Women's health and performance: how training, nutrition, and hormones interact across life stages | Abbie Smith-Ryan, Ph.D.

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Abbie Smith-Ryan. Abbie is the Associate Chair for Research in the Department of Exercise and Sports Science, the Director of the Applied Physiology Lab, and the Co-Director of the Human Performance Center at the University of North Carolina at Chapel Hill. She's authored more than 180 peer-reviewed papers, books, chapters, and has led NIH and industry-funded trials on exercise and nutrition interventions. Her research focuses on body composition, metabolism, and cardiovascular health, but with a special attention to women's health through the perimenopausal and postmenopausal transition, as well as overweight and obese populations. She is also a dedicated mentor, educator, and advocate for empowering women with evidence-based approaches to health and performance. In this episode, we discuss how early exercise and play shape bone health, muscle development, and cardiorespiratory fitness in young girls, the impact of puberty and menstruation on athletic performance, motivation, and recovery, how to tailor training and nutrition throughout the menstrual cycle, including strategies for fueling, hydration, and managing inflammation, the science behind supplements such as creatine, omega-3s, and magnesium in supporting women's health and performance, the transition into perimenopause and menopause, and how hormonal changes influence metabolism, muscle preservation, and fat distribution, practical exercise, programming for busy women, balancing resistance training and aerobic training for those with limited time, nutrition and training during pregnancy and postpartum, including common mistakes and how to safely rebuild strength, and the evolving role of hormone therapy and how women can better advocate for their health through evidence-based and lifestyle-driven approaches. So without further delay, please enjoy my very informative discussion with Abbie Smith-Ryan.
Hey, Abbie, thank you so much for coming out to Austin.

**Abbie Smith-Ryan** (3:00)
I really appreciate the invite.

**Peter Attia** (3:01)
Tell me a little bit about your background in terms of what got you interested in this space. You look pretty fit. I assume you were an athlete growing up.

**Abbie Smith-Ryan** (3:10)
Yeah, I'll take that as a compliment. I was a collegiate distance runner, but I have always had a love of strength training, which is a little bit impeding for endurance goals. I really fell in love with science, the ability to ask a question and answer it. And so I started early with research and then fumbled my way in that space, really understanding the more you know, the more you don't know. And here I am.

**Peter Attia** (3:34)
As my friend Bob Kaplan used to say, the further you get from shore, the deeper the water gets. Okay, so you're a distance runner. So in college, that's what, 5K, 10K?

**Abbie Smith-Ryan** (3:44)
Yeah, 3K, 5K, 1500, 800 if my coach was mad. I'm not that fast.

**Peter Attia** (3:50)
Yeah, my daughter runs track. I feel like the 800 is the worst, most painful event in the lot.

**Abbie Smith-Ryan** (3:57)
I would add the 1500, you have to do two more laps at a similar pace. So it leverages that too.

**Peter Attia** (4:03)
Yeah. But there is something about that approximately two-minute all-out effort that is really brutal. So, all right, there's a lot I want to talk about. I'm trying to think of the best way to help orient it. But clearly, there are certain things that just seem obvious and true across the board.
For example, we know that exercise is a remarkable tool to delay the onset of chronic disease. We also know that it's a remarkable tool to improve health span or quality of life. But particularly, I want to just focus with you and your expertise around what we can understand in terms of exercise across the life cycle of a woman. And I want to almost start basically at the beginning. So, I'm pretty sure there are no teenage girls listening to this podcast. I would be comfortable saying there are exactly zero of them. But there are probably parents of those. And a previous guest made a point that I thought was amazing and has never left me, which is osteoporosis is a childhood disease. What she meant by that, of course, was that particularly for women, they are reaching their genetic ceiling at about the age of 19 in terms of bone density. And then from 19 until the end of life, they're sort of hanging on to what they've got. And then they've got all of these things that get in the way, such as menopause. Let's just start with that. So if you're even not a teenager, you're a 10-year-old girl, how do you think about the role of exercise across several dimensions, but not the least of which being bone health, but muscle health and reaching their cardio respiratory potential?