Coach Anne talks with Wild Health

Wild Health Episode 46 – Women are not small men! And masters women, are not older small men.

There are more differences between men and women than the obvious, especially in athletes. Coach Anne talks with the guys at Wild Health podcast about masters women athletes, training, nutrition, and the dreaded M word, MENOPAUSE

From the Wild Health podcast:

”Our masters female athletes have unique physiology, and we have to start treating them that way. In this podcast, Mike and Mark interview Anne Linton, a physician, trainer, and masters athlete herself. No one is more poised to answer the tough questions regarding training masters female athletes. If you are a masters female athlete, a younger female athlete who plans on aging, or a man who knows or cares about women, this podcast is full of tips and tricks to dial in your training and get the most out of life and your physical pursuits.”

Find more from the folks at Wild Health Podcast at

Here’s a summary of the podcast:

Mike and Mark of Wild Health podcast introduce to the studio, Anne Linton. Mark got to know Anne about a year or so ago, through cycling. Anne works a lot with women athletes and has done some pretty unique coaching with post-menopausal and peri menopausal female athletes and endurance sports.

Anne is a retired, as she says, “burned out” physician who has practiced everything from general surgery, orthopedics, emergency medicine, to addiction medicine and psychiatry. Stressed out, overweight and overworked, it was when her husband had a life-threatening thoracic aortic dissection at the age of 35 that she got a big eye opener and took off some time to help take care of him. He survived and is doing very well now. When a friend called asking if she wanted to do a Half Ironman, she decided to put more focus on endurance sports and competing in triathlons. Anne had done many short distance triathlons in medical school, was very athletic in her younger years so was excited about the challenge. Eventually she took a sabbatical from her practice to train for an Ironman and in the process left the practice of clinical medicine and decided to really focus more on coaching, exercise physiology, and recovering from burnout.

In this podcast, they talk about how the training for peri and post-menopausal women differ from the general population, and what kind of things Anne is seeing as far as how to train this unique population and how we should be thinking about, not only as clinicians, but as general population to best help these women achieve their goals.

Mike refers back to a menopause episode of the podcast, to give a brief overview of the more “medical” version of what menopause is:

  • Peri menopause is the beginning decrease in the production of hormones estrogen and progesterone.
  • Effects include difficulty with temperature regulation, difficulty putting on muscle mass, to loss in bone density, increase in depression, and many more
  • Menopause occurs on average around the age of 50 but can happen anywhere from 40 to 60 years of age.

Athletes experiencing peri menopause and menopause can make nutritional improvement to better fuel their training. Anne highlights:

  • Protein, protein, protein!
  • Protein with Leucine and other essential amino acids
  • Lots of fiber
  • When you are training, you need carbohydrates, essentially to get them in before workouts, you don’t metabolize carbohydrates as well when you’re not training. Post workout, limiting carbohydrates to the recovery window then try to diminish your carbohydrate intake as long as you took in enough carbohydrates during your workout and immediate post recovery.
  • Good quality complex carbohydrates, sourced from real foods not “Twinkies” as Mark comments
  • “Hydration in the bottle, food in the pocket,” to quote Dr. Stacy T. Sims, MSc, PhD (Environmental Exercise Physiologist- Nutrition Scientist; Expert in Hydration, Nutrition and Sex Difference)
  • Although there’s not extensive research on it yet for women athletes, some women may find it beneficial to do time-restricted eating on their off-days, then implement higher carb real foods on training and performance days.
  • Peri and post-menopausal women need to pay attention more (than others) to how their bodies are responding to dietary changes. What helps one, will not help another.
  • Nutrition, especially in post-menopausal women is not one size fits all. If an athlete is considering time-restricted eating, and notices they’re not recovering as quickly, it may be as simple as adding in more carbohydrates.

In addition to nutrition, strength training is key. For peri and postmenopausal women, they really want to look at strength and power gains. While Anne admits she is still in experimentation with her own training, she likes to focus on functional training, alternating with muscular strength, ie: machine training. Quality higher intensity workouts make a great addition to one’s training routine, but the rest and recovery period may look different for each individual. While in training, Anne recommends her athletes communicate with her. She likes to track their heart rate and other variables like HRV (heart rate variability). An increase in heart rate while training could hint to another issue going on, such as oncoming illness, dehydration, overheating, lack of sleep or other life stressors.

Mark introduces the topic of Hormone Replacement Therapy (HRT), which was covered more extensively in episode 35 of the Wild Health podcast, and how it goes with training. Anne says training does not need to change too much if they are on HRT, but if there are concerns or symptoms of a problem, to talk to their health care provider.

Having read Stacy Sims’ book, “Roar,” there’s the idea that women perform better when they’re in the follicular, or low-hormone phase of their cycle, but if their hormones are replaced in menopause, some of that strength and performance is retained, which seems “counterintuitive.” Anne’s “not scientific” thoughts on that are HRT helps with temperature regulation, and ability to dissipate heat, and ability to recover, that can mimic the luteal phase performance, or at least “alleviate some of the symptoms that interfere with their training.” Mike and Anne note there are some studies that show HRT can help with:

  • Maintaining lean muscle mass
  • Improving bone density
  • Increases resting metabolic rate
  • Low dose progesterone can help with sleep, and night sweats

Those things can all contribute to training to performance. Mike wonders if there will be more studies on not just estrogen or progesterone only based HRT, but also low dose testosterone in female athletes who are post-menopausal, as there is some degree testosterone production/conversion from estrogen in premenopausal women. Anne remarks one of the difficulties with using low dose testosterone is can it be considered “doping,” and they may need to get a Therapeutic Use Exemption in order to race USA Cycling Sanctioned races. Mike though holds the opinion that low dose testosterone therapy, “within physiological ranges,” should not be considered doping.

Here are some other ways Mark, Mike, and Anne recommend women can optimize performance during menopause, other than HRT:

  • Vitamin D
  • Iron levels-are they anemic?
  • Branched chain amino acids
  • Protein
  • Magnesium as a sleep supplement
  • Weight training in conjunction with a whole food diet with dietary calcium
  • Fiber
  • Tart cherry juice, may stimulate melatonin, and contains antioxidants

Anne cautions not taking antioxidants immediately post recovery, as they can interfere with adaptation. Women have a significantly shorter window of recovery than men, at 45 minutes to maximize glycogen storages vs. men who have up to 24 hours of recovery. It is recommended that any women training about level 2, or more than an hour and a half need to take in proper nutrition and supplementation during that short recovery period. Some suggestions for recovery include:

  • Getting a 2:1 to 3:1 ratio of carbs to protein (instead of the previously recommend 4:1 ratio)
  • Leucine from whey protein or if they are vegan they can take branch chain amino acids
  • Adding in a scoop of casein protein (as a source of gradual protein absorption) along with whey protein, which has faster absorption)

Anne’s TOP 3 take home pieces of advice

  • Eat more protein (Carbs on workout days)
  • Maximize your recovery (Get more quality and consistent sleep, meditation, recovery supplements, etc.)
  • Strength training