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.
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.
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.
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.
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.
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.
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.
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.
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