WHOOP Podcast - Dealing with the Physical and Mental Toll of Injuries and Recovery with Dr. Kate Ackerman

Episode Date: March 22, 2023

On this week’s podcast, WHOOP VP of Performance Science, Principal Scientist, Kristen Holmes is joined by sports medicine expert Dr. Kate Ackerman. Dr. Ackerman is the Founder and Director of the Wu Tsai Female Athlete Program Boston Children’s Hospital and Biennial International Female Athlete Conference and Associate Professor of Medicine at Harvard Medical School. The sports medicine expert focuses her research on female athlete health and is currently the chair of the US Rowing medical committee and a member of the World Rowing medical commission. Dr. Ackerman and Kristen will discuss Kate’s time as a student-athlete at Cornell (3:50), the Female Athlete resilience study at Boston College (11:00), questions to ask to learn more about someone’s health (13:47), people being more open to discussing their mental health (16:37), the factors behind injuries and setbacks (18:50), the importance of young athletes being active and a part of a team (24:00), behaviors that can lead to energy deficiencies (27:23), the Wu Tsai Female Athlete Program (32:30), recovering from an injury and the path back to peak performance (42:00), the process of seeking help (45:40), mantras that inspire Kate (47:35), and the lifestyle tips and things outside of training that set athletes up for success (50:50).Resources:Female Athlete ProgramThe Female Athlete ConferenceDr. Ackerman on TwitterSupport the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

What's up, folks? Welcome back to the WOOP podcast. We're on a mission to unlock human performance. I'm your host, Will Ahmed, founder and CEO of Woop. All right, we got a good one. This week's episode, WOOPVP of Performance Science, principal scientist, Kristen Holmes, is joined by Dr. Kate Ackerman.

Dr. Ackerman is the founder and director of the WU-Sai Female Athlete Program, Boston Children's Hospital. and Biannial International Female Athlete Conference and Associate Professor of Medicine at Harvard Medical School. The sports medicine expert focuses her research on female athlete health and is currently the chair of the U.S. Rowing Medical Committee and a member of the World Rowing Medical Commission. She's authored or co-authored over 100 articles

and book chapters related to sports medicine, endocrinology, rowing, bone health, and female athletes, including position statements with the International Olympic Committee. Kristen and Dr. Ackerman discuss Kate's experience as a student athlete, she actually walked on as a rower at Cornell, eventually winning a national championship, understanding athletes and their stresses,

talking about mental health and how it's okay, the Wu-Sai female athlete program, recovering from a major injury or septu, back, having to find other passions to take your mind away from the sport when you are injured, behaviors that can lead to Reds, that's relative energy deficiency. This is very interesting. They can lead to injuries, so it's important to know how to prevent them. And lifestyle tips and things outside of training that help set an athlete up for success.

If you're new to WOOP, you can use the code Will, that's WILL when you're checking out, get a $60 credit on WOOP accessories, you can use that credit for new bands, battery packs, body apparel, and more. Head to join.wop.com to get started. If you have a question you want to see answered on the podcast, email us podcast at whoop.com or call us 508-443-4952, and it might just be answered in a future episode. Without further ado, here are Kristen Holmes and Dr. Kate Ackerman. Dr. Kate Ackerman is the founder and director of the Wu-Sai Female Athlete Program, Boston Children's Hospital,

and biennial International Female Athlete Conference and Associate Professor of Medicine at Harvard Medical School. Kate earned her BA from Cornell University, her MD from the John Hopkins School of Medicine, her MPH from the Harvard School of Public Health, and completed her residency in internal medicine at the hospital of the University of Penn. Pennsylvania. She completed her sports medicine fellowship at Boston Children's Hospital and endocrinology fellowship at Brigham and Women's Hospital. Most recently, Kate has become a member of the National Leadership Council for the Wu-Sai Human Performance Alliance, a $220 million initiative to improve health and performance globally. Dr. Ackerman is leading the alliance as

focused on scientific advancements for women. It will definitely get into all the work that Wu-Sai is spinning up. Kate, welcome to the Wu podcast. Thank you. I'm happy to be, Houston. When I read your resume, I'm just like, how is this even humanly possible? I'm just old. I know. That is not true. You have accomplished an insane amount in a very, very short time. I'd love to start at Cornell. So you were a student athlete. You walked on to the crew team. Tell us a little bit about that trajectory and how that led you into sports medicine yeah it's kind of funny when people first meet me they don't realize the backstory which is that i was an outdoorsy kid but i was not the jock i was a musical theater geek um i like skiing

and doing fun things but i was not the varsity athlete that everybody thinks i must have been um so i got to cornell and i tried out for a couple acapella groups and it came down to four of us and they took two both times and i thought what the heck like i thought i was going to be that girl in college. So I guess I'm not. I guess I can't sing as well as I thought. And so I lived in a dorm with these really fun guys that all happened to be on the crew team. And so they were all rowers and rode in high school. And they said, you should come down to the boat house. And I said, why? And they said, because you'll be good at it. And I said, because they're no cuts. It's just survival. You're going to make it. If you can handle it. So the first year, I was not good.

And I just kept doing it. And I wasn't even sure if I should stay involved in it. And I didn't for part of sophomore year and then I just missed it. So I ended up saying, I don't even care if I'm the worst one on the team. I just want to get, those are my people. I really like the concept of pushing yourself and I love the team atmosphere and I fell in love with, you know, being on the water and all that good stuff. And then I just happened to get better and ended up in the varsity. And, you know, it literally just, I found the thing that got me excited. You know, there were things that I was good at and nobody looked at me and said, oh, no, she should be a rower. But I think my parents were excited to see oh yeah she's talented at music yeah she's pretty good at school but like

rowing she will just do all the time she's obsessed with getting better and like she loves it and so I feel like that was my struggle for so long was what do I love that like nobody needs to be watching me or like I don't have to be forced to practice like this is it so I think when you find that thing it's great it doesn't feel obviously it's hard but it's like a job you find the job that you love and it doesn't feel as much like work because you're just doing what you love and Kate you want a national championship and then you went on to compete for the U.S. at the world championships. Yeah. What was that? What was that like? I mean, they're just, again, going from walk on to like,

I'm not sure I'm going to play, but I love it. I miss it. Because I was a late bloomer, that was why I then wanted to see what I could do with it. So I entered, entered college as one thing and came out as another. Like I entered college thinking I'd be a lawyer or an actress, I don't know. And then I took a premed class for, or just took a science class for non-premed. premeds, like kind of just the required take a science class. And I got really interested in it. Wanted to know how the human body worked. And as I was getting better and more fit, I wanted to know how my human body worked. And then I got more into the exercise science part of it. So it seemed like

it was kind of blending. And I was becoming more and more of a feminist and wanted to know whether it wasn't more research in women. And so it was all kind of happening at the same time. I wanted to see how much faster I could get, what my rowing potential was. And I needed to take a little extra time to buff up my CV because I was a government major and became a government and bio major. But I remember going to see my advisor and my advisor said, oh, well, you started way too late. Yeah, you probably won't get into that good of a medical school. Like, maybe you could go home, like live at home with your family in Buffalo, which is nothing wrong with that. But I'm way too motivated. And when someone says, I can't do something, then I'm like, oh, yeah. So I just thought,

well, this is perfect then. I have a little extra time. There's no rush. I think nowadays could are smarter about that. They know there's no rash. Well, more of them do. Back then, it felt scandalous to take time off and pause in like the kind of environment that I was in. People were going straight to med school, straight to law school, straight to getting engaged. And I was like, ah, none of this is what I want to do. I need to take a pause. I want to row. I want to do really well on the MCAT. I need to study for that. I'm going to move to Boston Row. So yeah, I had a couple years there where then I was training and buffing up my CV. And so I tried for the national team a couple times. You know, I was going to all the selection camps and was just missing

the team. And so then I started med school at Johns Hopkins. And that was when it kind of all fell together. I had this great training group down in D.C. at Potomcoq Club. And then my doubles partner and I ended up making the national team that first year, which I don't recommend. Like, it's hard to go to med school and make the national team. But I was so, those were my people. Rowing was my people. And I was so excited to be in that community. I love it. That's such an unbelievable story. I, you know, just kind of going back to your student athlete days, I'm just curious, you know, we have a lot of student athletes on our, on our platform who are, you know, who are, you know, using who, you know, full athletic departments and, and lots of just individual student athletes, you know, really trying to manage your sleep and recovery. When you think back, knowing what you know now about sleep and recovery and the importance of sleep and athletic performance and the relationships there, you know, how did, how did you think about your sleep and recovery when you were a student athlete? Like I said, I'm old. So I'm 50 years old. We were not sleeping enough. There were just catch phrases, you know, oh, eat bagels because you need a lot of carbs. So, you know, we all gain the freshman 15 from over carb loading. And the sleep, everyone said, oh, it's the night before, the night before the night before. That's when you need to worry about it. So we didn't follow these things. We weren't considering it as part of our training regimen. And I know, obviously now, and as I got to be a better athlete at a more elite level, how important those things were. But in college, it was the 90s. We were went off the things wrong.

We, I would say when I started, from when I started to when I graduated, we learned about heart rate monitors. Like, that was new. Right. So we're so much further than that. Yeah. And I think one thing that whoop has done is just made people more aware of their own patterns and to see what works for them and what doesn't.

When they see these, these variability patterns changing, it makes them think about the choices they've made, which is very helpful for an athlete. Yeah. And Kate, we, you and I met. I guess Kim O'Brien reached out to WOOP, one of your many partners in crime, I imagine. Kim is at Harvard, and she's a researcher and a professor there in the field of psychology. That's correct, right? So she's a social worker who did a PhD and does research.

So she's a therapist. Okay, so clinical, okay, she's working in clinical practice. Okay. So Kim reached out to basically see if we, if Woop was interested in being involved in this female athlete resilience study, which I believe you and she kind of spun up and had this vision for and obviously just given our, I think at the time, we were, we hadn't really made a declaration as a company that we were going to be focusing on female physiology things, but obviously just knowing how little research there is out there and we were starting to get more females on our

platform. I was like, gosh, you know, this seems just an incredible fit to just at least start to get some of this type of research in our pipeline. Anyway, we fast forward, I guess, a couple of years. We got through IRB and the study has launched with the Boston College student athletes. Maybe talk a little bit about the female athletes athlete resilient study and kind of, you know, as a launching point for just some of this other work that you're doing with Wussai that we'll get into. Yeah, so much of what we know about sports science we know is based on men. We use this quote a lot of basically in the last few years, only.

six percent of research studies in sports science were focused solely on women. So we really wanted to blow that up. We wanted to change that and focus on how are women different? How can we be using our physiology to our advantage? And what are the different influences on that? So everyone talks about the menstrual cycle. That is definitely important. But there's also how people respond to stress. And so this resiliency study is incorporating qualitative interviews, there are surveys involved and then there's using the whoop and to see how that correlates, right? I think so much of what we're trying to do in sports science is figure out easier surrogates to get to the answer. For example, with a menstrual cycle, testing your blood every single day

for a year is very labor intensive. It's very expensive. Athletes study participants don't want to do that. Right. So are there surrogates? Is urine easier than saliva versus blood? Who knows? You know, we know that can whoop maybe anticipate some of these patterns. These are the kind of things we want to figure out so that then we can see these patterns and help people predict their own outcomes. Like, do I feel better at this stage? Do I perform better during this part of the semester when I do these things? So that, like you said, people are taking sleep into consideration.

They're taking their diet into consideration. They're taking how they're managing their stress around exams or training over into considerations. And using surveys, using blood and urine and salivary markers, and using whoop and other things, that's how we're going to get there, is figuring out, how do you do all that, distill it, and see what's a surrogate, and then can we use those surrogates to kind of glean some patterns? I love that we have, you know, kind of these invalidated qualitative measures kind of running alongside the physiological data. I think it's just so important, right, to be able to really contextualize that physiological data and then be able to say something more insightful

about the data. And that's why I kind of love the marrying of the psychology and the physiology because we're able to then tell a fuller story. And I think this study really attacks that head on, I think, with the quality of the surveys. And hopefully we get a lot of participation from the women and get a lot of good information. But maybe just talk a little bit about the type of questions we're asking to really unpack someone's mental state and to unpack their energy levels, impact some of their, you know, unpack some of their habits that might tell us, help us tell a fuller story around female resiliency. So they're different questionnaires. We have a few different questions or different studies going on, but some of them are about their sleep

patterns. Some of them are about their mood state and depression scales. Some of them are about their patterns of workload at school to understand what is the stress? Is it physical stress? Is it emotional stress? And do those have the same impact on them? Does that have the same impact on their whoop data? Right. Because we used to just look at the athlete as you do this physically. Let's follow your workouts and let's see what happens in terms of your games. And now we know an athlete is a complete picture. And I'd say one example that was really helpful for me. me to think about was during the Black Lives Matter movement, there are basketball teams of women who are African American who were very impacted by what was going on in the community.

Now, they might be performing really well and kind of faking their being put together, but they were feeling horrible by what was going on in the world. And so talking to athletes about what actually is impacting them and what kind of stresses are coming in, we soon realized, wow, this is affecting their day-to-day life. This is affecting their physiologic changes on their wearables. This is affecting their performance on the court. We need to be addressing the whole athlete. And so that's just one example. You know, I think when things are politically challenging in a lot of different parts of the country, we're seeing different influences on our athletes. It really depends what lens they're coming from, what state they live in, what's

going on in the political climate. So we're putting that into our whole picture when we're looking at our athletes. I love it. You know, I think that there's just such an opportunity to, you know, I think both, I think for you, I mean, you're dealing with a lot of injury athletes. You know, that's in your practice. You see athletes who, they come to you and they're broken, right? And I think this kind of study is to understand, you know, what are the conditions and what are the potential physiological markers that are potential precursors to an injury? You know, what what actually is going to help make us resilient? And when things do go south, you know, where, where is that breaking point?

And I think hopefully these are all things that we'll be able to isolate in this study, just the way that it's a beautifully designed study. And I'm hoping, you know, we're going to be able to isolate some of these effects to be able to answer these questions that you pose around, you know, what, what is that that moment where we really start to go, we start to go south? And are there things that we can do to kind of get people? back on track and before they get injured, you know, mentally, physically, emotionally, right? So I think that's the real opportunity here and what I get really excited about.

Well, I think it's nice that people aren't afraid as much to talk about these things. You know, the US has been doing a really good job with their mental health support of our Olympic and Paralympic athletes. When I was training, we didn't talk about this. You know, we just suck it up. Yeah. You had to, John, don't be weak. And the fact is everybody goes through phases of their life where things are really stressful,

whether it's family issues, it's dating issues, it's injury. These are normal stresses. But if you try to push them under the rug and you don't address them head on and address that these feelings are normal and give people the support they need, those athletes aren't going to perform well. And sometimes it can have really, really negative consequences. We know that the elite athletes have a really hard time, for example, retiring because they've lost They lost their athletic identity.

You know that after a really hard time when they get injured, if being an athlete, you're most likely going to get injured at some point. And so learning how to train around that and cope with that, these are real issues. And so we have to be looking at that entire athlete. When I have a female athlete come into my clinic and they've had a stress fracture, A, what led to the stress fracture, B, how are they coping with that stress fracture? C, how are we getting them back into play safely? So much of that is mental.

is what can you do, don't push yourself too much, but here's what you can do. This is what you do have control over. Giving people the tools and helping them cope with that is a huge component of sports medicine now and sports science. And I'm really glad that we're talking about it in normalizing that. I love it. When you have, when you have folks come into your clinic and they've been injured, is there anything? And I know this is in part where we're trying to get more research around so we could really validate. But I'm assuming you have some some understanding or some, I guess, an hypothesis around what, is it, you know, a loss of period that leads to a stress fracture, ACL, or is it, and I know some of it could just be, you know,

unlucky or whatever, just overtraining, or is it overtraining? Is it a combination of the two? Is it, you know, just low estrogen? Do you have a sense of what might be happening? I think this is why I will always have something to study. and of job security. Because all these things are multifactorial. There are some things that weigh more than others. So we'll use the example of a bone stress injury. If I have a female athlete who is delayed in getting her period

or she gets her period and then loses it because she's not eating enough or she's really, really stressed, a lot of people forget that stress alone can cause menstrual irregularity and can cause hormonal disruption. But let's say it's because they're not eating enough. They're relative to energy deficiency in sport or reds. that is a huge risk factor for a stress fracture. So you might have, and I see these athletes every day I'm in clinic, a teenage athlete who's training really hard,

she's super motivated, she thinks she's doing all the right things, she's deciding to do more training than her coaches are saying. She's realizing initially that if she eats less and gets thinner, that she's faster. And so initially she sees this great gain and she's the top grill on her team, then all of a sudden the wheels come off because that's not sustainable.

So then she gets an injury. she might see plateauing up her training before she gets the injury or not. But inevitably, somebody who is aminaureic and has all these hormonal shutdowns because they're not eating enough is at a much high risk for stress fracture and they will eventually get injured. And then that is devastating because they feel like they've done everything right. How could they be in this situation? Then they get into my clinic and I'm teaching them that they should have been getting their period this whole time. We check their bone density. It's low.

And then they're really depressed. I'm the bad guy. So that's why I really try to emphasize with our patients. We have the same goal. I want you to be as fast and get to your potential and, you know, get the scholarship and have a long-term career as long as you want it. But you're going to do better. If we can fix this hormonal disruption, you're going to perform better. This starving yourself and being fast initially is not sustainable and you will fall off the cliff.

And inevitably, it always happens. But I want to keep that from happening. And I think that's where we have to educate the coaches at a really, um, at a really young level. So the high school coaches, the middle school coaches, the elementary school coaches need to be talking about this. The parents need to know. So parents who might have trained at the same age that I did, they didn't go to medical school. They didn't get this information. And so they're saying, well, this is what worked for me, so you should do it too. I know. That's where there's this disconnect. We as scientists are talking about this till we're

blue in the face. We physicians who are in sports medicine. We know this. But these kids need to know it and we don't need we don't want to shame them we want them to just understand this is how we can do it better we're here to help you we're here to give you resources and that's why we do the conference i was basically going around to high schools and to different teams and saying the same thing over and over again and i thought this is not a good use of my time and it's not in the story out enough so that's why we do this international conference we have experts from all over the world it's now a virtual option it's in person because i wanted more research and so i wanted to be able to with all these amazing international people.

And I wanted this accessible to coaches and athletes and parents to get that info. For one issue is, yeah, the stress fractured from the relative energy deficiency. It can be fatigued when you talk about things like ACL. It could be maybe it's the phase of the menstrual cycle or maybe it's that they went through puberty and they didn't get the right kind of strength training because we know that men put on a lot of strength when they got this huge burst of testosterone, women have to train much harder and focus in on certain muscles. We're more quad dominant and hamstring dominant. So we've got to work extra hard to strengthen the hamstring. So some of it is

biomechanical and it's working on that strength training. But it's a combination of things. Yeah. A beautiful summary. And there's a lot in there. I think, well, first of all, just kind of thinking about this, the education piece. You know, thank you for all the effort and work that you're doing to educate families and coaches as a coach and a parent. I, I, I, I, I know that there are just massive gaps in understanding around fueling requirements. And people are at load management, you know, just high school kids have insane schedules, really. You know, college is much more easy, you know, been a student athlete, dual sports student athlete. Like, I really understand.

You know, I can say that I feel like college was actually easier in a lot of ways than high school in terms of just having some sort of control over my schedule. Even with all those demands layered on top, I mean, high school is hard. And I think coaches just don't understand how to how to manage load. And they certainly don't understand how to how to think about a female athlete versus a male athlete. So I think there is just a lot of work to be done. And when I think about, you know, not to get into a policy to conversation, but I think at a government level, you know, what kind of resources are we actually giving to our high school coaches, our middle school coaches, our elementary coaches, is, you know, how are we spending any sort of resources infusing education around, even if I don't have the means to, you know, to go to Whole Foods, what can I get at Aldi, you know, and having shopped at Aldi, you know, in places where it's, you know, it's cheaper.

But, you know, I just wonder, I just feel like there is just a lack of resources put into this area. And I just don't know that there's really anything more important than educating our parents and our youth. around these habits that are going to lead to, you know, to human flourishing, right? And so absolutely. I think, you know, when I talk about the female athlete, you know, some people think that I'm focusing on this elite group of people. Yeah. And I think of it as female physical activity. You know, not everybody needs to be a varsity athlete. Not everybody needs to be a collegiate varsity athlete or a national team athlete. In high school and middle school, we want these people to be physically active. We want people to be part of a team. You learn so much from being part of a team.

You don't need to be the fastest one. Right. Then we're talking about all these different communities that should have physical activity as part of their school day. Then yes, we need to be talking about communities that have food insecurity. Yeah. We're talking about reds. It's not always the rich, white privileged girls that aren't eating enough. Right. There are all sorts of communities of people that might not have access to food and good choices. Sleep inequities. Yeah. The equities are huge and the different resources at the different schools are huge. So it might be having an athletic trainer or not. It might be having school nurse who knows something about exercise and fueling and be able to spot issues that are happening in the community at that

school. I think, you know, this is where you start talking about the differences between some public schools and some private schools and how the resources might just not be there. So then you have to get creative. And the best way I can think about it is a lot of people ask, how did you start the female therapy program? They assume I'd work in a beautiful building. And we have this huge group of like tons of resources. Even now we don't have a huge beautiful building. We're still trying to build that. We're still trying to raise funds for that. When we started our conference, we did the conference at a local school. I was the doctor for their summer programs. We did a trade. They gave us the campus for free. And I had the out of town speakers

crash at my house. Like it was that scrappy. And then with our clinic, I was the only one doing this sports endocrine piece because I was seeing women who were seeing me for a stress fracture, seeing somebody in GI because they had abdominal pain and constipation. They had a different doctor in adolescent medicine for their eating disorder. They were seeing somebody else for their depression. I thought, that's crazy. This is all tied together. Why is nobody bringing this together? And so we didn't have within our program at that time, psychologists and dietitians like we do now. Sleep experts. I had to get community that I could work with. And so we sort of built.

built it organically, where people I could trust that I knew could also get it and we could be resources to these athletes. Yeah. You mentioned Reds, so just thinking about from an energy deficiency standpoint, is there, you know, what are, there's things that I hear on social media and just in mainstream media that's just great on my soul. Are there, are there any behaviors where folks are well-intentioned? They think they're doing the right thing, but it actually leads to edited.

deficiency and, you know, a host of other vilitarious effects that should kind of offshoot from that. Are there any kind of specific behaviors they can point to that that you see are just like, you know, reoccurring. They're thematic. Yeah, there are a bunch. I would say one thing is relative energy deficiency can happen inadvertently. So there are studies that have demonstrated when people increase their training load, they're accidentally not increasing their fueling. Right. And part of that is based on appetite regulating hormones.

So they are not as hungry. And so we know that exercise can be an appetite suppressant. Well, that's too bad because they actually need to be eating more. I know. So there's a great study looking at, in the study, there were some open weight, heavyweight male rowers. And they need, they increase their training by 20%, but they didn't increase their diet. They'd full access to food. It was at the Australian Institute of Sport.

They had the kitchen there. They were able to get food, but they didn't know they needed even that. much more. I'm married to a former heavyweight rower. He would eat 10,000, 12,000 calories a day. Most people can't fathom eating that much food. So I didn't have to eat more than that. And then if you're training three times a day, you might not want to eat over taking a nap. So I think with some of our elite athletes, it can be inadvertent even with the guys who don't think about food. They think that you're eating nonstop. So some of it's not increasing the eating with the training. So you have to eat past fullness when you're training that much.

The other thing is when people follow very specific diets, they're trying to be so healthy. We talk about that as being orthorexic, sort of a non-scientific term, where people are so specific about what they're eating. They're actually missing some micronutrients. They might not be getting enough calories in because they are so rigid. It's masked as clean eating. Oh, yeah. That's always a red flag for me. Yeah.

And not to turn this into a paleo debate, but we've seen in some of the endurance research when carbs have, They're really been cut down, act and have an effect both on performance, on bone turnover markers. So I'm not who-pooing any diet, but I really think it's important that people work with sports dietitians when they do follow something really strict so they can make sure that they are compensating in some way. It's like when someone first becomes a vegetarian and they don't really know how to then make a complete protein. And so they're just living on one type of food because it's easy for them. Right. So people who are too rigid in their food, that to me is a really big red flag. Yeah.

And I think what's tough is we, I think to your earlier point, we oftentimes when we change our diet drastically or do something drastic, we actually see these performance improvements and we tie it to that specific change where it could be short term, but a lot of times these more restrictive type of rigid type of diets long term are going to lead to deficiencies, both in energy but and then just micronutrients and potentially macronutrients. all the things that we need to kind of fuel our body for, you know, these massive energy requirements that you describe. Yeah, it's sort of when we'll make that January 1st resolution to eat, exercise more. Whenever you make big abrupt change towards being more disciplined and having more of a regimen, yeah, you're going to see some improvement. So any of these big shifts, you'll see an improvement, but they're not sustainable unless you're really doing something that has thought through it and it's modified a little bit.

If it goes two streams, it's going to fall off the cliff. Yeah, my goal is to try to help people think about how to never have to do a January reboot again. Right. You know, I started, I took on that mentality. Tim Ferriss, actually, this is like a decade and a half ago. I think when he first came out of this podcast. And I forget he was talking. Maybe James Clear, the atomic habits and just the guy that I think has really socialized,

just all these kind of micro behaviors and how they have a compounding effect and all these, yeah, He's been really wonderful, but I just remember that explicitly, I was like, that, that's it. Like, you never want to have to do a reboot when you have to, that, because if you, if you have to reboot, then you're just, you're off the rails, right? Like, and I, and I think it's just, it's a, it's a mindset of consistency. And, um, you know, not this kind of one time moment. And, and I think, I think when people, um, when they get injured, they get ill, you know, it's, it's kind of that awakening. But I think we can, you know, let's, it's my hope is that, you know, these kind of, this kind of this kind of, this kind of. of information. And it's like, all right, you know, I just, I just many behaviors every single day that I know are going to, you know, help me help promote sleep, are going to help promote recovery, are going to help increase my exercise capacity. You know, if I could do these little micro things every day, then, you know, these big resets are, are unnecessary. Okay, so let's talk Musai. This is just, in my view, just one of the cool things, coolest things to come down

the pike in a really, really long time. Talk a little bit about your role. the vision. We obviously have, I mean, by the time the end of this year finishes, I mean, I think we're going to probably have six research studies in the pipeline, of course, with your leadership. So the all around various aspects of female physiology, you know, from menopause to, you know, to kind of high school athletes. We're just going to hit, we're going to hit it all. So just talk a little bit about Wussai and how it came to be and what your plans are. Yeah, I'd say my, my stepping into that world felt like such an accident and such a blessing. It totally did not expect this to happen.

So it was, I think March of 2020, the whole world is shutting down. And I get an email from Clara Wu's scientific advisor. I get 300 to 400 emails a day. So I was just like, holy shit. You know, I didn't know who this was. It's kind of didn't register. I was super busy doing telehealth. My patients were all exercising more, eating less.

Like that was what they can control. So they're running like crazy and they're getting stressed. So I was busy. Everybody else was all making bread and, you know, sourdough from scratch. Yeah, exactly. And I was like, some of us were our female out. I get this email. I don't really pay attention to it.

And then thank goodness, her advisor emailed me again and said, I really think we should talk. Thank goodness I did and smartened up. And so basically there had already been some meetings with so Clara Wu and Joseph of SAI are very generous philanthropists who are interested in a lot of different things, social justice, they're interested in sports, they're interested in health, neuroscience, and they got this idea of studying human performance and human health from the healthy standpoint. Instead of, I mean, they've given money to cancer and all sorts of good things, but they decided to take a different take on it. What if you study human performance and then those effects, those things that you're

finding out in really elite athletes or healthy people? you can trickle down that information to make some changes in the world in general in terms of health and behavior. So it turns out that I was selected. We had a few Zoom meetings. It was over a year before I met everybody in person. So we did so much work on Zoom. So they had picked five different institutions. It's now six main institutions to kind of think up what we wanted to study.

And so they're all different leaders. It's these Boston Children's is one. So I was picked for the female athlete component. in. There's Stanford, there's University of Oregon, Salk, UCSD, and Kansas. So for all different reasons, and everybody brings something different to the plate, which is cool. And I've always been a fan of interdisciplinary research. Like, I don't want to just hang out with endocrinologists. Yeah, yeah. We're doctors. Yeah. I love new things like the American College of Sports Medicine because it is all different types of people. So it was, it was kind of eye-opening.

We had a month to put a proposal together. There were certain moonshots that were already sort of predestined from conversations before I got there. And so one is the digital athlete. And so that's doing things open sim and seeing how people move and making that accessible. Then all over the world, you can do these models with different people. Another one is the molecular athlete. So studying omics and getting culture and blood samples and all these different things to understand more about the cellular networks and cellular signaling. And then another one is the regenerative athletes so we know that tissues break down there's cartilage breakdown osteoporosis osteoarthritis all these kind of diseases so Oregon is a big hub for that component of it yeah and then for me so those are the

three main moon shots another one was developed that was sort of bringing it all together the multi-scale athlete and then I was the one in the room saying he don't forget to study women you see he's studying not only men and male raps but women and female rats yeah let's yeah how hard is it to get a female rat. How we've been excluded from mouse studies is like beyond my comprehension. I mean, good God. So there was a great article recently, I think he came out last week

talking about how even male rats aren't so great. Like maybe we've been avoiding the female rodents long because even like it was male mice, they have their own issues. So people have peers thought, well, we don't want to confuse the study by studying, like getting confused by that menstrual cycle, that

astro cycle, and all these different animal models. And they're like, ah, male rodents have their own issues and they actually do have fluctuations in hormones so whatever yeah basically because it's been great we digress run forward about all of that they're like you're right we need to make sure that we're studying women in all these different aspects amazing and also i'm the only doctor in the group so i'm also the one who's always saying hey make sure it applies to human you need both you absolutely can move fast with the basic science and it's easier to do the cell stuff not easy but it's faster right and so it's been nice to try to try to

marry these different worlds. For example, we did a study looking at women with stress fractures and then they were bone stress injuries, so they were grade two, three or four out of four on the MRI of the tibia. We did this study and we looked at their bone microarchitecture and we found that bone microarchitecture drops and is at its worst about 12 weeks after the stress injury. Well, that's when women are running and back to their training if they had a tibial stress injury. And it would take them another 12 weeks to get back to their baseline. So it's six months after bone stress injury that they have this change in bone microarchitecture. It happened in the injured leg and the uninjured leg. So then we some of their blood samples, a third of that population

got another stress injury, which now makes sense to me. But two groups didn't. So then we sent some samples over to Oregon for them to do some omics on them to see are there different patterns that we see between the ones who fracture and don't. That, to me, is the future of how we do sports science. I love it. We see a clinical dilemma. We see this pattern. We study it in one way.

But then we're chiming in and getting these other experts to study it in a different way. So we can come up with different training approaches, different. You know, how should we be managing these stress and roof right after they happen? Should someone be in a boot part of the time and loading more? And that to me is exciting because you can tie in the digital athlete, understand how much pressure and load that bonus getting. You can do the omics. You can do the clinical components and training the person. So the Wu-Sai Human Performance Alliance is really this 10-year initiative, studying all these topics and just trying to move this huge needle on a bunch of fronts. How do we

minimize injury? How do we improve performance? And realizing that it's about a lot of different things. It's mental health. It's doing the qualitative research. It's doing the bench research. It's doing the clinical research and bringing in other people. So we're collaborating with the USOPC. We're collaborating with the Australian Institute of Sport and all sorts of different organizations. And we're collaborating with industry so that we can help improve products that can go out there and answer more questions to the people that are buying them. So it has a ton of potential and it's been really exciting to be involved in. And it's just to hear you talk about it.

I'm involved and so, but just, yeah, it's, it's, I think the projects that are getting spun up and I think to your point, like the level of expertise that's coming through to kind of help solve these very specific problems related to your performance is just second and none. Just omics, just explain that a little bit so folks know the biological underpinning of that, of that, yeah, it's kind of calling out the person to explain omics. So basically you can take measuring biological molecules, right? Just do, yeah. So there's. So there's so many different proteins and things that are expressed. And so there are whole ways to take somebody's a tiny, tiny blood sample and then to break it down and look at protein expression

that might be different in one person versus another. I feel like my colleagues would be cringing at how I'm explaining right now. I'm not an OBIC expert. But the point is different things are expressed differently in people. And, you know, what are the reasons that are expressed differently? Then is there something that we can do to change that expression if we see a pattern, that correlates with a negative outcome? Or are there things that are inherently different in people? So, you know, we talk about proteomics, so that's the study of those protein patterns. Right.

So right now when we see a pattern, you see what the signal is that might be a little bit different in one group than another, then you get more samples and see if, okay, is that a trend? Then you narrow it down to just a few, and then you want to see what modulates them. That's my general understanding, but, you know, if there's an omics expert, I'm apologizing right now on this podcast. Yeah, I mean, I'm sure we'll hear about it. No, just kidding. So people are very kind.

You know, you have to realize, and I'm very good about this, stay in your lane. No, I know, believe me. Yeah. And an endocrinologist, I'll talk to you about hormone assays. I'll talk to you about the menstrual cycle. But that's why I love working with people that aren't afraid to call me out and be like, Kate, you're getting that raw. Let's do it this way, you know?

Right. So I love working in groups of experts because I just learn. learned so much from my colleagues. I know, same as it's the optimal, I think, way to to work for sure, because it's hard to be expert in all things, of course. So, although you are expert in many things, to be clear. All right, let's talk a little bit about recovery. All right. So we talked about kind of the lead up to an injury and kind of what's happening during the injury. We've diagnosed the injury. What does that path to recovery look like? And how much do you talk about sleep, how much do you talk about nutrition, you know, what, what does that conversation

where the patient look like? You know, what, how do you get them back on track as quickly as possible? What would be your primary interventions that you'd really, you know, want them to adopt in order to help give them the best chance of recovering? So it depends on the patient, it depends on the injury, it depends on the level of the athlete. So, yeah, you know, really basically, I think a lot of people that might have whoop and follow certain diet and are training 30 hours a week are very obsessive. And so one of the first things, not to say whoop is bad, it's not. I'm just saying, you know, people go into the gadgets and they're thinking about this

time. So when they have a setback, it really can throw them. Yeah. And what I try to remind people is this lifestyle, like you say, we want to be just doing consistently good behaviors. But when someone has those patterns that they're used to get derailed for an injury, very often I see people really freak out. Like they cannot imagine what they're going to do.

now they're not doing their 30 hours of this type of training. So some of the basic things are, okay, you can still train. There's always something that you can do. There's some sort of physical activity that you can do. So let's say you have a concussion. You can go for a walk. If you have a broken leg, you can do upper body stuff. If you, you know, so there's always something. So you don't have to give it up completely. But I also think it's important that people have other outlaps besides physical activity for their mental health. Right. Many of my athletes don't. So I tell them to try things like learning an instrument, learning a language, learning how to cook, you know, helpful laundry, whatever it is. Like there are other things. Like this

can't be everything to you because there are going to be setbacks. Secondly, yes, you need to eat well when you're recovering. And we saw a bit of a pattern with some of our female athletes where they would start restricting after they had major injury like an ACL tear or a really significant fracture like a femoral neck fracture because they were out for so long and so now they are they start to restrict because they think oh i don't deserve the food or need the food because i'm not training and burning as many calories but they need the food for recovery and they need to keep all of those those hormonal signals going or that's going to slow recovery so sleep and food are still really important when somebody's recovering from an injury and getting the mental health piece of you know

having mental support, if somebody is very, very closely identifying with that athlete identity and they're really thrown off by getting injured, then we need to make sure that they have that mental support to help get them through it. Because we do see people develop really bad habits that are sort of destructive because they're depressed, they're in pain that they're not doing what they love to do. They might be removed from their social group. They might be missing the major competition, the final game of senior year. We see that all the time. It's so devastating for people. So I have to remind them that it's a marathon, not a sprint, and these setbacks are really tough, but they can learn things during this process. Yeah. I mean, any,

you know, kind of big lifestyle shift, you know, and certainly an injury is one of those moments, you know, ending your, your collegiate or all of the career, these are, I think to your point, you know, around identity, these are really tough moments, you know, and I think that, because your identity really shifts and you can't kind of prove that identity to be true with your behaviors anymore. So it creates all sorts of dissonance. You know, talk a little bit about when would you recommend someone seek help? You know, so they're really strong. They have an injury. They have all these new kind of behaviors they can potentially adopt. You know, when would you recommend someone, you know, seek some professional help just to kind of reframe this new

life, even if it's temporary and can feel disruptive. Like, what would that process look like? Well, fortunately or unfortunately, I think during the pandemic, many people felt disrupted. Pretty much all of us. And the mental health specialists have been drowning pretty much since it started because so many people needed help. So I think if you can get access to help pretty much at any phase, it's great. And speed out because we needed different phases of our life.

Like, I have a therapist. Sometimes I'll see him more often than not. A year might go back, there might be a time I need to focus in. That's enough example of not having shame about it. It's just how to reframe, how to, I sometimes I get so busy because I have so many things pulling at me and I need him or my husband or a friend to remind me you do better work when you're less committed. When you get more sleep and you're exercising regularly, you will do better.

It's better than skipping that stuff to get this project done. Even I've been doing this for a long time, forget about these things. So it's always nice to have an option of a therapist or somebody that will help you shift your perspective on something. So I'd say whenever you feel like you're not yourself or you're going in a direction that you don't feel good about, having that therapist or having somebody that you can communicate with is important. Just there's no shame in it. Most of us who are firing all cylinders and getting a lot done need that support too. It's just, it's a good way to behave and to achieve what you want by having all the different things. It's your availability. I love that. Do you have like a sentence or, you know, kind of

a tagline almost that you find yourself repeating with, with patience or just, you know, as you're trying to get the word out there on all the education that you do, is there kind of this one thing that you kind of go back to every time like this, you know, kind of one thought or tagline that you feel as like gets people thinking. I think one of them is train smarter, not harder. So that's just using your time wisely and not being just burying yourself into the ground and digging yourself a hole because you're just trying so hard. I think when athletes are not succeeding how they want to because that'll happen for everybody, they hit our toes or something that used to work for them doesn't and then they just dig in their heels and so they do more of it I remind them is this

getting to getting you to where you want to go is this pattern working for you especially with our athletes that fall into eating disorders and over training I just remind them okay here's where you were before here's where you are now here's what you've been doing is that working and then they might say and yeah I guess not okay then let's ship it let's be smarter about this let's get the resources let's have you meet with the sports dietitians so many of my athletes say oh, I know everything about nutrition. They're not going to teach me anything. I still learn things from our sports dietitians.

They're trained in this. They're good at figuring out how somebody's training is affecting their performance and what they can do with their nutrition and where they might be lacking. We might be able to sync that up with a lab panel that I order. People can always keep learning about those things. Or like we just talked about, the mental health support. Maybe if you had somebody else kind of helping you reframe this, you will want to train a little bit differently.

You'll get more out of that workout. you'll put more rest into your schedule as female athletes get older for example we need to train differently now than we did when we were in our early 20s right more rest we need more strength training these are things that are shifts for us so I find that people get into these patterns like I'm a rower I have masters rowers friends rowing friends who do the same workout they've been doing the same stuff they like to get on the water and row six days a week and do similar workouts no we can't keep doing that We have to shift. We have to cross train.

We have to take care of our little injuries. We have to strength train. So it's about keeping an open mind and just constantly tweaking and seeing where we can make these improvements and not just trying to overdo it with volume. I love it. Yeah. More is not better. More is just more.

Yes. Yeah. That's the one that I always came back to once I started to actually understand this concept of load management. I'm like, oh, you know, more is not actually better. And it's just indeed more. Yeah, so there, and there's, yes, and there's a science to all of this, which is exciting. We don't have to do a lot of the guesswork, you know, and I think that's where, I think, you know,

whoop is really making a difference in, and the lives of athletes and just the lives of humans in general, you know, just this concept of, of really understanding your capacity and understanding, I think, the behaviors that go into that capacity or, you know, that ability to kind of recover from stress and um you know and how you're adapting you know to life's load um yeah and maybe we can kind of end there from your perspective like what are just a few lifestyle things that i know we've talked a lot you know in the podcast about various uh you know kind of behaviors and protocols and things that people can grasp on to but maybe just to kind of sum it up you know what are the three lifestyle things outside of training that help set an athlete up for um maybe

maintaining availability, i.e. not getting sick and injured. So I think with my friends who have been wearing whoop for a long time, they've talked about their individual lifestyle changes. Like here's an example. I don't know this should be on the podcast, but one of my friends said, oh, I feel horrible after I drink red wine. Wooop tells me. But I can handle tequila. I thought, okay. Well, there's, there's something. We hear that a lot. And there are actually some reason, some very, very clear scientific reasons behind, yeah, why not, why not it is but yes go ahead keep going i love that so there's somebody who was able to just shift their thinking when they're going out socially with friends they don't want to feel

horrible in the morning when they do their workout and so they shifted their beverage of choice simple things that we're seeing how you respond to things it doesn't mean that's the same for everybody but it's just like tracking your menstrual cycle not everybody's going to feel amazing when they have their period some people have really heavy bleeding and they have cramping other people think oh great My estrogen and progesterone levels are the lowest, and I have, and I feel amazing. I have great energy. So I think all of these things about tracking your own patterns and seeing how you respond to things, that's the way to go.

It's just keeping more of a, not an obsessive log, but just noticing what works for you and then being more consistent about it. That's one thing. Absolutely, we know sleep is important. We used to not pay attention to that, but that is just as important as food. And so we need to be paying attention to that. And then the overload, we need to make sure that. You have to take a whole lifestyle into consideration.

If you are traveling for work or you have exams and you're staying up late to study for them, you're going to have to back off on your training because you didn't get as much sleep. And this is where you're more prone to be injured. So just accept that there are going to be these little shifts in life, temporary shifts, where you then have to modify something else and it might be your training so that you don't get hurt. Those kind of changes, like you said, those microchanges are what's going to lead to major improvements over time and a decreased injury risk. Love it, Kate.

This was a sensational conversation. You're just brilliant on so many levels and just sincerely appreciate your time. Where can people follow your work? Well, we have our Femouthlyconference, so there's Femouthlyconference.com, and we keep that pretty updated. We need to link to that in the show notes, too,

so people can be aware of that. I cannot wait for it. I'm so excited. It's in June, right? Here in Boston. Yep. and the virtual one. And then I'm on Twitter.

I know I'm kind of old school. I should do more with Insta, but I'm on Twitter. So I try to keep things pretty up to date there. And then from there, I kind of link anything we're up to with some of our other websites. Perfect. Yeah. I feel like the medical doctors are all like just Twitter. Even though obviously Twitter is taken a shift, but that's another podcast.

That is indeed another podcast. We'll have to have Elon on to chat through that. No, it's not going to happen. All right, Kate, well, thank you so much. Have a beautiful day and excited to get this out into the world. Thanks. Thanks for having me. It's been fun. Thank you again to Dr. Kit Ackerman for sharing her insights on sports medicine and coming on the WOOP podcast. If you enjoyed this episode of the WOOP podcast, please leave us a rating or review.

Please subscribe to the WOOP podcast. You can check us out on social. at WOOP at Will Ahmed. Do you have a question you want to see answered on the podcast? Email us, podcast at Woop.com, or call us 508-443-49-2. New members can use the code Will, W-I-L, when they sign up for a new W-W-P membership. That's Woop.com. And that's a wrap.

Thank you all for listening. We'll catch you next week on the WOOP podcast. As always, stay healthy and stay in the green. Thank you.