Welcome to my Co host Blake Withers.

How you doing?

Going well, going well and our two lovely guests that we are going to introduce because we got straight into the podcast this episode.

We were very grateful to have two wonderful women from Femi come on and share their knowledge around training for women and building running programs that's tailored to the unique Physiology of women and the implications that we do have in this landscape that makes training for women a little bit more challenging in some ways.

So welcome to our guest Esther Cuen and Dr.

Claire Badenhurst.

So Esther is one of the Co founders of Femi.

She developed Femi with her Co founder Lydia O'Donnell.

I think it was about five years ago now.

And the idea of Femi is it's this community based running program that is tailored towards women's unique Physiology.

So it initially started with doing some individualized programming for women and it has now developed into an app which is on the App Store, is absolutely free to download.

And there are some free programs, but there is now also a membership option as well, which gives you more specific programs for events that you may have coming up.

So specific programs, for example, leading up to the Gold Coast Marathon, the Sydney Marathon, all very unique to those courses and very much in line with your Physiology as a woman.

So very much, yeah.

Looking forward to to talking about everything that that Femi has brought together and, and why.

And then Claire Badenhorst, she is a leading researcher in exercise science.

Her current research program focuses on female Physiology and how hormones affect Women's Health, well-being and performance.

So we got into some really interesting conversations with Claire around the menstrual cycle, around Iron, around considerations with your training for women that is different to training for males and then also how we can really integrate that into our clinical practice.

So I got a lot out of this episode.

I'm sure Blake got a lot out of this episode as well and things that we were able to really implement with some of our young female patients or female patients in general.

Yeah, definitely.

It was.

It was a great episode.

Yeah.

And even just the communication with certain clients and their families around how we can really optimize the, I guess the prognosis, I guess you would call it, of a woman's development with their sport.

I think it's really, really important for us to all be aware of our, you know, language, communication and and how we can keep running and sports sustainable for all athletes.

Yeah, I agree.

Yeah, it was a really good episode.

Enjoy.

Thank you so much to Claire and Esther for coming on, and hopefully you get a lot out of this.

Welcome back to the Sports Medicine Project.

I am excited for today's episode.

I've been thinking about all these questions over the last few weeks and just been writing down this endless list of things that I'm very keen to ask both of you.

So welcome so much to Claire and Esther to the podcast from Femi.

Thanks for having us.

So let's just get straight into it and have a chat about our weekly recap.

So just to sort of set the scene to preface what we're, we're going to be getting into for the rest of the conversation, my, my weekly recap and topic that I sort of wanted to, to reflect on with both of you and, and actually get some advice because it's something I've been thinking about for a while.

Is a bit of a, a complex, tricky case of a young runner.

And then mom would attend the sessions with them and often comment on their body type and the body type of other female runners during the session.

So they might say, oh, that person's been looking really like bulky.

They must be in the gym doing a lot of work and saying things during the session, like maybe we should do more push ups because she's starting to get big boobs and we need to try and change those like just really uncomfortable conversations like that.

And it would often really take me back.

And I didn't know what to say at all.

Like I hadn't absolutely no idea how to manage the situation.

Whether it's something that I should pull the mum outside and talk to her about later to try and, you know, help this vulnerable young girl for later on in life, or if it's something that I should have brought up at the time.

And I'm interested to hear your thoughts on how that could be best managed.

I'm.

Going to learn is to get into that one as a hunter and then I'll dive in after her.

She's got probably really great insights on how she'd probably approach that one.

Yeah, it's such a tough one because like, it's, it's really complex.

And the reasons that they think that that's so important is, you know, a societal issue and something that they've grown up with, no doubt, and thinking that the leaner you are, the better of a runner you'll be.

And it is a really complicated one.

And it's something that I've dealt with personally.

My old coach used to say comments like that and it led to, you know, suffering eating disorder when I was younger.

And, you know, you look up to these people who are around you in in a sporting environment, especially when you're young, and especially if it's your mom as well.

And you're hearing those comments.

I think what you mentioned before about bringing them to the side and just explaining privately, I think it's probably what I would do personally.

I would pull them to the side, explain how that can be really damaging.

And it's probably one of the last things you would ever want to talk about, especially to a growing woman whose hormones are suddenly changing.

She's going through puberty.

Of course her body is going to change.

Of course she's going to start getting breast development.

She's probably going to put on some weight.

And that's actually a good thing.

And I think so when we look at like a male trajectory from younger, you know, going through puberty, they tend to get faster and faster and, you know, they they get more testosterone and they perform better.

Whereas women actually take a bit of a dip around puberty.

And it's just not well known and not well explained.

So I think, yeah, pulling her to the side and saying if she can get rid of anything that speaks about the way a young woman looks, it's going to have a lot of impact on those those athletes.

So instead of saying, you know, she looks fast or she looks strong, it's, you know, she is fast and she is strong.

Steering clear of trying to change their body type.

So, you know, the bulky comments and the breast changes like that is completely normal.

And just explaining, you know, this is part of puberty.

She may have a performance dip, but if we can keep her consistent in training, keep everything really positive around her, she's probably going to last a lot longer and actually see progression once she comes through the on the other side.

So yeah, it is a really tough one.

It's a sensitive topic because it's probably going to be hard for her to take on board.

But you can only try and I think having those conversations in private is the best action to take.

That's what I would do anyway.

Yeah.

I think building on what Esther said, I think as someone like as a research in the space, but also someone that's done a lot of sport herself, like in triathlons, I think it's so unfortunate to hear a lot of women my age sort of like my and Esther's generation of females all having a very similar narrative.

But the unfortunate thing that I think is how problematic this perception in sport is across so many different sports.

And how or what is the impact of this?

I guess these kind of, I guess this terminology with my parents in this kind of like or not even with parents with coaches.

And like how this kind of narrative gets I guess almost like embedded in young girls from quite a young age as they start going through these changes.

Whereas Esther said like naturally there are these physiological changes that are going to result in changes within their body.

And instead of learning how to appreciate those changes and work with them, the unfortunate narrative is that it is wrong to have these changes and that it's detrimental to them.

So you literally can look at research and there was some great work done where they like a surveys with a whole lot of elite athletes here done in New Zealand and the proportion of elite female athletes.

So these are women that have worked through those changes that are at the top tier of their sport that actually felt that there was a huge amount of pressure on them and it was perspectives on their bodies versus like performance related pressure.

It was like perceptions of like what the body looks like and how people perceive me to look athletic or not within a given sport.

Like seeing this as a huge issue throughout women's sport and then the impact that that has on the mental well-being of active females and female athletes.

It's it's a huge issue that needs to be addressed.

And unfortunately, it might start with having these conversations when they come up at a young age with either the coaches or the parents or the support network.

And actually, as you say, Esther said very kindly, maybe taking the individual to the side and pointing out that like these are natural changes, we don't need to avoid them, but rather we actually need to learn how to work with them so that this girl can actually learn to appreciate her body but still perform to the best of her ability.

Yeah, that's such a great answer.

And I think that it's it's really confronting when you get into the situations to be able to find the right words in a way that's going to be best received, that's ultimately going to be helping the girl in the center of it all.

So yeah, I think that's really great advice.

So thank you.

Once you all weekly recap.

Yeah.

I just wanted to add to that because it is, it's definitely having as a male, having that conversation is more difficult and I feel pretty well versed in the information how to communicate that.

But as a clinician, I've found the best way to do that.

When I'm doing my assessment, I'm watching them run and move and we're going to be gym space at work or watch them walk up the end and walk back.

We've probably got maybe 30 to 45 seconds.

And I'll have that conversation with the mom or the dad in that time really short.

And then whenever I'm in the actual assessment and, and in the appointment with them, I'm just constantly reiterating to to them and the daughter or even the the boy as well, just that everything with their body is normal, is a normal age-related change.

We expect this to happen.

They're performing really well.

They're happy that everything they're doing is great for their development.

That seems to, to go OK, But I can't say that I've had the direct conversation around female bodies.

And that's why I just think having a female question who can speak about that is it's just so important.

And as I've said to you, directing them to an online resource like them or even to your pure page, Claire, it's been really cool.

And I've had and even mums come back and say, hey, thanks for that recommendation on that Instagram page.

It's really helpful.

So if you're a male, listen to that.

That's how I've navigated it and hopefully that continues to evolve.

Would you have any advice?

Yes, Sir, on that.

I guess sending them to resources when you are feeling a little bit maybe scared to have that conversation.

Yeah, definitely for me, I mean we many years, well not many years ago, but a couple of years ago launched a an online resource called Femi Theory and we have modules on this.

So I would suggest having a look at that Femi theory.

These modules go into great depth about the impact of certain comments on young women and how that can impact their entire life.

I think a lot of coaches and people and women don't understand or mothers don't understand or anyone the impact of their words on someone's mental health for a really long time.

And if I take myself as a prime example, I still really struggle to wear a crop top.

And this is something I've spoken openly about in Femi and we now call it like rocking the crop because you're owning your body and, and you're doing it even if you don't really feel that confident in doing it.

But you know, the reason that I feel self-conscious about wearing a crop top is because the comments a coach made to me that I carry too much fat on my stomach to be in a late 1500m runner.

And so from then on out, I never wanted to show my stomach.

And so I think examples like that really open people's eyes to the power of their words.

And I think that's something we focus a lot on it for me, and that's why we created Femi Theory.

Like it goes into so much more than just that one thing.

But we do have a whole module on, yeah, how to build confidence in young female athletes rather than, you know, looking at things that you think could make them better athletes, which are probably actually going to impact them more negatively.

So yeah, Femi Theory.

I'm just going to plug Femi here.

Femi, we also have a podcast, so Femi podcast is a good one as well where we talk a lot about this as well.

And then yeah, of course, the Femi experts.

So we have 6 incredible experts on our team.

Claire is one of them.

She has amazing resources on her Instagram.

But all of our experts, you'll be able to find them on the Femi page as well and they all talk a lot about these type of issues and topics.

Yeah.

I wanted to ask you, Claire, because we if we look to the kind of must go skeletal sports medicine space, there is there is just no debate anymore that our words carry so much meaning.

If you tell someone they have a flat for it.

If you tell someone they're spined out of alignment, they're more likely to suffer disability sooner.

They're more likely to suffer a higher intensity with pain.

So we clearly know words matter.

Are you aware of any research where it comes to speaking about females bodies and looking at outcomes and things like that where it is shown to have a negative or consequential effect?

Is it mostly survey research or we've got some quality of data as well?

I think in this area it's mainly qualitative research, and I think that is the beauty of qualitative research.

Like I will openly admit as a physiologist, my background is generally in more of the quantitative research.

So people don't understand that the quantitative research, we're really looking at numbers, collecting data on specific hormone levels and concentrations and things like that.

We're looking at performance numbers and variables.

So it's very much a bit of a numbers game, but qualitative research searches of course, those individual perceptions, ideas, beliefs, values.

So it's very much interview based.

So you get a lot of really rich data from individuals that can really help describe the experience around the numbers that maybe I would generate and research.

So while I don't have any of that kind of research myself, there is a lot of brilliantly done qualitative research that does kind of show that either those conversations aren't getting had with coaches because there is that kind of fear from female athletes with working with a coach where they just, they just don't feel like it's appropriate.

Or they don't feel like they've got the knowledge to talk about like certain aspects or changes that are happening with their body.

Or like the fact that there is this really interesting relationship between an athlete and a coach, which we all know exists.

It's a very, I guess, important relationship for an athlete to have.

And so if there are, it's kind of like having a role model say something really challenging to you.

And if you take that on board like that, is that that person you're looking up to, that person you're looking to get advice from?

It can have a flow on impact.

And I think it then also raises a really important discussion when you look at both sides of the research.

Performance and training isn't only about numbers.

You've also got to recognize that mental well-being has a huge, phenomenal impact on how someone shows up to training and how they perform every single day.

So that qualitative research there provides a lot of really interesting perspectives on how these interactions, if not managed respectively, can actually really be detrimental to an individual's mental well-being.

And the flow on effects that that could have within their life, within their performance is quite substantial for that individual.

But I also think that research then points out those individual differences because there are going to be some people that are maybe more mentally robust.

So they could hear that but just not believe it.

So of course those kind of words aren't going to have any impact on them and that's fine.

But then there are individuals where recognizing that individual difference where those words are going to be taken on board and that's going to have flow on impacts to their mental well-being and of course their performance, how they start engaging with food and everything like that.

So there is that evidence there and you can't discredit any of it because it exists and it needs to be acknowledged because you never know how the individual's going to respond.

Yeah, and that just speaks to that important one-on-one, you know, the the conversation and that relationship that you develop with people is just so important.

And that's why, as you said, population data is so hard to interpret because you don't really get what the individual is is feeling my case study a little bit different.

It's really common to have a musculoskeletal podiatrist.

So I just say lots and lots of blown knee condition pathology, lots of runners and we'll plug family.

I do get some ladies on the Family Run app, which is awesome, but we'll speak about that later.

Big family advocate.

But it's really common because I rightly or wrongly, do like the yap a bit with my patients and really try and over explain probably to my my detriment.

And I think as a result of that, patients like to ask me a lot of questions and sometimes it probably gets a little bit out of my field.

I feel knowledgeable enough to speak a little bit about female Physiology or at least direct them in the right to the right people.

But perimenopause post menopausal women, it's really common for them present to a Podiatry practice for a really common condition, you know, plan to heal, plan plantar fasciitis, any kind of below knee soft tissue injuries.

And a lot of the time I can ask does my menopause or do my menopause symptoms have anything to do with this?

And on both end of the spectrum, it certainly could and on one end it certainly couldn't.

And it's very hard for me.

And I, and I tell them bluntly, like I can't really know exactly.

However, let's talk a little bit about what's happening, symptoms.

How is the body feeling?

Because I can direct you to the right person.

That's certainly it's not in in my field, but how would you plan navigate that conversation and how would you want clinicians and people working with someone going through that to explain what is happening?

Because it is incredibly difficult to explain to someone what may be happening within their own body.

Yeah, I think that's brilliant that firstly you're having these discussions and bringing that to the attention of the woman that is maybe having this niggle.

I think for so long that hasn't been something that that has been recognized, but as you rightly say, the Physiology of a female is 1 aspect of all the things that could be influencing injury presentation.

And so I think it's a really interesting discussion of your menstrual cycle.

Physiology is a marker of health.

So like the quality of food can determine your health.

The amount of sleep is a key marker of health.

All of those things together can give us a really good indication on what are you doing to help manage your health.

And so if you are having perimenopausal symptoms that are influencing how you sleep and you're not getting enough sleep and then you are in a highly stressed out work environment, that's then when we add in training on top of that is an exceptionally high low that could have been contributed to this injury with maybe inappropriate rest or recovery or whatever has occurred that has resulted in this injury.

We need to be looking and asking questions about all of these aspects.

So it's not just saying just because you're in perimenopause, yes, the likelihood that you're going to get injured is going to skyrocket, but it's acknowledgement of like there is a change in your Physiology that's happening.

It is a key marker of health.

We know that some of these symptoms are going to change how you feel in certain areas.

They might impact other key markers of health, nutrition, sleep, etcetera.

And cumulatively, when we look at you as an individual, everything that could be impacting it, this is a conversation we need to have because it could be a key factor.

And if we're going to give you really good support on how to.

And once we've treated this injury, how can we put in a supportive structure around you so that you can stay healthy so that you can do the running that you need to do After that, we need to be considering this as part of how do we keep you healthy because it's going to be one of the key players in that, along with sleep, nutrition, appropriate training and everything like that.

So I think from that aspect, that's probably how I would come at it as a clinician when talking at it with an individual.

Yeah, I like that.

It steers clear of the Physiology stuff which we just don't know or can't predict without any internal Diana like blood tests and things.

Yeah, I was gonna say as well, I guess.

And we've spoken about this before on the podcast too, is our key role in some of these areas is to be really good identifiers and maybe just bring up a conversation that the woman in front of us hasn't had the confidence to discuss with their doctor or maybe even hasn't been aware of it.

So if we do start to move in towards that conversation and ask those questions for them to become aware of it themselves, then perhaps we can then make that recommendation to some of our resources to for them to be able to explore the insurance and outs a bit further in terms of blood tests and potentially HRT if that's an Ave.

that they'd be interested in exploring with their GP.

Definitely, yeah.

It just, it amazes me.

I mean, it's why one of the reasons I love family and another reason why doing this podcast and people are there creating resources because more times than not, the conversations that I have, you know, as a musculoskeletal podiatrist around these symptoms, that's the most they have spoken about it with anyone.

And I'm their podiatrist.

I'm just managing that here.

I'm like, you have a doctor, you have an endocrinologist, some of them have diabetes.

Like you've got all these medical specialists and no one has spoken to you about these symptoms and saying, you know, this is a part of your Physiology.

You know, you can actually see people to help you manage it.

It's just blows my mind.

And then obviously with younger females as well, it's definitely getting better, but that's one of the reasons why things like this are so important.

What's your weekly recap S stuff to share for this week?

Anything that you'd like to highlight from your exciting week?

Yeah, I feel like I maybe I misinterpreted this because it's a little bit further back in a week.

That's fine.

There was something really cool that happened recently, and it's about Doctor Stacey Sims, who's one we kind of call the godmother.

Yeah, we had her on the podcast 1010 episodes ago.

Amazing.

Yeah, amazing.

I'll have to have a listen to that one too.

But she's recently been on Diary of a CEO podcast, which is one of the the leading podcast in the world.

It's a massive platform.

And like, if you get place on that platform, you know you're gonna have a massive audience to speak to.

And her podcast is actually the fourth most listened to.

I'm literally talking about.

This.

Yeah.

And it was sitting the top five on Hubermans as well.

Yeah.

Yes, yeah.

So it's just incredible and like I think it just highlighted for us at Femi and I'm sure beyond like how many people are seeking this education and information now.

And it's, you know, something that Femi stands by is bringing that education in a really digestible way to woman who never got taught any of it at school.

We never got equipped and empowered in our bodies when we were at school.

But hearing these things now on one of the most popular podcasts in the world is so exciting.

And it just shows that there's a real shift in society.

And the fact that it's so highly listened to also shows that, you know, there is this knowledge gap and people are seeking information.

And then following that, we also noticed a bigger, quite a big influx of American downloads of Femi.

And I think what happened was, you know, people listen to this podcast, they're like, holy moly.

Like this stuff is I've never heard this.

This is amazing.

How do I get more information?

They go in the App Store, they search for something around running and female Physiology and they find Femi.

So I just think it was a really cool flow on effect shows.

You know, people want this information.

There's a knowledge gap and they're going out and seeking out more guidance, more education, you know, following that podcast.

So that's kind of like a really positive thing that happened.

I think it was maybe a month ago.

But yeah, that's so sneak it in there.

That's.

Right.

Yeah, We can just say it was a week, a long week.

It's the.

Week, it's just perfect.

That's great.

What about you, Claire?

Well, I think mine kind of maybe even leads on from that.

I, I will say I feel always very incredibly fortunate because Stacey and I collaborate a lot on research projects because she's based here in New Zealand.

And so we actually have a great time doing a lot of research together even in some of our bigger projects.

So even some of the, the stuff that we've been working on, it's like it's in collaboration.

So and it's just awesome, like being in the room with other women that share that passion and can just like the bounce ideas of each other is just fantastic.

But I think so I've just come back.

It's like the January period where you return to work and like you just kind of catch up and everything.

And so for me, what I was reflecting on this week is the fact that we've spent two years collecting data in women menstrual psychophysiology data.

So just for reference for people like to do high quality research in women taking into account menstrual psychophysiology and to do it in substantial number of women.

So we've done it in about 92 women in one project and like a ballot, 70 more in another project.

It's taken 2 years and like we're nearing the end and it's just reflecting on that and actually how long it actually takes to do this quality research in women so that we can provide the right answers.

But when we look at the data, especially because our projects are designed not so much around a single cycle, they're more continuous.

They're looking at consecutive menstrual cycles in women.

And when you start looking at that data set, you just have this immense appreciation for how dynamic and how individual each woman's Physiology is.

And I think my reflection is pretty much how excited I am for this year 'cause I'm finally going to analyse the data and not just collect data.

So I am I'm buzzing for 2025.

I guess that that leads to one of our main questions for you, Claire, is where are we exactly up to with the menstrual cycle and what we know about it?

I, I think there was maybe like, I don't know, four or five years ago there was like Stacey Sims brought out her book.

Maybe it was even longer ago, but that was probably when I first read it.

Maybe it was longer than that actually.

And we, I was like, I'm going to train with my menstrual cycle.

I'm going to do all my high intensity sessions at this phase and then I'm going to do really easy intensity sessions in the next phase and follow it to a tee.

And then some more research sort of came out that was like, maybe it's not that black and white.

Maybe it is a bit more individual.

So right now, because it has swung quite a few times that I feel, and that's just due to a lack of research and trying to grab onto anything that we really can.

Where do you feel like we're up to at the moment?

I think this is a great question and I am going to explain it a bit from a researcher perspective.

So you guys might have to humor me a little bit here.

But when we actually look at some of the research that comes out where it shows like where they've stated maybe like the menstrual cycle has no impact on performance and training, we really have to look at, OK, what are the limitations in that research design that maybe have contributed to those results.

So the things that we actually need to acknowledge is those big reviews that kind of looked at a lot of that research.

One of the key things that they actually recognize is most of the research to date in sports science in these Health Science areas that they've used for these reviews have been very low quality, which means they haven't confirmed ovulation.

They haven't done blood tests or even urine tests to confirm what those reproductive hormone profiles are.

People have just labeled it as follicular phase, luteal phase.

Ovulation definitely happens.

I can tell you right now from our data set, it doesn't always happen.

And so then you've also got very small samples.

So like you might have a study with ten women and over a single menstrual cycle.

So even if you combine all of that data, it's just not enough.

And if you then think about how the subsequent studies that have tried to look at, OK, are they performance differences in these different phases that again have shown no significant result.

It is.

They have tried to take a specific hormone measure on one specific day and then try numerically, almost relate that to a performance outcome.

But actually what we know about this Physiology in women is that your hormone levels can change within 24 hours, sometimes within 12 hours.

So it is a very dynamic and responsive physiological system, which means yes, in your follicular phase you might have increasing estrogen levels.

What that increasing estrogen level looks like day on day on day between myself, Esther and maybe you, Kelly is going to be completely different.

So if I measure us all on this day to get high estrogen levels, the likelihood of me getting very high estrogen levels between all of us and then all of a sudden relating that to a specific performance outcome.

Like I'm, I'm never really going to see the, the, I guess a correlation there.

Like it's just the design is literally taking snapshots and then almost hoping that all women's performance outcomes are going to be exactly the same at these given time points.

It doesn't account for those individual differences or the dynamics of the Physiology that you would expect with something like the menstrual cycle.

However, what's really interesting now is a lot of the more recent research that has subsequently been done, but kind of looks at the more individual aspects of the menstrual cycle.

So we're looking at menstrual cycle symptoms that occur.

So presentation of menstrual cycle symptoms will vary between women.

Again, this is mainly due to genetic differences and individual threshold sensitivity towards their reproductive hormones occur within the menstrual cycle.

So because of those individual differences and sensitivity, the symptoms I experienced in my menstrual cycle as a result of my hormones are going to be very different from Ester, very different from yourself as well.

And So what they're actually finding and reporting in a lot of research is the total number of symptoms and the severity of symptom or even the type of symptom that has a very good or a very strong correlation with impact on training and performance.

But that research recognizes the individual differences.

So a woman that doesn't experience menstrual cycle symptom, she's not really likely to report any impacts of this Physiology on training and performance.

But someone that maybe experiences or very severe symptoms or maybe a large amount of symptoms, she will often report that it does impact her training and performance.

But the beauty of that research, even though it's quantitative and looking at numbers, is that you're actually seeing weight behind that evidence of that individual impact of this Physiology is quite individual to each woman.

And yes, as a result of those individual differences in those hormones as and the symptoms that may be present with it, yes, there is that impact on training and performance.

So I think it's one of the things that we don't do well as researchers, and this is maybe a pet peeve of mine as a researcher is that we're not very clear when we're translating that information.

What exactly have we researched?

How have we designed the studies so that we can get the right results out and all the results being communicated to everyone properly.

And so I think sometimes, so if we can understand that well, then we can really start teasing out like some of the really key and important pieces of information there.

And then on top of that symptom stuff, we've also got a lot of qualitative research interviews and stuff like that with women, again, showing that individual experience with their Physiology.

Again, some women no impact and that's completely fine.

That's their individual experience of their Physiology.

However, others will experience something quite distinct and quite different, and it's recognizing those individual differences because yes, those individual differences and experiences will influence your training and your performance.

A question for you, Claire, and then to us to do we have any broad associations with hormones and symptoms or performance?

Like we've found that, you know, if you have an increased amount of estrogen, this generally might be the result to your soft tissues or your performance as one question.

And then to us to base off the app, is that why having an individualized the program in the app will then tailor to that individual person.

So if someone's on one end of the spectrum and they get, you know, really severe symptoms, the running might be a bit easier for that week versus someone that doesn't have severe symptoms that would change.

I guess it got to you first, Claire, and then to your stuff.

I think the research in this area is still growing and developing because again, it's even if they're looking at the presentation of a specific symptom and trying to associate it to that hormone.

Again, we need to recognize that I might design the study that every single woman comes in and I'm going to do a blood test on day 13 to try get that peak and oestrogen before she ovulates.

And I might capture that in five out of ten women.

And the other five, I missed that estrogen peak because they ovulated a different time in their cycle.

So then you don't necessarily have consistently high estrogen levels to then specifically related to a given injury.

And this is where maybe some of the more mechanistic research, which is maybe outside of sports science or maybe you have to look outside of that to actually look at where a lot more of the cellular based research is looking at potentially what estrogen does to I guess not only soft tissue, but like your ligaments and your tendons, elasticity.

Some of that make a mistake.

Research actually becomes quite valuable there.

But because we're still in that process of really learning how to design research well for women and actually try to capture those key high hormone phases, the conclusive evidence around like specific symptom related to specific hormone concentration is still an area which is developing.

So yeah, I unfortunately cannot give you a conclusive answer on that.

It feels like my general response for most research and women these days.

That's we we joke and say that's how you can tell someone actually understands the research because they have nuance.

It's the people that are like, Yep, put the the horse horse before the cart.

This hormone does this.

You train slow here, you train fast there for everyone.

It doesn't work like that.

No, absolutely not.

Yeah.

And then as, as Blake mentioned to Ester, So what is Femi like how is Femi tailoring then female specific Physiology to their training programs with all of that evolving research in mind?

Like it's quite hard because I think things often like just have to be updated so regularly because there's just new things coming out like every month.

Totally, totally.

And I feel like where Femi is right now is, you know, only a snippet of our vision and what we're working on is going to be extremely personalized.

Like where we are right now.

Nothing else exists like Femi.

Like we are literally the only running app for women that are built by women, you know, in the world that exists today and acknowledges that, you know, female hormones for the majority of women that we've worked with at Femi do impact how they feel and do impact their performance.

And you know, the research out there tends to sway towards in the follicular phase, women do tend to feel a little bit stronger.

And in the lateral phase, they can be more impacted by those symptoms because as progesterone peaks and then drops away, we've got this big change in hormones and we can tend to feel PMS symptoms if we're going to feel them individually, right?

So the way FEMA is structured at the moment is all about periodization.

We know that, you know, breaking your training into kind of like 3 weeks on, one week off is really, really positively impactful on progression and training.

So we sort of tailor that down week more around the majority of women and around their PME symptoms and when they're potentially going to be impacted by their hormones.

So this is kind of phase one, but where we see Femi going like our big vision of Femi will take into account every factor that could influence how she's going to feel each day of training.

So what we call it is the Femi intelligence system, and we're pretty excited by it, but it takes into account symptom tracking.

Claire always feels really fatigued between days 20 and day 24.

We noticed that happens month on month on month.

This is clearly how clear is impacted by her hormones versus me.

I feel more fatigue days 27 to days three of my cycle.

So this is clearly how Esther's impacted by her hormones.

We want to take all of that into consideration.

We wanted to take into account her training history, her current training data or the data that we consume from her wearable, other factors like sleep stresses in her life, take that all into consideration and then adapt her training accordingly to the individual.

So that's kind of where we're working to.

But the way we've structured it at the moment, you know, it's based on science.

It's backed by science around periodization of training.

We just bring that down week into the late lateral phase, early sort of menstrual phase where most women are impacted by their cycle.

But, you know, the, the vision and what we're working on now at Femi will be so much more dynamic and so much more adaptable to the individual.

But yeah, like you say, Kelly, it's complicated and it's complex, but we're already seeing like incredible impact on the woman that we've worked with.

And I think that also comes down in part to feeling finally feeling validated, I think for a really long time.

Like Clea said, a lot of the research that has been poorly done said that there's no clear evidence that hormones impact you.

But then we work with thousands of women who are saying it does, and we're then providing them education, positive affirmations around how they're feeling or potentially feeling or how they may feel that aligns to how they're feeling.

They finally feel validated, they finally feel sane, and they feel more empowered in their body.

So 100% of the woman that have trained with me feel more empowered in their body, which is pretty great statistic.

But then on top of that, when you look at, you know, training protocols out there, less than 1% of fitness software.

Is built with female sex hormones in mind, so they're just completely ignored.

And most training software out there is basically just built for men.

And based on, you know, male data and how men respond to training, ignoring this, you know, continual change of female hormones is basically just undermining.

Undermining the impact of female hormones on how we can perform and show up day-to-day.

So hopefully that answers your question.

The female intelligence system is in progress right now, which is very, very exciting.

And I think it will get us to that point where we do acknowledge, you know, like every single woman is impacted completely differently by their cycle.

There may be majority feeling certain ways throughout the cycle, but everyone is completely different and even every cycle to cycle is different.

Yeah, I'll be the first to admit that when I first read that like initial piece of research that said that there's in the follicular phase, you are tending to be a little bit more, yeah, stronger and faster and then and have more energy.

And then in the luteal phase you tend to feel a little bit more lethargic.

I was like, yes, 100%.

Like that's me.

That must be true for everyone.

And I recommended it to absolutely everyone because I just bought into it so heavily because reflecting on it myself, I really noticed.

And then following up the research that maybe sort of brought more nuance into it, I was kind of like, really, I'm sure that that must be correct because that's always how I feel.

So I totally agree.

I think there and now talking to so many female runners all the time, I think there's, there's always some comment on feeling better or worse at different phases.

And I I certainly realize that that is on an individual basis now, because, you know, some person might feel better at one point in their cycle than another, but there certainly is peaks and troughs throughout the, the month.

I would say so.

And then at the moment, just following on from that as well, Esther semi right now is guided by pace.

Is that something that's going to be that, is that what you feel is the best way to sort of guide intensity and then easy runs for women?

Or do you think that further looking into symptoms and the Femi intelligence system is going to then be incorporated into how you're prescribing intensity within the app as well?

Yeah, for sure.

I think when we get to that point of the Femi intelligence system, it will be a lot more dynamic.

I think at the moment with paces, we, we chose paces.

There's pros and cons to it, but we chose paces because there aren't that many other Well, firstly, there's not running it for women.

I'll say it again, but then not many running training programs, you know, in software form provide paces.

And we think that that's actually an incredible place for people to learn about, you know, how to how to periodize a week of training and how different an easy run pace should be versus a tempo run or a steady run or a interval run where you're doing kilometer reps at 5K pace.

And I think the amount of woman we've worked with all the way from beginning even to like, you know, you're looking at people who have even run like their first half marathon.

How many of them make so many mistakes around paces And they they do these speed sessions way too hard.

They absolutely dig themselves a hole week on week, or they push the easy runs way too hard when they should be running so comfortable that it's a little bit boring.

And I think that from that knowledge that we've gained through the one to one coaching we did initially with Femi and then building it into software form in our app, we've realized how many women could make so many gains by just understanding paces, you know, and adapting their training around a week, you know, month on month around those paces and learning how to structure training around paces.

I think alongside that with the education learning, you know, how to periodize around your training.

There are limitations with paces.

Like it doesn't acknowledge that you're running up a massive hill, right?

Like you might live in a really hilly area.

So there's some inflexibility with it.

We did introduce pace ranges recently.

So an easy run might now be from 5 minute per kilometer to five minute 30.

So we give a bigger range.

So the bottom is kind of like that limit, like don't go faster than that.

So we brought a little bit more flexibility in, but where we see it going soon is bringing in kind of more effort based training, more RPE based training.

Reason being we want to start tackling trails and I don't think you can ever give a pace on a trail.

Let's go hit a long run with massive elevation and you're getting told to run 5 minute case by for me, it's not going to work.

So it needs to be effort based.

Also acknowledging you know what I mentioned before around hill training.

So we are going to be introducing that next in terms of like heart rate and that sort of training.

I think it's quite complex.

Unless you can, you know, get into a lab, get proper testing done, it's never going to be super accurate.

We don't know how accurate the watch is, the wearable that she's wearing.

We could ask, you know, are you wearing a heart rate monitor or not?

But there's so many variables that play into heart rate training.

So I think it's definitely valuable for some people.

It's just a little bit more complex than providing paces based on goal time or current ability, which is what we do at the moment.

And then bring in that effort based training soon will help us expand into other areas.

And I think some people also just prefer effort based training.

They like tuning into their body more, seeing how they feel.

But I think providing both gives a good outline where we can educate more around paces if there's someone that thinks a 5 out of 10 is actually way harder than it should be.

So yeah, that's kind of why we started with the paces and where we see it evolving in the future.

Yeah, that's cool.

Another question for you, Claire.

And this is inspired by a post that I read from your Instagram.

It really, I found it really, really fascinating because it's not something that I consider when I'm treating patients and I'm not sure if it's something that I can consider more so which I'm keen to ask you.

But so my tend to see a lot of runners and a lot of female runners and treating a lot of bone stress injuries, tendons.

I'm often asking about if someone is trying to get clues as to if someone might be experiencing low energy availability or red S.

And the the easy questions around that is, you know, are you experiencing a regular menstrual cycle?

Are you fueling around training sessions during training sessions?

Is there any food groups that you might eliminate from your diet as a way for me to currently get some insight into, you know, the, the health of their system?

I saw a post that you did that wasn't just considering amenorrhea.

It was also looking at, you know, luteal phase deficits and, and, and in ovulation cycle and some of those other less common or less known or talked about disorders or problems that can happen around an irregular menstrual cycle.

Is there any good clinical questions that clinicians can be asking about that I suppose aren't so black and white just asking about, you know, the are you getting a menstrual cycle?

That might give insight into whether there might be some of these other, either less common or less talked about conditions that someone could be experiencing on the way to rats, I suppose, or amenorrhea.

I think this is a brilliant question and thank you so much for asking it because I think it's a really important question firstly to raise because it's unfortunately the key metric that a woman is educated on in terms of recognizing if there is an issue with her menstrual cycle Physiology is regularity.

So how regular is your, are your periods, like do they come within that 21 to 34 day window?

Are they quite consistently?

As soon as they are extended, then we refer to that as oligomenorrhea.

So of course you're having probably less than 9 menstrual cycles a year and of course amenorrhea being if you have missed a menstrual cycle bleed naturally for more than three months.

So regularity is that key metric every woman will go yes I am I am quite regular.

The unfortunate thing is that in a lot of research, because the focus has been on can we show performance impacts at different phases naturally, what a lot of researchers have done because of that strict criteria of trying to capture those key hormone heats in the different phases.

Any woman that presents with A1 an ovulatory cycle, which is a menstrual cycle where she doesn't ovulate as a result of not ovulating, she doesn't have high progesterone levels in that luteal phase.

Or she might present with a luteal phase defect or deficiency, which is either way her luteal phase is less than 10 days, so quite a short cycle.

Or she has inadequate progesterone levels, so quite low, moderate to low levels.

So women that present with those cycles within research projects are usually excluded from analysis because they don't present with the correct hormone profile.

So if you're looking to standardize research, you eliminate them.

So our really understanding about how do those different hormone presentations or how does that different menstrual cycle Physiology, how does that present for women?

Again, lovely gaping hole in our research vocabulary.

We can't tell you.

The unfortunate thing is because regularity is the key metric that we've told women is an indicator of like you're healthy because you have a regular menstrual bleed.

Women that have a luteal phase defect or even an an ovulatory cycle will still menstruate regularly.

It doesn't change the length of the cycle.

So these presentation, these, I guess menstrual cycle physiological presentations occur very regularly in exercising women and in healthy women.

I think some of the first research that showed this was done by a lady in the US, her name's Mary Jane D'souza.

She's done some incredible work in and around female Physiology and some of the initial work around the female athlete triad.

And she actually looked at the the prevalence of these, I guess presentations in our menstrual psychophysiology in sedentary versus just regularly exercising women and luteal phase defect cycles.

So where we have low progesterone or very short luteal phases in three months, the prevalence was about 48% in exercising women.

So about 50% of women in three months will at some point experience a luteal phase defect.

But because we don't actually know about what actually happens, how that might change maybe a menstrual cycle symptom or anything like that that a woman experiences at that time, we're not really able to provide really conclusive recommendations of these are the questions you should be asking.

And then from some of the research we've done now in our lab, again, our research has an eliminated woman because of menstrual cycle Physiology.

We've literally just tracked them over three to five menstrual cycles.

And with all my projects, I actually generate a report for the individual and give her data back.

And for literally the majority of women, like majority of them, I have to give them back data that shows like one cycle you did ovulate and you had enough progesterone in your luteal phase and two cycles, one of them you don't have enough progesterone, one of them you actually don't ovulate.

Altogether, there is a very small, very small minority of the women in our research projects that 3 cycles consistently actually ovulate and have adequate progesterone levels.

And in fact, a lot of research shows that about three to four cycles within a year for naturally menstruating women, there will be the sporadic and ovulation.

And So what we're actually seeing is this really adaptive responsiveness of this menstrual psychophysiology to different stresses, different life events.

So we usually see these changes where there is things like illness, travel, high amount of work stress, a social stress, emotional stress.

Like that's also a huge thing that psychological stress and social stress, what that can do to female reproductive Physiology that often sometimes gets ignored in place of maybe asking a woman about nutrition, but actually asking about some of those other aspects around.

Like are you highly stressed out?

Like are you managing that stress?

Is it impacting your sleep?

Like have you been sick?

Have you traveled?

Like all of that can influence this Physiology and it can cause these slight disruptions.

So at best, like what I usually say to people right now is let's just acknowledge that it is adaptive Physiology.

These changes can occur in response to many lifestyle stresses.

And unfortunately, our current metric of is it regular might not be able to detect that these are occurring for a lot of women.

Of course, the women that are maybe looking ongoing on a fertility journey might become a bit more aware of it because I stopped measuring whether or not they're ovulating.

But even then you don't know if you have a luteal face defect.

And So what I and currently suggesting to people is in the absence of this research, the most empowering thing you can do for women is get her to track her menstrual cycle of Physiology.

So how she experiences it, those symptoms for more than one cycle a bit continuously.

Because then if you get a deviation away from your normal.

So if you get a menstrual cycle presentation that is quite different, that can actually give you a really good indication of, OK, like even though I'm regular, I've experienced something quite different here, which could be because of maybe lifestyle stress or in the absence of that, if everything else in my life is static, maybe something has changed here in my Physiology, which could be indicative of some hormonal change.

So I think as clinicians actually supporting a woman to recognize and recognize as Physiology so that she can practice some self advocacy for herself in communicating when a change does occur from her normal is probably the most empowering thing you can do in the absence of research that shows like this is the specific change that happens with these hormonal changes.

I say something similar, definitely not as articulate as that to the people that I work with.

And you know, I say it's on an individual level.

It's very hard on a population level to be able to recommend something to you.

But I maybe three months ago, before we did Berlin Marathon, I jumped on the app as well.

And it's training.

Yeah, I was training the app, yeah, because Kelly was using it and I was like, well, I want to use it too.

Don't, don't cut me out.

And we would chat about it and that I could tell you that app is empowering.

I was like, which the guys had something like that.

But it was, it was, it was really cool.

And the thing that I and you know, I wanted to use it as well because I'm recommending it with, with patients, but it really, it really does make you aware, even though those things obviously weren't happening in my body and we set it up so we're on the same cycle.

So I can guys do it together.

But it really does make you recognize what's happening in in your body.

And I think as you said, that seems to be as far as a clinician, that's probably as far as, I guess musculoskeletal conditions different with, with your aspect of work.

But as clinicians work in this space, that's about as far as we can go.

And then using applications like that and directing them there could all the information is there on, on how to do it.

That should be going to be the most important part.

Could you raise an interesting point around the deviation from the normal?

And I'd never thought of how you said when you were mentioning as well as like different training for different people based off how they're feeling, you know, day 21 to 24 versus day 27 to 30.

Because when we prescribe rehab, especially post bone first injury and post tendons, you know, we need quite a high stimulus on these structures to elicit a response.

And especially with stress fractures, like the higher they're, the better you, you know, your bones need that.

And you know, I'm prescribing and telling people your intensity needs to be high.

And it's never occurred to me to be able to then I'm just recommended that broadly that saying that some days you should probably just go as high as you can and that intensity that you're able to have is probably going to be different.

Would that be right?

Would that, you know, say they're doing 15 minutes worth of ply metrics and heavy calf raises, Depending on where they are during that month, it may be different on how hard they can push.

And that should have some relevance for rehab as well as they're running.

I mean, I completely agree with that.

I think it's all relative like as I am sure, yes, we'll touch on, I think as you say like yes, the research shows like bones love high magnitude load like it is the best thing.

It's why these days for perimenopausal, menopausal woman, it's like, no, no, no, no, no, please.

Like go lift something heavy, put that lovely load on your bones like it is a savior to them.

But it's all relative.

You've got to recognize that high intensity on one day is going to look very different.

And I think the example I always give to people is high intensity and maximum effort on a day where you're sleep deprived versus a day where you've had enough sleep, you're still showing up and putting in maximum effort.

It maybe looks very different, but it's still high intensity for that day.

Yeah.

I think taking into account those differences, that can be incredibly important, but it also can help support compliance with any rehabilitation program that you provide.

I like that it's good.

Yeah, I always like to line up.

All the all the aspects of someone's training in a deload week.

So some people will like be having a deload week for their running and that means rehab gets deloaded that week too.

Doesn't matter if we're trying to have as much of an impact on our bones or our tendons as we can.

Everything needs a week to recover at some point.

So I think that, you know, if we can line that up at a time that the woman or person in front of us is in like in line with their Physiology as well, then probably just makes more sense.

Totally.

And that's like Femi's whole ethos is really like track your individual experience with your cycle and how you feel day-to-day and then listen to your body.

Like I think for so long and this, this may not be only for women, but there has been so much pressure on women societal wise about how we look and like moulding our bodies to look a certain way, especially in running and a lot of individual sports or endurance sports.

And so we just push ourselves so hard.

We train hard all the time, you know, under fuel.

We're not actually listening to our bodies and listening to what our body bodies need.

So that's really what Femi's ethos is.

And when you said like that you felt empowered by Femi, that made me feel really, really happy.

I was hyped up.

I felt like a queen that day.

It was good, yeah.

You're a.

Queen yeah, we want women to feel and men and everyone to feel empowered in their bodies and to make the right decision for them on the day.

And I think that comes down to understanding your body, being educated because the more you can understand how your hormones may influence you, because you understand, you know, the impact on your whole body systems, then you can be like, OK, well, actually today I might push my training a little bit or I might, you know, pull back because I feel really fatigued because, you know, every single month because I've been tracking my cycle, I see that I'm tired here.

So it might be best for me to actually take a rest day today.

Or, you know, we, we really want to encourage that infamy because I think for a long time we've used women have used exercises like a form of, you know, punishment or molding our bodies rather than actually understanding, you know, how beneficial exercises, understanding the importance of our hormones and our menstrual cycle and then listening to our bodies.

As we sort of understand how we're influenced individually.

Yeah, I love that.

That sustainable model I think is so important.

And I'm gonna pivot a little bit here because I have so many questions that I wanna ask you.

Claire on Iron.

I run with so many runners, female runners, and I think the majority of the female runners that I run with have had an iron infusion before or have begged their doctors for one if they'll give it to us.

And it seems like it is a very common thing for females, but particularly female insurance athletes.

Can you speak to this a little bit more scientifically please?

This is pretty much like my initial research when I started out as a researcher years and years ago when I was doing my PhD.

So it was a lot of iron status and endurance athletes.

So it's still there as like one of my main areas that I love to talk about.

So yes, happy to do it.

But actually iron deficiency, the risk of iron deficiency is increased in a lot of endurance athletes and that is males and females as well.

So generally when you look at the statistics on it, like if you look at sedentary men, risk of iron deficiency is maybe like 1 to 2% in the population.

If you look at the age match to men who are endurance exercises, all of a sudden it's up in and around that like 5 to 8, sometimes up to 10%.

So it like it dramatically increases.

So I think when you exercise, you actually need to recognize that exercise itself naturally accelerates iron loss from your body.

So things like sweating, gastrointestinal bleeding, all those kind of things, cumulatively they all can accelerate natural iron loss processes from your body more so than if you were sedentary.

And a single one of exercise session where you accelerate iron loss is not going to have a major impact on your iron stores at all.

However, if you are a regular exerciser and you do that continuously and if you're an endurance athlete, you're on that program for a very prolonged period of time, huge amount of training load and volume that accelerated iron loss can start to accumulate into the fact that you are potentially going to be losing more iron then potentially you're putting into your body.

And the only way in which you can get iron into your body is naturally through dietary iron intake.

So if you've got what we call a negative iron balance, where the loss of iron from your body is greater than the amount of iron that's going in, then you're almost going to be relying very heavily on your body, our stores, and gradually you're going to deplete them.

Then around the turn of the century.

So yeah, it's about 25 years into this kind of research.

So in research words, that's still like relatively new.

But around the turn of the century, they actually started really looking at the effects of a hormone known as hepcidon.

So hepsilans are peptide hormones or a protein based hormone that actually helps your body regulate the amount of iron that's absorbed into it.

Because we don't want huge amounts of iron in our body because iron is a very reactive substance in the body.

It's great because of that reactivity and we need it.

It can be very helpful with a lot of chemical processes, but too much is toxic.

So when you eat a steak, you don't absorb all of the iron from the state because if you've got good iron stores, you don't want to absorb all of it because that could be quite detrimental to you.

So this hormone helps regulate the amount of iron that you absorb and it does so in relation to your body.

I thought things like inflammation will naturally increase this hormone.

And when that hormones have high levels in your body, it stops you from absorbing a huge amount of iron, even if your body iron stores are being used quite regulate.

And what a lot of my initial research kind of showed, and it was kind of from like a lab of researchers in the space, was that after exercise, because of that natural inflammatory response that you get, there's this increase in this hormone that regulates iron status.

So about three to six hours after you finish exercise, you're suddenly getting this peak in this hormone that's preventing you from absorbing iron maximally or to the amount that you need to account for what you've then lost as well.

So you've kind of got two things almost working against you.

You've got exercise accelerating the amount of iron that you're losing through natural processes, plus you've got a hormone that's potentially not allowing you to maximally absorb iron from the food that you're eating.

And that whole combination regularly over and over and over again really supports that negative iron balance.

Which means as an endurance athlete, I start to rely very heavily on my body iron stores.

I'm going to start depleting them because I need to use those body iron stores to produce red blood cells to allow me to train to do all of that.

And so naturally, I start depleting my iron stores.

And that's where you get that increased risk of iron depletion and iron deficiency in a lot of athletes.

So yes, in athletes, naturally you should see that increase in iron deficiency, and it's for men and it's for women as well.

And is that why if you then try to supplement, you know, it's something hormonal, it's reducing or inhibiting absorption, so supplementation isn't as effective?

It really depends on what your body's iron stores are.

So if you are iron deficient or iron depleted, then yes, supplementation can be incredibly beneficial because it can mean that you are starting to put in a little bit more iron, so you're starting to auto correct that negative iron balance.

So instead of having less in and more loss going out, you're putting a bit more in so you can counterbalance that relationship going on there.

And for iron supplementation to work in iron depleted and iron deficient individuals, you need to be supplementing for about 8 to 12 weeks for any benefit to your body's iron stores.

And interestingly, because that hormone that regulates iron absorption is very sensitive to your body's iron stores, when you're depleted or deficient, the increase in that hormone isn't as high because it wants to absorb iron into the body because you need it.

However, if you've got good iron stores, So what we say is sufficient level so you're not depleted.

If you are supplementing, you're naturally going to drive a peak in that hormone because again, you don't want to absorb huge amounts of iron in.

So if you're a you've got good healthy iron stores.

Managing your iron levels through dietary intervention with the support of like I'm a nutritionist or dietician if this is an issue, can be your best prevention strategy in maintaining your iron stores while you are a regular exerciser as well.

And you said that the peak was three to six hours after exercise or that hormone.

So if you were doing it, if you were doubling like you're exercising twice a day most of the time, does that just mean it's chronically elevated?

Or yeah, actually some really brilliant research I think more recently done, I think it was maybe in the last year, two years maybe, I can't remember the exact date, but it was done by Alana McKay and Louise Burke where they actually looked at that double up session and they did it with rowers.

And because people were trying to figure out like, if I do a double session, does it increase further?

And generally they found that the double session didn't increase epsilon further.

It did just kind of go up and it just kind of stayed there a little bit.

So yeah, it didn't have that like additional effect, but it did almost prolonged that kind of area where you were not maybe maximally absorbing iron to the best of your body's ability.

But again, that response in the iron depleted or iron deficient individual, that didn't happen because again, our body iron stores are low.

So I'm not going to drive that hormone up.

I'm going to try and maximally absorb as much iron as possible.

Some it's, yeah, it's very much dependent on the individual's iron stores.

But yeah, this is some of that really intricate, interesting Physiology find why this happens.

For a lot of endurance athletes, it's unfortunately what we're doing naturally, kind of creating a bit of a situation which if we don't account for, can increase our risk.

I love evolutionary adaptations like this whole hormone adapted in response to inflammation, because when you're sick, there's an inflammatory response and you don't want an invading pathogen to have access to iron because they'll also use it to grow and spread around your body.

So your body, this ingenious evolutionary thing is OK, so we'll produce a high hormone response to information.

So invading pathogens don't have access to iron, but that's how you end up with this response post exercise.

So it's brilliant, it's ingenious, it works fantastically.

And then when you kind of put it with exercise and now everyday lifestyles, now you're like, OK, interesting.

But different.

What about foot strike hemolysis?

Is that Is that real?

I've heard it.

I've had a.

Skeptical every time we hear people strike got.

It I've had a few people mention it to me and when and then I've tried to read about it and it just sounds like there's a bit of conclusion hopping from my interpretation of the the research.

But I'm interested to hear your thoughts.

Is that something to be debunked or or am I being too much of A skeptic?

Skeptic.

And it is a It is real.

No, I actually love this.

I love way researchers are asked that kind of thing, like, yeah, I'm a skeptic.

Like what actually is happening here?

I think post exercise from the blood markers, again, I'm coming out of purely from a researcher perspective, when I look at those blood markers that indicate that there is that disruption of red blood cells as a result of those ground reaction forces.

Yeah, You do see that change in the hematology of an individual immediately post exercise.

And if I kind of think about it from like a physiological perspective, you're looking at cells that if we look at the membrane or the surrounding area, like 1 cell thick, like red blood cells aren't the most robust cells in our bodies.

They're not made to loss for a prolonged period of time.

They have a lifespan of about 3 months, like they turn over quite regularly for that turnover to occur.

They do breakdown.

There is that natural homolysis that occurs.

Can it be accelerated with exercise?

I think from the results that I've seen immediately post exercise, yes, that can occur.

I think it is a natural process in the body.

But yeah, I think my question back to you guys is what creates that skepticism for you as clinicians?

Because that's a learning point for me as a researcher.

I think for me it's in endurance sports iron deficiency or everything that you just explained in the natural adaptation that occurs from exercise and iron over time, depleting happens across all sports.

So why are we then sort of blaming it on foot strike in running and there the ground reaction forces having such a profound impact on the on iron rather than looking at, you know, the effect of any kind of physical activity or exercise for a sustained time period having a similar or the same type of effect on iron over time?

Think that's a great way of looking at it.

And I think if we kind of take a step back, it's there has been research in both running and cycling and naturally because cycling is a weight supported activity, the degree of hemolysis post exercise is a lot less than running.

But as the only thing, no, because I think as I mentioned, exercise as itself accelerates iron loss through various aspects.

So there are a handful of natural ways in which your body eliminates iron of which red blood cell turnover, that hemolysis is one of those aspects.

We can lose it so many other different ways.

So sweating, shitting skin, bleeding that occurs in the gut that like can naturally happen for women.

Like if you are a heavy menstrual bleeder, you're naturally losing more blood every month when that occurs and stuff like that.

That's those are all natural processes that are going to accelerate the iron loss, of which hemolysis is only one of them.

So by itself, it's probably not going to have a huge impact.

But cumulatively with everything else, that's where you start getting that accelerated iron loss.

So I think that's a really great way of raising it, but also acknowledging that as researchers to standardize how we conduct our studies and so that we can get the best results, we have to be quite strict on our methods.

What different sports that I can use where I can measure things quite readily.

And it's quite easy to put someone on an exercise bike in a lab.

It's quite easy to put them on a treadmill in a lab.

Sometimes doing some of those other sports where it's very dynamic and everyone's moving around.

If I'm trying to test and analyze those responses in a lab, it suddenly becomes quite tricky.

So I have to fall back onto those methods that allow me to standardize protocols.

And unfortunately, what that means is then we're extrapolating a lot of information to some of those other sports as well.

So again, it's just recognizing the fault set and limitations of research.

Now, Esther question, there are some very questionable running programs out there, very generic, I'm talking Bill to a marathon in 10 weeks kind of stuff, which I think we would maybe not agree with.

But what do you see is the problem with people following these, especially females following these generic programs and then how is the family app going to be different or how is the programming going to be different?

Yeah, for sure.

That's a great question.

I think I wish I had like a little screen to share with you.

But like I mean everyone listening probably has seen like a graph of, you know, a menstrual cycle over the month and you see like all the changing hormones that are happening throughout that time period, say it's a 28 day cycle.

And then if we look at male hormonal profile, which most generic programs, like I said before, are based on male data and the way that males respond to training protocols.

But if we look at those two comparatively, it makes sense that a program for a woman should be different, right?

Because you've got all these changes that are happening.

And like Claire was mentioning before, female hormones can change within 12 hours.

So the fact that we for so long have been handing out these generic plans based on like, male hormones and, you know, like you said, get ready for a marathon in 10 weeks, which no one should do.

And if you've.

Never run a marathon before.

Like if you're really fit already and you've got 10 weeks before marathon, like yes, that's maybe OK.

But general rule of thumb is no, don't do that.

But if we look at that graph, for example, and then we take a generic program based on male training protocols and how they respond to training, you're already ignoring this extremely important factor that's going to influence how most women feel.

So I think that's the first one, right?

Most generic plans are built from male data, male hormones and how they respond to training.

Whereas we've got this whole other thing to take into consideration when we're looking at programs that should be specific to women.

But then there's things like, you know, you're running history, your injury history and so on.

Like I just know for a fact me personally, I can't really.

Even when I was peak performance aged 24, me tendons were strong, everything was really good.

I still couldn't really run much over like 100K's a week and I would get injured.

Whereas when you look at someone like Lydia, the other cofounder of Femi, her body can handle up to 160 K.

So if I was given a program that was kind of, you know, a marathon based program, it was generic, it was built off male data and it was getting me running up to 120 KS per week.

And that build I'm most likely going to get injured.

So I think, you know, there's so many factors that play into making a good program.

Female Physiology for one, you know, injury history, running history, How many years have you been running like Cleo was mentioning before, sleep, things like that.

Like should we be pushing training to the next day and so on if we feeling really fatigued?

So I think it's just dangerous really to hand out a program that's super generic to people.

And we know the incidence of injury and running is already pretty high.

So handing out generic programs that don't take into account all these factors is just going to put someone at really high risk of injury.

So that's why generic programs are not good.

Yeah, I agree.

And to finish up and wrap up from both of you, starting with you, Claire, three ways that you see females be able to maximize performance I.

And like, I think when it comes to this kind of area on like, what are the, I think I always think about what's the main thing I would say to women if they wanted to maximize performance.

And of course, I'm going to be biased towards that physiological aspect as a researcher, but I've also seen how incredibly important and empowering it can be for women in terms of being able to advocate for herself.

What that can mean in terms of her confidence and her mental well-being as well, is actually making sure that you stop paying attention to this Physiology.

It might not dictate everything in your life.

So it might not dictate how you sleep.

Like there can be other things that can happen in your life like work stress, life stress, all that other jazz.

But actually empowering yourself to understand what's happening in your body so that you can communicate that and you can have the terminology to talk about it so that you're not suffering in silence if there is an issue is something that I can think of as a game changer to performance, whether that is in sport, but also in work and in life in general.

But then also recognizing it that it's not the be all and end all.

So if I also want to maximize performance, not only do I need to understand and respect my body, but I also need to acknowledge that I need to fuel it properly.

I also need to be getting enough sleep.

And so for me, that trifecta there of understanding your body, being empowered so that I can communicate and I have the terminology to talk about that when there is an issue, but also making sure that I'm feeling myself and sleeping properly.

Those are the three key things as a researching physiologists I would say are going to pretty much really ensure some real great performances there.

Esther essentially train with Femi is what you're saying?

Yeah, pretty much.

So hop on the Femi app.

No, I love that.

Yeah.

I mean, my top three would be very similar to what you've just seen clear.

And then I think just on top of that, by understanding your body more and, and you know, knowing your limits and understanding how you're impacted by hormones by tracking your cycle.

You'll become more consistent and I think consistency and training is sometimes overlooked for like short term gains.

Consistency over years is how you get better at running.

And I think the only way you can be consistent and stay injury free is, you know, tracking a cycle, aiming to have a regular menstrual cycle.

If you do have a natural cycle, listening to your body, resting and recovering when you need it and fueling your body, well, that is how you're going to stay consistent and running.

So yeah, everything Clear just said.

And then on top of that is that you'll be able to stay consistent so you can maximize your.

I love that.

And so this podcast, I've been, we've been saying for probably like 2 years that we should get you guys on or someone representing Femi onto the podcast.

And recently you launched the Femi membership and we thought, you know, what a well timed podcast to talk about, you know, everything that is behind Femi and what has brought, you know, light to, to Femi existing and you know, us being so lucky to be able to train with it.

Can you tell us a little bit about the the Femi membership and and how you see that you know, further empowering women to being able to achieve their goals or work towards particular focuses sustainably?

Yeah, for sure.

Yeah.

We launched the Feebie membership at the end of last year and we call it the ultimate membership for women runners.

So we see that as holistic, right?

We don't want it to just be a training program for women.

We see it as everything we just spoke about before in terms of like the education, learning from experts to therefore understand your body and feel more empowered and your body because the more empowered you feel, the more confident you're gonna be.

And therefore your performance is going to get better anyway because you're more confident in your body.

So the Femi membership is kind of wrapping that all up in one.

So within the Femi membership, we've got what we call specialized focuses.

So that's at the moment from a 5K up to the marathon distance.

Like I mentioned before, we do want to get into trail races and training, which is going to be a really exciting step for us.

And then we've got some other specialized focuses like mellow moving or like fire ups.

They all have descriptions within them, but they target certain areas of running.

So it might be that you just want more variety and spice things up because you find running potentially a little bit boring for mellow moving is more for someone that wants to still train hard, but reduce that intensity a bit and really like look after their body or sort of nurture more of that like tempo threshold training alongside long easy runs, that sort of thing.

So there's all of that wrapped up with what we call internally coach notes.

So we've gone into a lot of detail within each workout explaining, you know, what is a stride, what's the benefit of a stride, how to do a stride properly, You know, what's a fart leg session?

What's the benefit of a fart leg session at this time in your training block?

And how will that help you, you know, be ready for your marathon in 16 weeks, for example.

So there's a lot more education we've done to the specialized focuses.

We do still have free parts of the app as well as well, so you can access basic focuses so such as build your base or recover and reset because we want people to still be able to try FEMA and get access to running programs.

But then also for that more specialized personalized program, they can be part of the FEMA membership alongside that.

We've bought in our incredible experts a lot more.

So Clear, for example, is one of our amazing experts, but we have a whole team and we've launched what we call the FEMA group chat.

So this is essentially a web page where you can ask questions to our experts.

They'll be assigned the question.

They write A blog post that responds specifically to your question.

So it could be really personalized to you.

You might have an Achilles issue such as myself right now that you want help with, and that will be passed on to our incredible physio, Grace, and she will write A blog post answering that question.

So that's all part of the Femi membership.

Alongside that, one of our most sought after things from Femi is our merch.

People really want our hoodies and T-shirts and those sort of things.

So you'll get first access to the merch and exclusive merch drops.

So yeah, that's pretty much that.

The Femi membership as it stands at the moment, we have so many ideas of where it's going to go, and it's going to obviously include that Femi intelligence system that I mentioned before.

But yeah, it was I guess our response to holistically serving women to be the best runners and perform the best and feel the best in their bodies.

And that is basically, yeah, the Femi membership.

Yeah, it's so good.

I followed Femi consistently for the entire of last year and I ran a 10K half marathon and a marathon PB all last year and.

Congratulations.

And my and I, the other thing that I want to add so specifically to the listeners of this podcast who are predominantly clinicians is I will frequently recommend for new runners or depending on the injury, sometimes a return to running plan.

Learn to love running component of the Femi app.

Yeah, particularly like you female runners who haven't really got much guidance in the way of where to start is probably where I would recommend it the most clinically or someone who's had a long period of time off running and just trying to get back into it.

I, I find that to be so nice to give that to them.

Like it's very easy for me to ride out some random recommendations and, and a progressive run program, but I, I love that, you know, Femi encompasses everything within the app and I, I think that that's a really nice way to start to get people involved and women, you know, sustainably building up their running.

So I think that that's a really useful tool as a clinician.

And the other thing is the Femi Run communities.

So Newcastle launched our Femi Run community in April last year.

So we've been going strong and it is, yeah, such a wonderful way to bring together like minded women to run and we love it like every Friday.

It's such a nice thing to look forward to but, and there's also Femi run communities all around Australia and New Zealand.

So wherever you are in Australia and New Zealand and maybe beyond soon, have a look and see if there are any communities near you and go and check it out on a Friday morning.

Yeah, I'll just, so I just want to add to that with the return to run because I've mentioned that a little bit as as well.

And you know, as clinicians, we certainly have the knowledge to be able to help people get back to what they want to be able to do in between Kelly and myself.

You know, we see, you know, hundreds if not thousands of runners and right lots of programs and strengthening.

And the challenge we know even for the research is compliance.

And one thing the app does really well is it makes it fun.

Don't get me wrong, I love looking at a Word document with a nice return to run.

But when you.

Writing them.

Too yeah, but the app but I just makes it fun of convey.

The best?

Yeah, it's cool colors, it gives you some motivation.

It's it's time and you did mention it and I'm going to put you on the spot.

Kelly gets around in her family shirt.

And I love the women made to move.

Is there possible for a male drop?

I don't know there's any males wearing that.

But I really do like the T-shirt.

The merch is really cool, so I'm putting it out there.

Yeah, definitely, definitely.

We can come up with a slogan together.

Yeah, we need to.

We need to get more behind our male allies.

So absolutely, Blake, let's let's do a male drop for sure.

Sweet.

Extra large.

Extra.

Maybe extra, extra, extra large.

Yeah, cool.

I like that.

I've got that in there.

And good.

Amazing.

And So what is there anything coming up that that our listeners can look forward to in the way of Femi or where can our listeners find you if they do want to, you know, come knock on your door and ask you more questions about everything that we've spoken about already?

Yeah, for sure.

I think what you were mentioning before about the run communities, Kelly and yeah, she is obviously one of our incredible run leaders.

We're so grateful for Kelly showing up every Friday to lead the way there with in Newcastle.

But we have just launched the ability to search and find a run community in app.

So you can register, you can see who the run these are and then we see that evolving quite a lot to really connect women all over the world.

So we are currently working on the next feature around community and bringing more women into running and connecting through the sport of running because, yeah, just seeing the impact of the run communities on women's confidence and their sustainability and sports.

They feel supported by other women.

They feel confident to show up because they have that group around them has been really awesome to see.

So we see that growing quite a lot.

So that's kind of mixed up in terms of like the app progress.

And if you want to get in touch with us, just come to our Instagram page, femi.co.

We've also got a Femi Run community Instagram page.

Come and chat to us there or send a message or a question through to the Femi group chat web pages as well.

If you've got specific questions for our experts, we can get those blog posts ready for you.

But I think those are probably the best channels.

And if you do send an e-mail to support@femi.co, you'll be talking directly to me because I answer all those emails.

So if you want to chat to me, send us an e-mail as well.

Great.

And that'll be all tagged below as it typically is, just in the below the show notes.

Awesome.

Very good.

Thank you so much guys for coming on.

Really appreciate it.

Thank you.