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Katie: ?Hello and welcome to the Wellness Mama Podcast. I’m Katie from wellnessmama.com, and this episode is about the gender health gap and specifically in fitness and how not understanding this has been harmful to women, and how some small shifts in our understanding can make a big difference when it comes to fitness.
And I’m here with Dr. Jessica Shepherd who’s a board certified OB-GYN, and she’s the founder of Sanctum Med and Wellness, where she combines traditional and holistic approaches to women’s health, as well as the author of Generation M and a leading voice in women’s health. And we talk about muscle, maintaining muscle tone for longevity, how hormones come into play, why women are not just small men, and how understanding our hormone shifts can make us more effective in our fitness, especially as we get older. So let’s join her now.
Dr. Jessica, welcome. It’s such an honor to have you here. Thanks for being here.
Jessica: Absolutely. I’m so glad. I can’t wait to hear what you have planned for our time together.
Katie: I am excited to get to have two really specific conversations with you that I think cover two topics that are especially important for women and moms especially, which are most of our listeners today. And the first one, I feel like you have very unique and specific expertise when it comes to the gender health gap, and especially its correlation in fitness, and I know people listening may be familiar with the idea that women were not even included in medical research until 1993, which still blows my mind. And this has been now talked about much more, but there, I have not heard it talked about as much, how this actually affects fitness as well. And I see so many training programs where women are kind of trying to emulate men.
And I also hear in the health world, women are not just small men. So I know there’s a lot that goes into this and it’s a little bit of a controversial topic, but can you walk us through kinda what the gender health gap is, and then the nuance specific to fitness for women?
Jessica: Yeah. I think that when we consider just health overall, you know, that’s where we could probably make the umbrella of this conversation is, yes, for a long time when it came to health. Meaning being healthy and then in illness and what kind of goes on in the body. A lot of that research was just incorporating men. And the idea behind it, it’s not like, you know, this was something that was a conspiracy theory and we’re not just gonna include women. The belief really is, was that the physiology would be the same. Right?
And so accounting for that difference in physiology would mean we are going to make slight adjustments based on maybe height and weight, because women typically are smaller, is that that would make up for the differences that we would see in that type of research. And so from that context, you can pretty much put everything else onto that, even when we come to like the fitness industry. And so for so long, you know the outcomes that were, you know, from research were really reflective of not a woman’s physiology, which is very different to a man’s physiology and a male’s physiology.
So now we are seeing that obviously we are having data that includes, by gender, male and female, or you know, for research, just women. And that can really help women thrive, do better with their overall health and in this instance in fitness.
Katie: When it makes sense to me. I mean, obviously it seems like it would be common sense, and I can see I guess how it wouldn’t necessarily have been malicious, but just like a math misunderstanding that we could just like adjust the numbers and women would be the same as men. But it seems like that also ignores the elephant in the room, which is that men and women have drastically different hormones, which of course would show up in a lot of instances within the medical world, and I would assume also hugely come into play when it comes to fitness.
And I’ve heard at least anecdotally, or people talk about how men are more anabolic, for instance, and women tend to be more anti catabolic. I don’t even know if that’s necessarily accurate, but I know hormones do come into play in a big way. And for that reason, men and women could probably eat the same things and have way different, kind of, results or exercise in the exact same way and train in the same way and have drastically different results.
So like understanding this gap and that we’re now getting to learn more specifically about women’s physiology. Like what are some of those things we now know when it comes to health and fitness specifically for women?
Jessica: Yeah, I think looking at, so there’s, you know, obviously women have different kind of phases that they go through when it comes to hormones. So for example, you know, first starting your cycle and you know, the first years into that versus what we’d call like our reproductive phase, which can really be maybe, you know, obviously when you start your cycle, but maybe if you were to say 18 through mid thirties is a good timeframe, and then after 35, obviously, working towards a shift or a decline in those hormones towards perimenopause and then after menopause, you know, when you have a significant or drastic drop in estrogen and progesterone and testosterone through that rest of the kind of phase of a woman’s life.
And so in all of these, hormones do play a significant part in how women show up and what their outcomes will be when it comes to a plethora of things, their health, fitness outcomes, also like mood when these are done. Food, nutrition, how that is incorporated into a woman’s body in these specific phases. And so I think that it’s important for a woman to understand that so that she can be in her best power throughout the phases of her life, and I think that we owe it to women to show them the physiological and performance differences when they are going through a certain phase in their life, based on their hormone and their reproductive phase or outside of a reproductive phase.
Katie: That makes complete sense, and I’ve talked about this a little bit only in like the stress realm and how physically like women’s and men’s bodies respond so differently to stress. And that’s why I think personally there’s the nuance around some women don’t do well with like extreme cold plunges for instance.
I think there’s like a kind of a hermetic curve and women are on the gentler end of that, whereas men’s bodies have more resilience to certain types of physical stress. And I would guess like this also comes into play in a big way, potentially in fitness, it like, potentially maybe more is not better or women can be more aware of the hormones you’re talking about in their training to get much better results without having to just like destroy their bodies with super high intensity all the time. Kind of more is better training methods.
Jessica: I think that you basically said exactly what I know and in truth is, women, we have been, it’s almost like swinging the pendulum, you know, before it used to be, women are going to have that type of Richard Simmons, Jane Fonda fitness approach with cardio. Not to say that cardiovascular exercise is not important.
That’s not what I’m saying. It’s was, that was the realm that we can live in and reside in. And now we have this other pendulum of, that we’ve seen maybe through kind of the high intensity CrossFit, severe cold plunge and all of those, there needs to be a gradient of that, of the versions of that because of our physiology. And so that’s, you know, this is just how science evolves, is seeing those changes that we have, as we’re learning something new. Right?
And so when it was realized that, say, resistance training or strength training was actually very important for a woman’s physiology and how she is able to say, build muscle or improve her metabolism, it’s like we swung to the other side of the pendulum and had a lot of rigorous activity when really it needed to focus more in the gray area between the Jane Fonda and the excruciating, like what we would call like intensity training. So I think we’re getting there. I think we have seen a lot more strides in what that should look like and can look like for a woman. Again, based on her lifestyle, her physiology, her specific outcomes that are important for her later on in life, and really using exercise as a way to improve quality of life, but also how can we use that to predict the quality of life for women when it comes to exercise.
Katie: That’s fascinating and I love anytime we get a chance to talk about strength training even briefly. Because I personally am so excited that now many more women are on board with this. And I think like it’s worth repeating all the benefits of maintaining lean muscle mass as we age, whether men or women.
This seems like an actually like, the more lean muscle mass we maintain in a healthy way, the better, the better outcomes for longevity kind of across the board. I also feel like for women especially, maybe it’s helpful to distinguish between like movement and the category of like exercise or training.
I feel like that was, at least for me, very helpful as a paradigm shift of like humans as animals were meant to move all the time. We’re not like meant to sit at a desk under fake lights all day long, and we weren’t meant to do high intensity exercise all day or to do CrossFit all day. We were meant to like walk and do functional things and lift our babies and grow gardens and things like that. And then there’s the place for the training and the strength and the like, more targeted, specific movements. And for me, that really helps me like kind of paradigm shift. But in your opinion, what are some of those kind of like, what would be key things for women to focus on as far as like training types, training volume, nutrition.
I’m glad protein for women is also now being talked about in fueling versus unit restriction. But I would love any guidelines you have on that. Because I feel like now that we’re talking about this for women it’s important to have kind of like benchmarks of what to look at for that.
Jessica: Yeah. And I wanna move back to, and you touched on it, is the functionality of what we’re seeing in resistance training. And, you know, with Pvolve, you know, as their women’s health advisor, is that’s why I found it important to partner with them because I feel that, when we were talking about swinging the pendulum, is what it’s able to provide is resistance training in a way of functionality. Because when we look at decrease in lean muscle mass, or decrease in bone mineral density in women as they start to age because of the decline in estrogen, in midlife.
So what comes with that is the functionality. And that’s what we typically do see in women who are older is they lose a lot of say their balance, their flexibility, their posture. And so there has to be a component of resistance training that incorporates functionality. And I really believe that’s what Pvolve does because it focuses on the core of let’s increase hip strength. Let’s look at balance. Let’s look at flexibility. All while still contributing to improving lean body mass and muscle mass.
Because this is, I really feel that midlife is that ability to change the trajectory of a woman’s life as she gets into her sixties and beyond. And so the benefits of that resistance training, in a functional component, is what women specifically need at that stage in their life. And this is what I find is imperative for women to understand because there is this kind of crux of time, I would say from 40 to 55, even if you wanted to increase that to 60, where we have this ability to change the impact on what we are seeing later on in life in our seventies, eighties, and nineties.
That’s super fascinating and really good to know. I’ll make sure I link to that. I know you have resources on a lot of this. I’ll put those in the show notes so people can actually learn from you and keep training and going deeper. But I love that you brought up the balance and the flexibility and the posture.
Part because I feel like those get lost when it’s just like training in a single plane, doing the same activity over and over. And we know like at least statistically that fall risk is huge. So like actually I could see balance and posture being equally important and not nearly well talked about. And circling back on the hormone side, can you go a little deeper on how women’s hormones influence, like the performance aspect, recovery and then injury risk?
Because it seems like those are kind of categories where if women are just sort of training like small men, they might miss some nuance that’s really important for them.
Jessica: Yeah, I, you know, I like to kind of level set with hormones really are chemical messengers and they’re sending messages out every day very consistently. And when we think about estrogen and progesterone and testosterone, and namely estrogen because it’s, you know, for a woman, it’s her most, I guess, vital hormone, or the one that kind of shows up in the most spaces is that we have receptors for these hormones all over our body.
A lot of times we feel that they’re just typecast to the pelvis because we associate it with our menstrual cycle and lack of. So understanding that helps why when we decline in these hormones over the course of perimenopause and menopause and midlife, then the muscle doesn’t get to interact with estrogen and testosterone as much, or the brain, or the heart or the bone.
Because there’s receptors there for all these hormones. So that’s why we see that muscle mass starts to decline in midlife, bone mineral density, which is gonna contribute to our strength of our bone, and also everywhere, our gut, our brain. And so going back to the muscle and the bone, you know, when we’re talking about functionality, as women start to age and these hormones are declining, it makes sense that you start to see these changes in bone and muscle, which then contributes to flexibility and posture, which then later on, if we’re not paying attention to it, contributes to the risk of a fall. And not only the risk of the fall is when you fall, what is the injury then that can occur because the bones are weak.
So it’s this domino effect that really is shaped over 20, 25 years with the outcome of what’s gonna happen when these things happen and are you able to prevent these things from happening and being in a preventative aspect of, if I improve my functionality and balance and posture, then my risk of falling is less, and because I’ve done the exercise, the risk of having a bone break when I fall or fracture is less. So it’s like you’re trying to like stop the domino from like the first one, from falling as much as you can so that the domino effect is either not happening or not as severe.
Katie: That makes sense. And I guess now that we’re at least studying this, talking about this and realizing there’s differences like we got to talk about some of the negatives that have happened in the past, but I would love to also hear like, what are you encouraged by and like what are you seeing in the emerging data and research and clinical experience that you actually are very encouraged and excited by?
Jessica: I’m definitely encouraged by the, obviously the medical breakthroughs that we see in hormones and the benefit of, and being able to offer women that conversation so that they can decide for themselves if they wanna do hormone therapy in midlife. But on the other side of it is the science behind sports and exercise. Understanding the context between hormones and how it impacts our physiology. Understanding how we can maintain skeletal muscle strength, how we can improve balance through exercise and how we actually can use this transition as a mode of prevention rather than of dread.
And I think that we’re only going to get better in this, kind of sphere, and allow women to really believe in their selves. You know, I think for so long it was almost like, this is gonna happen to me, and I guess I’ll just kind of flow with it. And now we have the ability to say from a statistical standpoint, I know if you take part in exercise, you can improve your bone mineral density or if you do a exercise routine consistently, I think consistency is always a big part of this algorithm as well. I know that you can improve your flexibility.
I know that you can improve your balance and your total body mass when it comes to lean muscle mass, that now we have data that shows that, and I think that that’s exciting because women should be offered the substantial evidence that shows if you take part in this, this is what the outcome is. Because I want women to know that they can live better, they can feel better even as they start to get older.
Katie: I love that. And you mentioned Pvolve, I’ll make sure that’s linked in the show notes because that might be a new resource for a lot of people and make sure people can find that and learn more about it. I’m also curious because it sounds like understanding this actually gives us such a deeper insight into our bodies and a much more effective roadmap for how to train, how to live, how to support ourselves as these incredible bodies we get to live in.
So I would love to know, for women especially, kind of what is both your personal and clinical sort of 80/20 of like most impactful first steps that women can make, especially if any of this is new to them that can like help move the needle in a significant way.
Jessica: I am gonna pause there. Can you ask the last part of the question again?
Katie: Yeah, like what would be your both personal and kind of clinical 80/20 of things that have the biggest impact? If someone, if some of this is new to a woman and she wants to start making changes that are gonna be like actually impactful for her health long term.
Jessica: Yeah, I give a little bit of like my cheerleader rally to the patients that I see when they’re in this moment and, you know, they may be struggling or being like, what do I do is, it’s never too late to start. That’s where I always like to start, you know, with the kind of the messaging behind what do I do next, is it’s never too late to start. And the biggest thing that you can do to get you the best impact is to do small, consistent changes. And when we think of our lives in 20 years, the things that you start to do maybe three times a week for 20 minutes, right?
Giving yourself back that time, over the course of time, those three days that you gave yourself 20 to 25 minutes or even 30 or increasing in that time over years, is, that’s where you see the biggest impact. And I think, you know, we live in a society that may message, you have to do significant change, overnight, is not good messaging. It is not how humans function as far as something that’s motivating and getting to that goal. It’s not sustainable. And so I want us to have more grace with ourselves as we start to transition and giving ourselves time to do this. And then from a personal standpoint, you know, for me as an OB-GYN, like I see women all the time and, but my personal experience, a lot of that comes through the stories of the women that I see and incorporating my own story into that, is that it, one takes time.
We’re not gonna get it correct every day. But for me, I really find comfort in knowing that I am an active participant in what I choose to show up in, and I so am, know that the basics, when we go back to the basics of nutrition and movement, just as you said, we were never built to be sedentary. We were meant to move all throughout the day and finding pockets of time to move, fueling our bodies with what are the best things that it can function on. And then the last thing that I would say is, for me specifically, is hormone therapy is really an opportunity.
Because I want women to make a decision based on if they feel it’s for them, is an opportunity to give your body back something that it really used as fuel to function. And so however you decide to do that, however you choose to enter that journey, for all of those different aspects of movement and nutrition and hormones, I feel can really be a good base when we think of like a trifecta of what you get to navigate throughout the rest of the years of your life. Because it’s not about balance. It’s not about everything has to be perfect, but it’s at least incorporating a sense of, with these three things I know that I can focus on them and they may not be the greatest all the time, but I know that that’s my fundamental core, I think our, is an easy way to conceptualize it while giving ourselves grace.
Katie: I love that and I think that’s a perfect place to put a pin in this conversation. But you guys stay tuned, Dr. Jessica will be back to actually go deeper on what you just touched on, which is the hormones and menopause side. And I get so many questions about this and understandably, it seems like there’s a lot of confusion and so many different opinions on this, so I am so excited to get to really dive deep into that with you. But for this conversation, thank you so much for your time. This was such a joy.
And thank you for listening and I hope you will join me again on the next episode of the Wellness Mama Podcast.
