70- Train Smarter, Not Harder: Hormones, Recovery, and Strength with Dr. Lizzie

In this episode of 'MilesFromHerView,' host Kat welcomes Dr. Elizabeth Williams Ruing, founder of Active Health DPC, to discuss the nuances of over-training, strength training, and recovery, especially for active women. They explore the role of hormones, the impact of stress on training, and how to effectively use wearable device data to enhance workouts and prevent burnout. Dr. Lizzie also emphasizes the importance of proper nutrition, adequate sleep, and tailoring training plans to individual menstrual cycles and life phases, such as perimenopause. This episode is packed with practical tips and expert advice to help women better understand their bodies and improve their fitness journeys.

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Website: https://activehealthdpc.org/

00:00 Introduction to Today's Guest and Episode Overview
01:11 Welcome to MilesFromHerView Podcast
02:02 Exploring Training and Recovery for Active Women
03:10 Understanding the Mental Shift in Training
04:49 The Impact of Hormones on Training and Recovery
06:34 Defining Overtraining and Its Phases
09:23 The Importance of Recovery and Avoiding Overtraining
12:53 Postpartum Training and Overtraining Syndrome
18:55 The Role of Wearable Devices in Monitoring Training
27:16 Understanding Heart Rate Variability
29:21 The Importance of Sleep for Recovery
30:32 Optimizing Sleep Hygiene
34:09 Managing Training and Sleep
39:44 Nutrition and Hydration Tips
44:50 Final Thoughts and Contact Information

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Transcript

Kat: 0:00

Before we dive into today's episode, let me tell you a little bit about today's guest. In this episode, I guarantee you'll wanna stick around for Dr. Elizabeth Williams Ruing is a board certified internal medicine and sports medicine physician and the founder of Active Health DPC in King of Prussia, Pennsylvania. She left the traditional healthcare system after a decade because her patients needed more, more time, more connection and better answers. Now she's helping people thrive. With a whole person approach to health. In today's episode, we are going to break down the warning signs of over-training, dive into the role of strength training and how it plays into long-term performance, and we're even gonna dive into the numbers on your wearable device. To know exactly which ones are worth paying attention to. Oh, and by the way, there is some hormone talk and what it means for us as women as we move through the decades of life. So if you're training for an ultra chasing strength or just wanna get a handle on your health, this conversation is packed with takeaways you can use right away. Welcome to MilesFromHerView, the podcast powered by KatFit Strength, where busy women like you find practical solutions to fuel your fitness journey with authenticity and resilience. I'm Kat, your host, a mom of two active boys, a business owner, and an ultra marathon runner and a strength trainer in her forties with nearly two decades of experience. I'm here to help you cut through the noise of fads, hacks, and quick fixes. This is a space where we celebrate womanhood and motherhood. All while building strength and resilience and reconnecting with you from a place of self-compassion and worthiness. Whether you're lacing up your running shoes to go out for a run, driving your kids to practice or squeezing in a moment for yourself, I'm right here in the trenches with you. Let's dive in. Welcome back to MilesFromHerView. I am Kat, your host, and today we're gonna be exploring what it truly means to train smarter and recover better as an act of women. You know, if you've ever thought, I just don't feel like myself anymore, you're not alone. There are real reasons behind it, and I'm joined today by Dr. Lizzie. From active health DPC to break down how hormones, stress and nutrition impact your workouts and why recovery takes longer than it used to. Get ready for the conversation that will help you understand your body, avoid burnout and feel stronger at any age. Welcome, Lizzie. I'm happy to have you here today.

Dr. Lizzie: 2:38

Thank you so much. Thank you for having me on your amazing podcast. I'm honored to be a part of what you're creating and have this opportunity to talk to your listeners about such an important topic.

Kat: 2:47

I know we have so much to get into, so we're gonna dive right in. And I was definitely in that camp of where I just didn't feel like myself anymore. Probably in my thirties. It was just like. Things just felt different and it's hard to explain sometimes and, you know, I would love to hear your thoughts on mental aspect

Dr. Lizzie: 3:08

Thank you for this great question. One thing that active women often miss when it comes to recovery and over training is understanding that their bodies are forever changing and evolving. Understanding that our bodies are not functioning the same way that they did when we were in our teens or early twenties, requires a mental shift. What we were able to handle and the time it took to recover from that is different than what it is later in life. Mentally adjusting to this evolution and adjusting our workload and stress input into our bodies, and also allowing our bodies, the time that it needs to fully recover is really hard. In our mid to late thirties is when many women really, really start to feel this. They feel, wow, this is not how it used to go, and I just don't feel like myself This, I don't feel like myself occurs. For those with and without biologic kids. Yes, having a kid can hit very abruptly, but this feeling of this isn't my body occurs for women without kids as well. Part of this shift of this isn't me, this isn't how training has been for me and et cetera, can go on for several reasons. Some women may be coming back to exercise from a complete time away for whatever reason, injury, work, family, or some women may be understanding the importance of moving their body and trying to get into this movement rhythm. They're just finding that they're struggling to progress or they're not able to train like they used to. They're always feeling tired or they're getting injured repeatedly. Or there may be women who are trying to train like they used to, and they're finding that their ability to push and recover just isn't what it was when they were younger in those late teens and early twenties. And this can be much more drastic for females in that perimenopause postmenopausal timeframe. One of the main reasons for this change in how much load is appropriate and the recovery time that it takes for our body to adapt is due to the changing landscape of our hormones. Specifically, I'm talking about estrogen and progesterone in our menstrual cycle. With the changes in our hormones, there's a shift in our recovery here. Many women underestimate how much time it takes for their bodies to recover from a workout and underestimate the rate of progression through a training program. Meaning that it can take longer to see gains and strength through that change in body composition that they're working for. And when we try to push our bodies like we were used to, it can lead to over training, which has its own slew of consequences.

Kat: 5:32

I wanna highlight that you said, and this is my, my favorite sentence, and it's two words. Bodies change, and I talk a lot about this with clients is bodies change. And that's a fact. It's just a neutral sentence. And I think. We tend to forget that. and with that,, our fitness our,, nutritional intake, our sleep and recovery demands also need to be adaptable and flexible with us, so. I was a college athlete. We talked a lot about over training and then when I coached in college athletics, we were always looking at over training and over training., We kind of jumped to the twenties, look different for each person., When someone is getting back into working out, is there ways to understand if they're over training versus. Are they getting back into training? Because I know those are two different things and that's something that I also look for with my clients. I'd love to hear your thoughts more on that.

Dr. Lizzie: 6:33

Yeah, that's a great point. And I think when we're talking about over training, it can help to kind of define what we're talking about, so we're all on the same page with that. So over training is the stress of training and exercise. Your body's ability to recover. There are three main phases of this. So functional overreach is the first phase of over over training, and in this phase, this is where athletes are really working in and that's where they're trying to make their gains and ideally operate in that period of training. Again, when they're trying to increase strength or increase speed, there's periods of increased training with appropriate rest. This must be, must be monitored very carefully because without the adequate rest, one can. Easily slip into the subsequent phases. Symptoms of this functional overreach that I suspect all of us have experienced at some point is, you know, you're really tired, your muscles feel heavy, you're sore, and you can have a decreased athletic performance for, for whatever timeframe it takes you to recover. And the recovery timeframe is very individual and it can occur from days to even weeks. The recovery time will vary on many factors. But I want to stress that it can last longer than just a day or two. I think we're very used to hearing that delayed onset muscle soreness or dos. You know, it starts a day or two after and goes away in a day or two, but just that resolution doesn't necessarily mean you're fully recovered. And again, this is the stage where many athletes are going to be trying to operate to achieve those gains. But as you're getting back into an exercise regimen or within your training, it's important to understand your goals of what you're training for. So you need can understand how far into this functional overreach you really wanna reach into. Right? If we're really training for a race or a strength competition, you're gonna be pushing pretty hard into this versus somebody who, you know, we're trying to get back into it. Isn't necessarily gonna be reaching that far into that real muscle soreness that, you know, no pain, no gain needs to be erased. You can have gains without feeling like you've destroyed your body.

Kat: 8:39

I fullheartedly agree and that's something that, I see clients come in, it's really distinguishing that difference because I feel as a society we've taken to heart that no pain, no gain with generalized fitness. If my muscles aren't sore, did I do a workout type scenario where that is not a metric for a good workout at all? We don't wanna live in a constant state of soreness that's not. Healthy for our muscles and our body. It's not a healthy way to train. I always say we want our muscles to have this kissed worked, feeling like they feel tired, but I can still handle the loads of life. And when you feel that it's, let's double down on sleep

Dr. Lizzie: 9:22

yes. Now the next stage, right? So that functional overreach we're reaching, we're adapting, our bodies are growing and evolving into that strength or into those goals that we're reaching for. But if we're going along and we're not giving our body the proper time to recover with all of that encompasses you can go into the next feed, which, which is non-functional overreach. And so this is prolonged exertion without adequate recovery. So time to progress from functional overreach to non-functional overreach is variable, but it can occur as shortly as within a few weeks. So we wanna be very mindful about that, listening to our bodies, like you're saying, and seeing how we're, we're adapting and feeling. As we're going into this non-functional overreach, you're gonna develop more symptoms, both physical and mental. So it may look like muscles that are always, or almost always feeling really heavy sore. You can start to notice some more joint pain. You can also start to say, you know, I'm not enjoying this training regimen, or, why am I even doing this? If you're really feeling these things, you wanna seriously evaluate and consider non-functional overreach. Mentally feeling this way impacts your quality of life and can affect interpersonal relationships and can be really detrimental to those goals you've set. You know, I've met some athletes where it's like, you know, training, I'm training and I'm pushing. I'm knocking where I need to go. I just need to push harder. I just need to push harder for that goal, and that can actually be more harmful to, to what they're trying to accomplish, rather than scaling back, recovering and then having the ability to push harder. Also, it really increases your risk of injury. It increases risk of overuse injury, and just injury in general.'cause you're gonna be more tired, you are gonna be decreased, focused on your form'cause you don't really wanna be there and your body's not performing at optimal levels'cause it's running in this deficit and always in repair mode. And it has this decreased ability to adapt to additional stresses.

Kat: 12:31

That is so true. I've seen it in the sport of ultra running, you see a lot of people push, push, push because it is, you're supposed to feel fatigued. Even in everyday culture fatigue and overexerting ourselves is kind of a unspoken badge of honor. It's look how much I can do without recovering. And it's, it's not healthy.

Dr. Lizzie: 12:52

No, it's not. Yeah. And it's one of the things we should push against, you know, and de-normalized.

Kat: 12:58

And then I also see a season of life prenatal postpartum, and this is when I look at the, the clients and when I take them in it's really focused on not only giving back to the body what the, you know, plus or minus 40 weeks took from your body, but also what the under. Standing of you are already sleep deprived and we're working on building a body back up to put in that good, strong foundation. So now's not the time to push. And I always have the mantra, just because you can doesn't mean you should. And this is why we wanna work on giving back to our body. Our body is still strong and is super resilient, but we want to give it the competitive edge and set it up for success with our training. So that you're not riddled with soft tissue injuries or,, chronically getting sick because your body is to, to your point, constantly in recovery mode while you're training and you're going to lose those training stimuluses because you're not going to those training a adaptation. So it's essentially. Work for work, which I don't, I don't like to just show up and do work for work,

Dr. Lizzie: 14:05

exactly, yes. And that postpartum period really reminds me of an just over-training syndrome. So over-training syndrome is the most severe and the worst. Most worrisome of this spectrum of, of Overtraining. And so with the Overtraining syndrome, you have these worsening symptoms, which can include that are not limited to,, decreased physical performance that can last months. Excessive and constant fatigue, chronic muscle and joint pains, change in appetite, loss in enthusiasm for your sport or what you're doing in general. Personality changes, irritability, difficulty concentrating, restlessness, anxiety, burnout. I mean, to me that sounds exactly like the postpartum time. You're not sleeping'cause caring for this newborn and then women are expecting their bodies to just, go back and train like they used to and bounce back this bounce back culture. And we know even from our most elite athletes who have slipped into this over-training syndrome, when we pull them back and we. You know, optimize their nutrition, their, their exercise or their activity has been really scaled back and modified. Now, that doesn't mean just sitting on the couch and binging Netflix, right? There can be functional activity, but that really training hard mentalities scale back and their sleeping. It can even take those individuals weeks to months to recover from that. So then we're thinking about, you know, our postpartum or our moms with littles or any individual in that phase of life. It's gonna take you even longer to recover and for your body to be able to make these gains that you're searching for. You know? Now of course with, with everything in life, there's caveats to this. Yes, there's Olympians and our elite level athletes that have a baby and are able to go back to training really quickly. But for our. You know, average, not average individual, but for those who are not in that elite level, please have respect for your body and give your body that grace to say, you know, it's going to take months before we're really able to engage in that. But again, doesn't say we shouldn't be engaging in some movement plan, but just a change in that mental shift like we were talking about before, about what that movement plan looks like.

Kat: 16:23

And with the elites, we only see a small percentage of what they're doing. So one person who is. Phenomenal athlete that comes to mind. Allison Felix, she went through and competed, through pregnancies, but the one thing that the general population feels to see is how dialed in her training and her decades of competing and base. Also help her be able to show up and her training stimulus only needs a little like dosage of to get to be able to highly perform. So. I think we can also glean a lot from elite training. The master's recreational athlete where I'm not elite, but looking at, you know, she has her nutrition, her recovery dialed in. She, is doing things a lot different now. In the world of ultra running where, and I don't wanna make this all about ultra running, but you know, where you see someone like Jasmine Paris. Where. The cool thing about her story and her phenomenal performances that she has done is she's also incorporated her life stress of owning a veterinarian practice, and also being a mom of young children. She incorporated her life stress in as a part of her training and adapted those things. It's hard to measure life stress because, and speaking from a big runner, it's like, well, if I'm not putting up the miles is it even training? But it is because the body can't differentiate between stress. It doesn't say, well, this is life stress, so it's not gonna impact my training. Stress and training stress won't impact life. It all impacts each other. So to your point, it goes into that. Go into the factors of over training?

Dr. Lizzie: 18:17

Yes. That's amazing. That's wonderfully said. And then as we're talking about trying to normalize some different things, right, and we should be normalizing that life stress really does need to be impacted and taken into account into our training regimen. But also a slight about. What it means for our females to be training in relationship to their, their menstrual cycle. And you know, I've worked with many different running. Programs as well as other sports too. But I think this, the thinking is still more heavily into our running community, that if you are still getting your period, you are not training hard enough. And that is if you're not on certain birth controls, but are normally menstruating women and we really need to. Get rid of that mentality because if our young women competing in athletics or engaging in movement are not getting their periods, this is a huge red flag. We need to be seen and evaluated and figure out what is going on. Because if that lasts for a really long time, that can have irreversible consequences to your health. And this is kind of like a parallel to over training syndrome. It's something called relative energy deficiency syndrome, where a lack of a period falls into that. Used to be called Female athlete Triad Syndrome, but we recognize that men can have this as well. It's a whole energy imbalance is what the, the root of that is. And so I just wanna plug that if you're in a community and that is still being pushed, we need to fight against that. And if you need help, I'm happy to come and talk to whatever thought leaders are pushing that mentality.

Kat: 19:53

Yeah. And I'm so glad you brought that up because I, you know. Growing up in sports, that was kind of again, like this badge of honor. Like, I must be training really, really well because I don't have my cycle. Important piece of our life. We do need it. So we've talked a lot about over training and in this day and age of digital tech checking out sleep scores and HRV and, you know, resting heart rate and, and all of that. If someone's over training, or even if someone's just trying to be like, am I recovering well? How can I gain some sort of idea and let their device set them up for success versus creating anxiety or telling them that? Well, you slept poor so that they're gonna expect a poor workout or omit a a workout because of that. We would love to hear your thoughts around that,

Dr. Lizzie: 20:45

for sure. This is a really, really good point and a hot topic. Before we just jump into that, just wanna highlight, and we may circle back to it, but with recovery, you've mentioned a few times, dialing in your sleep is really, really. Important. Your nutrition is really, really important. Short plug as we go through life, you need more protein. But there is a max of protein that's beneficial water intake. And again, with nutrition, that's Whole Foods as it comes up. And our supplements are that supplements not to replace those whole foods and good nutrition. But back to these wearables, because yes, we can listen to our body. We can say, you know, I feel tired, but is that just because. Of the stress of life and this or that. And people want some more data-driven ways to decide, knowing if that's gonna cause more stress for you. Or like you had pointed out, oh, I got this bad score. So it's a self-fulfilling prophecy of then you're going to feel bad after that. You gotta introspect and see for yourself how you respond to that and. As you had mentioned on one of your other podcasts, which was great. Some weeks it may work and some weeks it may not. So if you're going along and it's adding to this, oh, I should be doing this category, put it aside, come back to it when you, when you feel ready for that. But with that, there can be really good data and it can help gauge some decisions. You had mentioned some products that are out on the market. And they are different with how they get the different variables. So I do encourage people for your specific product to go and look and see its reliability and see how it gathers this information for you. Because good data in will lead to good decisions, bad data in bad data out. So I'm not saying go buy a new device, but just understanding what the, the data is that you're working with. So yes, some of the big metrics that we can look at, one is resting heart rate. Resting heart rate is defined as the number of times your heart beats in one minute, and this is measured in a lying or sitting position in a calm setting. Usually you wanna be sitting there quietly for at least five minutes before we're taking that resting heart rate. First thing in the morning can be a good thing if that's available to you. And overall with this, you're looking at trends. It's not an hour to hour, minute by minute thing. It's like, you know, a week by week type of thing. Some day, sometimes day to day. Usually lower is considered more fit, but this does have an extent because you should not be having more than a three second pause between heartbeats and the level of your slow heart rate should reflect your level of training. Meaning that if your heart rate is in the low forties, but you walk one mile a day, while that one mile a day is great, it should not cause that level of a slow heart rate. And if you're having this mismatch or you're not sure if it's a missed. Match talk to somebody who's trained in this area. And one thing that if you have a sudden increase in your resting heart rate, aside from like your normal menstrual cycle.'cause depending on where you are in your menstrual cycle, you can have changes in that resting heart rate. That sudden increase could signal over training, illness, or inadequate recovery. And you can use this to adjust your intensity of training. So if all of a sudden, you know, you're normally somebody that's. In the sixties, right? And all of a sudden you're in the mid seventies to eighties, of course your heart rate's still quote unquote normal.'cause normal is 60 to a hundred technically. But for you, that's off. So you may wanna, you know, take another scan, be like, oh, am I feeling off? Or did I sleep well that night? And depending on that, you may say, oh. M, maybe I'll back down slightly on, on the workout, or if you're going, no, I actually feel kind of good then fine, go on with your normal training. It's just something to consider as part of your, of your training regimen. With that you have heart rate variability. So we just talked about resting heart rate is measuring the times your heartbeats in one minute. Heart rate variability is the difference in time between heartbeats, and this is measured in milliseconds. So again, heart rate variability looks at the beat to beat difference versus how many beats per minute. And this is a reflection of your autonomic nervous system, right? This is your sympathetic, which is your fight, flight, or freeze, or your parasympathetic, which is your rest and digest. A higher heart rate variability suggests a more adaptable and resilient sys system. This suggests that your body is able to switch easily between stress, response and relaxation, and this suggests a strong parasympathetic response, which is associated with better recovery. Lower stress and potentially improve cardiovascular health. Now, if you're having a lower or heart rate variability, this indicates a system under stress. It may also suggest a more dominance of the sympathetic nervous system, which can be triggered by factors like stress, which we alluded to before, is emotional and physical, right. Exercise stress, life stress is, it's all stress, lack of sleep and or illness. So factors, again, that factor heart rate variability, or age as we. Up in age, our heart rate variability tends to decrease stress, again, both physical and mental and health, especially cardiovascular conditions. But please note that a low heart rate variability does not diagnose heart disease. If you're concerned about this, please come see a knowledgeable professional. And another factor is lifestyle. So exercise, sleep, diet, substance use can also impact heart rate variability. So what are some normal ranges for this? So if you're in your twenties, a normal range can be about 55 to 105. In your thirties to forties it can be around 50 to 70. And in your sixties it's around 25 to 45. So then you're wondering, how do I measure this? So the gold standard is within EKG machines, we had talked about some of the wearables watches, you know, the wrist or armbands rings can measure it. And again, they all have different ways to do it. So. Their websites and the different things you can Google will will tell you about that. And then how to use heart rate variability with training. It can be used to gauge how hard or intense to work out. So if you're having a low heart rate variability day to week, this may indicate that you need more recovery. And this is where this data can be helpful. As we're reaching into that, you know, functional overreach or are we going into non-functional overreach? This can be a metric to use, and if you're finding that you're getting lower, consider focusing more on form instead of working for those gains in speeder strength. If it remains low, it could mean that you've stepped further down that non-functional or into over-training syndrome, or that you have another medical condition going on. So if you're not recovering to your baseline, seek help again with a medical professional or work with a personal trainer who can help guide with that.

Kat: 27:45

I find the heart rate variability so interesting. As you were talking, I was like, lemme check mine. I haven't looked in a couple weeks. It's cool that we have this technology. Is there a specific site, because I know you talked about looking at how it's calculated or how different devices are, calibrated

Dr. Lizzie: 28:06

that's a good question. I haven't found one that's just overall lays it out. It may be out there, I should just type into Google, like, how is your Garmin watch versus your Apple Watch, you know, versus your R Ring versus the whoop. And you can see how they're calculated and what the reliability is there. Some of the ones that you wear overnight can be more reliable because you kind of wanna look at it. Again, it's not one of those ones you're looking at hour to hour.'cause it will fluctuate, right? If you're running versus if you're sitting doing breathing exercises. And so the early morning or that overnight measurement is the one you're looking at. Because I've definitely messed around with the watch that I use and you're sitting there and you're doing your breathing exercise where you breathe in for four, hold for a longer time. Breathe out for a longer time than what you breathed in is really amplifies and turns on that parasympathetic. Part of your nervous system. And so that will then increase your heart rate variability. Right. And so you just wanna, again, make sure that you're understanding what the data is you're looking at. So that overnight or early morning time is the one you're looking at.

Kat: 29:09

I have a Coros and the HRV is dependent upon overnight. I'm probably the worst at like checking my watch. But with the sleep, it's so interesting to me. The mornings I wake up and I'm like, man, I just don't feel like I slept well. It actually says I slept great. It's always kind of like, okay, challenge, accept, watch. Let's see how much energy I have. But it is. Interesting.'cause the days it says I slept great, I feel really good throughout the day, even if I wake up feeling like, oh, I don't know if I got the best night's sleep. And it's also interesting, like last night I'm, I woke up and I was like, man, I slept amazing. And I looked at the score this morning'cause I was just looking at something and it said fair sleep. And I'm like, huh, I feel amazing. So it is that, that is interesting how it also measures sleep.

Dr. Lizzie: 30:00

Sleep is a very interesting one with the wearables and the data and like you're saying, how that correlates to how you're feeling and the, the true measures, how you feel later in the day.'cause when you first wake up, it's more of a dependent on like, where in your sleep cycle did you actually wake up? You know?'cause if you were deep in your, you know, pre rem, rem and your. Woken for whatever reason, it's gonna be harder. You're gonna be groggy, you're gonna be slower to wake up, you're gonna feel like you're dragging. But then through the day you're like, ah, I'm fine. You know? Versus if you actually slept poorly but woke up on that lighter sleep phase, which is more likely because you don't go into deepest sleep. But then you kind of drag later in the day. Which is interesting. And then, I don't know if you wanna talk about sleep now since we're kind of on this.

Kat: 30:37

Absolutely. To dive in.

Dr. Lizzie: 30:39

This is absolutely necessary for recovery. You cannot have a conversation about training performance without talking about sleep. More and more data is coming out about like how critical sleep is. And insufficient sleep has been linked with poor health outcomes such as obesity, diabetes, cardiovascular disease, certain cancers in addition to. Poor recovery and poor performance. There's an interesting study outta the UK that showed that individuals that have poor and insufficient sleep and they lack physical activity, they have a higher risk of death compared to each behavior individually. So it's not all one plus one equals two, it's a one plus one equals five type of thing going on. And this is important because as we age, we tend to move less, and as we age, we tend to sleep less bad combination and so, right. You might've heard the com mattress commercial, but we must treat sleep like an activity, right? You must prepare your body for sleep. It seems like you just lay down, you fall asleep. But it's this whole process that has to occur. And so to prepare your body and optimize yourself for sleep, there's several things that we can do, right? A lot of people might have heard of this as quote unquote sleep hygiene. And, but it works, right? So no eating three hours before bedtime. The higher your age, the earlier you need to stop drinking caffeine because everything takes longer as we age, and it takes your body longer to break things down and metabolize it. No alcohol, right? There's no safe amount of alcohol. We debunked that myth of a, you know, red wine keeps your heart healthy. It's not true. It impacts you for days. So really no alcohol if you do it really limited. And be mindful about your timing with your training and, and competitions. Screen time is really, really important. You wanna get off your screens an hour or two bet before bed because that light goes into your eyes and it triggers your brain to be awake. And unfortunately, some people are even sensitive to their Kindles. Yes, dark mode helps but be mindful of your body, right? If you're doing these things and still waking you up, try to. Ditch it. If you're like, no, I'm doing fine with it, fine. Do the dark mode, you know, put those red light glasses on and see if that helps with your sleep. The other thing, instead of doing the screens, you know, you could read a book, do an audiobook on a timer. Journaling at night can be really, really helpful. Kind of like a brain dump. And just that other mental health benefits of journaling can be really important. You wanna drink your water during the day, but do it during the waking hours. Limit the amount of water you're drinking one to two hours before bed, so you're not up all night going to the bathroom. You wanna start dimming your lights. This one I have trouble with'cause I like really bright environments and I wanna keep the lights on all the time. But really being mindful an hour or two before bed starting to, to turn those down or turn some lights off. And if you take melatonin, you wanna take it three to four hours before you go to bed. So if your bedtime's at nine, you wanna take it at six. Now this is different than what the bottle says, but in my experience it works a lot better'cause it takes time. For your body to absorb it in, for it to do its thing in the brain to make you sleepy. The other thing is the dosing. With melatonin, you can buy up to 20 milligrams, but at doses higher than five milligrams, you can get this paradoxical stimulatory effect. So higher is not better. And then move your body. But we wanna be mindful about how your body responds. Some people can do a hard workout and go straight to bed and have no problem. Some people are really stimulated by that heavier exercise. So for those, if you can move it early in the day and maybe just take a light walk after dinner, because that movement after dinner's really good for digestion, glucose regulation and mental health. And there have been several studies that have used physical exercise to treat poor sleep. So it's really, really important.

Kat: 34:34

Yeah, there's several things you said there that I love. One, definitely the lights, we redid a lot of lighting and I was like, put the dimmers in. So I'm always like dimming the lights. There. I, I'll never be able to track it back down. But there was a really cool study that they did, and it talked about like hormonal health and fertility and talking about how the incandescent light bulb kind of changed some of that as well as our, our sleeping habits, because people used to go to bed when to dark out before we had electricity in households. It was all by candle Light And then it would, you know, it was dim and you went to bed, you woke up with the sun. Like you said, we have this big, bright environment and to your point, it's like, okay, it's bedtime, turn off, light, go to bed. And it doesn't always work that way. And creating, you know, that sleep hygiene is, is paramount. Like if you can create that, I always say when school hits for us. And all the activities my kids have they're not overscheduled, but sometimes we just don't get home until nine o'clock, which means we're not going to bed until close to 10. And we're up at five. So that is not a lot of sleep time. It's between, what is it, seven to nine hours of sleep? Every person's different. And then you throw in training. And just using myself specifically, when I'm in higher training blocks, I'm craving a little bit more sleep on top of that seven hours, but I just can't get it. So what I found is, and I, I try and with. Clients that have newborns., If you can teach your body a habit like you're teaching your newborn, like you will teach a toddler, teach it the routine so the body knows this is time for me to go into a state of rest and sleep. And it is a habitual thing that you're gonna repeat. So do whatever you need to do and allow for that body to to go to sleep. And that I found has helped me now. I do need more rest in certain areas, but it's outta my control. And that's where I go into my training stimulus and know, hey, I gotta pull back a little bit. Not every running session or strength training session, am I gonna be hitting prs and nor should you. So it works hand in hand, but we need to have that system and that routine down. There was one other thing I was gonna say and I cannot remember. In regards to sleep. Oh, one thing with over training and maybe you said it earlier with over training. Oh yeah. You did with disrupted sleep. Like if you're waking up in the middle of the night with over training When you're training or pushing your body or when stress is really high, you will wake up kind of in that one to 4:00 AM range.

Dr. Lizzie: 37:10

Yeah, that, that one to four 8:00 AM wake up time is very common across a ton of different, like diseases or pathologies that that occur. It's a very, yes. Be aware of that and it really does, can impact your sleep. And then as we're talking about disrupted sleep, where you are in your menstrual cycle can really affect how your sleep goes too. And so you definitely will have changes in how you're able to train, how you're able to recover and your sleep quality. Depending on where you in you are in your menstrual cycle. It is not all in your head. It is a. Physiological thing that is happening. And so again, being aware of that can help you tailor how you're training.

Kat: 37:50

It's so true. I'm 43 years old. That is something I've noticed. Like the week before my cycle starts, I start to see some disrupted sleep and I plan for that in my training. With that, and I'll just use myself as an example with the planning. The mileage might stay the same, but like my coach knows and it's. Adjust when needed. So I myself will have a note the legs may not be feeling poppy. It may take longer time to recover. And so, like I've said. On this episode, it's like that's where I'm really focused on is my sleep dialed in? Maybe cutting the run a little bit shorter because, at the end of the day I need to honor my body because what's one extra mile or, 10, 15 extra minutes that could be just enough to put myself into that over training hole or beg a soft tissue injury or an illness.

Dr. Lizzie: 38:45

That's so amazing and it's so hard in that moment to make that decision. But your future self, thanks you so you don't perpetuate this cycle of like poor sleep. But just a short summary about like. Potentially planning around your menstrual cycle. And again, every person is different, every female is different. So if you don't align with this, that's fine, but listen to your bodies and you may notice that you may fall into some sort of pattern. So your early follicular phase starts on day one of bleeding. And during this time when you're bleeding, you wanna optimize sleep and nutrition. Maybe consider strength training. Your late follicular phase is from when the bleeding stops to ovulation, and this is when your body is optimized to repair muscle tissue. So you may wanna really focus more on strength training during this time. Ovulation is right. When your egg releases, you may notice that you need longer recovery time'cause you're having these huge ho. Surge in hormones. And then your luteal phase is where your may wanna consider lighter or more moderate intensity exercise. And this, especially as you alluded to, a lot of people have sleep disruption, which is gonna impact recovery. Right. And so, poor sleep, poor recovery, you don't wanna push as hard as you don't dip into some over training.

Kat: 39:59

So going into perimenopause is all the rage right now and with female athletes training with perimenopause, do you find over training goes up or like what have you found? I'd love to hear you talk about that a little bit more.

Dr. Lizzie: 40:18

Yeah, that's a great question. It's kind of this black box, right? Because perimenopause is so hard, right? We're still getting our cycle, but our hormones are off. We're transitioning through to this. Menopausal phase. And the interesting thing is it's you can check your hormones and if you want to and your doc's not, I'm happy to, to check them before you come see me. But they can be normal and you can still have these symptoms. So even if a lab says it's normal, you can still be having symptoms of perimenopause. And then you have, you're kind of getting into that sandwich generation, right? Where you're caring for young kids, you're caring for aging parents. So you have that stress coming in, the stress of our body changing and trying to figure out that adaptation. So to your point, yes, over training can happen as we're trying to learn our bodies in this new phase and how we're recovering and nutrition with that, one way that you can help fuel your body is through, again, like we talked about nutrition. It's how. The composition of your nutrition right calories in does not equal calories out. This paradigm is wrong. We need to shift away from it. It's not a simple math problem. As we go into this next phase of life, we need more protein. Kind of alluded to this before, For protein that the standard recommendation is 0.8 grams per kilogram. So to find your weight and kilograms you take your weight and pounds, you divide it by 2.2, and that gives you your weight and kilograms. So for that standard recommendation of 0.8, you're gonna take 72.7 kilograms times 0.8. So that's about 58 grams of protein a day. But studies have shown that an intake of 1.2 grams. Per kilogram of protein a day has been associated with decreased risk of fertility. So for that 160 pound female, that means she would wanna aim for about 87 grams of protein a day, but more is not always better. We've also seen that if you consume more than 1.6 grams of protein a. Per kilogram a day, you do not have an increased benefit. So in short, aim for 1.2 to 1.6 grams per kilogram per day of protein, and I think that can really help fuel your body as well as making sure you're getting in your seven to nine servings of vegetables and fruit and water. Water intake is an also interesting debate about how much you actually need overall. We say about a hundred ounces plus drink to thirst when you're exercising. Another question comes in about replacing electrolytes in glucose, which I know you're very familiar with, with ultra training. But if you're exercising less than 60 minutes, especially if it's not in a hot environment, we don't need to be. Putting those extra supplements in, into the water.

Kat: 42:59

I'm so glad you said that. I I talk a lot about with individuals is, and even my kids are younger, they're in sports, sports drinks are so popular, kids will be sent with a sports drink versus water Everybody needs to be drinking their water. And I strongly urge clients. I'm like, please, and I'd love to hear your thoughts on this. Drink water over carbonated beverage because carbonation puts more air into the digestive tract in that sense, and can cause irritation and bloating over time if that is your sole source of hydration.

Dr. Lizzie: 43:30

100%. I echo that. You know, bloating is a very common symptom that does need to be taken seriously and evaluated. But things that can decrease bloating. One of the things I ask about is carbonated beverages. Interesting. If you're not drinking enough water, a lot of. Women will be bloated with that if they're not drinking enough or eating throughout the day. It can lead to some increased bloating, artificial sugar. Now I have an unpopular opinion. I don't think stevia is any better than our, yellow or blue packet, artificial sugar. So I really encourage people to stay away from all of those, especially if you're having symptoms with it. And then making sure you're eating your fiber and your fruits through your fruits and vegetables.

Kat: 44:11

I find with Stevia especially with sports drinks, the one thing I found in Stevia is a very big known bladder irritant. So if you are someone who has poor bladder control or you are working through some pelvic floor challenges and you introduce stevia, it can actually increase urges to have to. Use the bathroom more often or encourage more leaking because it is such an irritant in that regard. They sneak that in because it is deemed as the healthy sweetener because it is derived from a plan and it's like, okay, that's great. Some people can tolerate it, some people can't. But I've seen a lot of women that I've worked with where they're like, I can't drink that'cause it's stevia in it. To your point with like too few eating throughout the day, that is something I see. And, women are very shocked that if they eat too little, they bloat during the day. The body doesn't like to have peaks and valleys with its metabolism. It wants to be fueled steadily throughout the day. It helps with the minimizing blood sugar spikes and getting the whole foods in there. Fruits and vegetables, you know, protein, whether plant-based or animal-based. We want that in there. We want that from the start of the morning till about, two, three hours before bed. We want good whole foods in our body. So,

Dr. Lizzie: 45:29

yes, definitely agreed. And to your point your, your protein source can be animals or plants. You don't have to eat animals to be strong and healthy. We've demonstrated that. Just. Making sure we're getting all of those essential amino acids in. And then yes, fueling your body throughout the day.'cause if you're going, if you're awake, you're talking, you're chewing, you're breathing, you're swallowing air basu. So if you don't have the food to kinda metabolize that, and that can lead to that. And also too, if you're drinking the carbonated beverages, chewing gum, which is also gonna have artificial sugar in it. So all of it can play together.

Kat: 46:03

To wrap up, we covered a lot of ground today. If someone's listening to this and they're like, A lot of this has resonated with me. I feel like I could be over training or I really wanna get my training sorted out to understand I'm constantly feeling fatigued when I wake up. My sleep patterns are all outta whack. What would maybe not a playbook, but like one or two things they can take away of like actionable items.

Dr. Lizzie: 46:29

Yeah, for sure. It's a great question. So if you're feeling off in your body, you need to talk to somebody about it. If you're talking to somebody and you're feeling dismissed or not heard, come see me. I will happily listen to you. What you're saying is valid, but you need to get an evaluation, right?'cause we wanna make sure that. If we're not anemic, that our thyroid's not off that our kidney, liver, gi, heart, all of these things are working appropriately before we say you are in over training. And to solely focus on that.'cause we may need to address other things as we're addressing the training. And I think the other component is, is that if we're struggling to. Move forward with our training and meet our goals. Have a coach, have a personal trainer that aligns with your goals, right? So if you're an ultra marathoner, you're not hiring the strength coach, right? You're hiring your running coach. You want somebody that aligns with your goals, or if you want somebody that is going to help you be strong in your body, feel energized, feel good. You want somebody like you, right?'cause you know how to focus on that and how to help women reach those goals. And you wanna work with somebody that aligns with that. You've already highlighted for you, you have all this training and knowledge, and you have your running coach because it can be hard to self-reflect and have that appropriate, unbiased viewpoint. So working with a trusted, knowledgeable, reputable professional, I would say to do that. And I think the bottom line with all of it is if you feel off talk to somebody.

Kat: 47:55

Where can people find you? Where can they reach out to you? And we'll have your contact information in the show notes too.

Dr. Lizzie: 48:00

Perfect. Yes. Thank you so much for that. My website is active health dpc.org. You can also call or text my office number, which is 4 8 4 9 2 3 9 1 7 6. My email is info at. Active health dpc.org. I'm also on social Instagram and Facebook. My handle is Active Health dpc. I would love to hear if you guys found this episode helpful. Tag me, tag Kat and let us know how everything's going.

Kat: 48:31

This is great. Thank you so much for coming on.

Dr. Lizzie: 48:34

Yeah, thank you so much.

Kat: 48:36

Thank you for tuning in to MilesFromHerView, powered by KatFit Strength. If this podcast inspires you, don't keep it for yourself. Hit follow or subscribe to stay updated on the new episodes, and leave us a review to help more women and moms discover this space. Your feedback fuels this podcast and I'd love to hear what's working for you or what topics you want to dive into Next. You can connect with me on Instagram at KatFit or share this episode. Road with a friend who is ready to embrace her strength. Remember, fitness isn't about perfection. It's about showing up for yourself and finding strength in every step of your journey. Until next time, keep moving forward one mile at a time.