have to look. Like, I mean, what it is indirectly assessing is VO2 max.
And VO2 max or maximal oxygen consumption is directly related to mortality and fitness. so like we measure that in the lab. I don't know about the mile piece, but it would make sense. Like if you can run a mile faster, your aerobic capacity is better, which then means that your heart is getting more oxygen to and from your muscles. So indirectly, it makes sense, but I have not seen that data.
Dr. Spencer Baron (50:44)
Something I heard. and by the way, you started to, you mentioned Valsalva's for those who don't know that, you that that's a, you know, you hold your breath, bear down squat and so on, which is really something that we do all the time when we were going to lift something. you know, it was interesting because you mentioned also about pelvic floor and that is why one of the most neglected ⁓ muscles that nobody thinks about. actually we had two, we had two guests in the past that were physical therapists
Abbie Smith-Ryan, PhD (50:50)
Yes.
Mm-hmm.
huh.
Dr. Spencer Baron (51:14)
and so on that specialized in pelvic floor. One of them was called the buff muff. How great is that?
Abbie Smith-Ryan, PhD (51:20)
That is amazing. I'm gonna go look her up.
Dr. Spencer Baron (51:25)
But again, for libido or sexual enhancement to have that kind of strength down there, it's obviously an important feature. ⁓ So with that said, because we're talking about, obviously, ⁓ my generation, baby boomers, I almost said our generation, and I know you would have corrected me real quick.
Abbie Smith-Ryan, PhD (51:36)
100%.
Dr. Spencer Baron (51:52)
But the baby boomer generation is the one that's really, you know, fueling that anti-aging longevity thing. So could you share what you would, how you feel about the youth, know, girls in childhood and what they should know now for their future? Because obviously, you know, they're on their phones and they're not doing as much as they used to. So I would love for you to expound.
Abbie Smith-Ryan, PhD (52:00)
Yeah.
Yeah, so I work more with like college age women, but ⁓ a key thing that does come up all the time is a little funny joke that you maybe have seen is most of the women going through perimenopause are dealing with daughters getting their first periods. It's like these hormonal ⁓ upheavals in...
I say that jokingly, but I do think we're now in a generation. I came through a generation where no one talked about any of that. And it was a badge of honor not to have a period. And flipping that conversation of teaching young girls and boys, to be honest, of what does it mean when you start bleeding, and what does that signify, and how does that impact your body? think having those conversations are really important and preparing them for that. ⁓
I don't know. There's this New York Times article that just came out and there's lots of conversation about like why are so many girls getting ACL injuries and it's Yeah, and it was a great article, but it's not ⁓ It's not because of their hormones like girls don't need to be afraid of that But they don't have the resources they're not getting resistance training and strength and conditioning as early as boys and they're now training the volume and the opportunity is higher so
Dr. Spencer Baron (53:21)
I saw it. Yes. Yes.
Abbie Smith-Ryan, PhD (53:42)
⁓
It's like one of those things like I want every young girl to be able to advocate for themselves and to say like, you know, like be able to openly ask of like, I'm having you might know this but more than 75 % of women and girls have menstrual pain when they're like they have we call it dysmenorrhea and most girls just like grit and go through it when in reality like some of those things can impact how you train or how you sleep or like so like my goal
is that these girls and with help of moms and dads that we can have those conversations so that you know it's an indirect effect on injury.
Dr. Spencer Baron (54:21)
that's great. By the way, I can't believe you brought up that article. How good was that article? As I went through it, I said, gosh, I would love to interview, have the woman, the physical therapist on our call. And then when you read down a little bit further, lo and behold, Dr. Terry is friends with Dr. Mendelbaum, the orthopedic surgeon that they work together. So we will have her on our show. I can't wait, right?
Abbie Smith-Ryan, PhD (54:25)
This is a very good idea.
Mm-hmm.
⁓ that's amazing. I love that. Yeah, and I think it's
Bringing those worlds together because like I think from currently it's been like we actually have some of the best ACL researchers here at UNC and you know we're looking at all the mechanics and early on like a couple years ago they not even they never even thought to ask about menstrual cycle or previous training history or like and it's part of like as a researcher we always learn more but it's bringing all these fields together to say okay what do you know from your field what do you know what do we need to be doing differently for these girls yes their cue angle is
So how do we train that to stabilize that based on strength and conditioning that no young girl is getting?
Dr. Spencer Baron (55:25)
Something that's very important to that whole schematic there, and then Dr. Terry can also relate to it, is that I too am seeing many more females with ACL tears. And then simultaneously, there's research out there that actually discusses about antibiotics and NSAIDs, how much of an effect they have on weakening ligaments and tendons. So.
Abbie Smith-Ryan, PhD (55:45)
Mm-hmm.
Hmm. That's really fascinating.
never, I don't, I mean, I generally knew that, but I wonder if that's also related to ⁓ symptoms. Like so many women are dealing with painful periods and symptoms and, you know, using NSAIDs to treat that. So I want, know, like there could be a number of angles to look at. Interesting.
Dr. Spencer Baron (56:04)
Yeah, yeah.
Yeah, the work is out there. I think it's fascinating and I think it's about time, but in the article they also mentioned how women's sports is becoming a ⁓ huge endeavor, soccer, volleyball, hockey, and that's where I'm seeing some of these ACL tears. ⁓ Of course.
Abbie Smith-Ryan, PhD (56:26)
Mm-hmm. Mm-hmm.
Can I make one mention of that? I know you work with some pro
sports and I've had an opportunity to work with the US soccer and it's really cool what they're doing. So Emma Hayes is the head coach and she takes everything from what she calls like a her lens of like everything is female forward and then how do you then bring that down to the younger players? It's very cool and just shows like how it can come from the top down and start to change things.
Dr. Spencer Baron (56:39)
Mm-hmm.
Terry, I'm gonna, I think we're ready. Okay, okay, okay.
Dr Terry (57:04)
Hold on, getting close, but I do want to ask one thing to close.
We've been talking about your research, your published stuff. What's the one thing that you hope women, you kind of touched on, but I want you to kind of finish this before we go to the next section, that you hope women actually feel or believe differently about their bodies because of the research you've done?
Abbie Smith-Ryan, PhD (57:26)
Well, that's a great question. ⁓ I mean, my hope is that we can teach women about their bodies to be empowered. I think now
perimenopause and aging and menstrual cycle. I wouldn't say it's scary, but no one has taught us what it means and how to use it. Like estrogen is such a powerful hormone when we're younger, it can make us stronger, recover better instead of being afraid of it. And then into perimenopause, some of the trouble comes from, it takes a long time for women to realize what's happening. Instead, they feel terrible. They think it's just them. So it's saying like, here's what it means. Here's what your body's doing. Here's how we modify.
in a way that you want to and it's not under eating and you know over exercising because that makes things worse so really giving women the data to be able to implement it in their day-to-day that's feasible while they're raising a family have careers and still trying to take care of themselves.
Dr. Spencer Baron (58:26)
Ready for rapid fire, Terry? All right, Abby, I got five questions for you. We look for a short answer so we can get through all five of them. Notice I'm sitting up in my chair because I'm bracing myself for some of your answers. Are you ready for question number one?
Dr Terry (58:27)
Always, always, always.
Abbie Smith-Ryan, PhD (58:28)
okay.
Okay,
Let's
go, I'll try and be succinct.
Dr. Spencer Baron (58:48)
If your grad student secretly followed you around for a week, sleep, workouts, food choices, what's something they'd see that would make them say, wait, our professor does that too?
Abbie Smith-Ryan, PhD (59:04)
⁓ gosh.
Dr. Spencer Baron (59:06)
Hahaha!
Dr Terry (59:10)
This is Spencer's payback, by the way.
Dr. Spencer Baron (59:12)
⁓ yeah baby,
Abbie Smith-Ryan, PhD (59:13)
Well,
my grad students already know. So they already know. ⁓ Okay, here's what. Okay, they already know everything about me. Here's one that will go off. I listen to very loud rap music with a lot of bass and with tinted windows so no one can see. I love a good jam session in my vehicle.
Dr. Spencer Baron (59:14)
yeah.
Abbie Smith-Ryan, PhD (59:40)
with probably inappropriate music for a white professor.
Dr Terry (59:47)
You
Dr. Spencer Baron (59:48)
You feel my pain. When I was at Miami Dolphins, they would play that music and I would say to some of the players, go, I love this song, but I can't sing the words because the N word is in it and every other word.
Abbie Smith-Ryan, PhD (1:00:02)
Yeah, when
I was younger I had a subwoofer in my car. ⁓ There you go.
Dr. Spencer Baron (1:00:10)
You're really a bro
below that white skin, huh? What's up, Abby? All right, wow. Question number two. Man, we could go into that one. All right, that is great. right. Okay, Abby, question number two. Your bio lists lots of titles, and they're very impressive. Professor, researcher, lab director. But one of the ones that you highlight most is mom.
Abbie Smith-Ryan, PhD (1:00:19)
you
you
Dr. Spencer Baron (1:00:38)
Be honest, has motherhood ever completely humbled you, your exercise physiology expertise?
Abbie Smith-Ryan, PhD (1:00:46)
I mean, every day, not from an exercise perspective. I actually think pregnancy and delivery is the most athletic event you'll ever do. And you should train for it. And I loved it. Like I squatted out my babies and I squatted right up to it. then, but I think the humbling part is you have no fucking idea what you're doing. Like, ⁓ and especially from like a nutrition exercise space.
Dr. Spencer Baron (1:00:47)
Yeah.
Yeah.
Abbie Smith-Ryan, PhD (1:01:14)
Yeah, you don't want to push them too hard, but you want them to love it. So yeah, it's all very humbling and I have no idea what I'm doing. But I love my kids.
Dr. Spencer Baron (1:01:26)
⁓ obviously. Yeah. No, no, that's great. And it's
Dr Terry (1:01:27)
That's the most honest
answer I've probably ever heard.
Dr. Spencer Baron (1:01:31)
No, but you know what? She just
created a complete paradigm shift on the concept of labor and delivery. An athletic event. How freaking cool is that?
Dr Terry (1:01:41)
Right.
Abbie Smith-Ryan, PhD (1:01:42)
It is literally
Dr Terry (1:01:42)
Right.
Abbie Smith-Ryan, PhD (1:01:43)
like the human body is so cool. Like think about, ⁓ yeah, was amazing. And then even postpartum of like nutrient timing. Yeah, it's amazing. Yeah.
Dr. Spencer Baron (1:01:53)
no, that's brilliant, brilliant. Okay, so let's see. Question number three. Was there ever a moment in your lab when a student asked a question that was so good it made you stop and think, wow, this next generation might actually be smarter than us?
Abbie Smith-Ryan, PhD (1:02:11)
What my honest answer? ⁓ My honest answer is the opposite. It's like, shit, these people are going to take care of me. ⁓ I just don't think they have the resilience yet. I feel like we're still on COVID. They don't have critical thinking, not all of them. They just, we're still teaching them how to do hard things and be resilient and think critically.
Dr. Spencer Baron (1:02:13)
Yeah, I have a feeling of I agree with all agree with you.
yeah, now I have interns that circulate in our office and I ask the same questions. I got you. ⁓ Although there was something, No, I actually also have some brilliant ones. Question number four. ⁓
Abbie Smith-Ryan, PhD (1:02:46)
Yeah. We're going to get them there, and I'm not giving up on them. And we've got some good ones, but yeah.
Yes.
Dr. Spencer Baron (1:03:01)
I was actually gonna add a question and ask you if you were given a rapper's name, what would it be? But that's not, I'll give you time to think about that. Cause at Miami Dolphins, they used to call me Doc Speezy. I go, like that Doc Speezy. That was my rapper name.
Abbie Smith-Ryan, PhD (1:03:16)
I do like that.
Dr Terry (1:03:19)
god, we're gonna have Lord Baron
Abbie Smith-Ryan, PhD (1:03:19)
⁓ for a long time.
Dr Terry (1:03:22)
Doc C.V. now.
Dr. Spencer Baron (1:03:24)
Yeah.
Abbie Smith-Ryan, PhD (1:03:25)
I love that.
For a long time, my lab group called me Honey Badger. It's not really a lab name, or not really a rapper's name. yeah. Right. So there you go.
Dr Terry (1:03:34)
Is that a rap? That could be.
Dr. Spencer Baron (1:03:36)
Well, honey badgers are badasses, so that may be the reason.
Dr Terry (1:03:39)
Yeah.
Dr. Spencer Baron (1:03:41)
Don't
mess with the honey badger. All right, the real question number four. If the 18-year-old version of you could see your life today, what do you think would surprise her the most?
Abbie Smith-Ryan, PhD (1:03:56)
That's such a good question. ⁓ This is a terrible answer. As someone that I don't think that far ahead, like every day is like I'm just gonna squeeze the most out of it. And so I think my 18 year old self would be like, you're just still doing it. You're just still, yeah. I have to think about that one.
That's what I got. That's a lame answer, but yeah.
Dr. Spencer Baron (1:04:23)
you? No, not at all. Never a lame
answer. You ready for question number five? All right. Question number five. Abby, what do you want to be remembered for?
Abbie Smith-Ryan, PhD (1:04:29)
I'm ready. It has to be better than the last one.
That's a great question. I thought a lot about that, especially ⁓ my mother recently passed away unexpectedly, and it's given me a lot of thought of like I want...
I don't necessarily want to be remembered. I want to have a legacy based on the people that I've trained and the science that I've produced and the facts that I've given people to empower themselves. So I want to really be more known for how I made people feel and for the contributions to the knowledge that I've given.
Dr. Spencer Baron (1:05:16)
doing it and I want to thank you for being on the show. I would also love to know who your favorite rapper is Rick Ross, Pop Smoke, 6ix9ine, what do we got?
Abbie Smith-Ryan, PhD (1:05:23)
Okay, all right
funny that you say that I once won a big award I think it's like one of I had to pick a walk-up song and Do you know what my walk-up song was? Yeah, it was Rick Ross hustlin like literally like like that is life every day I'm hustlin and that is yeah pretty much sums it up So the funny that you brought up Rick Ross, I don't know if he's my favorite, but that's a good one
Dr. Spencer Baron (1:05:34)
I got it here.
Love it, I love it.
Purple Lamborghini, purple Lamborghini,
Dr Terry (1:05:51)
you
Dr. Spencer Baron (1:05:53)
come on. All right, we're gonna start emailing each other. Hey, have you heard this song? All right, all right, this is great, this is great. ⁓ Thank you so much for being on the show and you gave us some tremendous, tremendous information. Thank you.
Abbie Smith-Ryan, PhD (1:06:06)
Yeah, thanks so much. It's been great. Really appreciate it.
Women's health is finally having its moment. From cycle tracking apps to hormone therapy to wearables promising to optimize every workout, but there's a problem. Most of the science, the algorithms, and even the fitness advice were originally built around the...
male physiology. Today we're joined by exercise physiologist Dr. Abby Smith Ryan, one of the world's leading researchers in female metabolism and performance. To explore what happens when we finally study women's bodies on their own terms and how simple lifestyle strategies may outperform the expensive hacks everyone's chasing, welcome to the show Dr. Abby Smith Ryan.
Abbie Smith-Ryan, PhD (00:46)
Thanks
so much for having me. Excited to be here.
Dr. Spencer Baron (00:50)
That's great. great. We'll hope you still feel that way after our times of question. ⁓
Abbie Smith-Ryan, PhD (00:57)
I did notice
that you both have the doctor in front of your name and then I put my credentials at the end of my name and we could always start with a little healthy debate. I always say I'm the wrong kind of doctor, but I know it's going to be fun. I'm not going to have all the answers, but.
Dr. Spencer Baron (01:11)
No.
Well, no, actually, you know, it's funny is it I've noticed that because we're chiropractors, but we're our specialties in sports. We always have to throw that doctor on the front end to carry some weight there. So I don't know. Well, we'll we'll let we'll let the audience be the judge of how smart we are. Here we go. All right, Abby, let me ask you just to start. You know, for decades, women have been really been told that follow the same training diet and recovery advice that we didn't realize until
Abbie Smith-Ryan, PhD (01:19)
Yep. Yep.
I'm sorry.
Dr. Spencer Baron (01:43)
recently that is for men, by men, and so on. But it's just scaled down. But what does that really mean? Is there one myth about female physiology that you wish would disappear tomorrow? And what would it be?
Abbie Smith-Ryan, PhD (02:00)
Yeah, I I think I love science and the foundation of science and it was largely built on male physiology and I think we can draw a lot from that.
But I also would love us to have a better reckoning that there are key differences between males and females in our physiology. Not everything is different, ⁓ but there are key things that do impact performance, recovery, how we feel mentally, physically, emotionally, and that awareness can be really powerful. That doesn't mean we have to change every approach that we've always done. ⁓ But yeah, I think having those direct conversations about what is different and how might that
change how we approach things is really important. ⁓
Dr. Spencer Baron (02:42)
Are there
any things that really get you going from the start or maybe questions that you've been asked often?
Abbie Smith-Ryan, PhD (02:51)
gosh, so many.
But one of the things that I think is the most clear in the literature, I'll just give you this example. ⁓
we know that the way a man's vessels dilate is very different than a way a woman's vessels dilate. And so what I mean by that is blood flow and vascularity and delivery of nutrients and removal of nutrients. And so as someone, as a physiologist, when we think about vessel dilation and getting blood to certain tissues, and then I also study sports supplements, think about all the supplements that are claimed to increase vasodilation and
vascularity, they will work different for males and females and even recovery, etc. And so that's just a true example of we might need to think about all this foundational work that we've done on the vascular system and how then things like exercise and nutrition impact that not only across the menstrual cycle but then also as women go into peri and postmenopause and those hormones change. And so that's just one example of
key foundational physiology, then that leads to more questions that we really need to understand now that we understand the hormonal influence.
Dr. Spencer Baron (04:09)
Hmm. Go ahead, Terry. I was just gonna make a crack a joke, not a joke, but okay, because...
Abbie Smith-Ryan, PhD (04:15)
I think you should.
Dr Terry (04:17)
Okay, well now you opened the door, right?
Dr. Spencer Baron (04:19)
Yeah, yeah, because I
got to tell you that it wasn't too long last year. was walking into the gym and one of my ⁓ training partners found a box of or an empty box of Viagra in front of the gym. we got I go, what? He goes, look what I found. go, well, he he actually took a picture of it and pick it up. And he and I find out that that's something that bodybuilders do because that it opens up the blood vessels. Now would.
Abbie Smith-Ryan, PhD (04:46)
Mm-hmm.
Dr. Spencer Baron (04:47)
That's not something women would do, I would imagine.
Abbie Smith-Ryan, PhD (04:50)
I mean,
not Viagra, but we could talk a long time about conversations about the women, like women needing something like that that's not available. ⁓ But.
Dr. Spencer Baron (04:58)
something.
Abbie Smith-Ryan, PhD (05:01)
If we look at it slightly different, if you look at anything that increases blood flow, it's still going to increase blood flow for a woman. It might just work slightly different. It might need a higher dose or a lot of times women's vessels are smaller. So things like I think about even bodybuilding, ⁓ like what you might do to increase vasodilation. Well, exercise works better than anything, but then you might add, think about like some alcohol would increase vasodilation, caffeine, maybe some vasodilation to some areas of the body. ⁓
the degree and the impact can be different between men and women.
Dr. Spencer Baron (05:35)
Is that something that is important not just for training, but for anti-aging and longevity to increase dilation of the... Isn't it transient ⁓ if you take a supplement and it only happens for a short time or is that something that someone or a woman would do on a continual basis?
Abbie Smith-Ryan, PhD (05:59)
Yeah, I mean,
it's, I think the other thing we know very well is that one of the key things that happens to women in perimenopause is...
pretty significant changes to cardiovascular health and the cardiovascular system really relying on vasodilation and vascular changes because of the hormonal aspects. So yes, you can't just exercise once and I mean you'll get some acute effects of vasodilation or just you know, take one beetroot supplement. You'll get those acute effects of vasodilation, but it's really that chronic lifestyle that helps with vasodilation and capillaries.
and oxygen delivery, CO2 ⁓ removal, that is a key foundation of why we exercise for, maybe we could discuss this term, longevity, but why we exercise for health and applications of that.
Dr Terry (06:53)
you know, on that note, I have patients come in, women wearing wearables now, right? They have the Apple Watch, the rings, and everything like that. And they're listening to their wearable or they're paying attention to that more than how they feel. And I have women going, I have a sleep score of 92, and my HRV is fantastic, and I like it, how do you feel? She goes, like shit. You know, so, and I feel sleep deprived, but my sleep score
Abbie Smith-Ryan, PhD (07:09)
Mm-hmm.
you
Dr Terry (07:23)
It's great, it must be something else. What's your answer when people, especially women, start talking about wearables?
Abbie Smith-Ryan, PhD (07:32)
I mean, think wearables are a powerful tool, especially. mean, think that is one. Men use wearables too, but I do feel like there's data that women really want that data. They want to understand. There is some empowering. ⁓
kind of element to it. And we use wearables all the time. But what's really interesting, and I'm a quantitative researcher, and wearables are quantitative, but what I continue to see is like performance outcome numbers, wearable numbers, often aren't detecting any changes, let's say with across the menstrual cycle or with hormones, but those qualitative, how do you feel change? And as someone that is very data-driven,
to adapt a bit and say like, it does matter. We have to capture that qualitative how do you feel because that indirectly impacts a lot of things. It might not directly and I always say that of like no matter what we know about the physiology, a woman she can perform at any given point in the cycle and she will perform. However, based on some of those feelings like if she's feeling like shit she's going to show up but then she might need to recover different or we might need to modify her you know her sleep habits
that day or her nutritional intake that day. so wearables are good, but I actually find the opposite. ⁓ It'll say like, I, you know, it'll tell me like I suck. I need to sleep more. When in reality of like you have, like I don't need the negative feedback. I think the positive feedback can be helpful, but I love to use wearables as a way to inform men and women about, okay, well actually what do we need to do? Do we need to look at training or use it as a tool in the toolbox?
Dr Terry (09:14)
So as wearables, is there any style you recommend, the watch versus the rings or stuff like that? Is there anything in your research that you find is better and which one do you feel does one thing better and which one feels like you do another thing better?
Abbie Smith-Ryan, PhD (09:31)
That's a good question. think a couple of the wearables are working really hard to be integrated where it's not just one thing and consistency is going to help with a lot of things. Like what does it show for you? ⁓ I'm going to talk about something, it's not a wearable, but what I think is cool. Like we've used aura and whoop and ⁓ you know, Garmin and Apple and all the things. And it really just depends what you want. And most importantly, what will participants use and wear all the time? And you might use one
for sleep and one for temperature or something like that. But we've actually started using at home urine trackers that were meant for fertility, but use it as a way that we can capture hormones every day of a cycle or two. And let me tell you, it's really empowering to say like, well, no wonder I feel like shit today. My estrogen is low and my progesterone is high. Or no wonder my sleep, I had a hot flash. Especially in that perimenopause,
really variable. The other thing that we're seeing that maybe you guys see is there's this group of women that are very active and they're you know Title IX, they're training all the time and they're late 30s early 40s and it's a mix of hormones and it's a mix of I wouldn't say over training but like training and maybe not getting the most appropriate fuel.
And so hormones are low, and they're getting symptoms of perimenopause, but it actually may be more low energy availability. And these urine hormone trackers can be really helpful of like, OK, there's a reason I'm really tired, or like, I felt really good. So that's not a wearable, but I think tech is really interesting and enhances our ability to translate to people's lives. That doesn't happen in a lab or having a ton of resources.
Dr. Spencer Baron (11:24)
Wait, I gotta ask. This urine track, this is, see, I love this stuff, because nobody knows about this. Nobody should, and people should. So the urine trackers, is this the same thing that my ex-wife used when we were trying to get pregnant? I mean, we have two boys now, but at the time she would go, okay, it's time, we can have sex now. Is this the same thing?
Abbie Smith-Ryan, PhD (11:31)
Oof.
Kind of. Well, so
like it used to like there's still ovulation that usually is like you you an ovulation stick and when you ovulate you're the most fertile and now they have them like they it started in the fertility world. So like you could track for more than just those few days. ⁓ And now though they are tracking more than just estrogen progesterone. A lot of times we're getting LH, FSH ⁓ at home. You I don't have one up here but in the lab it's it's you just like
read a QR code after you pee on it. It's very cool. Yeah.
Dr. Spencer Baron (12:19)
So,
where can we, where can we, I mean, where could they get this? No, no, no. It'll come back saying reject. What are you talking about?
Abbie Smith-Ryan, PhD (12:23)
Yeah, well you could get a two. I actually think you should pee on a stick.
Dr Terry (12:24)
He's gonna be peeing a stick every morning. He does. No he won't. He watches
Barbie. So he'll measure his estrogen and it'll totally work. And we'll probably find out why you're more sensitive than me and we'll balance it out.
Abbie Smith-Ryan, PhD (12:35)
⁓ You do have estrogen, so ⁓
Dr. Spencer Baron (12:38)
That is true.
So it would work if I did it?
You
Abbie Smith-Ryan, PhD (12:51)
That actually would be quite hilarious.
Dr. Spencer Baron (12:51)
was Abbey talk, man. I don't want to hear that.
Abbie Smith-Ryan, PhD (12:54)
You know, maybe we just found the thing that is more supportive for women than men. You guys don't have an at-home urine tracker for testosterone, and maybe we need that.
Dr. Spencer Baron (13:02)
No!
Dr Terry (13:05)
Actually,
that's not bad idea. Tell ⁓ me.
Abbie Smith-Ryan, PhD (13:08)
Bye!
Dr. Spencer Baron (13:08)
be awesome. I would love to know. And you know it's funny because
you know I often tell patients that do you know that especially the females that get you know they get their testosterone, estradiol and all that and progesterone tested I go that's just a snapshot that's not a movie we don't really know. And so what you're saying is...
Abbie Smith-Ryan, PhD (13:21)
Yes. Yeah, which is what we're trying
to do. Yeah, so you can get them over the counter and like we've used, there's a couple different brands. Anita, we've used in the lab. Mira, we've used in the lab.
There's all sorts of them on the market and ⁓ they all have a similar technology. Some of them have different hormones per stick, but it's, I mean, it obviously is a cost, but I agree. Like my hope is that in the future, when someone goes on hormone replacement therapy or is having some hormonal changes, instead of just saying, take it one time, we can allow more of this tracking to understand what's really happening.
Dr Terry (14:05)
I'm going to ask a question. Have you seen any integration between this stick that we're talking about and can you upload that data to your wearable ring so it can actually start correlating the two?
Abbie Smith-Ryan, PhD (14:17)
They're trying, yes. So I think absolutely. I don't see why we're not at this point. ⁓ But over the last, like we've been using them for the last two years and I know there are a few groups that are definitely trying to do that. Yeah.
Dr. Spencer Baron (14:31)
Interesting. Really, this is actually fascinating because I'm immediately going to tell several of my female patients that that would be a great tool to use to identify what you're really feeling versus maybe your R.R. ring or what have you. you know, you actually.
pretty much answered one of my questions regarding energy or the women feel like they're under fueling and then they get all these different, ⁓ you need to add more calories and they're afraid because they're gonna get overweight or what have you. And you hear so many things, especially from the influencers that think they know what they're talking about. So what...
Abbie Smith-Ryan, PhD (15:05)
Mm-hmm.
Dr. Spencer Baron (15:12)
This could be a way to identify the reason why you're not having energy is based more on something objective like your hormone levels, because that could make a huge impact. Now.
Abbie Smith-Ryan, PhD (15:26)
100%. And
I think it's indirect and direct, but absolutely. Like if you have very low hormone estrogen, progesterone, obviously testosterone, we don't have on a stick yet. ⁓ But that absolutely can impact energy.
Dr Terry (15:43)
You know, can I interject something really quick that kind of ties into this? know, for a lot of the lay listeners, the doctors understand, but a lot of the lay listeners will say, women, feel like everything breaks in their 40s and 50s. Can you kind of tie this in and educate the listener what's really happening in this transition? And is it a hormone thing? Is it a training thing? Is it diet? mean, it's kind of tying this in, but I want the average listener who doesn't really
Dr. Spencer Baron (15:43)
So, yeah.
Dr Terry (16:13)
understand this to go, what is really happening so they understand when they pee on a stick what a hormone is telling them.
Abbie Smith-Ryan, PhD (16:19)
Yeah, and I mean, this is a key area of my research is to try and figure out what is happening. And so the first thing I'll say is every woman has different symptoms and it's hard to know what is happening. And really, essentially what's happening is ⁓ you're producing lower amounts of estrogen and progesterone. And ⁓ FSH is often an indicator identifying when someone is in perimenopause. But before
⁓ perimenopause, not most, but cycle. It's cyclical where our hormones are low and they peak for ovulation and then luteal phase becomes much higher, preparing for fertility. And essentially rolling into midlife, ⁓ we no longer have eggs to ovulate. So ovulation goes down, our hormones are low. Well, what happens in perimenopause is it's often up and down, up and down, up and down. It's no longer like a nice cycle.
into post menopause, ⁓ often women feel better because the hormones are more stable. They're less variable. And so why I am kind of not avoiding your question, it's if a woman is in perimenopause, first of all, it's often a slow transition and they don't understand what's happening. so they may, someone may get hot at night. Someone may have brain fog. Someone may be tired. ⁓ I posted this thing and I was like, I'm playing a
fun game as a midlife woman. Am I dying or is it perimenopause? And ⁓ all the women wrote back is like, I play a game. Like, am I pregnant or am I perimenopause? Am I crazy or am I perimenopause? ⁓ And so there's lots of different.
side effects per se, ⁓ and it is driven by hormones, but I think the other piece is the indirect. And so one key takeaway that is consistent in the literature is like there are body composition changes, there are brain changes that tend to stabilize into postmenopause, but you know what is really helpful? Consistent exercise.
fueling yourself, sleep, ⁓ and that's often hard. So then that's where the indirect piece, like if I'm really tired and I don't have any energy, well then am I going to train? And so we need to lower the barrier. It goes back to how we started this session of like, I tell women in this life, just do something, just do something that you can do every day and take care of yourself. And then if we go back to like vasodilation, we are finding that women that exercise consistently,
they're not the ones that are having a lot of hot flashes. Their bodies are used to kind of that cooling and that vasodilation. So that's really what we're trying to also understand is how do you feel better during this life space and like really being powered to take some action.
Dr. Spencer Baron (19:19)
So let me ask you, a lot of my patients that, actually a lot of our patients that are into a healthcare that's void of medication and surgeries and all that, they're turning to nutrition and peptides. Peptides is a big one nowadays. Would that be a good tool, the urine hormone stick, to identify how some of the peptides that do enhance, would you? ⁓
Think that you know in your best guess would that be something that? Could be a good way to monitor changes because some people aren't sure if peptides are working or not or the ones that enhance some of the hormone like growth hormone or what have you
Abbie Smith-Ryan, PhD (20:04)
Yeah, I mean, I think I don't
But for the peptides that I'm aware of, ⁓ I think some better tracking tools would be some simple strength outcomes, like what are some peak strength changes. You're not going to get that in urine hormones, but I think any time you can do some measurements of tracking, it's really helpful. So whether that be, if the goal is to get stronger, ⁓ we'll then do some strength outcomes. If the goal is to lose body fat and increase muscle,
do those measures to see. And I think on the opposite end is true. And that's where I spend a lot of my time is ⁓ understanding those body composition changes and actually measuring it. So like a classic example I have with midlife women is let's say we just finished a big study looking at twice a week, heavy resistance training with creatine or without. And a lot of these women, yeah, and that's a hot topic. A lot of these midlife women ⁓
Dr. Spencer Baron (21:00)
Yeah.
Abbie Smith-Ryan, PhD (21:03)
didn't change a whole lot of weight or gained weight in the six weeks. But when we looked at their body composition, there was some really fascinating body recomposition happening, a decrease in fat and an increase in muscle size and quality, which we never would have known if we only looked at body weight. And so it's just very telling during a time when weight changes across the cycle and into perimenopause.
Dr. Spencer Baron (21:27)
Abby, could you just, would you mind just mentioning, because I get asked the question all the time about creatine, ⁓ a dosage for women? Is there a formula?
Abbie Smith-Ryan, PhD (21:37)
Yes. So
funny. Okay. So I think it's okay. Two things. How I know. And I just want to I don't know if people realize this, but have you seen the creatine sales? It's like projected to be like, it's like triple of what it has been. And
Dr Terry (21:41)
By the way, did you see how he went all excited? did.
Dr. Spencer Baron (21:43)
I actually break out in a sweat. don't know.
What's up with that?
Abbie Smith-Ryan, PhD (21:59)
The
Dr. Spencer Baron (21:59)
Yeah.
Abbie Smith-Ryan, PhD (21:59)
cool thing I don't think people are realizing is it's because it's not just men buying it anymore. It's women and, you know, just active individuals. And so to me, that's a really empowering like if if you give those people education, they will help with the market. ⁓ But from a science side of things like I've been studying creatine since I was in grad school. And yeah, for dosing, what I always tell women is like if you want to short like if you want to know if it's working for you,
⁓ A loading dose is something that will get you there faster and a loading dose is ⁓ five grams four times a day for about five days.
Now, I'm not saying that you do that, but like if someone's like, ⁓ I'm really fatigued. I want to see if it impacts my exercise. I want to see if it impacts anything. A loading dose just gets your muscle saturated more quickly. So in about five days. You also then can see if there's any, I mean, there's not really any side effects. We can come back to that.
The other approach is to do ⁓ five grams a day every day for three to four weeks. And I would start with that to see everyone responds differently. But five grams over three to four weeks would result in a similar muscle saturation to the 20 grams a day. ⁓ But new research also shows that 10 grams a day can help with more of the brain and cognition ⁓ and maybe slightly better effects. But if someone's just
starting, I would start with five grams. If someone's been taking it a while and wants to see, like the theory is that once my muscle is saturated, then it will go to my brain. And we're about to look at some of those dosing differences in women.
Dr Terry (23:48)
So I got a quick question.
Dr. Spencer Baron (23:48)
Okay, wait.
No!
Dr Terry (23:49)
got the people to say if 10 is good, 100 is better.
Abbie Smith-Ryan, PhD (23:54)
Yeah.
Well, so couple of things to think about. You don't want to take it all at one time. But for me, ⁓ for example, like if I, let's say I have to give a talk and I'm traveling across country or like overseas or like whatever, I'll take, you know, 10 to 15 to 20 grams in those days, even though like I take it every day, it gives you that boost. And so there's cool data up to 30 grams in concussion, post concussion. ⁓ So there does seem to be a higher level
needed for brain targets. And there are very minimal side effects. I think the one thing that people don't talk about is you do need to consume more water because it works by pulling water into the muscle. And so one, if you're dehydrated, ⁓ you won't see effects. And then if you're drinking more water and it's pulling more water into the cell and you're having high doses, you're going to hold on to some water weight short term. ⁓ We don't see it as much in women, but again, those are those higher doses.
and we can talk about weight gain, etc. ⁓ But that's yeah, 20 grams ready. Yeah.
Dr. Spencer Baron (24:58)
Okay, ready?
Powder or capsules?
Abbie Smith-Ryan, PhD (25:05)
I thought you were or okay, so totally biased here. I help accompany with gummies. ⁓
And gosh, did you see? So I like the powder, ⁓ plain creatine monohydrate powder for my daily dose. But then I like the gummies as a travel or like I'll grab a couple as like my second dose. So I'll do five grams in a powder, whether it's in my shake or my coffee or whatever. And then in the afternoon, like before I go teach, I might take, you know, a couple gummies, get another five grams or throw them in my bag.
Dr. Spencer Baron (25:13)
I was.
Okay, this wasn't gonna be a question because we don't like to promote anybody on the show, but I do wanna know what company the gummies or the creatine powder comes from. Did you say monohydrate? Creatine monohydrate, is it?
Abbie Smith-Ryan, PhD (25:49)
Creatine monohydrate,
yeah. then what I always say, like, so creatine monohydrate, all types are very bioavailable, absorbable, meaning if I take five grams, I'm going to absorb 4.8 grams. So creatine monohydrate is what I would recommend. And then ⁓ if I have someone that, like, sometimes some people might get some bloating or digestion issues, and it's very rare, but it's usually what they mix it with. ⁓
And then for the gummies, the only thing that I would caution and say is like many companies are making gummies, but not testing them to make sure the creatine is still in there. And the one that I helped does it's NSF certified and they test it to make sure that there's actually creatine in the gummies. well, I don't want to promote and it's not like I make money on it. I'm a scientist.
Dr Terry (26:38)
And the name of it.
Dr. Spencer Baron (26:38)
I gotta ask, give us the name of the company. I'm good with it.
Abbie Smith-Ryan, PhD (26:44)
Yeah, so
Dr. Spencer Baron (26:44)
Terry.
Abbie Smith-Ryan, PhD (26:45)
I helped create gummies. They were like the first gummy on the market.
Dr. Spencer Baron (26:49)
C-R-E and the number eight, create. Oh, create, oh, the real, okay, create. All right, all right, thank you. Wait, I still got more. How about, okay. So five, five grand, that's women, yes, women. What about dudes? Same, same? Okay.
Dr Terry (26:49)
What's it called again?
Abbie Smith-Ryan, PhD (26:51)
C-R-E-A-T-E, create. Yeah. Yeah.
Dr Terry (27:00)
No, you're good.
Abbie Smith-Ryan, PhD (27:09)
Same. So it's the same
creatine, same dose. I think the dosing differences come. And I have this debate a lot of people like, well, should you take it per pound? Like, obviously, I'm assuming you're bigger than me, but maybe not. I got a lot of muscle. ⁓ But what are we talking? We're talking about ⁓ a gram difference? Like, I'm going to see the same benefits.
Dr. Spencer Baron (27:20)
That's what I was.
Abbie Smith-Ryan, PhD (27:35)
There's no point in doing that research because we know it works and the dose is going to be so slightly different. I think that the difference is, ⁓ you know, what's the goal? Are we trying to like saturate it quickly? That dose might needs to go higher. we trying to, we're really trying to understand the impacts on brain that might need to be higher depending on how much muscle, also depending on how much meat you have. So I would still right now make that blanket ⁓ gram dose. There are some gram per kilogram, but it's really not that much
different. We're talking about a couple grams.
Dr Terry (28:06)
I gotta
Dr. Spencer Baron (28:06)
before
Dr Terry (28:07)
ask one thing. Okay, go ahead. Go ahead, sir. Yeah, okay.
Dr. Spencer Baron (28:07)
or after a workout? No, no, it could be a one word answer. Hold on, before or after a workout.
Abbie Smith-Ryan, PhD (28:13)
Most important is that you take it every day.
Dr Terry (28:16)
Okay, what would a person that loves data that looks at their watch or their ring, what can they expect to see when you start adding creatine?
Dr. Spencer Baron (28:16)
Go Terry.
Abbie Smith-Ryan, PhD (28:27)
That's a great question. So a watch is not going to pick it up. ⁓ The effects that you might see are indirect.
So the way I describe creatine is it will help with your training volume. You might be able to do a few more extra reps. You might be a little bit stronger. That's not gonna show up on a watch. However, if you are able to recover faster, that might over time show up with a lower resting heart rate or your recovery heart rate. But again, indirect effects because it's now allowed me to train harder or recover faster. There's some early data we're actually trying to dial into this.
sleep. Some early data that on training days it might be helpful but honestly we just saw some opposite I think.
it allows you to train harder. And so sleep is worse. And we want to look at a couple of days after. like, you know, like that recovery piece. ⁓ The interesting thing that we like might be relatable to your listeners is we're seeing some really cool effects on fluid distribution and like cell integrity. So if you have someone that has a home scale, like a bioelectrical impedance analysis,
⁓ Creatine works by bringing fluid into the cell. And we actually saw this across the menstrual cycle. ⁓ So in the luteal phase, women tend to have more fluid extracellularly. They're like puffy, gain some extra water weight. And creatine supplementation appeared to make it go more intracellularly, which then if you have more water intracellularly, that's also a prime for greater muscle protein synthesis and, you know, nutrients, et cetera. So that fluid change you might be
able to detect on like a home scale depending on how good it is.
Dr Terry (30:10)
What about for injuries?
Dr. Spencer Baron (30:10)
Let's go.
Abbie Smith-Ryan, PhD (30:12)
Yeah, injury data is very interesting. Creatine is not magic, and people talk like it is. But with injury, it's pretty interesting. If you ⁓ supplement with creatine either right after injury or surgery and with PT, there's really cool data that shows that it helps you get back stronger faster compared to not.
Dr. Spencer Baron (30:38)
That is golden. I didn't even think about the injury part of it. I'm only thinking about training, you know, post training repair, you know, but that is fantastic. Yeah.
Abbie Smith-Ryan, PhD (30:39)
Yeah.
Mm-hmm.
When someone in my family has a surgery,
one of the key things I send them is creatine. I send them, you want to know what else I send them? ⁓ Omega-3, if they're not taking it. It helps with inflammation, healing, and then usually some sort of essential amino acid to help with amino acid availability in between meals. Accelerates recovery, repair, protein synthesis.
Dr. Spencer Baron (30:56)
Tell me, tell me.
a combination of essential not one in particular, not any in particular, just the compensate composition. You know, just I'm curious because I did creatine many, probably 20 years ago when it.
Abbie Smith-Ryan, PhD (31:18)
a cloud area.
before I was born. I'm just kidding.
Dr Terry (31:32)
That was awesome! I didn't even know they made Create Team back then.
Dr. Spencer Baron (31:35)
Terry, she is perfect for this show. Did you tell?
yeah, well, yeah.
Abbie Smith-Ryan, PhD (31:51)
I'm done.
Dr. Spencer Baron (31:53)
All right. I have no comeback for that one. ⁓ hell. All right. Back to the. I forgot what I was going to ask. yeah. Yeah, I need I need it bad. ⁓ so. ⁓
Abbie Smith-Ryan, PhD (31:55)
Hahaha! ⁓
No.
Dr Terry (32:05)
He needs creatine for his brain.
Abbie Smith-Ryan, PhD (32:08)
What
do you mean?
Dr. Spencer Baron (32:12)
some time ago when I first started creatine. All right, try it. There was a company ⁓ by a guy named Bill, well, Bill Phillips came out with, Bill Phillips, right? Yeah, yeah.
Abbie Smith-Ryan, PhD (32:13)
Hahaha!
Go Phyllis! Yeah, eight ball nutrition, right? I love eight
ball.
Dr. Spencer Baron (32:26)
So so he when he had bought the company EAS many many years ago There was this whole you know challenge that he came up with but I thought creatine Well, creating was an integral part of it I tried the creating but it had so much sugar sweetener or sugar in it that I became terribly hypoglycemic because I would train and then take it and then and I stopped after a week because I would be miserably tired now I imagine creatine is a little
Abbie Smith-Ryan, PhD (32:31)
Yes.
Mm-hmm. Yep.
Dr. Spencer Baron (32:57)
more advanced now that you know powders don't have as much sugar or sweetener.
Abbie Smith-Ryan, PhD (33:03)
Yeah, I mean, way back then, I'm just kidding, they used to think that you had to take it with sugar.
Dr. Spencer Baron (33:05)
⁓ you got to rub it in.
Abbie Smith-Ryan, PhD (33:15)
could be absorbed to be up. And it does help. Like if you take creatine with some sugar, it actually really helps with ⁓ carbohydrate, like glycogen recompensation. But you don't need the sugar. Like we know it will absorb anyway. So I think that you can take a plain creatine monohydrate now and it's unflavored and it will still work. Now a little bit of sugar can help, but you're right. Like the old products, it was mixed in a lot of sugar or mixed with a lot of things. ⁓
Dr. Spencer Baron (33:15)
⁓ yeah.
Yeah.
Abbie Smith-Ryan, PhD (33:44)
Some people, it goes back to your question about before or after exercise. I once did a study and we were looking at a pre-workout and it had creatine in it and we'd have to get them to take it and then get a bathroom break before they did their intervals on the treadmill. And it wasn't just from the creatine, but if you mix a bunch of stuff before you go train, so you know, if you're sensitive that way, otherwise like post exercise, I always say is a good time to take things because your muscle is like a sponge. You've just rung it out.
Dr. Spencer Baron (34:05)
Mm.
Abbie Smith-Ryan, PhD (34:14)
and if you add things like sugar and creatine and amino acids it's just going to get there faster but you you don't have to take it then.
Dr Terry (34:24)
If you're going to take it daily, is there a time of day that just for the average person is better morning, noon, or night if you're just trying to do that stacking thing?
Dr. Spencer Baron (34:24)
I have...
Abbie Smith-Ryan, PhD (34:34)
Yeah, so I would say ⁓ just pick a day that you can do, pick a time that you can do it every day. I like to do mine in the morning. I do think I see like a bit of a brain effect. And so I like to either do mine in the morning or in that like afternoon slump.
Dr. Spencer Baron (34:50)
I'm so going to do that. I know I'm glad I clarified that because I had this fear that it was still made the same way. Because back then when I would crank up that Model T Ford, you know, I would get a pump in my arm. All right, never mind.
Abbie Smith-Ryan, PhD (35:00)
Yeah.
You're probably
Dr Terry (35:05)
in my way.
Abbie Smith-Ryan, PhD (35:06)
taking NO explode too at the same time or you could talk about peptides. I'm sure you were taking peptides then, huh?
Dr. Spencer Baron (35:11)
yeah.
yeah, sure. Back then it was all
out, man. You could go into a pharmacy. No lie. We did bodybuilding back then. In South Florida, where I'm from, where I'm here, we could go into a pharmacy in, it was Miramar Pharmacy. You could ask for a testosterone or any kind of steroid and they would give it to you over the counter. It was shocking. That's how long ago this was. Yeah.
Abbie Smith-Ryan, PhD (35:36)
That's crazy. Yep, exactly. ⁓
Dr. Spencer Baron (35:41)
Terry quick, ask a question so I can recover. While I can recover. I'm sweating.
Abbie Smith-Ryan, PhD (35:44)
I made you blustered! Look at that!
Dr Terry (35:48)
Yo Abby, I
hope you're going to clear your schedule because I'm gonna have you on once a month just for that.
Dr. Spencer Baron (35:55)
Yeah,
yeah. We call it cracking backs comedy central. That's what it'd be. ⁓ man. ⁓ yeah. I'm having a hot flash. Sorry.
Abbie Smith-Ryan, PhD (35:58)
I got more. I got more. can keep going. Hot Flash! I know! You could
Dr Terry (36:06)
All right, yeah.
Abbie Smith-Ryan, PhD (36:11)
see it happening.
Dr Terry (36:11)
All right, and thank you for really diving into the creatine, because that's such a hot topic right now. But the other hot topic is hormone replacement therapy. And some of that stuff is so expensive. And some of our patients listening going, you know, is this something I need to take? Do I put the patch on? Do I do the pellets? Do I do that?
Dr. Spencer Baron (36:16)
Yeah, big time.
Dr Terry (36:35)
then it's expensive. So what are some things that, like three highest impact habits that you can do when you start in that perimenopause stuff, or you just, and then I have other people going, I'm just gonna let nature take its course. So what are some of your advice? ⁓
Abbie Smith-Ryan, PhD (36:53)
Yeah, it's a really good question. And I am not a hormone replacement expert. ⁓ do like a lot of our work is really focused on one, what if you don't want to take it and or can't take it? Some women, you know, it puts them at greater risk. And more importantly, too, of like even if you're taking or provided with hormone therapy, you still need these lifestyle changes to ⁓ and lifestyle habits to be really healthy and have an impact. And so I
will also reframe this. There's nothing that you need to take. Hormone therapy is often ⁓ prescribed to treat symptoms. So I would say if someone is really struggling with symptoms, that would be something to advocate for. And so like I know a lot of women with really bad joint pain or you know mood disorders or ⁓ you know they can't sleep at night or really fatigued. It's like those like let's leave space like a provider really should help you.
And
a lot of providers don't know how. And so it's very dismissive. And same thing, ⁓ insurance doesn't often cover it. But if you find a provider, it's managing symptoms. So that's one thing. Now, if we look at some of the other things that hormone therapy is being touted for, it's not going to give you massive amounts of muscle. It's not going to make you lose a bunch of fat. It may make you feel better, and then your workouts are better.
Dr. Spencer Baron (37:58)
you
Abbie Smith-Ryan, PhD (38:23)
the energy to do your workouts. ⁓ But you know, this is has not been studied yet. ⁓ I have a feeling that as we see this hormone therapy increase and then you have all these active women, you have like a different group of women going into perimenopause. They've been active their whole lives because of Title IX and then they crank up their training. We're going to see there's differences in how the muscle and tendons adapt and so will we see greater musculoskeletal injury maybe?
And so like I think there's a lot we need to know on the back end and and so what advice I would give is one if you have symptoms Definitely get a provider that can help you It's very dismissive and very hard to find someone that can help you on the reverse. It goes back to consistency And I'll give you two two thoughts here like I hear from a lot of women that are like I've been doing the same thing as always and I'm training hard, but I'm gaining belly fat And so in those scenarios, I always say like that's that's exercise metabolism
for you, we train to become really efficient. So go do something you're not used to or add some intervals. If you run all the time, go swim. ⁓ know, obviously lifting weights, you can do more progressive or do some more power training, kind of switch it up so that your mitochondria are being kind of targeted, et cetera. And then from the nutrition side, it's also about consistency. And the one thing too, I see two things. Women are under fueling because they're trying to lose
fat, so therefore they're not eating and that's not causing, that's causing more fat gain over time. Or they're avoiding certain food groups like carbohydrates or fiber or some of those things. And so like another thing that's pretty rooted in science is kind of modify your carb to protein ratio. So one and a half to one carb to protein ratio per meal and per day. So what that would look like is maybe I'm getting, you know, 50 grams of carbohydrate and I'm getting 35 grams of protein and then add in a vegetable
or a fruit, some sort of fiber, really important. And do that a couple times a day, like kind of keep it simple, keep it fueled, and keep it consistent. It's going to be really the most helpful things. And then another really, I think, thing that impacts the whole body. I'm not a sleep researcher, but so much data on sleep and sleep habits going into bed. And then the other thing, women wake up, like I always joke, I have like 25 squirrels in my brain, and once they're up, they're ready to go. And so like even
those sleep habits can have a pretty big indirect effect on body composition and microbiome and all of those things. ⁓ to sum that very long response up is take care of yourself and find like consistent habits to do and if it's not working then do something slightly different that your body's not used to.
Dr Terry (41:12)
So on that note, have people, libido is a big topic, especially when it comes to paramodipalism and all that. So a lot of women.
Abbie Smith-Ryan, PhD (41:20)
Yeah, how did I forget
that important symptom? Maybe because we talked about that.
Dr Terry (41:23)
I have no idea. You got stuck
in the black and white movie from my partner. ⁓ Where the couple slept in separate beds on TV. and libido. You have research, you're exercise scientist that says exercise, maybe even creatine, strength training can increase libido and then women being driven into taking all this hormone replacement can eff their body up.
Abbie Smith-Ryan, PhD (41:29)
Yes. Yes.
Yeah.
Dr Terry (41:53)
the research to compare the two of what works better if they just get into a strength exercise lifestyle program versus going the hormone replacement?
Abbie Smith-Ryan, PhD (42:03)
I don't think head to head, but if we just think about this. So libido is one of those first symptoms ⁓ that women complain about and that is treated, people will treat that. But you're right, if you think about all exercise, exercise is the best way to cause vasodilation and that's blood flow to your muscle or your sexual organs. It's very healthy and that's a key part. So blood flow is one thing. The other thing is,
every muscle like if you think about a valsalva maneuver a valsalva maneuver that you do for a squat or a deadlift that's making your vaginal wall stronger and it's going to have that experience be better and so but it's those things that aren't necessarily like again
How are gonna research that and is it worth the funding and et cetera? So like I'm not sure there will ever be a head to head because no one cares about women's sexual health enough. I think yes, like an active lifestyle, like your sexual organs are a muscle and they need to be moved and it's not just, you like you can do that in the gym. It's all supportive muscles. And then another key thing is hydration.
All these principles of active lifestyle have a direct impact on libido and sleep, which sleep impacts libido, et cetera. So absolutely. Now, there's no head-to-head and I don't study that, but I'll have to go look.
Dr. Spencer Baron (43:31)
Okay, so strength training, just to be specific, because women often complain or comment on they don't want to look pumped up, or they don't want to get big muscles or anything, but when you say strength training, do you have a suggestion?
Abbie Smith-Ryan, PhD (43:43)
Mm-hmm.
Yeah, I mean, I've been trying forever to get pumped up, so it doesn't work. And so.
Women are never going to naturally gain a lot of muscle. they have, you know, even if you take testosterone, it's not going to have massive body composition changes. It's just to get you to normal. So when I say strength training, I really, it's really a stimulus above normal, some sort of push-pull, most muscle groups. ⁓ Now, if someone like one approach, I'll just use an example. If we're trying to have pretty important effects in a short period of time,
⁓ We will often use progressive resistance training and what that means is that you are adding in weight as you get stronger and you are pushing the intensity a little bit. ⁓ And most women, like right now, and I'm sure you talked with Stacey about this, a lot of people right now are saying, you need to lift heavy weights and do a lot of jumping.
Like, yes, that's true if you've been jumping and already lifting, that's great, but that's not the only way you can do it. Like, what you need to do is stimulate the muscle with ⁓ a load that you're not used to. So if you've never done anything... ⁓
stimulate the load or the muscle with some resistance bands and as that gets easier add load. And then the opposite true is like you don't necessarily have to lift heavy. If you're not going to lift heavy then you need to do more repetition so that your time under tension is there so that you're really ⁓ basically building up and breaking down the muscle is really what you want and you can get there in a few different ways.
Dr. Spencer Baron (45:27)
That was great. I was always curious about repetitions, but you made a good point in saying it, know, just progress from where you're at now and then move into a heavier or more or greater resistance.
I was just, I think even Stacey had mentioned something like, know, even bring it down to four repetitions after you've done enough of a warmup, which most women wouldn't imagine that would be a thing. But hey, strength training is probably one of the, the, the best researched items for, or activities for longevity that there is. It's indisputable.
Abbie Smith-Ryan, PhD (46:01)
Well, longevity,
and when you say longevity, think the organ of longevity is muscle.
And the way we know that stimulates muscle is resistance training. And that doesn't have to have a lot of rules. Now the rules come around preventing injury. And then a lot of my research is around like timing. How much time in the day you have? I don't have two hours to train. I need to be in and be out and make it work for me. And so like that's where some of the heavy shorter like it's it's how do we match lifestyles? Depending, you know, when I was younger versus I'm
sure at your age you have lots of time to train.
Dr. Spencer Baron (46:41)
You know, I almost brought it up before you said it. But.
Abbie Smith-Ryan, PhD (46:42)
you
Dr. Spencer Baron (46:47)
Back in the day, the old guys would come up to me when I was a 20 year old and say, how long do you train in the gym? They would measure your intensity by the amount of time. I'd go, oh, about an hour. And they go, oh, that's not training. What? They would spend two or three hours. And I would look at my dad, and my dad says, that's because they talk most of the time. So I'm in. Yeah.
Abbie Smith-Ryan, PhD (46:59)
Yes.
Yes.
Yes, yes. They have time. They chit chat. yeah.
Dr. Spencer Baron (47:15)
No, I'm in for a half an hour. Hello. And I get a good workout. ⁓ I'm teasing. That's fine. But the
Abbie Smith-Ryan, PhD (47:17)
Okay, okay. You're not that old. I'm just kidding.
Dr. Spencer Baron (47:23)
the other the other thought was ⁓ so strength training. No, I appreciate that. But if you're a runner and you like doing endurance now, you started to mention or you did mention something about more, ⁓ you know, cardio, cardiovascular. Do you have any suggestions in that area?
Abbie Smith-Ryan, PhD (47:40)
Yeah, so even now the message to a lot of people is, well, endurance exercise makes you fat, or don't do that, you need to lift. ⁓
Which is not true. ⁓ It's really like, what are you spending your time doing? If you want to be really good aerobically, like you need to do aerobic exercise, ⁓ you absolutely do need to include strength training. It's just different goals. And so like I was a collegiate runner. I love to lift weights and even as a runner I did, but I'm not going to go lift for repetitions. I'm going to make my resistance training more injury prevention and slightly higher repetitions to help with that. And I will overemphasize
like the importance of aerobic exercise as we age, particularly for women, because of the cardiovascular changes that we see, we know that aerobic exercise is a huge stimulator for cardiovascular disease risk that you don't necessarily get with resistance training. You get some of it, ⁓ but the only way to get some of the mitochondrial and vascular changes ⁓ is from aerobic exercise. I just, if you want to run, ⁓ one thing would
be integrate some intensity. some, lot of my work is around high intensity interval training. Not that you, you shouldn't be able to do that every day, but instead of walking for two hours, maybe what you do is take 20 minutes and do an interval style workout.
or instead of running for eight miles, again, maybe it's more of a fart lick or you're adding some of that intensity in there. And some of it as we age, just the repetitive nature, people don't often talk about the negative sides of exercise. Like as a runner, likely gonna have to have some joint replaced, but as I age, I do it smarter. I don't need to, depending on what you're training for, if you are doing a long volume, then make sure those muscles around those knees and hips are also supporting those joints to prevent
of that. So it really is dependent. But yes, we need aerobic exercise and we need resistance training.
Dr. Spencer Baron (49:41)
familiar with there was a conversation some time ago about the you know over 50 if you can run a mile in 10 minutes you're in a you're you're fit but if you can run it in nine minutes you're fitter and if you can run a mile in eight minutes you're at the fittest level over age 50 have you heard anything about that I've been using that as a guide no okay
Abbie Smith-Ryan, PhD (50:04)
Hmm. I have it. I
have it, but I'll have to look. Like, I mean, what it is indirectly assessing is VO2 max.
And VO2 max or maximal oxygen consumption is directly related to mortality and fitness. so like we measure that in the lab. I don't know about the mile piece, but it would make sense. Like if you can run a mile faster, your aerobic capacity is better, which then means that your heart is getting more oxygen to and from your muscles. So indirectly, it makes sense, but I have not seen that data.
Dr. Spencer Baron (50:44)
Something I heard. and by the way, you started to, you mentioned Valsalva's for those who don't know that, you that that's a, you know, you hold your breath, bear down squat and so on, which is really something that we do all the time when we were going to lift something. you know, it was interesting because you mentioned also about pelvic floor and that is why one of the most neglected ⁓ muscles that nobody thinks about. actually we had two, we had two guests in the past that were physical therapists
Abbie Smith-Ryan, PhD (50:50)
Yes.
Mm-hmm.
huh.
Dr. Spencer Baron (51:14)
and so on that specialized in pelvic floor. One of them was called the buff muff. How great is that?
Abbie Smith-Ryan, PhD (51:20)
That is amazing. I'm gonna go look her up.
Dr. Spencer Baron (51:25)
But again, for libido or sexual enhancement to have that kind of strength down there, it's obviously an important feature. ⁓ So with that said, because we're talking about, obviously, ⁓ my generation, baby boomers, I almost said our generation, and I know you would have corrected me real quick.
Abbie Smith-Ryan, PhD (51:36)
100%.
Dr. Spencer Baron (51:52)
But the baby boomer generation is the one that's really, you know, fueling that anti-aging longevity thing. So could you share what you would, how you feel about the youth, know, girls in childhood and what they should know now for their future? Because obviously, you know, they're on their phones and they're not doing as much as they used to. So I would love for you to expound.
Abbie Smith-Ryan, PhD (52:00)
Yeah.
Yeah, so I work more with like college age women, but ⁓ a key thing that does come up all the time is a little funny joke that you maybe have seen is most of the women going through perimenopause are dealing with daughters getting their first periods. It's like these hormonal ⁓ upheavals in...
I say that jokingly, but I do think we're now in a generation. I came through a generation where no one talked about any of that. And it was a badge of honor not to have a period. And flipping that conversation of teaching young girls and boys, to be honest, of what does it mean when you start bleeding, and what does that signify, and how does that impact your body? think having those conversations are really important and preparing them for that. ⁓
I don't know. There's this New York Times article that just came out and there's lots of conversation about like why are so many girls getting ACL injuries and it's Yeah, and it was a great article, but it's not ⁓ It's not because of their hormones like girls don't need to be afraid of that But they don't have the resources they're not getting resistance training and strength and conditioning as early as boys and they're now training the volume and the opportunity is higher so
Dr. Spencer Baron (53:21)
I saw it. Yes. Yes.
Abbie Smith-Ryan, PhD (53:42)
⁓
It's like one of those things like I want every young girl to be able to advocate for themselves and to say like, you know, like be able to openly ask of like, I'm having you might know this but more than 75 % of women and girls have menstrual pain when they're like they have we call it dysmenorrhea and most girls just like grit and go through it when in reality like some of those things can impact how you train or how you sleep or like so like my goal
is that these girls and with help of moms and dads that we can have those conversations so that you know it's an indirect effect on injury.
Dr. Spencer Baron (54:21)
that's great. By the way, I can't believe you brought up that article. How good was that article? As I went through it, I said, gosh, I would love to interview, have the woman, the physical therapist on our call. And then when you read down a little bit further, lo and behold, Dr. Terry is friends with Dr. Mendelbaum, the orthopedic surgeon that they work together. So we will have her on our show. I can't wait, right?
Abbie Smith-Ryan, PhD (54:25)
This is a very good idea.
Mm-hmm.
⁓ that's amazing. I love that. Yeah, and I think it's
Bringing those worlds together because like I think from currently it's been like we actually have some of the best ACL researchers here at UNC and you know we're looking at all the mechanics and early on like a couple years ago they not even they never even thought to ask about menstrual cycle or previous training history or like and it's part of like as a researcher we always learn more but it's bringing all these fields together to say okay what do you know from your field what do you know what do we need to be doing differently for these girls yes their cue angle is
So how do we train that to stabilize that based on strength and conditioning that no young girl is getting?
Dr. Spencer Baron (55:25)
Something that's very important to that whole schematic there, and then Dr. Terry can also relate to it, is that I too am seeing many more females with ACL tears. And then simultaneously, there's research out there that actually discusses about antibiotics and NSAIDs, how much of an effect they have on weakening ligaments and tendons. So.
Abbie Smith-Ryan, PhD (55:45)
Mm-hmm.
Hmm. That's really fascinating.
never, I don't, I mean, I generally knew that, but I wonder if that's also related to ⁓ symptoms. Like so many women are dealing with painful periods and symptoms and, you know, using NSAIDs to treat that. So I want, know, like there could be a number of angles to look at. Interesting.
Dr. Spencer Baron (56:04)
Yeah, yeah.
Yeah, the work is out there. I think it's fascinating and I think it's about time, but in the article they also mentioned how women's sports is becoming a ⁓ huge endeavor, soccer, volleyball, hockey, and that's where I'm seeing some of these ACL tears. ⁓ Of course.
Abbie Smith-Ryan, PhD (56:26)
Mm-hmm. Mm-hmm.
Can I make one mention of that? I know you work with some pro
sports and I've had an opportunity to work with the US soccer and it's really cool what they're doing. So Emma Hayes is the head coach and she takes everything from what she calls like a her lens of like everything is female forward and then how do you then bring that down to the younger players? It's very cool and just shows like how it can come from the top down and start to change things.
Dr. Spencer Baron (56:39)
Mm-hmm.
Terry, I'm gonna, I think we're ready. Okay, okay, okay.
Dr Terry (57:04)
Hold on, getting close, but I do want to ask one thing to close.
We've been talking about your research, your published stuff. What's the one thing that you hope women, you kind of touched on, but I want you to kind of finish this before we go to the next section, that you hope women actually feel or believe differently about their bodies because of the research you've done?
Abbie Smith-Ryan, PhD (57:26)
Well, that's a great question. ⁓ I mean, my hope is that we can teach women about their bodies to be empowered. I think now
perimenopause and aging and menstrual cycle. I wouldn't say it's scary, but no one has taught us what it means and how to use it. Like estrogen is such a powerful hormone when we're younger, it can make us stronger, recover better instead of being afraid of it. And then into perimenopause, some of the trouble comes from, it takes a long time for women to realize what's happening. Instead, they feel terrible. They think it's just them. So it's saying like, here's what it means. Here's what your body's doing. Here's how we modify.
in a way that you want to and it's not under eating and you know over exercising because that makes things worse so really giving women the data to be able to implement it in their day-to-day that's feasible while they're raising a family have careers and still trying to take care of themselves.
Dr. Spencer Baron (58:26)
Ready for rapid fire, Terry? All right, Abby, I got five questions for you. We look for a short answer so we can get through all five of them. Notice I'm sitting up in my chair because I'm bracing myself for some of your answers. Are you ready for question number one?
Dr Terry (58:27)
Always, always, always.
Abbie Smith-Ryan, PhD (58:28)
okay.
Okay,
Let's
go, I'll try and be succinct.
Dr. Spencer Baron (58:48)
If your grad student secretly followed you around for a week, sleep, workouts, food choices, what's something they'd see that would make them say, wait, our professor does that too?
Abbie Smith-Ryan, PhD (59:04)
⁓ gosh.
Dr. Spencer Baron (59:06)
Hahaha!
Dr Terry (59:10)
This is Spencer's payback, by the way.
Dr. Spencer Baron (59:12)
⁓ yeah baby,
Abbie Smith-Ryan, PhD (59:13)
Well,
my grad students already know. So they already know. ⁓ Okay, here's what. Okay, they already know everything about me. Here's one that will go off. I listen to very loud rap music with a lot of bass and with tinted windows so no one can see. I love a good jam session in my vehicle.
Dr. Spencer Baron (59:14)
yeah.
Abbie Smith-Ryan, PhD (59:40)
with probably inappropriate music for a white professor.
Dr Terry (59:47)
You
Dr. Spencer Baron (59:48)
You feel my pain. When I was at Miami Dolphins, they would play that music and I would say to some of the players, go, I love this song, but I can't sing the words because the N word is in it and every other word.
Abbie Smith-Ryan, PhD (1:00:02)
Yeah, when
I was younger I had a subwoofer in my car. ⁓ There you go.
Dr. Spencer Baron (1:00:10)
You're really a bro
below that white skin, huh? What's up, Abby? All right, wow. Question number two. Man, we could go into that one. All right, that is great. right. Okay, Abby, question number two. Your bio lists lots of titles, and they're very impressive. Professor, researcher, lab director. But one of the ones that you highlight most is mom.
Abbie Smith-Ryan, PhD (1:00:19)
you
you
Dr. Spencer Baron (1:00:38)
Be honest, has motherhood ever completely humbled you, your exercise physiology expertise?
Abbie Smith-Ryan, PhD (1:00:46)
I mean, every day, not from an exercise perspective. I actually think pregnancy and delivery is the most athletic event you'll ever do. And you should train for it. And I loved it. Like I squatted out my babies and I squatted right up to it. then, but I think the humbling part is you have no fucking idea what you're doing. Like, ⁓ and especially from like a nutrition exercise space.
Dr. Spencer Baron (1:00:47)
Yeah.
Yeah.
Abbie Smith-Ryan, PhD (1:01:14)
Yeah, you don't want to push them too hard, but you want them to love it. So yeah, it's all very humbling and I have no idea what I'm doing. But I love my kids.
Dr. Spencer Baron (1:01:26)
⁓ obviously. Yeah. No, no, that's great. And it's
Dr Terry (1:01:27)
That's the most honest
answer I've probably ever heard.
Dr. Spencer Baron (1:01:31)
No, but you know what? She just
created a complete paradigm shift on the concept of labor and delivery. An athletic event. How freaking cool is that?
Dr Terry (1:01:41)
Right.
Abbie Smith-Ryan, PhD (1:01:42)
It is literally
Dr Terry (1:01:42)
Right.
Abbie Smith-Ryan, PhD (1:01:43)
like the human body is so cool. Like think about, ⁓ yeah, was amazing. And then even postpartum of like nutrient timing. Yeah, it's amazing. Yeah.
Dr. Spencer Baron (1:01:53)
no, that's brilliant, brilliant. Okay, so let's see. Question number three. Was there ever a moment in your lab when a student asked a question that was so good it made you stop and think, wow, this next generation might actually be smarter than us?
Abbie Smith-Ryan, PhD (1:02:11)
What my honest answer? ⁓ My honest answer is the opposite. It's like, shit, these people are going to take care of me. ⁓ I just don't think they have the resilience yet. I feel like we're still on COVID. They don't have critical thinking, not all of them. They just, we're still teaching them how to do hard things and be resilient and think critically.
Dr. Spencer Baron (1:02:13)
Yeah, I have a feeling of I agree with all agree with you.
yeah, now I have interns that circulate in our office and I ask the same questions. I got you. ⁓ Although there was something, No, I actually also have some brilliant ones. Question number four. ⁓
Abbie Smith-Ryan, PhD (1:02:46)
Yeah. We're going to get them there, and I'm not giving up on them. And we've got some good ones, but yeah.
Yes.
Dr. Spencer Baron (1:03:01)
I was actually gonna add a question and ask you if you were given a rapper's name, what would it be? But that's not, I'll give you time to think about that. Cause at Miami Dolphins, they used to call me Doc Speezy. I go, like that Doc Speezy. That was my rapper name.
Abbie Smith-Ryan, PhD (1:03:16)
I do like that.
Dr Terry (1:03:19)
god, we're gonna have Lord Baron
Abbie Smith-Ryan, PhD (1:03:19)
⁓ for a long time.
Dr Terry (1:03:22)
Doc C.V. now.
Dr. Spencer Baron (1:03:24)
Yeah.
Abbie Smith-Ryan, PhD (1:03:25)
I love that.
For a long time, my lab group called me Honey Badger. It's not really a lab name, or not really a rapper's name. yeah. Right. So there you go.
Dr Terry (1:03:34)
Is that a rap? That could be.
Dr. Spencer Baron (1:03:36)
Well, honey badgers are badasses, so that may be the reason.
Dr Terry (1:03:39)
Yeah.
Dr. Spencer Baron (1:03:41)
Don't
mess with the honey badger. All right, the real question number four. If the 18-year-old version of you could see your life today, what do you think would surprise her the most?
Abbie Smith-Ryan, PhD (1:03:56)
That's such a good question. ⁓ This is a terrible answer. As someone that I don't think that far ahead, like every day is like I'm just gonna squeeze the most out of it. And so I think my 18 year old self would be like, you're just still doing it. You're just still, yeah. I have to think about that one.
That's what I got. That's a lame answer, but yeah.
Dr. Spencer Baron (1:04:23)
you? No, not at all. Never a lame
answer. You ready for question number five? All right. Question number five. Abby, what do you want to be remembered for?
Abbie Smith-Ryan, PhD (1:04:29)
I'm ready. It has to be better than the last one.
That's a great question. I thought a lot about that, especially ⁓ my mother recently passed away unexpectedly, and it's given me a lot of thought of like I want...
I don't necessarily want to be remembered. I want to have a legacy based on the people that I've trained and the science that I've produced and the facts that I've given people to empower themselves. So I want to really be more known for how I made people feel and for the contributions to the knowledge that I've given.
Dr. Spencer Baron (1:05:16)
doing it and I want to thank you for being on the show. I would also love to know who your favorite rapper is Rick Ross, Pop Smoke, 6ix9ine, what do we got?
Abbie Smith-Ryan, PhD (1:05:23)
Okay, all right
funny that you say that I once won a big award I think it's like one of I had to pick a walk-up song and Do you know what my walk-up song was? Yeah, it was Rick Ross hustlin like literally like like that is life every day I'm hustlin and that is yeah pretty much sums it up So the funny that you brought up Rick Ross, I don't know if he's my favorite, but that's a good one
Dr. Spencer Baron (1:05:34)
I got it here.
Love it, I love it.
Purple Lamborghini, purple Lamborghini,
Dr Terry (1:05:51)
you
Dr. Spencer Baron (1:05:53)
come on. All right, we're gonna start emailing each other. Hey, have you heard this song? All right, all right, this is great, this is great. ⁓ Thank you so much for being on the show and you gave us some tremendous, tremendous information. Thank you.
Abbie Smith-Ryan, PhD (1:06:06)
Yeah, thanks so much. It's been great. Really appreciate it.