Episode 49: When the Same Habits Stop Working: Midlife Nutrition Explained with Amanda Nighbert, RD

In this episode, we sit down with registered dietitian Amanda Nighbert to unpack the connection between hormones, metabolism, and nutrition in perimenopause and menopause. We explore why your body can feel so stubborn during this stage of life—why the same diet and exercise you’ve always done may suddenly stop working, or even lead to weight gain. Amanda explains how hormonal changes drive insulin resistance and increase risk for metabolic syndrome, what nutrients are most important to support bone and muscle health, and why overcomplicating nutrition is the biggest trap midlife women fall into. We also tackle common social media myths and the key mindset shift: stop collecting information and start putting change into action.

Find Amanda Nighbert:

Learn more about Amanda and her LEAN program

Follow on Instagram: @amandanighbertrd

Amanda's You Tube Channel

thestartinggatepodcast.com

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contact@thestartinggatepodcast.com

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The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Episode 49: When the Same Habits Stop Working: Midlife Nutrition Explained with Amanda Nighbert, RD

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship and is not a substitute for professional medical advice. Diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting day. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

 Welcome to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. We're excited to be jumping into a new series of episodes, focusing on menopause. We have a lot of different aspects we're gonna cover. We're gonna be talking about menopause and its effect on your mental health, menopause, and its effect on your sexual health.

We're gonna talk about breast health, we're gonna talk about movement, all the things. But today we're excited to talk about, our favorite topic, nutrition. Nutrition. So we're really excited to talk about nutrition and the effects in menopause, and even more excited because. We have someone that really knows a lot about it.

With us today, 

we are so excited to introduce today's guest. We have Amanda Nighbert who is a registered [00:02:00] dietician and she specializes in women's health. She's the creator of the Lean program, which has helped over 150,000 people with weight loss and hormone friendly nutrition. She is really focused on this patient population in that perimenopausal and menopausal stage of life.

So we want to welcome you, Amanda. Thank you so much for joining us. Could you give our listeners a little bit of information? About what inspired you to create lean and also focus now specifically on women in this stage of life. 

Yeah. Thanks so much for having me. So I actually worked in a hospital setting for 16 years and I mainly worked in the field of weight loss and disease management.

And I just felt like my, patients were coming in and they were just overwhelmed and confused because there was just so much information out there. And they just didn't really know , what to do. And at the end of the day, my philosophy is you're making it harder than it has to be. [00:03:00] So I wanted to reach the mass population and hold their hand and be like, listen, it's very simple.

It's, whole food, nutrition. It's move your body, it's sleep, it's hydration. You're, again, you're just making it harder than it has to be. And so , when I created the Lean program, which actually stands for Living Energized and Nourished, just to help people simplify nutrition for health and wellness.

That's fabulous. 

Yes. 

We love 

that. I think to get us started, I wanna bring up something that I felt like I heard a lot from my female patients and hear a lot from friends, and that is just feeling like, okay, I'm in this timeframe between 40 and 60. I'm doing everything I've always done my whole life.

I'm not eating any differently and I'm gaining weight. Why is that happening? 

Why? Obviously we have this shift in our hormones that are having impacts on systems in our [00:04:00] body, but, , the biggest thing that I wanna, before we dive into, all the things that impact why weight loss is a little bit harder as you get older, I think the most important thing to understand is that you are not broken, and this is fixable.

It's definitely harder. And what I want women to understand that maybe we can, give back to our daughters is that the more you focus on optimizing your health and wellness in your twenties and thirties. The easier and better your life will be in your forties and fifties and sixties.

And I think a lot of women put themselves on the back burner during that period. 'cause we're raising children and spouses and doing all the things that we put ourself last. And at the end of the day, then your children leave, , the nest or , your life changes in your forties and fifties and then you're left with kind of a broken you.

So in that situation, you have to regroup and it's definitely a little bit harder to regroup in your forties and fifties than it is in your twenties and thirties. So, , Keep that in mind as you're, , trying to instill some of these healthy habits [00:05:00] to your family members and your daughters and your younger children.

 But at the end of the day, the reason why. Things get a little bit harder while you're doing the exact same thing that you did in your twenties and thirties in your forties and fifties. And you're starting to gain weight is because of the decline of estrogen, progesterone, and testosterone. And those three hormones are gonna impact different systems.

Number one, starting with your muscle health. Sarcopenia is the loss of muscle mass as we age, and that tends to go up as women get older. As our testosterone levels go down, it's harder to build muscle, it's harder to sustain muscle. So in that scenario, when we are older, adequate protein is way more important, and strength training becomes way more important in order to sustain that muscle mass.

So I always say the number one goal is to keep what you have. And then the secondary goal is to add more. And what people don't realize is that as we age, our protein [00:06:00] needs. Increase because our body's ability to utilize the amount of protein that we actually eat goes down. So you have to eat a little bit more to give the body what it needs so that muscle mass and that muscle health is really important as we age.

think that is very critical because women for many years didn't really focus on their muscle. Instead, we were focused on just being small, and so I think. We are seeing a lot of the repercussions from a couple decades ago of that focus where women literally were just like, I need to be smaller. I need to eat less, less less, and maybe more cardio.

And then that actually hurt them. And so that's becomes such a challenge to change that mindset. I know I personally had to work on that because that was how I thought about it. And even in healthcare, that's not something necessarily doctors knew to be advising their female patients. It's no, we need to be talking about strength training.

I don't know how many times did you talk about strength training kitty [00:07:00] with patients? So rarely. Yeah, and I think 

you're, I love what you're saying about we need to teach our daughters now because I think our generation, and I'm 42 and you know, you just take what you see your mom and that generation of women doing for their health as what you need to do for your own health.

And that's what we saw. We saw our moms doing cardio, doing low fat. and then as we've said multiple times before, we really didn't talk about this in medical school. So now luckily, I feel like the data and the medicine and the teaching is coming up behind and saying, no we really need to be teaching our patients, not just all going off of what , everyone else in our life has done. And I'm so glad we're putting the emphasis on this. And just as you said, , the earlier you can start, just like we talked about in our dementia episode, the earlier you can start with things, the better your life is gonna be as you go on and.

Speaking of muscle, can we talk about how muscle is gonna help a woman at this stage of [00:08:00] life? 

Yeah. Muscle is , your metabolic powerhouse, and there's a lot of kind of shift, I feel like, in the field of longevity and, optimizing health to this muscle centric theory.

And at the end of the day, when we look at the muscle mass of our population as it is right now, it is significantly less than it was, 20, 30, 40 years ago. And that plays a huge role. I mean, When you have a lot of muscle, you are more insulin sensitive. Another thing that happens during, your perimenopause or menopause period is, this blood glucose issue, when your estrogen goes down, you become more insulin resistant, and the number one fat storing hormone in the body is insulin. So what that means is when you're having a blood sugar response, your body's producing a lot of insulin. The more insulin your body's producing, the more likely you are to actually store fat versus burning fat.

So if you're less sensitive to insulin, your body has to produce so much more in [00:09:00] order to manage your blood sugar. So the ultimate goal is to have your insulin levels, your blood sugar levels as low as possible and muscle really helps that. The first place glucose goes is your liver. The second place it goes is your muscle mass.

So when you have a lot of muscle mass, you tolerate carbohydrates better. You don't gain weight as quickly, and your metabolic rate is much higher when you're just like sitting versus someone who has a really low muscle mass. One of the things and I don't know about you guys if this is something that you recommend, but the first thing that I tell my lean clients is I want you to get your body composition evaluated.

The number on the scale means absolutely nothing. It is your percent body fat and your lean muscle mass. That mean everything. And if you're losing weight at the expense of muscle loss, then you're gonna stay on that kind of yo-yo cycle where you lose 20 pounds and you gain it all back. We've gotta be really focused on fat loss versus weight loss, google InBody Scale, [00:10:00] I-N-B-O-D-Y. Dexascan is another one that you can get and get that baseline. Where are you? Women need to be under 30% body fat, ideally around 25% body fat. But most women are sitting at about 40%. And guess what, when your percent body fat is that high weight loss is harder.

It is harder. 

Yeah. I will second that because patients that I see in my practice, I use an InBody and I find it so valuable because sometimes even when we're working on these changes. Our weight may remain stable for a little bit, but we're losing the body fat and we're either, gaining or increasing our muscle mass.

And then suddenly you hit that perfect spot and then the scale starts to go. But so many people lose hope in that first month or two when maybe they're having a change in their body composition and then they give up just because of what a regular scale. So I totally support that and I've seen it in action and make a huge difference in patients being able to find that perfect formula, [00:11:00] per se, in this change of life.

Yeah, and I love how you bring up, it's like our metabolic powerhouse. And I think so many women, and I had this misconception too, think that your metabolism is going down in your forties, but. The evidence really shows that's not happening until your sixties. So some women are having a decrease in their metabolic rate, but it's because of that loss of muscle and not because just their baseline rate is changing.

So if you can preserve that muscle, then you can maintain your metabolic rate during those years. What's your advice on preserving muscle? 

So you need, I would say you need three solid things in order to sustain muscle mass and or grow muscle mass. Number one, you need adequate protein. As a general recommendation, I think all women should be getting at least a hundred grams of protein.

But , I would say for most people, that's probably not enough. But what you guys have to understand, so protein is a very unique macronutrient in the fact that we have no adequate protein stores in the body. [00:12:00] We have fat stores, we have carbohydrate stores, but we don't have readily available protein stores.

Protein is that one macronutrient that you must consume every single day. I describe it to my clients. As your body has two options. It can burn fat or it can find protein. It can't do both very well together. So when you don't provide the body with adequate amounts of protein, it's really gonna shut down fat burning mode and it's gonna focus on going to get the protein and it will get it in the form of muscle and tissues.

So that's why when we talk about , fat loss is more important than weight loss is that a lot of people are doing a lot of things right now that are promoting weight loss, but they're promoting it at the expense of losing muscle mass. So I'm someone that 

struggles to get , all of that protein in on a daily basis while still getting the other things I wanna get in.

Can you give me some tips? 

The best way, 'cause there's so many lifestyle habits and I we're gonna thread them through here that are important to maintaining a [00:13:00] balanced blood sugar, to optimizing your protein, all the things. And one of those habits is to stop nibbling and grazing.

Women love to pick, and guess what? You cannot get a hundred, 120, 140 grams of protein if you're picking all day long. I encourage my clients three to four solid meals a day, sit down, eat a full meal, and then don't eat between meals. Nibbling and grazing is horrible for your blood sugar management.

It's horrible for caloric control and it's horrible because it makes getting your protein in hard. So when you look at each meal you want to, basically, every time you sit down, you wanna get about. 30 to 40 grams of protein at every meal. I teach a strategy in my program called the Core Four.

And basically what I help my clients do is I want you to establish it's really five to 10. Go to breakfasts, go to lunches go to dinners that you lean on. You know that, every time you grab that cup and a half of cottage cheese with your blueberries and your basil seeds, you're getting 40 grams of protein.

When you [00:14:00] grab that, cup of yogurt, you're getting 40 grams of protein. You need one egg and one cup of egg whites to get 40 grams of protein. So you have these kind of meals that you lean on. Same for lunch, same for dinner. So that's number one. I feel like everyone needs a little bit of nutritional awareness.

Everybody hates to count macros, but the goal of like really looking at macros is to, again, create these kind of core things that you fall back on. Another way to look at, protein optimization is it, I would say at least 30% of your plate needs to be protein. Whether it's animal-based, whether it's plant-based.

But if you sit down to a bowl of oatmeal, then again where are you hitting your protein goal? You're not, so if you're gonna have a bowl of oatmeal, you need to have, some scrambled eggs, you need to have some Greek yogurt with it. So it's recognizing how to pair your meals together and the more balanced your meals.

That's another, habit that is important, is this balanced meal approach where you have adequate protein, you have tons [00:15:00] of fiber, and then you have small amounts of carbs, which are gonna help again, balance your blood sugar and improve your overall intake. Those are the two things that I think are the best way to go at it.

Stick to three to four meals a day and have these kind of go-to meals that you lean on. 

Yeah, I think that's great advice. And I think that's something we haven't really talked about on the show as far as snacking. 'cause I totally agree. When you graze throughout the day and then you're not as hungry for the meal and you're not going to eat as much protein and fiber in that meal 'cause you're not starving , changing that.

'cause I used to really love to just snack around. Yeah. All day. That made a huge difference for me to just know, just have a meal then. 

Yeah. Again, and I think a lot of times you're like, oh my God, to get a hundred grams of protein, I gotta eat 10 times a day because every little snack has 10 grams of protein.

Whereas if you sit down two, four to five ounces of chicken breast, which is a little over the size of a deck of cards, boom, you're done. You've hit that number. 

I know I'm guilty. Just if if I reflect on my own day of how I eat, if I allow [00:16:00] myself to skip a meal, skipping meals just doesn't work.

It doesn't not work. Right. Sarah Kitty's witnessed it. Yeah, because you reach that ravenous state and it's literally gonna be whatever is the quickest and easiest. And I think a lot of women this age, when they are in that time of life where they're running to this sporting event, or, trying to coordinate everybody else's things, if there's not a meal plan or something specific, then it's just something out of the pantry really quick as you're going out the door or something that can fit in your car that you just always have there.

And those tend to not be protein rich. 

Yeah. Another thing that I. Try to teach my clients is you gotta stay in front of hunger. You mentioned that. Yes. You're like, so hungry. And I always say hunger's like pain, if you eat on more of a schedule, I know people don't love that.

They love like intuitive eating. Let me eat when I'm hungry. But we don't live a lifestyle that allows us to eat intuitively because we, like you said, we're on the go. I can't, whereas when you eat on a schedule, then [00:17:00] you might not necessarily be. Starving by noon. But if you wait, then you get to the point where you're starving.

And a normal portion of food, at least for me, and a lot of people that I, I talk to, it doesn't satisfy that hunger. Now you need more food. So it's like pain medicine. Yes. They say take your pain medicine before you're in pain. Because once you're in pain it takes so much more to address it.

is a great analogy is yeah. Yeah. So 

it's eat on a schedule, , we have so much automation in our life with, our schedule and our work and all that stuff, but we failed to automate some of these healthy strategies that are just gonna make things so much easier.

Yeah. And I like that 

you just said have four to five things that you know you can fall back on. We don't need to have. Endless variety in our day-to-day 

menu. Agree. And, but people think they do. And we were talking before we started about how in my opinion and in my experience, everyone's just looking for [00:18:00] information and they just continue to collect information, but they fail to implement the information.

And I hear that a lot. And they're like, I just need recipes. I need more recipes. And I'm like, you don't need more recipes. I promise you, you know, number one, you're gonna be more successful if I can teach you how to modify the foods that you're already creating for your family to meet your nutritional needs.

And number two, more recipes is not going to, change the fact that you eat out, seven days a week and you know you failed a plan and all of those things. 

So I think you said there were three things. So protein, getting in your protein was one. 

What else do we need to do? So number two is obviously strength training you've got to overload your muscles, with weight.

Ideally I say three to four days a week, and I think women, we grew up in this whole. Era of Jane Fonda and, jazzercise and aerobics like you mentioned earlier. it cracks me up because there's still this like fear of bulking up. I can't tell you how many people are like I don't [00:19:00] wanna bulk up.

And I'm like, you have no idea how hard it is. To bulk up. It is impossible in your lifestyle, I promise. So we have to get over that fear of, bulking up with strength training. the one thing that I just wanna say, obviously where do you start? If you're not doing anything, then body weight exercises are strength training.

That's where you begin. And I think one of the things that, women are struggling with is that a lot of people are strength training now. Like they have the message. So they're, implementing this into their lifestyle, but they're failing to continue to progress and challenge themselves.

So that's the next step. The first step is to start, get in the gym, body weight, , grab the five pound, grab the eight pound, whatever it is. But, after six months, like you should be picking up the 10 pound, you should be picking up the 15 pound. So again, finding ways to continue to actively overload your muscles.

'cause just cardiovascular health. The first time you run a mile, you [00:20:00] can, you think you're gonna die. Or at least I do. And then, every time you run a mile, you get more athletically inclined to run a mile. It's the same thing with strength training. So I hear a lot of women that are like, I'm doing everything.

I'm eating i'm strength training, I'm, checking all the boxes. And it's just that they're just not continuing to push themselves a little bit more, over and over, throughout their program. So how do you know if you're lifting heavy enough? this is the question.

What I suggest is, take a normal exercise that you typically do, let's say a squat. Let's say you typically hold a 20 pound dumbbell when you squat, and then, go to the gym and I want you to do as many reps as possible. And if you're knocking out 20, 30, reps to failure, then it's time to go up.

It's time to go up and wait. So that's a really good indicator if you're ready to progress. 

Yeah, 

I've definitely 

been guilty of that and sometimes because I do have joint pain, which I know you've heard me mention on this show before. But , I finally went to physical therapy, [00:21:00] which is great.

And she told me the same thing that. I actually can go higher and I'm just plateauing and not pushing past the point that I need to be pushing to actually strengthen the muscle and the tendon that's causing the pain. Yeah. So if you are scared or if you are feeling like you're worried you're gonna get hurt or do feel pain, then don't just keep doing this forever at the lightweight, go see a physical therapist, go see a trainer and let them help you Absolutely.

Figure out how to keep going. Yeah, 

and I think, I know this is was my struggle, so I'll put it out there from someone who loved cardio. I loved running, et cetera. When I. First starting to do resistance training. I was used to like getting more out of more miles, right. that whole mindset. So it's like trying to teach myself, wow, I pushed myself so hard, I only did eight reps and that was what I needed to do versus what I made it to 20 reps.

That switch in mindset took me a [00:22:00] while, but once I got it, I actually saw the progress that I wanted to see. But it was switching from someone who is just used to more time, in cardio. But that's not how resistance training necessarily works. Correct, 

yeah. And sometimes I'm like, take your Apple watch off.

Yeah. Because a lot of people are like I burned, 400 calories when I did my run, but I only burned, 200 calories when I strength train. And again, you're not doing the exercise, especially with strength training for that. Burn during that session. What muscle mass gives you is that burn for the next six hours, 12 hours.

It gives you that accelerated, caloric capacity while you're sitting all day. The reward is tenfold. 

And you had mentioned it, it makes a big difference. I know when working with patients that use a continuous glucose monitor, whether it's with pre-diabetes or diabetes, the impact of regular strength training on those results, it actually gives them that feedback.

So they see that in real time and it is so powerful. [00:23:00] Powerful. Yeah. 

I have a full program that runs with all my clients wear A CGM and you can tell night and day, when we look at body composition compared to sugar response. And then even when you talk about, just movement after a meal and how powerful that is.

We can dive into some of that with the blood sugar talk, but again, the problem right now is just people are sitting way too much. We just gotta get up and move our body. 

And that's a great segue into that. 'cause I know you love to promote steps, right? Yes. And how important steps are and. I just think that's one thing that has happened in our culture is just we do not move hardly at all based on what our occupation may be.

Correct. And so it's really learning to add what we like to talk about. Neat activities. Some of those maybe doesn't even feel like exercise to you, but it's bringing back some of that movement in your daily life that we had decades ago, but no longer as a part of our daily life. So what are some [00:24:00] of those tips and tricks to help women get more steps in?

I'm sure the ones that you've already heard, it's apart, further away, walk around the house. Again, I just think that you have to look at your lifestyle and you gotta figure out how you're gonna get it done. I know for me, I think walking pads have been really helpful for a lot of people.

Just finding the ability to jump on your walking pad for 10 to 15 minutes in the morning, 10 to 15 minutes in the evening. They're very inexpensive. A lot of people are putting them in their, jobs in their offices while they're on phone calls, they can jump on them. So I love a walking pad.

I think that's a great way to increase your steps. One thing that I try to. Get people to really understand is that your ability to move your body throughout the day is far more important than your ability to get 10,000 steps first thing in the morning. And that's a, I think a new concept.

A lot of people will, get up early, they'll go to the gym, they'll crank it all out and they'll feel accomplished and then they will go sit for the next 10 hours and that's not good. 

[00:25:00] And that's where many of medical guidelines have even tried to switch, because at first we were really pushing you gotta get this set amount of time in a row.

And then we actually proved that's not necessary. Correct. We can split it up and it's even better to split it up. And you had mentioned, I know something we love to talk about is that post dinner walk and the big impact that can have for many people, because sometimes that's people's largest meal of the day and then they immediately sit to sleep.

After that meal. 

Yeah. And I'm, I don't know if you guys have talked about this, there was a study that came out that just doing 10 body weight squats every 45 minutes improves your blood sugar regulation by up to 30 or 40%, which to me is bonkers. Who doesn't have 60 seconds to jump up and do 10 body weight squats, and that type of blood sugar regulation improvement is huge. 

Yes. And I like to give that advice and I've had patients use it that have office jobs. 

Yeah. 

And it's it's, I have to go to the bathroom, do some [00:26:00] squats before you sit back down and it makes a difference in the results.

It does. It's very powerful. So if you can link that to a habit Yeah. The bathroom, or every time you open your emails to check your emails, you stand up and do squats. So try to think about. What's something you're doing repeatedly and link it to that, or even just checking social media or something. So many people do that briefly, multiple times a day.

 , There's all sorts of reminders and stuff. Sarah saw me do one where I had to do 10 pushups in order to open Instagram, and I was trying to get it open one day and then I'd just stop wherever we were and do 10 pushups. But that was fine. , There's apps out there that can help you do these things if it doesn't come to mind naturally.

Yeah. Definitely. 

And then I'll just briefly mention the third one. I was gonna say, I don't think we got to the third one and that's sleep. Hopefully y'all gonna do a full episode on sleep because it is just the most underrated health habit for women. We are just taking advantage of how important sleep [00:27:00] is and, we're not getting it and it's impacting so many areas of our life, specifically our body's ability to build muscle and sustain muscle.

It's so important to be getting good sleep for that. 

, If you're a new listener here in the month of June, we had a sleep series where we did three different shows about sleep. So if this is something you struggle with, can go back to those to get even more detail. But I think for women, a lot of times they're using their sleep as extra time to get things done.

And. I really hate it because sometimes, and I don't know how you navigate this, a lot of times people are cutting into their sleep to maybe get that workout in or, they're trying to do these other healthy habits, but they're taken away from their sleep and then they look at you and they're like, but that's the only option I have.

 , It's a struggle of like, where do I find the time? And because we tend to steal it from sleep, women do at least. 

Yeah. And I'm, I would probably say more women are using it as me time than they are using it as like [00:28:00] exercise. Bing. Yeah. And meal prep time. Again, it's like this is the one part of my day when I can sit here by myself and watch TV or scroll social media, so it's just aligning with, your goals and making it a priority. Yeah. 

And especially if weight is something that you are worried about in this time, just one poor night of sleep, you're gonna have. Decreased insulin sensitivity the next day. Your hunger hormones are gonna be encouraging you to eat.

you're gonna be less likely to make a good meal and go for those quick things. You're gonna be less likely to exercise. So I think prioritizing sleep totally agree is just so important. 

I know reflecting on residency when our sleep is like a hot mess, the cravings for carbohydrates without sleep is insane.

And and I don't know if everyone has made that connection, but if you really think about after a poor night's sleep, the kind of foods that you crave, a lot of times it's not usually protein. Oh no, I'm not like, gimme that protein, [00:29:00] 

not craving hard boil eggs. That's for sure. 

It really makes you lean into some of those simpler sugars and it makes it harder for you to hit your goals.

Absolutely. So my number one tip for improving sleep is to go to bed and wake up at the same time every single day. As close I, I think the recommendation is within 30 to 45 minutes. And I struggled with sleep for years and finally about three years ago, I was like, okay, I guess I'll just take my own advice and it, it definitely is what kind of helped me get into better sleep patterns.

And if you are struggling with sleep in this because of hot flashes or hormone changes, it is worth your time to talk to your physician or a provider about what you can be doing to make sure you're getting sleep. Otherwise, all these other things we're gonna be talking about are just so much harder.

 Okay. We've touched on this a little bit, but I think this sometimes is one of the things that can make the biggest difference for women at this [00:30:00] age is really understanding how to manage their blood sugar or blood glucose because they struggle with insulin resistance at this time in their life.

 How are you able to help women with this? And this doesn't even mean they have diabetes. 'cause a lot of times people are like, oh, I'm only dealing with issues with insulin resistance if I have a diagnosis of diabetes. But that's not necessarily the case. How are you able to educate women and make a difference in their weight loss goals and overall health goals related to this?

,, to really understand the relationship of blood glucose and your weight, you have to understand this, hormone, insulin and back to what I said, it is the number one fat strain hormone in the body. So anytime that you eat a meal , unless it's just a stick of butter, if it has protein or carbohydrates in it, you're gonna have a blood sugar response in response to how high your blood sugar goes.

Your pancreas is gonna secrete insulin, how much insulin you secrete is really what we're looking to manage. So we [00:31:00] do that by, number one, improving the blood sugar response of the meal that we're eating. And then number two, figuring out how can we clear this glucose as quickly as possible. So when we talk about blood sugar management, there are so many.

Applicable tiny habits that you can be doing that have a huge impact on your blood sugar regulation. Number one, stop nobbling and grazing. Stop snacking. So we talked about that. , In a normal blood sugar response, it takes two hours for your blood recover. That's what we wanna see.

So if you're eating every two hours, you're basically eating while your blood sugar is, potentially still elevated, which can be problematic. So getting yourself down to, breakfast at eight, lunch at 12, dinner at six maybe one snack kind of in and there can be really helpful.

So that's number one. Number two the makeup of your meals. Every meal has to have some protein in it. Every meal has to have fiber. So I usually, my meal makeup suggestion is anywhere [00:32:00] from 25 to, 40 grams of protein per meal. And then anywhere from at least five to 10 grams of fiber per meal.

And then you add, carbohydrates. So 50% of your plate is vegetables, high fiber vegetables, 30% of your plate is protein, and then the rest are carbohydrates. So creating that balanced meal is gonna help improve. Your blood sugar response. Okay? Then you can take it a step further and the order in which you eat that food matters.

So let's say you have, chicken broccoli and a baked potato. If you eat the baked potato first, you're gonna have a very high blood sugar response. But if you eat the broccoli first. Followed by the protein or even half the broccoli, half the protein, and then you eat the baked potato your blood sugar response is improved by up to 30%.

So it doesn't mean you have to give up carbohydrates, you just have to be conscious of the volume that you're eating them and maybe the order in which you're eating them as well. That is very helpful. Fiber and even vinegar. Fiber and vinegar are very [00:33:00] powerful at the front of a meal. So having a small green salad with a little oil and vinegar on it can really help balance out, the meal in which you're going to eat.

Fiber actually coats the stomach. It helps to delay the absorption of carbohydrates. Vinegar has acetic acid shuts down the digestive enzyme that carbohydrates need to be absorbed. So again, anything that we can do to slow down, glucose getting into the blood is gonna help improve that overall response.

And then we talked about. Exercise, when you exercise before a meal, and again, it could be 20 body weight squats, it could be, jumping jacks, it could be a full workout. You're depleting your muscles of stored glucose. So then when you go to eat a meal, , your body has the ability to push that glucose into your muscles versus your fat stores.

When you exercise after a meal basically you force the body to utilize that glucose that you just ate, so therefore it is not stored. So that's the goal. , You [00:34:00] can store glucose in your liver. Then it goes to your muscle mass. If you have a lot of muscle mass, you have a lot of storage.

If you don't have a lot of muscle mass, you have a little storage. The last place it goes is your fat cells. So we wanna prevent as much glucose going to our fat cells as possible. So exercise helps that as well. Those are the main, things again, everybody can do in order to improve their blood sugar regulation.

 . I think that's great advice. that applies to everyone at every age. If you are a woman that is going through menopause and your estrogen levels are going down, you do have a change in the types of fat that are active in your body.

So those fat stores around your thighs and hips are gonna be less active and the fat around your belly and your abdominal organs is more active. And so then the reactions that happen in the fat and the inflammatory response also reduces your insulin sensitivity. So , without you doing anything wrong, your body is [00:35:00] becoming in a shape where it is going to already be less insulin sensitive.

And so it's even more important to be thinking about these tips and just figuring out a way to incorporate them in your day without having to think about it. I think, yeah. 

Kitty and I both have worn CGMs and it's just fascinating, like watching different habits and their biggest impacts.

And we talked about snacking, but I'm gonna point out one type of snacking that was just mind blowing to me of how crazy it had a glucose response was the before the bed snack. And it was crazy, the difference in what my morning glucose was and then what they did overnight by just having a snack 30 minutes, an hour before bedtime.

 It was crazy. And I knew this, right? I knew that this would be the case, but it was such a big response. That is one that I'm always like, Hey, we're working on snacking. This is the absolute number one snack that we wanna try [00:36:00] to. Get away 

from. Yeah. And a lot of women, struggle with sleep.

They'll be like, I wake up throughout the night. And in many cases, that is low blood sugar. Obviously you guys know Yes, the body's very attuned. If your blood sugar goes low, it's gonna send out red flags. And when you're eating, especially like a high carb snack. 'cause the worst snack of the day is the bedtime snack.

Yes. We're not eating carrots and, hummus, we're eating ice cream and popcorn. And when you incorporate, an unhealthy snack right before bed, it. Put your blood sugar on a rollercoaster. It does. So a lot of people are waking up throughout the night because their blood sugar's just dropping.

So that's another way that, poor blood sugar management is gonna impact your overall health. It's the snowball effect. It's, it's, 

yeah. And I've mentioned this before, but I was a late night snacker for a long time and I blamed my waking up through the night on I've just been so used to listening to having young children on the monitor and now they've screwed my sleep forever.

But it wasn't true. It wasn't their fault. It was snacking. Mm-hmm. And [00:37:00] when I stopped late night , snacking. I slept throughout the night. 

Yeah, it makes a big difference in people's sleep. As we were talking about how to have better quality sleep, those late night snacks, not only is it impacting your insulin response, but it's also impacting the quality of sleep that you have.

'cause your body is not trying to really digest when it's sleeping, so it's wanting to focus on those aspects. So really trying to improve your sleep also requires not having those late night snacks. 

 And I know that, you work with a lot of women in the perimenopause and menopause stage. Is there anything you've seen as far as things that tend to trigger poor sleep tend to trigger hot flashes that they could be eating at dinner that make things worse?

It varies, from client to client. Some people are more sensitive to carbohydrates and things like that than others. But number one will be alcohol for sure. Alcohol is absolutely gonna wreck your sleep. And until you start wearing [00:38:00] like wearables, like the ora ring and the whoop, you really don't understand the impact that alcohol's gonna have on getting into your sleep cycles.

A lot of sugar. I think if you're having, foods that are high and added sugar right before bed, you're, again, you're gonna be on that rollercoaster. You're gonna have more hot flashes and things like that. So it just comes down to, creating those balanced meals. 

Now as primary care doctors, there's something that we always like to emphasize with women in this stage of life, and that is their bone health.

However, I feel like we didn't really talk about it until. Patients were in their sixties. 

Yep. Because 65 was when insurance would cover. Your bone density. And so we just didn't really bring it up until 65 when we were actually testing it, 

but we should have been talking about it way sooner to have the biggest impact to protect bone health.

Not just wait for a problem to happen and then talk about it, but to actually be in that preventative stance. What are some of the things that you are always [00:39:00] trying to educate women in this stage of life on nutrition and exercise related to improving their bone health? 

It all comes down to the decline of estrogen and the impact that has on our overall bones.

And the same things that we do to lose weight and, feel our best are the same things that we do to optimize our bone health. Obviously weight bearing exercise strength training is really important. It's always comical to me because clients will. Reach out to me and be like, oh, I'm osteopenia, or I've got osteoporosis and my doctor says I need calcium.

And I'm just like, that's like the last, the end, the last thing that you need. Before that you need strength training, you need adequate magnesium, you need vitamin D, you need K. So there's a lot of things that , in my personal opinion, come before just needing calcium.

I think for the most part, Americans consume enough calcium. We really lack the secondary nutrients that bring calcium into the bones and, help us utilize calcium in the right places. Not in our arteries, but in our [00:40:00] bones. , I think most women need to be on a magnesium supplement.

Most women need to be on D they need to be probably on some K. , When you optimize those nutrients, then again, typically, your calcium's able to perform the way it needs to be performed. Optimizing your magnesium is really hard. It takes a lot of work. Magnesium is our, what I call our calming mineral.

And so because we live in such stressful lives, we burn through it a lot. Sometimes like a low dose supplementation is not enough. We also have mineral magnesium deficiencies just due to the fact that we don't eat a lot of whole foods, and the foods, the whole foods that we do eat are grown.

And soil that's nutrient depleted and, all of those things add up to the need to maybe supplement and utilize some things to help our overall bone health.

Yeah, I know that was something that switched during our training. We were advising just blanket statements about calcium and then we roll back the [00:41:00] recommendations.

It's oh, based off of your nutrient intake and , many patients, just like you said, they get enough calcium. That's not the one they're actually missing out on. There are patients that may be low in calcium. Not saying that there aren't, but , you should actually assess your own diet to see if that's really the one of concern.

and I think stressing something that you said earlier about progressing your weight, we learned when we had Nick Trube on to talk about osteoporosis back in the spring, he taught me , you really do have to push it. Yeah. In order to get those bone benefits from weight bearing exercise, if you really wanna see improvement and not just slowing the decline, you need to be pushing 

yourself.

Yeah. And again, it's, forties and fifties we're just all about vanity. We wanna be skinny and we wanna look good. But at the end of the day, once you get, 60 seventies and eighties, it's about not falling. And that's the, the benefit of strength training and balance training so that you get to the point in your life where if you do fall, you're gonna be strong.

You're not gonna break a hip, [00:42:00] you're not gonna break a bone. Because we know how detrimental that is the older we get.

 So I think when most people think of calcium in their diet, they tend to think of dairy. Can you enlighten us on. Places that people can also get calcium aside from their cheese and 

their cottage cheese and yogurt. The best place is green leafy vegetables. Salmon shellfish you don't have to eat dairy to get the calcium that you need.

 Another plug for broccoli.

Yes. Vegetables. 

 I'm gonna change focus for us here and I wanna say you have a great social media account. You give a lot of wonderful practical tips. So if you haven't checked her out, definitely put her on your follow list. Is that what you say? Follow list. I'm still social media ignorant, but how do you feel about what people are getting as far as health information on social media? And are you seeing things that you [00:43:00] feel like we need to talk about and make sure people understand the 

true truth behind? Oh, yes. Definitely there's a lot of information on social media, and I think the biggest thing before we dive into the specifics is what you guys have to understand is that, people are looking for views, they're looking for clicks, they're looking for interaction.

And the best way to get those is to say something very polarizing. Say something very, to the left, to the right. And so a lot of times, a lot of the stuff that you're hearing about is what I call people focusing on the blade of grass, dialing down to something that maybe it matters, but in the grand scheme of things, it doesn't matter that much, for example, cortisol, I think is the big one right now. Everyone's. It's your cortisol, it's this, and yes, cortisol is important, but at the end of the day, if you focus on optimizing your health and all the ways that we talked about today, you're gonna fix your cortisol. Like you don't need this, cortisol drink in order to do that.

So, um, [00:44:00] Thank you. Thank you. Thank you for that statement. Yes. You, so you have to be careful with that. But, there are definitely a couple of things that kind of stand out for me. And, we could talk about supplements, guys, there is no supplement out there that is going to make or break, what you do, especially in the presence of unhealthy habits.

I would never encourage someone to take a supplement over moving their body more, eating more whole foods, sleeping. So it's if you're not doing the bare minimum the basic stuff that we've talked about today, then again, save your $50. Save your $60 because that, cortisol supplement, that GLP one supplement, those are really big right now, that fat burner supplement, it's not gonna do anything.

So I think that's a big myth is that, there's supplements out there that are gonna optimize your health. 

And then on the flip side, we, for years and we did a whole show on this and we'll do another one this month we talked about [00:45:00] HRT and that's actual hormone replacement therapy from a provider, not a supplement, that it can make a difference.

Yeah, and I know you probably have seen this even with your clients that you have 

Personally. Personally, I'm 48 years old. I started my hormone journey about a year and a half, and it's been life changing, and so I think a myth out there that I even see in my clients is I'm not a candidate for H-R-T-H-R T's bad for you.

I can't have it because of this, and this. And I think that, just really over the last 12 to 24 months we've come to realize that most women, obviously not everybody, but most women can benefit from some form of, hormone therapy. Progesterone at least, or testosterone.

I think all the, negative stuff that has been studied and looked at is all around estrogen. And that's just like a small piece of the puzzle. When we're looking at the whole thing. The hard part is finding practitioners that, you know are [00:46:00] comfortable. 'cause that's the problem is that there was just so much fear instilled in, again, I'm just speaking for what I know and in the medical practice about prescribing HRT, that it would do more harm than good.

That narrative's gonna take a while to be changed. 

And if you wanna learn more about that, we will have a show with Dr. Elkinson, who is a menopause certified ob gyn here in Lexington to break this down, talking about using it both in perimenopause, menopause so we have more information on that as well in addition to a show that we did back earlier this year with Dr.

Deidre Beshear, where she really breaks down why we changed our thoughts on this and trying to help people overcome that fear that was built for many years in women. Just wanna continue to get that message across so women feel empowered to have these discussions with their healthcare providers.

Speaking of 

fear, can you talk a little bit about, I think a lot of women have fear around soy.

Yes. Yeah. So again, the same, that we've been [00:47:00] living in terms of, soy promotes breast cancer and soy is bad for you. And we know now that is just not the case. Soy can actually be very beneficial. It has, phytoestrogens in it that can help support our bone health, that can help, support our hormones.

It's a great source of protein. Soy is a complete protein source. So it's a plant food that actually has the full amino acid profile. So we shouldn't fear soy, we shouldn't, avoid it. We should use it in moderation just like everything else. Anything in excess is going to be problematic.

But there's no reason to omit soy in your diet at this point. 

And the American Cancer Society promotes soy in the diet, does not promote soy supplementation. But yeah, use it as one of your sources of proteins as you're trying to Yes. Make these complete meals. Tofu 

and at a Mame and Tempe.

Yes. Those kind of whole options. And 

they are not scary. I used to think they were scary as [00:48:00] far as from a cooking standpoint. You just have to do it a few times and then you, oh, edemame 

I use almost every day. You throw it in a salad. You throw it in your soup throw it in your stir fry.

It's such a versatile protein, high fiber, everything. Yeah. It checks all the boxes. Does. It really does. 

Now, are there any other myths that you feel like you're constantly trying to help clients? Dispel . 

 , I think just overall the myth that, again, after 40, you're broken, like it's impossible to optimize your health through menopause.

Menopause is all about, physical symptoms. Again I work with a lot of women. They're like I don't have the hot flashes. I don't have, this kind of stuff. Is HRT still beneficial for me? And I'm like, yes. This is not necessarily about just treating symptoms, it's about reducing your risk for diabetes because you become less insulin sensitive.

It's about improving your bone health because you are at a higher risk of [00:49:00] osteoporosis. So I think just getting people to understand, that with the right lifestyle changes and with the right interventions, you can be the healthiest person you've ever been in 40, 50, and 60. 

I love that. you've given us a lot of great thoughts. if you were talking to a woman in her late forties that's starting to feel some changes of menopause and is wanting to really get on top of things, what would be your list of, these are the things that you just need to get started with?

Something's better than nothing. So I always like to, reiterate that because the only reason why you continue to fail to optimize your health and wellness is because you continue to give up because you lack consistency. So I think for most women, you need to sit down and you need to pick one habit to really focus on for the next 30 days and then continue to build on that kind of over and over.

So that's number one. Giving up will never , get you to where you want to be. But when I think about maybe four or [00:50:00] five key habits that you could start to implement in order to see progress and feel better number one, I would say start with whole food nutrition., I don't care what you eat.

I don't. Care when you eat, but make it whole foods, keep it simple. Animal products vegetables, fruits, whole grains, cook at home. It's so much better. If you wanna go home and you wanna ground some beef and you wanna throw in a jar of, low minimal ingredients, pasta sauce with some pasta, that's gonna be such a better route than going through fazoli's and getting the same meal.

Really just focusing on whole food nutrition. Secondary to that would be to stop snacking and grazing, get down to three to four meals a day. Think about your core four, what are these kind of go-to meals that you can lean on, not just for you, but for your family as well. I'm.

I have a 16-year-old daughter and we sat down, before the school year and I was like, okay, give me five breakfasts that I can make for you. And so she gave me the five breakfasts that she wanted, and then I tweaked them a little bit [00:51:00] to give her a little bit more protein and give her a little bit more fiber.

So we're not like guessing every morning in terms of what we're eating. Here you go, here's your, here's one of your five options. Eat it. So that's number two. I would also say. Eat very protein and fiber forward. You cannot have enough vegetables. You can not have enough fiber. And again, optimizing your protein.

What people don't understand is there's this kind of protein leverage hypothesis out there and basically what it says is that your body is going to continue to signal you to eat until you consume. A certain amount of protein. So you're gonna find when you start to eat protein and fiber forward, you're full, you're satisfied, you don't need to snack.

Versus when you're eating more carbohydrate rich foods that lack protein, you're gonna feel like you're hungry kind of all day long. So you eating protein and fiber forward helps to manage your hunger and it helps to again, improve your muscle mass, improve your caloric control, all of those things.

So [00:52:00] from a nutritional standpoint, those are the big three things that I would focus on. Hydration is really important. What a simple habit to drink, 60 to 80 ounces of water a day. Don't tell me drinking water is hard. It's not. And what you have to understand when it comes to dehydration, because.

Even mild dehydration reduces your body's ability to burn fat. Mild dehydration will show up in the form of hunger versus thirst, , if you're someone who wants to snack all day long, I promise you, you're probably not drinking enough. And those signals that you're getting that you think are hunger or actually thirst signals.

So when you stay well hydrated, when you optimize protein and fiber, I'm telling you guys, hunger goes away. You don't think about food all day long. Hydration is very important. And then the last one is again, just move your body. Find ways to incorporate more steps throughout the day. Find ways to incorporate some body weight squats, some strength training.

And again, one day a week is better than none. [00:53:00] Two is better than one. So you always have to start somewhere and then build on it. It is the stopping and starting of these healthy habits that cause you to continue to fail. 

How could someone either come see you or learn more from you? 

 Definitely follow me on social media and 

we'll 

put a link to that in the show, right?

That's where I show up the most Amanda Nighbert, RD is my handle on Instagram Facebook, TikTok, YouTube, Pinterest, I'm everywhere. And then, yeah, check out my Lean program. It's a seven week online program. It's run through my free private app., I call it a foundational program because we focus on the basics.

I really just feel like women are trying to optimize their health with what I consider advanced level nutritional strategies before they fix their. Foundation and you can't build a strong, house or body on a broken foundation. So if you're struggling to do the simple things consistently well, that's where this program will help you.

And really what sets it apart is the daily support and accountability. I [00:54:00] think most women know what to do, they're just struggling to do it consistently. That's what I'm trying to hold you accountable to show up. 

We love that. And we all always love the message of let's do the basics first.

Because I, there's so much out there on social media or other platforms that are just talking about the extremes, and we really need to focus on the basics because that is where you're gonna make the biggest difference in your overall health. We have really enjoyed today and look forward to the rest of this month as we talk about different menopause topics.

Next week, be sure that you tune in as we have Dr. Degler who's gonna talk about our mental health during this stage of life, and changes that we may be experiencing as we are having these fluctuations in our hormones, to be able to recognize them, as well as being able to talk to your healthcare providers about them and advocate for yourself about what might be going on.

. So please tune in. And then lastly, we [00:55:00] are about to have our unmuted conference that both Dr. Dotson and I are a part of, Amanda Nighbert is one of our sponsors for Un-Muted the Volume We Deserve.

So if you haven't got your ticket for that and wanna learn more about menopause and perimenopause, be sure that you grab one of those last tickets that are available. We are so excited for this month and please stay tuned. See you next time.