Ready to rethink your workout? In the episode, we dive into the empowering world of weightlifting for women, inspired by Casey Johnston’s book A Physical Education: How I Escaped Diet Culture and Gained the Power of Lifting. Host Dr. Denise Millstine and guest expert Dr. Sonal Haerter join Casey to explore how shifting from calorie obsession to strength training transforms not only bodies but mindsets.
Ready to rethink your workout? In the episode, we dive into the empowering world of weightlifting for women, inspired by Casey Johnston’s book A Physical Education: How I Escaped Diet Culture and Gained the Power of Lifting. Host Dr. Denise Millstine and guest expert Dr. Sonal Haerter join Casey to explore how shifting from calorie obsession to strength training transforms not only bodies but mindsets.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. Our topic today is weightlifting, weight training, and women. Our book is “A Physical Education: How I Escaped Diet Culture and Gained the Power of Lifting”by Casey Johnston. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine and I am so excited about my guests today.
Casey Johnston is a bestselling author, writer, and cultural critic. Her work covers the intersections of a diverse range of topics, including politics, identity, health, technology, power, womanhood, and embodiment. And she's earned critical acclaim from numerous outlets. “A Physical Education” is her first book. Casey, welcome to the show.
Casey Johnston
Hi. Thank you for having me.
Dr. Denise Millstine
Our medical expert guest today is Dr. Sonal Haerter. She's an assistant professor of medicine and the associate program director for the Department of Internal Medicine at Creighton University School of Medicine in Phoenix, while practicing adult primary care at St. Joseph's Hospital and Medical Center. She is a double board certified in internal medicine and also obesity medicine, and is a staunch advocate for healthy lifestyle.
Sonal, welcome to the show!
Dr. Sonal Haerter
Thank you so much, Dr. Millstine
Dr. Denise Millstine
“A Physical Education” is part memoir and part science writing that chronicles Casey's personal transformation from a life shaped by diet, culture and restrictive exercise to one of strength, self-respect and empowerment through weightlifting. From Casey's website, she writes. It's a journalistic exploration of the wide-ranging history, science and psychology of strength, braided with her personal story of learning to lift weights.
I'm excited to cover this topic that many women will have considered and then probably shied away from, which is weightlifting. Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences and experiences that impact health through story. In this case, we'll talk about weightlifting.
So, Casey, in 2014, you pivoted your approach to exercise and strength training by turning to weightlifting, which you then wrote articles and converted to a newsletter. What inspired you to turn that writing into this book?
Casey Johnston
So I actually started working on this book not long after I started writing about lifting. And at that time, I had been lifting weights for a couple of years when I started my column, which was called “Ask a Swole Woman.” But it was a really sort of non-linear, circuitous process to figure out what shape this book should take and what areas it should cover and cross into.
And I also had a I think I had a sort of notion in me that I also wanted to help people get into lifting, because the number one question people would write to me about was like, how do I get started with lifting? So I had to kind of separate that out from the story of it, which was much more, I don't know, I had to figure out how much of myself to integrate and also honor my inclination to explain some of the science of this and some of the concrete aspects that I think are not well communicated, or at least weren't at that time. I think we're getting better and better at talking about the benefits of strength training for everybody, and not just like 25-year-old men. But yeah, there were a lot of pieces that I wanted to bring together.
Dr. Denise Millstine
I love it, and I think you're right that it's getting better. But still, I think there are so many people who need to read your book to understand how they can exercise to be strong, but we're going to dive into that. Sonal, tell us your reaction to the book and also how you approach talking about weightlifting with your female patients.
Dr. Sonal Haerter
Casey, first of all, this was such a great read. I have to tell you. Like I so related to your entire book because my story is similar, but I started a little bit later than you did. So it was 2020 pandemic up until that point actually, I was all into cardio. I did a bunch of HITT classes all over the town. There was no structure. I looked great, I thought I was doing the best thing for my body until the pandemic hit, and I think this is where I started reading a little bit more about strength building versus having a specific weight on the weighing scale, which is which is what I obsessed about for many years now. Although I'm not a marathon runner like you did, you are. I did obsess about very similar things that you write about in the book.
Denise, going back to your question about how do I approach this with my patients? So one of the things that I do, number one, is establish trust before I talk about this topic. That's critical because a lot of times, you know, we are given such information that's misleading and there's so much shaming. I do obesity medicine now quite a bit, and there is so much shame in that field that I, I tread cautiously, I see where my patients are in general in terms of what is their understanding about exercise, strength training. What are the barriers and concerns about strength training or do they have resources? Do they understand what is the difference in cardio?
And as you know, I work in a downtown hospital and I see a lot of people from different aspects of life. Not everybody has the education or means or resources. So number one is establishing that trusting relationship where I make sure that my goal is metabolic health. It's not a certain weight on the scale. It's not the way people look or they appear. It's across the board. Right.
And so number two is understanding what is the concerns and barriers around this topic. What is their understanding of resistance training and strength training and reframing this weight training concept as how about we discuss improving your metabolic health. And that gets attention. That's like most people want that, right? Most people want to prevent diabetes and metabolic syndrome. So when you use language like that, they want you to process your insulin in your body better so you have a longer, fitter body. How do I get you to a point where you are very fit and independent in your 50s, 60s and 70s? So that gets those conversations open and a lot of open-ended questions in this area.
Dr. Denise Millstine
Well, in Casey, I think this mirrors a lot of your early experience with exercise. You wrote that for many years your target was to lose weight, to burn more calories, to beat cravings. And then when you pivoted from mostly running, which is what you were doing prior to 2014 to weightlifting, you realized you were not working to avoid or to eliminate weight. You were working to make yourself stronger. Will you tell our listeners how different that was compared to prior?
Casey Johnston
Yeah, I really was fully invested in like, what's the weight on the scale, like how many minutes of cardio I'm doing and it's never enough. And like how many calories are burned per minute of that cardio and what food does that sort of equate to? What food am I now allowed to eat because I have burned x number of calories? So it was a real paradigm shift for me to move away from that structure of how all of those pieces fit together, which for me, they had never really fit together that well.
I was never doing enough. And I felt like the more that I did, the less sort of impact that it had, both in terms of my physical appearance. I just wanted to get to a place where I didn't have to think about all of this quite so much. And I was never getting to that point of set it and forget was almost how I thought of it, which is that rotisserie chicken oven infomercial, right, like, I just wanted to not have to think about it. And I was only having to think about it more and more.
With lifting the pieces seemed like they fit together so much better. I didn't have to diet really, like you ate to support the lifting and you also rested to support the lifting. And then when you rested and you ate, you lifted. You were able to lift better. You felt better in the gym. The weights went up. I was able to. And you need these sort of inputs in order to build muscle, which I didn't even know you could lose muscle, really, as a young person, I thought muscle was just kind of there. I thought muscle loss was like for only for older people.
Turns out it's one of the things that your body will consume when you don't eat enough food. You need protein. Your body will sort of process away your muscle in order to help sustain what muscle you do have. So I was completely unaware of that when I realized that building back some of that muscle could not only give me back some basic functionality, I felt really weak and I felt bad in my body. I didn't even realize how bad at that time, but that I didn't have to diet to do it. In fact, I would have to sort of shore up all of these other parts of my well-being in order to make it happen. That allowed me to sort of back into all of this different way of seeing myself in my body, which is that I really needed care and consideration, and I needed trust for myself, really. Which is interesting that you bring up trust. And Sonal what I think of when you were speaking was actually something that I say often, but I would be interested in hearing you react. Is that a thing that I've started saying a lot about exercise and the food and the eating that goes along with exercise, the resting that's required, especially lifting. Is that the impacts of weight loss and even the fact of weight loss, like weight loss, takes a really long time to achieve even a modest amount. But you sort of feel the effects of exercise and eating well right away. Like we've been totally focused on weight loss as the number one point of all of this stuff, where in fact your lifestyle, just how you feel is so important. And that's an impact that happens almost immediately, I feel like.
Dr. Sonal Haerter
Casey, I completely agree with you. It's so interesting you say this because I remember talking to a friend of mine. She is about 20 years into medicine. She's an anesthesiologist, a very, very smart doctor, however, very stuck on the weighing scale as a way of feeling good and she's going through some menopausal issues. So it's very, very hard for her to focus on that weighing scale and feel good.
And one of the things I always tell people who ask me about weight training is I started lifting with a goal of getting a six pack. I was obsessed at one point I was like, I want those abs. And you know, what's happened over time is I've gained confidence. I think my self-esteem has seriously like, it's gotten so much better compared to where I was five years ago.
I have a healthy relationship with my body at this point. I have significant reduction in my anxiety and such better mood, like even keel mood for the most part. And these are things that happen immediately as soon as you are consistent and you are focused on improving your muscle health, your bone health, getting stronger. Your narrative in your mind changes you as you start to do this more and more, it's less about the six pack, more about how you start to feel metabolically and how strong you feel.
I'm not talking just about muscle and body strength. It's your mind strength. You really start to feel that strength from within from outside, which is so amazing. And I think that's a personal transformation I can attest to. And so I completely agree with Casey on that. That is a good transformation that I wish everybody experiences.
Dr. Denise Millstine
Well, Casey, you write in the book about the impact on mood from the calorie restriction, calorie burning approach. Do you want to talk a little bit about that?
Casey Johnston
Yeah, I wasn't really aware at all when I was younger and when I was going through all of this, that people experience emotional and mental effects from dieting. Even when we would talk about eating disorders in health class in high school. I don't recall that ever being part of the discussion. It was like, you'll lose weight, you'll be unhealthy. The main thrust seemed to be like you're going to be making other people uncomfortable with your behavior, so you should not do abnormal behaviors. And it was like, you know, you put yourself at risk of death and bad health generally, like it's not healthy. But there's literally mental impacts we can put words to, brain fog. I learned more rigidity about rules, even sort of like self scrutiny. Scrutiny of other people are documented impacts of being calorically deprived over a period of time.
When I started eating more, all of this just sort of went away in a way that sounds magical and sounds improbable, but it's like literally the mental impacts of emotional impacts of not eating enough are very real. And eating more, like, not endlessly, but enough food to sustain your lifestyle can help you recover from those effects.
I felt it very quickly and I was sort of like, oh, I didn't realize that. I didn't have to, for instance, not struggle mightily against my cravings because I was create I was in these obsessive loops that were created by just by the fact of too much dieting. I thought those things were a fact of being a woman on earth. It was always what I had sort of heard and was surprised to learn that they're not. They're a symptom, a medical symptom of being underfed.
Dr. Denise Millstine
And really prevalent symptoms as well.
Dr. Sonal Haerter
Denise, can I add something to what Casey said. It's incredible, Casey, that once you start to lift and train, your nutrition changes dramatically because the relationship with food changes. You don't look at food as good or bad, or I need to only eat thousand calories to maintain that weight. It's more about what is the quality of nutrition.
And believe it or not, there is this positive impact on your skin, on your hair, on not just confidence on your muscles. But I personally have also felt like my skin and hair is actually better in my late 40s than it was in the 30s. And I do think that it's because of enough calories, not obsessing about what good food, bad food, constantly thinking about what can I eat on the weekends and what should I not eat today so I can enjoy weekends.
People don't realize how obsessive that thinking and unhealthy that thinking is, and so focusing on quality of nutrition and not quantity is the biggest transformation as well. Along with like strength training.
Dr. Denise Millstine
Well and Casey, you comment in the book that it's very prevalent for women to have some characteristics of disordered eating and you referenced a “Self Magazine” article that said 65% of women who are responding at least to the article. So I guess it's a selected audience, but still were thinking about things in terms of dietary restriction and how their exercise was burning.
Can you talk about just that switch towards like counting? I don't know if you would say you count your macros, or at least being focused on a certain amount of protein intake. What was that literal mathematical switch that you made when you started lifting?
Casey Johnston
Yeah, I mean, I worry often that people think I just swapped one thing for another. But I think in the details of it, it's complete. It's markedly different in so many ways. So one of the things I wanted to highlight in this book was the study that I had run across, which was while we hear a certain small percentage of women or even people in general experience an eating disorder, a sort of clinical level eating disorder, there's a much larger population of people, it is the vast majority of women, at least, who are responding to the study, as you said, who experience symptoms of a what I would call a broader disordered eating. They have disordered eating patterns, disordered perceptions of their body. They may not rise to the level of needing inpatient and outpatient eating disorder care, but their lives are impacted nonetheless by the fact that they can't stop having thoughts about food, that they maybe think their appearance is the worst thing about themselves, or they think there's like one big flaw of their body that they fixate on.
So when I started to get more into strength training. I know tons of people who get into strength training and they leave aside all of the dieting counting. They can sometimes just focus on eating more and that works for a lot of people. That's even more effective for them than what I did. But I did go into this thinking, okay, I sort of need to make sure that I eat enough, because my sort of internal compass about food is so askew that if I just try and abstractly eat more or eat enough, I'm not going to get there. And I even tried and then measured how much I ate later and I had a shortfall. I was not able to sort of steer myself in the right direction.
So keeping track of my food for me was sort of accountability on the end of making sure that I ate enough in order to support what I was trying to do, which I was trying to build back muscle. I was trying to get stronger. Predictably in the gym, when I learned that I could add a little bit of weight to my lifts every session. And then that was how people got strong. I always thought you either lift the 5-pound dumbbells or you lift the 30-pound dumbbells and you're either one person or the other. But in fact, it's very easy for most people to add 5 pounds at a time at the gym if they are eating enough protein, eating enough carbs and fat to support that.
So because I wanted that progress, I wanted to see what it was like to get stronger and to build my muscle back. I needed to make sure I was eating and I could not do it, just sort of in a way that involved following my own guidance for it.
Dr. Denise Millstine
And there is math in this, right. Sonal, so Casey talked about like 500 calories in, 500 calories out as an old way of thinking and now thinking about literally calculating what your total daily energy expenditure is and then looking at how to feed your body to build muscles. Is this something you do in your practice?
Dr. Sonal Haerter
It's so nuanced. So it's not just calories in and calories out. I mean, I know that that sounds very basic. And of course, calories surplus in long run can be can cause weight gain and calories. You know, minus calories for a prolonged time can actually give you some other disorders. So like problems with your iron levels or your minerals and all of that.
When I have conversations with my patients, I always say that your calories are not just influenced by your willpower. It's a lot more than that. It's like your daily movement, your daily activity level, your genetics, your hormones, your quality of sleep, your stress levels, your other medical condition, if you are taking medications. Right.
So it's multifactorial. So it's very inappropriate for someone to come up with a formula that works for everybody. And so this is something that's nuanced and requires sit down conversations. Even when you are not really exercising in the gym you're still burning calories and how can you do little things even in those moments to keep your muscle and your body active?
You know, people who have desk jobs, for example, with the pandemic, we have this surge of people working from home. And what's happened is we have UberEats, we have DoorDash. People are moving less. People are going to the stores less.
And what that's done is our daily movements have gone down and people are taking lesser, lesser steps. Now, why do steps matter? Because they do contribute to about 25% of metabolism and energy burn even when you're not exercising at the gym. So the concept that you can move your body whenever, whichever you can, and that is actually saving you from getting metabolically unhealthy. That's a big concept that I'm very focused on in my practice.
Dr. Denise Millstine
I love that. I say to my husband all the time, the world is my gym. And so I, you know, really like to see, you know, some of the impacts of my own weightlifting when I can throw my suitcase up in the bin in the airline and not have to ask somebody for help, and it means I can pack more books on each trip because it's all right that it's so heavy I can handle that. Casey, you talk a bit about life impacts of becoming a stronger woman. Will you share the kitty litter story that's in the book?
Casey Johnston
Yes. I characterize in the book my one of my main nemeses. I'd never thought about how being an adult in the world required quite so much physicality. Now we have like a lot more delivery, as Sonal was saying, aspects of ways you can get stuff to your house.
But I lived in New York in an apartment, second floor walkup and when you live in New York, generally speaking, as a young person, you don't have a car. So I had two cats and I did not have any money, and I needed to be as economical as possible about a lot of things, including cat litter. I had to buy my cat litter in these giant 40 pound boxes, and it was the bane of my life to go to the grocery store, wrangle a 40 pound box of cat litter off the shelves into a cart, out of the cart, down several blocks to my house, up the stairs, and then pour it into the cat litter box.
This was very, very difficult, and I think it would have gone on being difficult. Forty pounds is heavy. And you know, a box of cat litter is an awkward object and it's dense and it only has this tiny, it only has this tiny little plastic handle.
So when I learn to lift weights, like 40 pounds is a lot in terms of daily tasks. Like if you're picking up a 40 pound child, a 40 pound bag of dog food, a 40 pound bicycle, there's lots of things that are in that sort of like 20 to 50 pound range that you have to physically deal with as an adult in the world, but you can get to the point of lifting 40 pounds, as I was describing earlier in the gym, in these ways that will translate so well to a real life, and adding 5 pounds every session.
That means in a matter of weeks you can be picking up 40 pounds, and that's like a skill that is available to everyone. And I think that was one of the first things that I realized had gotten so much easier very quickly was dealing with this box of cat litter that used to be completely impossible.
Dr. Denise Millstine
I love that.
Dr. Sonal Haerter
I was in the clinic the other day and I had a tall gentleman. He is very athletic and 6’ 5” and weighed over 275 pounds. He was on the exam table and the exam table was very close to the wall, and I needed to stand on his right side of his body, you know, you know, to do my physical exam.
So I kind of got in the little gap and moved the entire table with him on the table by my lower body. And, Casey, I am telling you, I give credit to all those lunges and deadlifts and all of that. And the gentleman looked at me. He's an athlete. So he looked at me and he said, “Dr. Haerter, that was the coolest thing I have seen.” And that was my moment of pride.
Dr. Denise Millstine
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine
Will you comment, Sonal, on how this is different when you do weightlifting and you're mirroring some of the movements that you'll do in your real life, versus you engage in strength training with a machine that isolates a specific muscle. Will you just comment on that distinction and how important it is to realize very few movements in real life are from one isolated muscle.
Dr. Sonal Haerter
Correct and that's kind of goes to machines that use specific groups of muscles versus free weights that kind of involve all the muscles. So this I think you're talking about free weights versus machines. Right. That's specifically so what I do with my patients is, number one, if somebody is actually struggling with balance or coordination, I prefer for them to do machine weights because they're a little bit safer from the standpoint of giving support. You're starting out with specific group of muscles. So like lower body strength. And because of the machines they are better supported, less risk of injury.
But let's just say someone has free weights at home. They aren't able to go to the gym. You can actually start with free weights because they can do squats and lunges and deadlifts at home with their weights if you kind of give them some caution on, you know, injury prevention.
Because you're right, those involve a lot more groups of muscles, core body strength. And so it depends on like what your goals are, who your patient is. In patients over the age of 50 and 60, I tend to be a little bit cautious. If they are lifting weights for the first ever time, it's better for them to do under some sort of guidance so they do not land up with any sort of injuries, especially to lower back or neck. Those are areas that you have to protect because if you have not done this before, this can be a little bit challenging. So really depends on what the goals are and who your patient is.
Dr. Denise Millstine
But Casey, I think when you started, first of all there was a lot less information in the world in terms of YouTube and, you know, fitness information being so accessible literally in your pocket on your phone. But when you started, you're actually pretty surprised at how simple your first exercises were. Will you share what you did when you first went to the gym.
Casey Johnston
Yeah, I mean, totally. I agree that machines have a place in the world, but I think I made the mistake that a lot of people make, which is that when you go to a gym, so much floor space is taken up by all of these fancy looking machines that you presume that that's the tool that you are supposed to default to.
And as a youngish, able bodied woman who does not have any conditions that caused balance problems or anything, I was able to use free weights for strength training and able to do it in using these, what are called compound movements, where you are using multiple muscles, multiple joints at the same time. And part of the benefit really, that you get from these exercises is the way you're building coordination between all these parts of your body. Coordination that you need in real life when you are, for instance, picking up a box of cat litter or putting your suitcase in the overhead bin.
So when you are using these multi joint multi muscle movements, you don't need to do lots of different things in the gym. I was used to thinking about it in the machine sense, where you do like the bicep curl machine and then you do the lower back machine and the crunch machine and the quad machine and the hamstring machine. And I was like, it must just maybe it's just supposed to take you multiple days to complete a workout because you have to do each muscle individually.
When I learned that not only was it possible to do a workout that used these bigger movements, that I think I had only really seen big, strong people do, but the fact that they were also appropriate for somebody who didn't have much experience with lifting weights, that was really mind blowing to me.
But it turned out to be the case that provided you don't have additional medical conditions or challenges, that it is possible for you to learn to do a bodyweight squat of sort of lightweight bench or deadlift, and that developing the movement pattern, especially when you're newer to it, is almost as important as using the weights.
Dr. Denise Millstine
And I think probably most of our listeners know what a squat is. It's what you do when you reach down into the bottom cabinet. You have to go, you know, drop your bottom to the towards the ground and be able to reach down low. I think people can envision that. But what's a deadlift?
Casey Johnston
A deadlift is a we refer to it as a hinge style movement. So you're basically thinking of your hips as a open and close hinge where your upper body, your torso, is one side of the hinge, and then your legs, mainly your lower thighs, are another part of the hinge. So when you do a deadlift, you are picking up a dead “weight” from the floor by reaching down, hinging at the hips. And the hips are important because like, that's where all of your body's largest muscles are your butt, your glutes are your biggest muscle in your body.
So a deadlift is the way that your body is capable of moving the most weight, because it uses your biggest joint and your biggest muscles. And learning a deadlift is learning to sort of bend down in the right way and engage all of those big muscles together in order to stand up with that weight in your hands.
Dr. Denise Millstine
It could look a lot like lifting a box of kitty litter from the ground, for example. If you had both hands on either side, you could bend and stand up and bring it, you know, up to waist level, for example.
Casey Johnston
Sure. Yeah. Oh yeah. You could deadlift a box of kitty litter.
Dr. Denise Millstine
Lots of other movements that are described in the book. Sonal, I wonder if you'll comment on this quote from the book. “Creating strength is actually a process of rupture, rest and repair within ourselves, as well as metaphorically within our psyche.” When I think of weightlifting and how it's described in Casey's book, there has to be kind of a tear down that happens and then a build back up. Will you talk about that?
Dr. Sonal Haerter
Yes, absolutely. This was enlightening to me when I started my journey. So rest was something that I thought was a no-no, if you're looking for a healthy body. And I remember way back, like I probably did six out of seven days of some form of cardio, and that one day of rest was very guilt ridden. Like, am I supposed to be resting?
So with muscle training, one of the things that we all learn and you see the benefits of this as you challenge your muscle, meaning the day that you're lifting, you're literally creating these microscopic tears in your muscle fibers. Then you rest, meaning you activate that repair, the satellite cells and they rebuild the muscle, right. That's how you become stronger. With that rest period, you actually build strength.
Now in real life, I look at this as a stressful time or a challenging time that you go through where you allow yourself to actually or you have no choice but to go through that tough period of time and then comes a time of reflection. You rest, you pause, you reflect, and you take those lessons, which is repair. You take those lessons and you integrate them in the next chapter of your life. And that's exactly how muscle builds and that's how muscle hypertrophy happens.
And for that muscle hypertrophy, you have to progressively load your weights. So you have to actually go up on your weights in order for your muscle fiber to tear and then rebuild, right.
And I remember that was one of the things that I do not like at the gym are the sleds, the I don't know, Casey, you do the sleds, but I've hated those sleds forever, and I've gotten better at it. But when I'm at the tail end of it, I tell myself this is where the transformation is happening. The first ten feet or whatever was just a trial period and the last bit where I'm actually hurting and about to give up is where my transformation is happening. And I think it's very similar with a life. So I think it's failures or life challenges. If you take it that way, it can rebuild and transform your life. If you take those lessons forward.
Dr. Denise Millstine
Casey, I know you have lots of thoughts about rest and how weightlifting and rest then impacted even things like how you functioned at work. And then of course, to build off what Sonal just commented on was the importance of failure in the gym, which is probably not something many people who don't lift weights don't think about.
Casey Johnston
Yes, I had also similarly rest in my mind was this thing that was the enemy. It was the thing that you were supposed to do as little of as you could, and you could connect this back to, like, you know, when I got into running, it was peak hustle culture time. And it was peak Great Recession time also, where everyone was like, we're going to make do and we're going to like work our three jobs and we're not going to sleep. We're going to do polyphasic sleeping. We're going to sleep 20 minutes a time, every four hours, and only sleep three hours a day. And it's all going to be great.
And, I had no concept of how resting could be complementary to exercise, when in fact I felt that when I learned about lifting, it was so much more built into the process. It was required in order to, as Sonal was saying, to build the muscle. The muscle is not built really in the gym. The muscle is built in the rest time and when you are recovering after when you eat your food, the muscle builds back a little bit. You're creating an adaptation in your muscles. They are when you do the muscle damage and they repair, they are building a little bit better so that you can actually lift more weight the next time. And that's just like how the human body works.
And I had to sort of integrate this into my understanding of life in, in addition to lifting weights and similarly with the failure aspect. And it's so interesting what Sonal saying about the fact that strength is built. I've thought about this so much in my own life, personal life also in work, which is the fact that the easy parts, you're just sort of like marching through the motions.
And it's the hard part is like a relatively small part of the whole thing, but it's also the most important part. So it's like the first like eight reps are you can do them no problem. Rep nine, rep ten are significantly harder, but they're the most important ones. And you have to do those first eight reps in order to get to those two hard reps.
To circle back to your question about failure, failure is we have a lot of like fear around that term. Nobody likes to fail. Failure supposed to be a bad thing, but failure comes into the picture when you can't figure out where your reps nine and ten are, those hard reps. If you are not working close to the point where you couldn't do another rep, you couldn't do rep 11 you're not doing your hardest reps nine and ten if you don't know where that point is.
So sometimes in lifting, as I describe in the book, you actually want to sort of court failure in order to discover where your actual limits are. You don't know how much you can do until you, like, throw yourself into that wall, in a sense. And that was something that was completely uncomfortable for me, especially when in the gym, if you fail at a squat, you're holding the bar on your back and you're going to fall to the safety arms below and it's going to make a big bang. You can try and prevent it, but for the most part, weights can make a lot of loud noises, and that was incredibly uncomfortable for me.
But when it finally happened to me, I didn't necessarily even do it on purpose. But I put myself in that position and not only did I find out I could do more than I thought, but that it was not so bad to fail. And it's like, now I know where I sort of stand, now I know what I have to work on. I know that I'm not leaving capability on the table, that I am pushing myself as hard as makes sense.
Like, you don't want to be failing all of the time. That's like not good for you, but a little bit of experimentation with where the limits are is really good for the practice and for us in general. You should we should be allowed to feel safe to fail sometimes, you know.
Dr. Denise Millstine
And you were surrounded by people who were also failing without feeling bad about it. There was no shame in it. There's one scene where you see this woman fail at an exercise, and she sort of jumps up and she laughs. And the guy she's working out with is also laughing. I mean, she's smart. She doesn't get hurt, obviously, but she was pushing her limits and she wasn't quite there yet.
There's so much to learn in that too, that if you're pushing your limits, if you're trying to grow, there going to be times when it doesn't work out and that's actually okay.
Casey Johnston
Yeah, I was so used to being so hard on myself for over any sort of perceived failure. And lifting was important in a lot of ways, because it gave me this sort of sandbox of understanding a lot of conceptual things that were separated from real life in a way that allowed me some experimentation and how I thought about them.
Like failure in real life, failure at my job, failure at paying my rent, that was unconscionable. But it helped me to wrap my mind around some of these things, both to think of them as being in this separate space, as well as seeing other people experience like it gave me a place to see other people experience it in this sort of microcosm.
Like you're not necessarily going to get to witness somebody failing in a real way in real life. But I could see somebody have a different emotional relationship with failure in the gym, and that was like an important model for me to know that there are other people who experience this in a way that has nothing to do of being super hard on myself the way that I was.
Dr. Denise Millstine
Yeah, I love that. Sonal, I wonder if you'll comment on the part of Casey's book where she talks about the differences in strength between men and women. I think culturally we have a tendency to think of men as being the stronger sex, but Casey really attacks that assumption in many different ways. I wonder how you approach that belief.
Dr. Sonal Haerter
I actually when I read that chapter, I completely agreed with Casey on that. So here's how I think about the physiological and objective difference between men and women.
For one, men do have more lean body mass, and that's related to the testosterone, right? So they have the hormone that directly impacts the muscle mass. Now, in all honesty, I think men and women can have different hormonal profiles, what we do and muscle distribution, but they can significantly actually get stronger relative to their baseline.
And as far as women go, think about it this way. Like when we start to talk about women lifting and game, it's only the recent times. It's only the last 5 or 10 years that we are talking about it. And maybe it's social media, maybe it's more knowledge. We are diving deep into what health should be, what metabolic health is, and muscle strength is not exclusive to men alone.
So I do think that in the future, I'm hoping that that's not the case and we don't discriminate that based on gender. But it's for both. And I can tell you that I'm actually stronger than some of the men. My medical students here tease me because they kind of compete with me. They see me on my Instagram, they think something and they'll come back and say, we tried.
And we aren't able to lift as heavy as you do. And they're in their 20s. So I can say that, you know, with practice, with proper nutrition, with proper knowledge, women can get just as strong and build muscle compared to where the baseline is.
Dr. Denise Millstine
And you navigated this to Casey from your, I think, high school chemistry teacher, who told you that women can't do a squat without lifting their heels, and then women aren't capable of doing a pull up. You had to overcome some of those cultural beliefs that had been fed to you, right?
Casey Johnston
Yeah, there are a lot of weird ones, and I think there are still there's still quite a bit of belief that because women, for instance, can't get as strong as men in the strict sense of if you gave a woman and a man even of the same size, the same amount of training, for the same amount of time, a man would be able to lift a raw maximum amount of weight, like, let's say, deadlift 600 pounds. A woman might only be able to deadlift 400 pounds only quote unquote.
But women, because of their hormonal make up or there's probably multiple factors. We haven't really looked that much into how women are strong in a unique way, or why women are strong, but it's a relatively accepted fact in the strength training community that the way we would explain it is they can do more reps at a weight that is closer to their max than men can typically like. All of this is sort of painting with a broad brush, but so this example, a woman might be able to her max might be 400 pounds, but she can deadlift 380 pounds for three reps, four reps, maybe even five reps. A man might only be able to deadlift if his max is 600. He might be able to deadlift 500 pounds five times, like just a sort of relatively smaller amount.
So women are relatively stronger, doing slightly more work. Their overall work capacity is greater, but we focus on conceptualizing strength as what's the most weight they can lift one time. Instead of how much weight can they lift three times five times? Women are better at that.
There is a lot to overcome. There's a lot of work that has not been done. A lot of science that is still to be scienced about. What are the unique offerings of older people, women. And a lot of the research is focused on young men, trained men, and what their hormonal profiles are good at and not what the contributions of women are.
Dr. Denise Millstine
Yeah, I think this is so important, and we've talked about it before on the show regarding how women have been excluded from scientific studies for literally decades, and then how much of the science that we operate on was done in men and extrapolated to women, which is completely unfair.
In addition to your point, Casey, which is going back to this being strong for your lifestyle, if you're chasing around a toddler, you would much rather be wanting to lift that smaller toddler up more times in a day than you would want to be able to lift one time your, you know, preteenager or whatever that might look like. So okay, we'll wrap up by having both of you give a short piece of advice to our listeners who are now convinced they want to start weightlifting. What should they do first?
Casey Johnston
One of my typical pieces of advice for somebody who's sort of on the precipice is oftentimes people's main option for getting into lifting is to join a gym. And I really encourage people to sort of separate the accomplishment of a workout from getting used to the gym. You should think about going to the gym as like it's a new place.
You're allowed to get comfortable for a while. You can go and just sort of post up on a treadmill and walk and just absorb the vibes of the gym and see, like, where do people do things? Where do they stand when they. Because you'll run into these like questions. If you try to do a workout, you'll be like, I don't know where to stand. I don't know where. The thing is, I don't know how people do this, but you can go and just watch and you can do that as many times as you need in order to sort of get comfortable. And eventually you do want to take the next step and try to accomplish a workout. But I think it can be overwhelming for people that they're in this new environment. They don't they're trying to work out for the first time. They're getting used to a gym and you can separate those things. I think that works for a lot of people.
Dr. Sonal Haerter
I think for me, I agree with Casey, but I also start with a conversation about consistency over motivation, because often times I hear a lot of my patients say, once things get better, I promise I will be back at the gym. I used to do this way back in my 20s and what I'd say is habits. Let's start to focus on creating a habit, and then we define your goals like what are your goals and what are your goals that you want to accomplish when you're looking at weight training. Is it because you're going through menopause and your weight is redistributed? It's not the same body shape that you had. Your strength is weaker than before. Are you looking at bone strength? Are you looking at maintaining healthy weight? Are you looking at cholesterol? All of that.
So once we have a goal then the number two step is how do we create habits? How do we stay consistent? Let's start with something that's doable. Can you do 20 minutes. Can we commit to 15 minutes? I have patients who have not been able to exercise for a while. I'd say, how about 15 minutes three times a week? Can we commit to that?
And all I want the first four weeks is show up, show up. As you said you will, and do 15 minutes of something that makes you feel good. And once you build that habit, then it's easy to give them a little bit more homework. It's like somebody who has not done homework. You can give them two hours of homework right at the get-go, right.
So I think defining goals, giving them very realistic goals, what are their resources. How are they achieving this. Are they doing it at home. Are they going to the gym. Do they have a trainer. And I think I based that little bit on that. And then slowly getting into it.
And once people form a habit, Denise, like for 8 or 10 weeks, I feel like they start to get a little bit excited. So that’s kind of my strategy around this topic.
Dr. Denise Millstine
I love it. I love the idea of immersing yourself in the place and not setting too high expectations initially until you get that comfort level. And also this concept of it's not just about doing it once, but it's doing it as a habit and building it as a regular practice.
It has really been my pleasure to talk to Casey Johnston and Dr. Sonal Haerter about the book, “A Physical Education: How I Escaped Diet Culture and Gained the Power of Lifting.” Thank you both.
Casey Johnston
Thank you.
Dr. Sonal Haerter
Thank you so much.
Dr. Denise Millstine
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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