Abbie Smith-Ryan is a leading researcher in exercise physiology whose work focuses on how training and nutrition influence body composition, metabolism, cardiovascular health, and women’s health across the lifespan, with particular attention on perimenopause and post-menopause. In this episode, Abbie explains how early exercise and play help build the foundation for bone health, muscle development, and cardiorespiratory fitness in girls, as well as how puberty and menstruation shape athletic performance, motivation, and recovery. She also explores how women can tailor training and nutrition across the menstrual cycle through smart fueling, hydration, and inflammation management; examines the evidence behind supplements such as creatine, omega-3s, and magnesium; and unpacks the metabolic and body composition changes that accompany the transition into perimenopause and menopause. Finally, she covers practical exercise programming for busy women, training and nutrition considerations during pregnancy and postpartum, and the evolving role of hormone therapy alongside lifestyle-based, evidence-driven approaches that help women better advocate for their health.
Subscribe on: APPLE PODCASTS | SPOTIFY | RSS | OVERCAST
“My mission for The Peter Attia Drive has always been to provide you with the most rigorous, evidence-informed insights on longevity. To do that without cluttering your experience with ads, we rely entirely on our premium members. If you’d like to support the work that makes this mission possible, consider becoming a premium member.”
– Peter
We discuss:
Timestamps: There are two sets of timestamps associated with the topic list below. The first is audio (A), and the second is video (V). If you are listening to this podcast with the audio player on this page or in your favorite podcast player, please refer to the audio timestamps. If you are watching the video version on this page or YouTube, please refer to the video timestamps.
- Abbie’s background in distance running and her interest in studying women’s health around exercise [A: 3:00, V: 0:11];
- The role of early-life exercise in building lifelong bone, muscle, and cardiovascular health in girls [A: 4:00, V: 1:23];
- Training principles for premenstrual girls, the risks of early specialization and delayed puberty from intense training, and how youth sport participation can shape bone and spinal health [A: 7:15, V: 5:00];
- Nutrition as fuel in young female athletes: supporting training, growth, and performance [A: 11:00, V: 9:03];
- Training and recovery across the menstrual cycle: recovery, nutrition, supplements, and practical strategies for performance support [A: 16:00, V: 14:51];
- The benefits of creatine supplementation and importance of protein intake across the menstrual cycle [A: 27:15, V: 27:31];
- How women should approach training intensity and volume across the menstrual cycle [A: 33:00, V: 33:57];
- How to identify and monitor the perimenopausal transition and why this phase represents a critical window for exercise and nutrition interventions [A: 37:15, V: 38:31];
- Case study: time-efficient exercise program for a busy, perimenopausal woman [A: 42:00, V: 43:51];
- Why improving body composition is a better goal than weight loss, and how to set realistic fat-loss targets in midlife women [A: 53:30, V: 56:50];
- How to preserve muscle and bone while using GLP-1 medications: resistance training, protein intake, and more [A: 58:15, V: 1:02:12];
- Designing a three-hour-per-week training plan for sustainable body recomposition [A: 1:03:30, V: 1:08:02];
- Abbie’s insights from her 20+ years of self-tracking: nutrient timing, injury prevention, excessive training, bone health, and more [A: 1:07:15, V: 1:12:18];
- How pregnancy and the postpartum period affect body composition, and how consistent exercise and intentional nutrition can prevent a permanent shift in body fat or muscle mass [A: 1:13:30, V: 1:19:13];
- Changes in muscle quality and metabolic flexibility during perimenopause and menopause, and how exercise may counteract hormonally driven sarcopenia [A: 1:21:45, V: 1:28:40];
- The biggest open questions about women’s health: combining menopause hormone therapy with exercise, GLP-1 drugs, minimizing injury risk, and more [A: 1:32:00, V: 1:40:26];
- How the training response differs between men and women, and the importance of type IIa muscle fibers [A: 1:39:15, V: 1:48:27];
- Training advice for the hypothetical 70-year-old woman who has never exercised deliberately [A: 1:47:00, V: 1:57:13];
- Misinformation about exercise and nutrition for women, injury risk, supplement hype, and the need for more nuanced messaging around hormones, recovery, and midlife training [A: 1:53:30, V: 2:05:05];
- Benefits of hormone therapy in midlife women and its interaction with exercise and lifestyle interventions [A: 2:00:15, V: 2:12:30];
- Peter’s overall take on how women should approach exercise volume and intensity at various life phases and time constraints [A: 2:03:00, V: 2:15:50]; and
- More.
Show Notes
Abbie’s background in distance running and her interest in studying women’s health around exercise [A: 3:00, V: 0:11]
Tell me a little bit about your background in terms of what got you interested in this space
- Abbie was a collegiate distance runner, but she has always had a love of strength training, which is a little bit impeding for endurance goals
- She really fell in love with science, the ability to ask a question and answer it
- She started early with research and then fumbled her way in that space, really understanding: the more you know, the more you don’t know
- As Peter’s friend Bob Kaplan used to say, “The further you get from shore, the deeper the water gets.”
You’re a distance runner. In college, that’s what, 5K, 10K?
- 3K, 5K, 1,500, 800 (if her coach was mad), she adds, “I’m not that fast.”
- Peter’s daughter runs track and he feels like the 800 is the worst, most painful even in the lot
- Abbie would add the 1500: you have to do 2 more laps at a similar pace
- There is something about that approximate 2 minute all-out effort that is really brutal
The role of early-life exercise in building lifelong bone, muscle, and cardiovascular health in girls [A: 4:00, V: 1:23]
Peter points out, “There are certain things that just seem obvious and true across the board.”
- 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
Peter wants to focus on Abbie’s expertise around what we can understand in terms of exercise across the life cycle of a woman
- And he wants to start at the beginning
- He’s pretty sure there are no teenage girls listening to this podcast, but there are probably parents of those
- A previous guest made a point that Peter thought was amazing, and it has never left him: osteoporosis is a childhood disease
- [episode #322 with Belinda Beck]
- What she meant was that women are reaching their genetic ceiling at about the age of 19 (in terms of bone density)
- Then from 19 until the end of life, they’re hanging on to what they’ve got
- And then they’ve got all of these things that get in the way, such as menopause
If you’re a 10-year-old girl, how do you think about the role of exercise across several dimensions, not the least of which being bone health but muscle health and reaching their cardiorespiratory potential?
- That’s a big question
Abbie would sum it up: exercise is the best medicine
- Starting young, consider it more play and then transitioning into lots of different types of exercise
- There’s lots of literature to suggest this
“The earlier you start and the better base that you have, the easier it is over time to maintain that fitness.”‒ Abbie Smith-Ryan
- When we think about young girls, the biggest conversation and even some of the research we do: menstruation often is a turning point when women and girls leave sport
- Based on a number of things, of how their body changes, how their performance differs
Abbie shares part of what her lab looks at, “Understanding how that menstrual cycle might impact performance, recovery, bloating, mental health.”
- Abbie is here in part to have that conversation
- When she was growing up, no one talked about it
Were you a runner growing up as well?
- Yeah, she played all sports
- She loved every sport you can imagine
- She grew up in a space where it was exercise more and eat less
- When you add running, it’s this ability to really see how your fitness changes
- The same with resistance training: you can see how strong you get
- It’s a very empowering tool
Abbie makes the point, “We don’t talk about it enough with young girls: What is menstruation? Why is it healthy?”
Training principles for premenstrual girls, the risks of early specialization and delayed puberty from intense training, and how youth sport participation can shape bone and spinal health [A: 7:15, V: 5:00]
Let’s talk first about the pre-menstrual cycle
Are there any dos and don’ts that you think of for young girls who are playing sports in terms of what they can be doing to augment their training?
{end of show notes preview}
Would you like access to extensive show notes and references for this podcast (and more)?
Check out this post to see an example of what the substantial show notes look like. Become a member today to get access.
Abbie-Smith Ryan, Ph.D.
Abbie-Smith Ryan earned her undergraduate degree from Truman State University. She earned her M.S. and Ph.D. in exercise physiology from the University of Oklahoma. Dr. Smith-Ryan is a Professor of Exercise and Sport Science at the University of North Carolina at Chapel Hill, where she also serves as the Associate Chair for Research, Director of the Applied Physiology Laboratory, Co-Director of the Human Performance Center and Adjunct Associate Professor of both Nutrition and Public Health.
Dr. Smith-Ryan’s research interests center around exercise and nutrition interventions to modify various aspects of body composition, cardiovascular health, and metabolic function. Her work has a special focus on women’s health, perimenopause, post-menopause, and overweight populations. She is an active researcher in the field of metabolism, sport nutrition and exercise performance, in both healthy and clinical populations, leading projects funded by the National Institutes of Health and International and National industry sponsored clinical trials. Dr. Smith-Ryan contributes to the current body of scientific literature with over 190 peer-reviewed manuscripts; a number of scholastic books and book chapters, and international/national presentations.
Dr. Smith-Ryan is an active member of the National Strength and Conditioning Association, American College of Sports Medicine, and the International Society of Sports Nutrition. She was recognized by the NSCA as the Nutrition Researcher of the Year (2013) and the Young Investigator of the Year (2015), and the William J. Kramer Outstanding Sports Scientist of the Year (2022). [UNC]
Instagram: @asmithryan
Website: Dr. Abbie Smith-Ryan
