Will
Next Level take you to the next level or leave you about the same as
yesterday? Assuming the reader follows the advice, that depends.
The book is, like most things in life, a mix of the good, the bad and
the indifferent. Many people would be better off; unfortunately some
will be worse. Overall, the book falls too much into the “cookie
cutter” approach to nutrition and training wherein all women are
treated much the same. Ironic really as Sims’ catch phrase is
“women are not small men” and should thereby train and eat
differently, and yet, in her book, the prescription for nutrition and
training is pretty much the same for all women.
The book is an easy and quick read, which is both good and bad.
Sure, you can get through the book in a weekend, but at the cost of
not really understanding the topic at hand and ending up with an
approach to training and nutrition that is overly prescriptive and
avoids nuance or human variation.
Like everyone, I have my own biases. I’ve heard Sims on a few
podcasts and I’ve also read her other book “Roar.” For better
or worse, Sims always strikes me as a person who searches the
literature to find evidence that supports her a priori beliefs
instead of using the literature to form a theory. In other words,
the information she promulgates always sounds like a “fit up” to
me.
Grandmother climbing at EPC
Chapters 1 and 2: The Stats, The Stigma, The Silence; and The
Science of the Menopause Transition.
The first two introductory chapters include the now compulsory nod
to victim ideology. Sims reviews the historical cultural view of
menopause through the years to the current day and claims that
menopausal women are still marginalised in our modern world. The
chapters end with a review of menopause across different races and
ethnicity in deference to the inter-sectional nature of female
marginalisation and oppression.
Personally, I feel neither marginalised nor oppressed, and I also
feel no need to be concerned about how the dominant culture portrays
older women. I was three years old when my Mum taught me to not give
a f888k about what other people thought, and, if that sentiment were
more common, most of the cultural issues we face today would
evaporate.
Encouraging a positive view of the changes women experience
throughout their life cycle is good, the idea that we need to be
influenced by the cultural narrative is bad. If every older woman
ignored the current cultural milieu, the milieu would shift. Sims is
writing a book about strong women who, presumably, should be able to
withstand media representations.
Grandfather climbing
Chapter 3: Hormones and Symptoms Explained.
The subtitle of chapter three is “hormonal havoc” which seems
a pejorative way to explain hormonal changes through the older years
and not really in sync with Sims’ primary thesis: that women can
thrive through older age. If language is important, which Sims
clearly thinks it is given Chapters 1 and 2, then less charged
language could be used.
The review of hormonal changes however, is clear and helpful. Of
course, short of hormone therapy (a poor substitute for the lost
hormonal milieu), there’s not much any of us can do about this, but
some women may feel more empowered by better knowledge. I admit that
the long list of symptoms at the end of the chapter is daunting and
reminds me of the lists that people with long Covid (post viral
syndrome) generate. I’m never sure how helpful these long lists of
symptoms are; sometimes the obsession with being in “your body”
seems simply to worsen anxiety among already anxious people.
Mountaineering Grandfather
Chapter 4: Menopausal Hormone Therapy, Adaptagens and Other
Interventions.
Sims provides a solid, but basic, review of current medical and
naturopathic remedies. This is a good starting point for anyone
considering medicating through older age. I particularly like that
the focus of this chapter is that the use of Adaptagens or hormonal
therapies is a way to help women through a difficult phase of the
ageing process rather than a state of continuous treatment.
Case Study:
If I could easily side-bar in my blog page I would so you could
get the feel for the first of many case studies presented throughout
the book. Here is another of my biases: I dislike books that include
case studies scattered throughout the text. I’ve never been able
to work out how best to read them. If you read straight through the
text, the case study always breaks up the flow of the chapter, if you
leave them to the end, you have to page back through (annoying with
E-Readers), if you ignore them altogether, you end up wondering if
you have missed important information (you haven’t).
Formatting aside, I am unconvinced of the utility of case studies
when every individuals life circumstances and behaviour is different.
With that acknowledgement, all Sims’ case studies are remarkably
similar so one could easily skip all of them and miss nothing. Sims
appears obsessed with “low energy availability” (LEA). Every
case study in the book features LEA, although every case study in the
book also includes women who have gained significant weight and are
“over-fat.” By definition, excess body fat is simply stored
energy so how it is possible to have LEA and be over-fat at the same
time is a marvel of thermodynamics Sims fails to explain.
The end recommendation of the first case study is the same as all
the case studies: 2 grams of protein per kilogram of body weight
(this should be ideal body weight not current body weight), and 3
grams of carbohydrate per kilogram of body weight. Sims protein
recommendation is spot on. Most women are eating far too little
protein which inhibits muscle protein synthesis. The carbohydrate
recommendation I’m less enamoured with. Physiologically, women
become LESS insulin sensitive with age when thickening waist lines
and belly fat become an issue. A more nuanced approach is to nitrate
carbohydrate to exercise intensity and duration, and individual
tolerance. Interestingly, Sims makes no mention of fat intake, which
is strange given that protein and fat are essential macro-nutrients
and carbohydrate is not.
Ski Mountaineering Grandmother
Chapter 5: Kick Up Your Cardio.
Sims begins the chapter with what now feels very familiar: a
diatribe against cultural expectations wherein women are positioned
as powerless victims of the dominant culture. We aren’t. We have
our own agency and can happily ignore anything that does not support
our own best interests.
The remainder of the chapter explains the physiology and practice
of short intensity training (SIT), a term that Sims appears to have
coined. Most writers refer to this as HIIT (high intensity interval
training). Whatever moniker is used, the idea that women should
incorporate intensity into their workouts is powerful. Sadly, as
both men and women age, our top-end output (primarily powered by the
alactic system and type two muscle fibres) deteriorates much faster
than low intensity endurance. True SIT/HIIT workouts are painful and
easy to skip over in favour of low aerobic intensity work, so I
really like that Sims explains the power and importance of these
short but intense sessions.
The only true criticism I have of this chapter is that Sims argues
for up to three SIT sessions per week which is likely way too many
sessions for almost all women, particularly women who are over 60 or
even 70. SIT/HIIT sessions require longer recovery than easier
aerobic efforts which could interfere with overall training volume.
This is another case where Sims appears to be able to brush logic
aside. Time under tension matters, and, by definition SIT/HIIT is
very short.
Again, one needs to balance generic recommendations with specific
individual needs. Women with a poor aerobic base will not be
rewarded by training as Sims recommends in this chapter.
Chapter 6: Now’s The Time to Lift Heavy Sh*t.
This chapter is a good introduction to the importance of strength
training for older women (and younger women, and middle aged women,
...etc.). Women who have never lifted before might have difficulty
implementing this chapter as the advice is sparse and generic, but
some kind of resistance training is extremely important and mostly
neglected. Most of the exercises Sims details are quite reasonable
although it is a shame she does not include body weight versions
because older women who have never strength trained will likely need
to start with body weight strength training. There is no shame in
that. The only shame is in not getting started.
There are two exercises that Sims includes which probably should
be avoided unless the woman has both good strength and good mobility.
These are the Overhead Squat – which demands a very good level of
mobility in order to maintain the proper position and not lean
forward, round the spine or default to the all too common “butt
tuck.” The second is the Pendlay Row. Underbar rows work the same
musculature and are more appropriate for most women.
Chapter Six has another strange case study. In this example, the
woman is advised to follow a heavy weight lifting day with Crossfit
(also heavy weight lifting) on the next day. Not even a man in his
high testosterone 20’s will recover adequately from the first days
workout (heavy lifting) to complete the following days (Crossfit)
workout.
Chapter 7: Get a Jump on Menopausal Strength Losses.
The chapter begins with the obligatory whine about how older women
are portrayed in popular media. I should not need to mention this,
nor should Sims keep repeating this completely unhelpful monologue.
A couple of dubious studies are briefly reviewed and then some
plyometric training is introduced. It is unclear how this extra
training stimulus fits into a regular training schedule. There are
benefits to plyometrics and they do develop speed and power, but
power is simply force divided by time; as such there is no power
without strength. Beginner trainees might do better to follow a more
standard periodised approach where the first training cycle focuses
on developing strength and the next cycle focuses on turning that
strength into power.
Sims’ recommendation is to add some kind of plyometric activity
three times per week for about 10 minutes each time. This is on top
of strength training and SIT training. The logic is somewhat missing
here as plyometric training is by its nature is glycolitic (aka high
intensity) so older women who physiologically need longer recovery
times are actually being encouraged to do SIT training up to six times
per week! Good luck with that.
Bouldering Grandfather
Chapter 8: Gut Health For Athletic Glory.
In Chapter 8 Sims provides a decent review of the constantly
evolving science of the human biome and how to keep yours healthy.
Unfortunately, almost all of the research Sims presents is
correlative in nature and thus must be treated with caution. There
is also a whiff of oversimplification in this chapter as there is in
much of the book, wherein the complexity of human biology is
simplified down to an implausible level. There is another case study
which will be familiar as it features the LEA status of an overweight
woman who somehow manages to lose weight while apparently eating more
calories! The miracle every fat person seeks. In this case study,
Sims recommends that the woman eat 40 grams of protein at each meal
which is an awful lot (approximately six eggs) for most women to
consume in one sitting and, it is unclear to how the client manages
this amount given Sims recommends a diet of carrots and houmous
(maybe 5 grams of incomplete protein).
Perhaps its not surprising given Sims’ obvious carbohydrate bias
that the chapter ends with an exhortation to drink sugar sweetened
water to “hydrate.” This might be a reasonable strategy if the
difference in hydration means winning a gold medal, otherwise, these
are just non-nutritive calories which will not benefit most older
women who are insulin resistant.
Chapter 9: Eat Enough.
Here Sims gets into what she believes about LEA (and REDS). This
is more mysticism than science, particularly given all of her case
studies involve women who are overfat. Somehow, to Sims mind, stored
calories do not equal energy even though the average non-obese human
could run for four days without eating on the amount of energy stored
in body fat. Body fat and glycogen stored in muscle tissue and the
liver are energy for use during periods when we are not eating
and it is not normal to eat all the time (or at least pre-obese times
it wasn’t).
According to Sims’: “Your goal is to have energy
intake that meets your energy demands. It is in this space—and this
is important—that you start losing weight if you have excess fat
stores to lose.” This is
magical thinking. Homeostasis is where energy intake equals energy
demands and there will be no loss of weight, fat or otherwise. The
only way to lose fat is to
achieve at an energy deficit.
Unfortunately, as anyone who has tried to lose weight, fat or
otherwise, can attest, the body tries very hard to prevent this by
subtly and subconsciously increasing hunger and reducing energy
output (often by non-exercise activity). Sims’ is once again
simplifying complex systems to support a dubious hypothesis.
There is yet another poor case study. In this example Sims
recommends “toast and almond butter” pre workout and then
“yoghurt, some fruit, nuts and seeds” post workout. How
this equates with the recommendation to eat 30 to 40 grams of protein
each meal is an enigma as these two “meals” are actually very low
in protein. The workout recommendations are similarly unusual; a
heavy strength session on day one is followed immediately by hill
sprints! Good luck with that. The nutrition advice for Wednesday,
which is a similar training day to Monday, is to snack on raisins
during a one hour workout, ostensibly to keep energy up. I would
suggest that there is some real pathology here if any female is
unable to access muscle/liver glycogen and stored body fat to fuel
such a short exercise effort. The reader might almost feel, as I
did, that the case studies were getting progressively more
ridiculous.
The remainder of the chapter is a caution against “trendy diets”
like intermittent fasting or ketosis, which, if the pejorative
language did not clue you in, Sims recommends against. I always find
it strange how the very people that recommend plant based diets (Sims
is an advocate of plant based diets) do not consider the exclusion of
ALL animal products a “trendy diet” or a “fad.” I must be
missing something, perhaps it’s ideology.
I’m an animal eater. I like my food to have possessed a face,
but I absolutely support every woman's right to choose. Sims,
however, should make it very clear that plant based diets lack
certain essential nutrients, rarely contain enough protein from high
quality sources and require supplementation to meet nutritional
demands.
Jumbo coffee, breakfast of champions
Chapter 10: Fuelling for the Menopause Transition.
Chapter Ten includes the all important macronutrient guidelines.
The protein requirements are legitimate but difficult to hit without
supplementation on a plant based diet. The carbohydrate requirements
seem excessive in a population that is insulin resistant and a better
recommendation would be to titrate carbohydrate to tolerance.
In the section titled “What About Protein” Sims enters the
world of the truly absurd by listing cauliflower as the top source of
meatless protein. In order to get the 30 grams of protein (the
minimum Sims recommends), a woman would have to eat a kilogram of
cauliflower. I will repeat that: a kilogram of cauliflower. Note
this is still incomplete plant protein that is not as well absorbed
or utilised by the body as animal protein (complete source of
protein).
The next two items on the “Top Meatless Protein
Sources” list are broccoli and seeds, both of which also
require a kilogram to be consumed to get 30 grams of incomplete and
poorly absorbed protein. Sunflower seed butter is another top
meatless source of protein. Getting 30 grams of protein from
sunflower seed butter would require eating 1000 calories of sunflower
seed butter! This is half the recommended daily calories to achieve
30 grams of incomplete plant protein. If you can make this
mathematics work I applaud you.
To round out the chapter, Sims gives a recipe for a “super
smoothie” which is billed as easily providing your “daily
dose of protein”. This super smoothie includes: “frozen
cauliflower, fresh spinach and kale, Greek yogurt, and mixed seeds
like hemp and chia for a protein-packed super-smoothie.”
Clearly, a smoothie made with an average amount of any of the above
ingredients will not get anywhere close to providing 130 grams of
protein, unless, of course, it includes multiple kilograms of
cauliflower, spinach and even yoghurt.
At this point, the reader might be wondering how much protein Sims
herself eats and whether she has actually calculated the protein
amounts in her dietary recommendations. Portentously, the chapter
ends again with older women, who are by nature of their hormonal
milieu insulin resistant, being encouraged to drink water with added
sugar!
Chapter 11: Nail Your Nutrition Timing.
Chapter 11 is ostensibly about how to time your nutrition to
minimise muscle loss. Again, this is more mysticism than science as
actual physiological science indicates that nutrient intake rather
than timing is most important for muscle protein synthesis. Sims
recommends foods such as “banana and peanut butter” or
“toast and nut butter” prior to training. Again, this is
in direct contrast to Sims’ own recommendation that women consume a
minimum of 30 grams of protein at each meal. It is almost as if Sims
is either ideologically captured or cannot do basic mathematics.
Quoting Sims: “I often see women skipping this important step
because they think that not eating after exercise will help them burn
more fat. The opposite happens. Their body ends up in a highly
stressed state, with high blood sugar, and is more apt to store body
fat and slow down metabolism.” This is another physiological
impossibility as one of the most effective ways to lower blood sugar
is to exercise.
Chapter 12: How to Hydrate.
Another of my biases. I think drinking to thirst is adequate for
almost everyone and water is better than sugar sweetened beverages.
Tim Noakes covers hydration well in his book “Water Logged.”
Sims argues that drinking pure water will result in increased
urination but then, somewhat bizarrely encourages women to
hyperhydrate pre-event. I don’t think anyone needs a case control
or randomized study to recognise that if you drink a lot before you
are thirsty (aka before an event) the only outcome is that you will
need to urinate a lot. We’ve all been there and been scrambling to
find the toilet.
Chapter 13: Sleep Well and Recover Right.
Chapter 13 includes some reasonable tips on how to improve sleep.
There is nothing revolutionary here but surprisingly few people have
good sleep hygiene habits. There is yet another not very good case
study this time about a 62 year old vegan for whom Sims prescribes
two hard training days in a row followed by an easier day and two
more hard training days thereafter. Show me a 62 year old who is
doing back to back hard training days and I’ll show you a woman
whose easy days are too hard and hard days too easy. The proverbial
black hole of training which works until catastrophically it doesn’t.
Chapter 14: Stability, Mobility and Core
Strength.
This chapter covers some basic foam rolling and easy core work
suitable for beginners. Advanced trainees will need to look
elsewhere for more comprehensive information.
Chapter 15: Motivation and the Mental Game.
A chapter with some basic motivational tips. Motivation is so
unique and individual that each woman will likely need to find their
own “why.”
Chapter 16: Keep Your Skeleton Strong.
Chapter 16 covers osteopenia and osteoporosis. Like the gut
biome, this is an area with an ever evolving knowledge base. Many of
the new drugs have been shown to improve bone density on scans but
not reduce fracture occurrence in life, so this is a complex
topic muddied by Big Pharma which makes Big Money on drug treatments.
To her credit, Sims entire philosophy of training and nutrition
should go a long way towards preventing osteoporosis, osteopenia and
even fractures.
Chapter 17. Strategies for Exercising Through the Transition.
In this chapter Sims pulls together much of the book to offer some
ideas for how active women can remain active throughout the aging
process. Sims has some good tips that may prove useful for many
women. The only thing I would quibble with is the amount of
carbohydrate Sims recommends.
Chapter 18. Supplements.
Sims is refreshingly anti-supplement except as an aid to
transition through difficult symptoms. However, given that Sims
advocates a plant based diet, most women who follow her plant based
diet will need to supplement with some essential amino acids as well
as certain B vitamins and possibly even iron.
A bunch of old people on an 8 day ski traverse
Chapter 19: Pulling It All Together.
In the final chapter, Sims attempts to pull the entire book
together with a methodology for following all of her recommendations.
I must admit that by the time I got to this chapter my eyes were
glazing over as there were so many charts and symptoms and
calculations that one might almost be inclined to give up before ever
getting started. Sims biases as a carbohydrate based athlete are
very clear in this chapter and are in opposition to much of the
recent research on fat utilisation during endurance activities. I
doubt anyone is motivated enough to go through her four week program
of implementation and even if someone did, four weeks (actually three
weeks as the fourth week is allocated to assessing the previous
three) is not enough to change habits.
Overall, the advice is too prescriptive and lacks the possibility
of individualisation to suit personal circumstances and responses. I
train virtually every day and have almost limitless enthusiasm and
energy for training and yet even I think that timing everything with
such regimentation would destroy my desire to train.
What’s good about this book: The advice to strength train and
to prioritize protein intake.
What’s bad about this book: The overly prescriptive advice to
eat (what amounts to) a high carbohydrate diet with no indication
that carbohydrate amount should be titrated to tolerance. The meal
suggestions make it obvious that Sims has no real life experience in
actually achieving the protein amounts she recommends.
What’s indifferent: Most of the book.
Is the book a “game changer” or even “level changer”:
Unlikely.
