Healthy Living Blog: GLP-1s, Protein, and the Truth About “Toning”: A No-BS Fitness Q&A with Dr. Stephanie Estima
Have you ever scrolled Instagram, seen someone tell you to “just lift heavy,” and felt your stomach drop a little? Like you’re already behind? Like everyone else got some secret manual to their body that you never received?
You are not alone, and you are not behind. I want to talk to you about something that has been bothering me for a while now, which is how much noise exists online about strength training, protein, and aging, and how little of it actually applies to your real life, your real body, and your real history.
We do still care about the number on the scale. We want to feel good in our clothes and like what we see in the mirror. That is real, and I am never going to tell you to stop wanting that. But there is a bigger conversation we are not having loudly enough. We are watching our parents struggle to get out of a chair. We are noticing stiffness in our own hips. We are watching friends our age get injured doing things we used to do without a second thought. So yes, the scale matters, but are we paying enough attention to how we are moving, how we are building, and how we are training for the decades ahead? How do we want to live in our 70s, 80s, even 90s?
Here is the truth. We can feel good, look good, and age well, all at the same time. But the advice flooding our feeds, the “eat more protein, lift heavy” mantra, often skips the most important part: what does that actually mean, and for whom?
That is exactly why I wanted to bring Dr. Stephanie Estima onto the show. She is a doctor of chiropractic with almost two decades of clinical experience specializing in body mechanics and female metabolism, the creator of the Estima Method, author of the bestselling book The Betty Body, and host of the podcast Better with Dr. Stephanie. She has helped thousands of women rebuild the way they move, train, and live through midlife. If you have ever felt confused, intimidated, or even a little defeated by fitness content aimed at women in their 40s, 50s, and beyond, this conversation is going to change how you think about your body.
The Problem With “Lift Heavy” (According to Whom?)
One of the first things we dug into is how much fitness advice gets copied and repeated online without any real understanding behind it. Someone posts that women need to lift heavy, it performs well, and suddenly everyone is repeating it without asking the obvious questions. Heavy compared to what? Heavy for what goal? How would you even know?
This matters enormously for midlife women because so many of us grew up in the cardio section of the gym. We never developed what Stephanie calls motor literacy, the nervous system’s ability to recruit muscle efficiently during resistance training. You would never hand a toddler a blank page and ask them to write a paragraph about their day. Toddlers speak in short bursts because that is where they are developmentally. The same logic applies to strength training. If you are new to lifting, your body has to learn the skill before it can safely push intensity.
So how do you actually know when you are lifting heavy enough? A few signs to watch for during a set. The speed of each rep starts to slow down as you approach the end of the set. You may feel a burning sensation as metabolic byproducts build up in the muscle. Your range of motion may become slightly harder to complete fully. The weight itself starts to feel subjectively heavier, even though the number on the dumbbell has not changed. And your form will show a small amount of natural breakdown by the final reps, though not a complete loss of control.
This is a much more useful and personalized framework than chasing a specific number that has nothing to do with your body, your training history, or your goals.
Progressive Overload Without the Injury Risk
Here is something that surprised me, and might surprise you too. The science shows that anything between five and thirty repetitions can build muscle, as long as you are training with enough intensity and effort, meaning you are landing somewhere between one and three reps shy of true failure. That single insight takes a massive amount of pressure off the idea that you need to constantly add weight to the bar.
For smaller muscle groups like shoulders, progress often comes from adding volume, more sets or more repetitions, rather than simply piling on more weight. For larger muscle groups like the legs and glutes, where women naturally carry more muscle mass than men, there is more room to progressively add load once your form is solid.
Rest periods matter here too. For most muscle groups, somewhere between one and three minutes of rest between sets is appropriate. For something as demanding as a heavy leg day, four to five minutes may serve you better, because your heart rate, breathing, and the surrounding stabilizer muscles all need time to fully recover before the next set. There is no universal magic number. The goal is to notice when your target muscle, your accessory muscles, and your cardiovascular system all feel ready to go again.
And if you are just getting started, body weight training is not a lesser option. It is the correct starting point. A glute bridge on the floor before you ever attempt a deadlift is not a shortcut, it is the foundation. Give yourself the same patience and grace you would give anyone else learning a new skill.
Why Your Glutes Might Be the Root of Your Back Pain
This section of the conversation hit close to home for me. Years ago I had a disc rupture in my lower back, and last year that eventually led to a full disc replacement after the disc had begun fusing on its own. During the worst of it, I could not train my legs at all, and the muscle loss in my glutes only made the pain in my lower back worse, because weak glutes place more pressure on the spine.
This connection between glute strength and low back pain is not anecdotal. Roughly 80 percent of the population will experience acute low back pain at some point, and a huge portion of that comes down to what is called mechanical low back pain, the dull, achy sensation coming from the joints, ligaments, and muscles surrounding the spine. There is a clinical evaluation called the Trendelenburg test, where a person stands on one leg and a clinician watches to see whether the pelvis drops on the lifted side. If it does, that is a sign the glute on the standing leg is not strong enough to stabilize the pelvis. In clinical practice, a striking percentage of patients presenting with mechanical low back pain, somewhere around 85 to 90 percent, failed that test.
The glutes are the primary stabilizer of the spine. They help prevent overextension and overflexion, they support rotation and hip movement, and when they are weak, other muscles like the lower back extensors are forced to compensate, which only creates more pain and dysfunction over time. If you are dealing with hip, knee, or lower back discomfort and feel unsure how to even begin training your lower body again, start exactly where I did after my surgery. Bodyweight glute bridges. Basic hip movement patterns. Progressive, patient rebuilding. Your version of progressive overload might look completely different from what you see online, and that is not just okay, it is exactly how it should work.
Cardio Still Matters, But Not the Way You Think
Resistance training gets most of the spotlight in these conversations, but cardiovascular fitness deserves real attention too, especially as estrogen declines, since estrogen acts as a natural anti-inflammatory in the body. One of the most important markers to understand is VO2 max, essentially a measure of how efficiently your body takes in and delivers oxygen to your cells. VO2 max naturally declines by about 10 percent per decade if it is not actively trained, which is part of why we see older adults get winded simply climbing a flight of stairs.
One highly researched protocol for improving VO2 max is a structured interval method involving four-minute bursts at roughly 90 percent of maximum heart rate, followed by a few minutes of recovery, repeated a handful of times, once per week. This kind of high intensity training does not need to take up your whole afternoon. The actual working time can be as short as fifteen or sixteen minutes, even though the intensity level is significant. If that feels too advanced right now, you can build toward it gradually on any cardio machine by tracking your heart rate and slowly increasing your effort percentage over several weeks.
Debunking the Trendy Wellness Devices
We also went through a rapid fire list of popular wellness tools and trends, and the responses were refreshingly honest.
Weighted vests can increase the number of calories you burn during a walk, but current research does not support them as an effective tool for building bone density on their own. Vibration plates may help with tendon and ligament strengthening and can add some instability-driven muscle recruitment, but again, the evidence for meaningfully improving bone density is not strong yet. Step counts above roughly 7,000 to 8,000 per day show diminishing returns for reducing all-cause mortality risk, meaning chasing 15,000 or 20,000 steps daily is not necessarily unlocking additional major health benefits, even though it is not harmful. Pilates is excellent for pelvic floor and deep core strength, which matters enormously for women given how differently our pelvic floor is structured compared to men, but it is not sufficient on its own for building bone density or significant muscle mass. And “toning,” as a fitness industry term, does not actually exist as a distinct physiological process. Muscle growth works the same way in men and women. There is no separate mechanism that creates a “toned” look instead of a “bulky” look. It is resistance training with progressive overload, full stop.
Rethinking Protein Without the Obsession
Protein has become one of the most talked about topics in women’s health content, and for good reason, since most women are significantly under-consuming it. Estimates suggest the average woman takes in somewhere around 40 to 60 grams of protein per day, which aligns with the bare minimum recommended daily allowance but falls well short of what is optimal for maintaining muscle through midlife and beyond.
A more useful target for many women falls somewhere between 0.7 and 1.2 grams of protein per pound of ideal body weight, though this should be built up gradually rather than jumped into overnight, since a sudden large increase in protein intake can be hard on digestion. The goal is not to obsess over grams or turn every meal into a math problem. It is to make sure you are consistently including enough protein to support muscle protein synthesis, especially since we naturally lose muscle mass as we age.
At the same time, protein should never come at the expense of the rest of your plate. Fiber, phytonutrients, antioxidants, healthy fats, and a variety of whole foods all matter just as much. Severely restrictive approaches that eliminate entire food groups are not the answer. Balance and consistency, built from whole foods roughly 80 percent of the time, will serve you far better than chasing the latest all-or-nothing food trend.
A Word on GLP-1 Medications
With an estimated 33 to 35 million people currently using GLP-1 medications in the United States, this is a conversation that touches an enormous number of women, and there is nothing wrong with using these medications if they are helping you move out of obesity and into better health. But weight loss on its own is not a specific enough goal. You can lose fat, muscle, bone density, and even a small amount of brain tissue on a caloric deficit, and the scale will not tell you the difference. That is exactly why pairing any GLP-1 protocol with resistance training and sufficient protein intake matters so much. Mechanical tension from strength training sends a signal to your body to preserve muscle and bone rather than let it go along with the fat.
The Supplement Short List
When it comes to supplementation, the recommendations were refreshingly simple rather than an overwhelming list of products. Creatine, in the range of about five grams daily, supports muscle and cognitive function, and women naturally produce less of it than men. Magnesium, often in the glycinate form for its calming effect and bioavailability, taken in split doses throughout the day. An omega-3 supplement providing roughly two grams daily of combined EPA and DHA. Vitamin D3 paired with K2. And for anyone eating larger protein-forward meals, digestive enzymes can help the body actually break down and use what you are eating.
Letting Go of “Skinny” as the Goal
Perhaps the most powerful part of this conversation was the reminder to unhitch our sense of worth from the number on the scale or the size on the tag. So many of us grew up equating health with smallness, and that message has simply been repackaged today into softer language like “long, lean, toned.” But if you fit into a dress today while quietly developing osteoporosis by the time you are 65, that is not a win. It is a trade you did not know you were making.
The goal is not to destroy your body in pursuit of skinny. The goal is to build a body that can carry you, literally and figuratively, through the decades still ahead of you. Strong enough to get up off the floor without thinking about it. Strong enough to keep up with grandchildren. Strong enough to recover quickly if life throws you a curveball, whether that is an illness, an injury, or simply the natural process of getting older.
If this conversation resonated with you the way it resonated with me, I hope it gives you permission to slow down, start where you actually are, and build something that lasts.
The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.
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by Natalie Jill
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