FASTR program podcast episode

FASTR: Closing The Gender Gap In Sports Science Research

Topics Covered In This Episode:

  • What is FASTR?
  • Early identification and interventions to prevent injury and identify ways to optimize performance in female athletes
  • How the research from the FASTR program will apply to athletes, coaches, and parents of young athletes


Our guests today are Dr. Megan Roche and Dr. Emily Kraus. Dr. Roche has a medical degree from Stanford University but is now a Ph.D. candidate in Epidemiology and Population Health at Stanford focusing on bone health in athletes and the genetic predictors of sports injury. Dr. Roche is not only incredibly smart but also a brilliant athlete as a five-time national trail running champion and six-time member of Team USA. Dr. Emily Kraus is a clinical assistant professor at Stanford Children’s Orthopedic and Sports Medicine Center and is board-certified in Physical medicine and rehabilitation sports medicine – and is the director of the Stanford Female Athlete program.

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Episode Transcription:

Please note that this is an automated transcription and may contain errors. Please refer to the episode audio for clarification.

Corrine Malcolm (00:06):

Emily and Megan, welcome to the show.

Dr. Megan Roche (00:09):

Thank you. It’s so pumping on here. I feel like you just contribute so much to like many different areas across sport. Um, and specifically this topic women’s health, uh, female athlete, the physiology. So when we got this invite, I was pumped and double pumped that it was you doing the interview. I think you’re just, you have a depth way of interviewing and talking about this stuff. So excited for this. So thank you.

Corrine Malcolm (00:31):

Yeah. I’m excited to have you both here. Obviously I’ve had Emily on the show before, and although I don’t think either one of you are strangers to our listening audience. We kind of have a, a broad reach. We reach into the cycling community as well. So I’m wondering if both of you can introduce yourself just to the listening audience at home.

Dr. Emily Kraus (00:50):

Well, Karen, thanks for having us. Um, I always enjoy conversations and I know we, we both go ways back, um, so happy to be here. So I’m Emily Crouse. I’m a sports medicine physician at Stanford. Children’s orthopedic sports medicine, primarily working with young athletes that do work, um, ski adults as well. And I’m the director of the faster program, which will, um, explain and describe in a little bit, I’m a, a runner, um, my first love, but also a cyclist, uh, um, prefer the dirt over the road, but do all the, all the bikes, all the things and, um, just, yeah, excited to be on this podcast today.

Dr. Megan Roche (01:29):

Excited to join you to Emily. So I’ve gotten to work with Emily now over the last seven, eight years in this research world and truly grateful. I think Emily has shaped the trajectory of like my career, the trajectory of just even like sports and how I think about the world. So thank you, Emily for that. Um, yeah, so I, I grew up, I loved playing sports growing up. That’s kind of brought me to where I am now played field hockey, went to college to play field hockey and actually, um, decided to take a fifth year to run track. I realized quite quickly that running circles was not really my forte. And so I graduated to more running on mountains, running on trails. Um, I just, I, I being able to connect with nature. Um, and also, so I was a med student graduated medical school, and I’m taking a pretty non-traditional path, post medical school, doing a PhD in epidemiology, um, in population health. I get to study athletes as my population, which I think is a gift. It’s a unique population. Um, one that will obviously dive into today and through that time have gotten to where, um, with Emily through the faster program. So excited to speak about it today and just excited to be here.

Corrine Malcolm (02:31):

Yeah, I think we’re gonna get to share a lot of really valuable information with our listeners. It’s kind of a topic that I feel like I’ve been pushing a lot this past year in part, cuz I think it’s so, so very important. It, you know, encompasses all my previous lives and interests as well. And so as I mentioned, we had Emily on the podcast last year to talk specifically about the Western state study, um, which was super, super cool. Having been a part of that study and then kicked out of that study personally, cuz my Farin was too high. Yay. Um, but I looked at bone density via DEXA scans, um, and surveyed. Um, I think it surveyed to assess disordered eating traits, looked at bone stress, injury, history, training volume, sex hormones, this whole thing to kind of look at this relationship in both male and female ultra runners, which I know is encompassed in some of the faster research. But since then, and most recently y’all have launched a very, very cool program outta Stanford called faster or the female athlete science and translational research, which is a great acronym. I think you guys knocked that one outta the park. Um, can you set the stage for us? Like what exactly is faster and what do you hope to accomplish with the research group?

Dr. Emily Kraus (03:42):

Yeah. Karen, thanks. Um, thanks for the, the first podcast. It was great to, to chat about Western states with you and our, our ultra marathon study. And, um, Megan and I are, are working on some manuscripts right now to hopefully get out, um, in the next few months or at least within this year is our goal. Uh, but um, yeah, we’re so excited to transition and launch. Um, at guess you would say faster, um, stands for female athlete science and translational research, as you said. Um, so this was, uh, created based on a new initiative, um, called the WSI human performance Alliance and that involves six different institutions, um, throughout the country. And um, it’s um, their goal is to really address, um, uh, really focus on research on health and performance of athletes of all ages and specifically, um, focusing on the female athlete.

Dr. Emily Kraus (04:31):

And so we’re working in close collaboration with Harvard, Boston children’s and their female athlete program and really trying to address this, um, gender gap that’s still present in, um, human research, um, are really trying to close that gap and help female athletes understand their body better so they can, um, perform in their sport better and um, just really, um, exercise in life better. And so it’s been exciting to just launch the program and dive into some of the research and um, I’m the director, Megan’s the research lead. I pulled her in very quickly after, um, catching wind that I would be, um, the director and kind of forming this program. And so we’ve had a great time building our team out and, and prioritizing our projects. And, um, Megan, I I’d love for you to share a little bit of, of your perspective, but so far it’s been, been a wonderful experience and really exciting, um, what we’re working on.

Dr. Megan Roche (05:28):

Yeah. I echo that 100%. I think the big thing for me is oftentimes in the research world, we spend all this time doing research. Um, we spend all this time then running up the manuscript and then it gets submitted to a journal and published. And oftentimes I feel like there’s this lack. So it goes into a journal and it just doesn’t reach the audience that we hope it, we hope that it reaches. And so a big part of this too, is figuring out how can we translate this research? So this research is being done. How can we help athletes, you know, break this down, explain it, make it tangible for athletes, parents, coaches, that way we can have hopefully the largest impact and make sure that this research gets translated, um, into this fields that, that it needs. And so I think that’s been a, a really fun part of this and we have one specific project and it’s kind of become a larger part of faster as well is I think sometimes when that information comes from scientists or clinicians, sometimes it can be like a little bit scary or it’s coming from a science perspective.

Dr. Megan Roche (06:23):

And so we’re also working with role models in sport to help translate that. So to help educate them, to help, um, use them as translators of this information. And I think for me, that’s been something that’s really rewarding is, is getting to have the education and making that education is strong and also working with role models to share their experience surrounding that education. Like how does that allow them to have longevity in sport or to have stronger mental health or stronger physical health? And that piece to me is very mean,

Corrine Malcolm (06:49):

Yeah, that’s, that’s huge. I mean, that’s what I realized while trying to be a grad student was that what I was really passionate about was not necessarily doing this science, but was about helping to translate that science to a wider audience. And it’s, it’s true. Like you can be the smartest person in the world doing the coolest research in the world, but if no one understands what you’re doing, it doesn’t, it doesn’t really help anyone. It doesn’t, it doesn’t like close that like I guess, gap in information or that, uh, gap in the loop of information. So I guess I’ve got two kind of questions that are gonna follow this vein, but the first one that you guys kind of touched on here is that your audience is coach not only the, the athletes themselves, but the coaches and the parents of these athletes, particularly young athletes, which seems to be a big focus right now is that yes, we can get this information to the athletes, but how do we get it to the coaches and to the parents? So how can those listening at home honestly, are predominantly going to be parents of young athletes or coaches of young athletes more than this information necessarily impacting them personally. Like how can they utilize what you all are doing?

Dr. Megan Roche (07:52):

That’s a great question. I think for us. So we’re really working in, we are very much in the early stages of this and excited to have kind of these timelines of where we’re ahead. The first part of the stage is producing educational videos and those are specifically four athletes and this is just one part of faster. And again, we have many different research studies, but in producing these educational video series, um, topics, we really hope to engage with athletes, to have these conversations with role models and to really just make the science fun and engaging in also powerful. So I think sometimes there’s like, you know, we, we come up at these terms of like, oh, periods are this like frustrating things that female athletes experience and really working to harness that in the positive. But as far as parents and coaches go, I think it’s about, you know, this, we have this educational video series and we have video series 2.0 and 3.0, we already have those like, thinking about those in the timeline.

Dr. Megan Roche (08:40):

I think it’s really about understanding, like what is the vetted content out there? What is the content you can trust? Like there’s so much scientific content. Like what do you trust? What do you believe? Like how do you actually distill that and practice that. And over time we really hope to become a platform where you can log into our platform. You can log into our website, you can come to our Instagram account and we’re highlighting the science that we feel like is vetted and done by experts in the field and really trusted. And I think that’s a big component of it too.

Corrine Malcolm (09:07):

Yeah. Emily, do you think? And another there, sorry.

Dr. Emily Kraus (09:10):

Yeah, yeah. Megan, you summarize that nicely. And yeah, our part of our pilot study is looking at how these educational videos, educational, inspirational videos can, um, how they’re accepted. If, if athletes even will watch these videos and engage and want to watch all of the videos on a variety of important topics that we feel are important for their health and performance. Um, but also we want to see if that actually can help change, um, their perceptions to body image, um, athlete mindset. We’ve got some great, um, collaborations that we’re working on within Stanford, um, that are really studying, um, kinda new novel ways to, um, change an athlete’s mindset. And, um, the other piece to this is, um, kind of beyond just, yeah, this faster pilot 1.0 video, 1.0 is in these next, next, um, variations in these next phases. We really wanna, um, focus on both the performance and the health health component.

Dr. Emily Kraus (10:08):

And, um, oftentimes when we’re working with these young athletes and coaches of young athletes, it’s, it’s nice to be able to make, help them realize that good health and optimal health will lead to optimal performance. And, and sometimes it’s like one or the other, like you’re sacrificing performance because, um, an athlete’s getting her her period and, and that’s an old, um, myth and misconception. That’s still being carried through in some of these teams. And so really, really wanna shift that at dialogue and say, Hey, it’s, it’s normal and it’s healthy. And, um, it’s, it’s going to help that athlete perform better to have, um, regular periods throughout the season. And it’s not Aite of passage to lose your period. So, um, finding ways to translate that information in different methods through the platform, through videos, through infographics, blogs, um, different ways that are really easy, short, um, and digestible for, um, whatever audience is, is our priority. And I think it will be a bit of trial and error. Sometimes we feel like we’re we’re startup, but, but it’s, it’s been exciting to just get the early feedback from, from different, um, different groups, um, including yourself

Corrine Malcolm (11:21):

That’s that’s so I think, I mean, I’m already excited about 2.0 and 3.0, and I would encourage anyone. Um, who’s listening to this, you have to go check out the Instagram page. It’s super interactive. It’s been great information to follow, um, and check out the website as well. And we’ll link all of that too, in our show notes. Um, and we’ll give you guys time to kind of plug if there’s any other way for people to get a hold of you, particularly in regards to faster, um, in a little bit, but I think something that Megan touched on, um, when she was introducing faster, was this idea that, um, you know, representation in the research is really important, um, historically, right? Like you look at particularly exercise physiology research. This goes for medical research as well, but who are the test subjects? The test subjects are male college students because we can pay male college students to do just about anything, but that is, doesn’t always represent the population that we’re trying to get to or get at or, or represent the population at all. When we’re talking about like, what, you know, how does this apply to female athletes or young female athletes or old female athletes? And so I’m wondering, obviously that’s been, that’s motivating some of this research, but I’m wondering, you know, how has that motivated, motivated the work that you’re both doing right now?

Dr. Emily Kraus (12:38):

Uh, no, Karen, I think you just, you highlight this, this importance, um, need and gap, and there’s been some good reviews, review papers out there, just identifying how many papers there are that are focusing solely on, um, female athletes and it’s alarm and Le low and, and it it’s is improving and there’s more dialogue out there. And there’s great both, um, kind of journal articles as well as just, um, kind of more media, um, presence or media about on these topics. But some of the challenges that have been previously, um, stated is that, um, with females, with their cycle, it is, um, harder to control and how or hard order to measure those different, um, different phases of the cycle. But there are a lot of great articles and, or research studies out now, as far as, um, outlining really good methods to conduct great research so that we can navigate those, those important questions.

Dr. Emily Kraus (13:35):

So we’re not trying to guess, and, um, try to extrapolate, um, male athlete research or take anecdotal, um, evidence from a couple of, um, examples of some very successful athletes. I mean, we wanna see larger population studies on these groups, but, um, I think there are just some challenges that have been just dismissed in past research. And I think now thankfully groups are like, no, this isn’t a challenge. These are, these are things, um, just like a workout. It’s like, you, you train for that and you prepare for that through good, good methods. And I’m lucky to have, um, people like Dr. Roach, who’s a getting your PhD in epidemiology. We’ve got a statistician, Chris and Sinani who, um, are kind of our, they help me make sure that we’re creating the most, um, high quality research possible. And we wanna take that, that research and share that information. So, um, coaches aren’t in the dark,

Dr. Megan Roche (14:33):

I think too, how I think about this is like, why is the gender gap happening in research? And I think there’s all these different tens and which you can extend it out and think about like where this originates from. And I think like in epidemiology, we like to draw arrows. It’s like this comical thing that we do in epidemiology. And I can just see this like field of all these arrows being drawn out to explain, and to even just partially explain why this gender gap exists. I think a few things that I can think of is we really need people at the top. So like top coaches, top academic institutions, um, top leaders in sport to ask for the science to so say like, uh, the science, it isn’t there for female athletes. Like we really need to see this. And so I think, you know, having that, having that conversation really helps.

Dr. Megan Roche (15:17):

I think also too, I think even, you know, there are some studies out there showing that women’s participation in sport is growing rapidly, but I think that’s also pockets in which women’s participation is smaller. Um, I think about like Western states in our study, we had a smaller percentage of female like participating, but it’s also a smaller percentage of female athletes that are doing the race and how can we create like systemic change to increase participation in those specific niches or those specific pockets. And so I think for me, it’s just about like untangling all those different areas of like where the origins of the gender gap exist as well. And thinking about each of those and just trying to, just trying to do the best we can, um, and continue to, to drive the research forward.

Corrine Malcolm (15:57):

Yeah. I mean, I think at best right now, particularly over the 50 K distance women make up about 20% of most races at, at best. And it’s like 9% when you nine to 11%, when you look at things like O C, C, C, C U T M B, these kind of big like international class, um, championship style races, let’s call it. So it’s, you know, there is this kind of, although that that field is growing more men are involved in the sport as well, but I don’t think that should negate research being done and lead us guessing or trying to extrapolate this information. And I think, you know, is there anything that you’d like to highlight in that space as far as like the research that’s been done or research that you guys are actively working on within faster to, I don’t know, ch change the narrative of how women can be used in, in research studies moving forward so that we do have actual information to go to coaches to go to athletes, to go to parents with.

Dr. Emily Kraus (16:56):

So I’m not gonna take, uh, credit for this one, but just, I just shared this with the slack channel today. Um, there is a recent methodology review paper from the international journal of sport nutrition and exercise metabolism that broke down. Um, and it’s called a protocol to audit the representation of female athletes in sports science and sports medicine, race search. So I think that is a great example of ways that all researchers have to start to design studies and even audit or look at, um, prior studies and review them, um, to make sure to help sniff out the, the important information and see what were the limitations of this study. So that’s kind of where like a, a starting point to, and a gauge for future researchers. But I also think that there is this interest, and now that we’re talking about it, more coaches are hungry for more information and they, they want to know how do we initiate this conversation.

Dr. Emily Kraus (17:50):

For example, I’m giving a talk to a local high school this afternoon about, um, pur periods, puberty, and, um, and, and reds. And, and that’s, that’s one way is kinda using these videos, using these different, um, ways that are a little less awkward, but help set the environment and create that culture. And, um, I think Megan and I, we both talked about some of the challenges that we’ve had in, um, some of our other studies, um, with, um, recruitment of female athletes and getting buy-in on certain, um, certain areas such as, um, optimizing nutrition and on a nutrition intervention and the collegiate world. And, um, Megan, I’ll kind of pass the bat on over as far as like what you felt like worked best because once we realized this, this piece of, and this important component, I felt like it really changed the changed the game as far as, um, our success in the study.

Dr. Megan Roche (18:43):

Yeah, absolutely. And I think that actually dovetails into what I was thinking about in general is the idea that I think, like it’s really hard to provide answers without asking the questions first. And so I think a big part of that sort, a big part of that PAC 12 study was going to athletes, going to coaches, going to like key thought leaders in sport and saying like, Hey, what is the information that you feel like we are missing? And like, are there ways in which you think we can go about doing it? And I think that asking those questions, I, for me, as a coach, as an athlete, as a reach, I’m sure has been really interesting. But speaking to that study that Emily was talking about. Um, so in the healthy runner project, in the PAC 12, we were largely recruiting athletes based off of, um, you know, kind of highlighting the study as an injury prevention study.

Dr. Megan Roche (19:26):

And once we shifted to talking about performance, I think it made all the difference and shifting into having like coaches talk about it, um, captains talk about it. And so I think those two points are really interesting when it comes to female athlete research is highlighting it in the frames of performance and having role models and thought leaders in sport. Talk about it in a way that’s really exciting and empowering and not just like, oh, we’re doing a research study to figure out when, you know, you might be most impaired. It’s like, no, we’re doing a research study to figure out how to most optimized performance, how to make, you know, this performance, like a really fun and exciting time for you. So I think the language surrounding how we talk about science is a big thing too.

Corrine Malcolm (20:03):

Yeah, that’s interesting. I’ve always kind of, uh, I don’t know, razed my previous like PIs and stuff, but the fact that I think there’s this dis connect sometimes between the lab and like the field when it comes to this. Right. And like, I’ve always thought about it in like other, other ways. Like I was like, no, if you give that person, this internal thermometer that they’re gonna ingest, they’re going to poop it out before they get to the start line, you know? And they’re like, no, no, no, no, no, that, that, that the transit time doesn’t line up, but, you know, so it was like this disconnect between the, like what we know happens in the field, in our specific sports versus what the lab thinks is gonna happen. And I didn’t, I’d never thought about that in the sense of language that if you change the language, how you’re present, like how you’re presenting it, that would have such a great impact. I think that’s really, really fascinating.

Dr. Megan Roche (20:49):

I love what you’re highlighting there. And I think actually what you highlighted about the disconnect between the field and what’s happening in athletes or in coaches, I think that’s where the idea of like asking questions and bridging that gap through questions. So the, the field can understand, like what, what, yeah, I think it’s just like, that question allows you to bridge both of those gaps in a way that helps like, reduce, reduce that gap over time. Um, but yeah, we’ve, we’ve seen a big impact on language and I actually, in our study, I think it would be really interesting over time to start to narrow down, like what is the most effective language, um, and to get at that through like control groups. And certainly that could be like faster 4.0 5.0, but I think there’s a lot of work to be done there. And we we’re bringing in some elements of mindset into faster, but, um, I think mindset surrounding the language that we use and how that inspires athletes could be really interesting.

Corrine Malcolm (21:39):

And then I think the other interesting thing here too, and then Emily, you can tell me whatever whatever’s on your mind, but is that oftentimes like, obviously I come I’m from exercise physiology background, but you both come from this clinical perspective as well. Obviously you’re both athletes and you both think about sports performance a lot, but I think that bringing this clinical aspect to what is in a lot of ways, exercise, physiology, or least inclined research is really cool because I think that elevates a lot of ways, the, like the, the field of exercise physiology, because historically there, I mean, there are many good studies, but there are also many bad studies in the field, right. With either small sample sizes or the methodology is really sideways or whatever. So I think is there, have you guys actively thought about that as far as coming into this kind of Cole and performance area when it comes to, like you’re talking about sports, but also health in general?

Dr. Emily Kraus (22:38):

Yeah. I think we kind of naturally just through our, like both training and in medicine and now like practicing medicine and the athletes that are coming into my clinic, I just, I feel like it hits home. When I see that athlete who comes into my clinic, who doesn’t have the information that they, they needed, who was either over training, who lost her period, who, um, did some other weird dietary habit because it was trendy or because, um, it was something that her parents were doing. So she was doing, because it was on the table. And so those things, I just, for me, it motivates me within the, the clinic, the research side, and sometimes either drives a certain research question or really like pushes something that we’re already working on. And I think for me, like language words, matter humanizing, some of these really tough science topics and, and sometimes normalizing it too.

Dr. Emily Kraus (23:38):

And so through even just some of our, our videos, we’re giving examples, we’re bringing an athlete’s story into the picture. And then that, that a, the athletes who listen to them, they’re like, oh, well, I’m going through that right now. And then they can be like, oh, that’s not, that’s not something that’s a natural process that that should be happening right now. And then they either talk to somebody or sometimes I’ll get an email or even a DM from somebody with at their story. And I’m like, oh my gosh, this is awesome. Probably shouldn’t be doing this through DM though. So let’s take this professionally and take it into a clinical study, but those are, that’s the segue. Or like, Hey, I read this, um, read this blog on this. Uh, and I, I wanna know more. And if that blog is scientifically sound, then we’re in a good, we’re in a good spot where we’re going somewhere. And so I think we’re just like pushing that, that good science out there in a way that actually is, um, approachable.

Dr. Megan Roche (24:33):

I think also too, on this topic, we’re pushing the idea of like a more complete athlete out there as well. So sometimes, like, I think it’s really easy and I’ve fallen into this trap before where like you just get going down this silo where sometimes athletes or coaches might think of athletes as like VO two max or hemoglobin or hermatocrit, but in reality, there’s so many variables that feed into that. There’s mental health, there’s bone health cycle, there’s, you know, V2 max hematocrit. And I think being in all of these different worlds, it’s cool to see how they all combine and kind of form this complete athlete. And that each element is very important to that equation. Even if it’s not like textbook within the field of exercise physiology or textbook within the field of sports medicine. Um, you know, there’s just so many different parts of what makes an athlete whole and perform well. And I think the more that we can talk about that and highlight that in the multidisciplinary way, like the stronger and our athletes are gonna be in the more resilient they’re gonna be over time.

Corrine Malcolm (25:27):

Yeah. I had set up a question kind of like, why is education important? And honestly, that’s kind of what we’ve just been talking about though in a lot of ways, right? Like it’s, how do you bridge that gap? How do you use language that’s familiar? And I don’t know, not like, not scary, but I’m wondering too, like, how do we, you know, obviously this, maybe this goes back to the clinical, you’re talking a lot about like the ho like a holistic approach to an athlete, like the whole picture, right. You’re not just performance, you’re all these other things. Um, is there a way that you found that’s easy to translate that into like approaching, you know, athletes, coaches, parents, their support system, et cetera, or has that been like the biggest, I don’t know, the biggest hurdle in a lot of ways of trying to ask those questions.

Dr. Megan Roche (26:09):

Yeah. I think for me that gets down to stories. Um, so I think sometimes there’s a lot of athletes and I know I was like this early on as an athlete. I loved math, but like when someone came to me with numbers and statistics, it just didn’t feel tangible. Like it felt like it was hard to apply to myself. And I think the more that we can share stories of athletes who have like been through the tough times and rally, or have like been through the tough times and are embracing it and working through it or any number of stories, I think they’re just so much more relevant for the athlete experience. And that’s, I think truly our goal at foster is to provide education through stories. And just to see if that, you know, helps athletes engage with this topic. Um, because I know that’s how I engaged as a young athlete. And, um, I think I’ve seen that in athletes. I coach too.

Corrine Malcolm (26:52):

Yeah. I’ve been talking a lot about representation recently. Like you have to see it to understand it or to know it or to see yourself in that position. So this is definitely like, this is a little bit tangent and I, and not send you guys this question. So bear with me. Um, but on that kind of idea of representation, how important do you think, like, is it like, I know I’ve had to share my story, Megan, you’ve been sharing your personal health story, um, with kind of, not beyond your athletes with like the, the running world. Like how important is that to encourage athletes to obviously, you know, privacy is privacy, but to, to make themselves vulnerable and share that stuff as far as like, okay, like, this is what I’m going through. These are the mistakes I’ve made, or these, this is what I’ve learned through this journey. Like how, like how much can we encourage athletes to share their stories in a form of mentorship in that way so that young athletes can see that and can relate to that. And can, you know, we recognize their own personal red flags potentially.

Dr. Emily Kraus (27:49):

Yeah. I think, I think very important. I feel like openness transparency and sometimes going off the cuff and being less scripted. So very, very timely print is, is so, so great. And it’s, there’s a lot of vulnerability with it too, because I think there is this or perfectionism at all times. And at some point we’re going to break, we’re all going to break and whether that’s an injury, whether that’s, um, just underperforming and when other athletes can share their own perspectives and their own experiences, I think it enriches the, the team bond. If there’s a team, um, it may enrich may be just this understanding and appreciation for sport and individuality within sport, and that every body is different. So we’re going to respond to training differently and we’re going to respond to fueling strategies differently. And so I think something that I’m very careful about in the education and even my clinical practice is it’s not making some blanket blanket statement and, and really making, making sure that I, I factor in that individual athlete.

Dr. Emily Kraus (28:57):

And I love, I love taking that holistic approach. And I think that’s why Megan and I really like bond over over the, the research that we do do conduct is there, there does need to be kind of this, this openness to different athletes of different body types and, and talking about it. And I think that’s, that’s where some, some people Dodge and don’t even get into it, but I’ve learned. And Megan, and I think we’ve learned even through our video experiences is if we don’t even express our discomfort in this certain area, and we just try to avoid it or, or maybe maybe script through it, people are gonna read right through us. And that credibility that we’re really trying to, to show, um, because we do have, um, the, the background to be able to share this information. Um, it’s just gonna get lost.

Dr. Megan Roche (29:49):

I, I agree so much with that actually, personally, I didn’t used to open up a lot as an athlete. I just felt like I was like, I’m oversharing. It just doesn’t feel right. And it’s really helped me, I think over the years as I’ve gone through some health stuff, because that community approach to me, I feel like it’s the, it’s the fodder for times when it’s just like hard to keep going, like seeing someone in who has had like for right now, for example, right now I’m dealing with myocarditis, my heart. And I’m like, I just wanna see one person who has come back and excelled in sport after myocarditis. And it’s like, you really like latch onto and like hold onto those examples of people and people have been so kind generous reaching out to me and we hope to do the same for other athletes. So, you know, provide examples of athletes across all kinds of background to have excelled in sport because hopefully that makes one young athlete feel like they have a role model or an example for them.

Corrine Malcolm (30:34):

Yeah. I want athletes per particularly the people who can act as mentors right now to, to not feel like they’re showing weakness, cool. Like vulnerably, they look at vulnerability as this, like this toxic thing, this bad thing. And really it’s like, no, like you’re hurt. Like, let’s talk about it. Let’s share that because the likelihood is that it relates to someone, or even with my own athletes, like, they’ll be like, oh, I had a bad workout or a bad day. And I’m like, cool. Like we all do like, and sometimes it’s just like, even they need to hear that they need to hear, like, they need to see on your Strava that you’ve had a terrible day and you sat on a rock and you cried for a bit. Like, I think that you have to kind of break down those barriers of like what, I don’t know, people, people have this like impression that our lives as like elite runners are perfect all, all the time.

Corrine Malcolm (31:16):

And like, everything’s just easy breezy. We’re never hurt. We’re never sick. We’re never upset. We never have a bad day. It’s like not the truth. And it, that goes probably to social media, right. And our, uh, our inclination to only share the highlight reels. But I’m glad that you guys have found this way to be like, okay, this topic might be uncomfortable and we’re gonna have to share it. We need to talk through it. Um, that’s a long rant on my end for the it’s. Okay. That’s my podcast. So I can kind of do whatever I want. Um, I guess one thing that I’d like to do, and this is kind of a pivot from what we’ve just been talking about. And obviously the unsexy answer is like, it’s individual. It’s gonna be different for everyone. But I joked with Emily A. Little bit. Last time I had her on the podcast and said, okay, we’ve discussed, you know, what is low energy availability?

Corrine Malcolm (32:03):

And we discussed what is relative energy deficiency in sport. But then I was like, maybe we should do one called like, oh, you, you really messed up now what? Or like you, you’ve got a bone stress injury now, what, and I’d kind of like to just spend the last kind of, bit of our show before I do it, my, my kind of Roundup questions of like, what can athletes do? Like if they, if they understand what, what reds is and what low energy availability is and they’re, and they’re worried, they’ve got all the red flags they’re feeling bad. They maybe they’re like me last year. And yeah, broke, you broke. You just like recently broke your pelvis, whatever it is. Like, what can an athlete do sitting in that position or a coach of an athlete who’s sitting in that position or a parent of an athlete who’s sitting in that position? Like what, what are the, like the broad next steps for those individuals?

Dr. Emily Kraus (32:52):

Uh, I, I vividly remember that that part of the conversation you’re like you have stress fracture now, what, and I think it’s, it’s really hard for an athlete to navigate. They’re frustrated. Sometimes they beat, beat themselves up about the, the, the fact that they got the injury. And, and first of all, I think just being really humble and like, and also just having some grace and like forgiving your yourself through that process and, and relaxing and taking a deep breath is, is step one. I think I also really advocate for athletes to advocate for themselves and, and seek out the right care. And that might be a second opinion, a third opinion, um, really using the resources within the community to find the right person to, because until that happens, it can be a very, very, um, discouraging experience. And I’ve talked to a lot of athletes who are in tears because they’re just so fed up with, um, a, a professional saying, just don’t do that activity.

Dr. Emily Kraus (33:57):

Or, um, you should, you should retire, or there’s not, there’s nothing else for you is no other help. There’s no other option. And, um, I think finding someone who actually listens and who will look beyond just maybe the injury or beyond, maybe kind of think outside the box is so important and sometimes vulnerable for a physician to do. And I think for physician, and to be able to even admit like, Hey, I’m gonna have to do some, some digging and find the right person for you, or, or maybe find it, someone that does have a better, more experience. But, um, those are like, I think the starting point is, is really advocating for yourself and the best care possible. And I know I’ve just, I’ve talked to a lot of, um, athletes and friends recently who really struggle show navigate the right, um, professional care for their injury or their, their medical issue and, and, and really being like persistent and cons persistent with that, um, pursuit for the best care.

Dr. Megan Roche (34:58):

I love that answer, Emily. I think that, I think too would be right alongside that clinical care is also thinking about mental healthcare too. I think there’s some really interesting lines that get drawn between relative energy deficiency in sport and mental health and lines that go both ways. And I think really starting to UN untangle the mental health piece. Um, and at the same time, as Emily was mentioning, like giving yourself grace, acknowledging that like going through this process and starting the process and re reaching out for help is a big, big thing and an awesome thing and something that should be celebrated. So I think, you know, adding a therapist, adding a counselor, even just like someone that you really trust that it’s been through this process before to your care team can be really helpful. And then, you know, giving yourself that grace, um, as Emily mentioned, just pivotal and important and paramount in this process.

Corrine Malcolm (35:46):

Yeah. And I, I can say I am an athlete that has cried in Emily Cross’s office, so you’re not alone in that at all. And I, and I also, I think this is important to add to this conversation a little bit here before we got on, before we hit record, Megan and I were chatting, waiting for, uh, Dr. KRAS to get out of another, another important meeting, maybe a more important meeting than this, but, um, that even as, you know, people who have a lot of connections into the health world who have high health literacy, it’s really hard to advocate for yourself in these settings. It’s really hard to find the right practitioner. And, and you will is like, kind of what I wanna say to the audience. Like you can find that, that person, even if you kind of the first one, isn’t it.

Corrine Malcolm (36:28):

Um, because we’ve all been told you run too much, right. Is that fair? We’ve all been told. Maybe you should run less. And that isn’t that maybe that is the answer, but it’s not always the answer. And so I of think, I just wanna encourage people to, to keep, to keep reaching out and to keep looking for more help, if you feel like you’re not getting the help that you deserve or need, or it’s not, it’s not, you know, it’s not sitting well with you, I guess how I’d put that. And so with that, we’re gonna kind of slowly round out this conversation. And what I wanted to do next is just if people obvious say faster 1.0 is kind of out into the world and faster 2.0 and 3.0 and 4.0 is coming down the road. So what can people do if they wanna learn more, just like generally find you, what if they, or if they, if can they get involved, is there a way for people to get involved down the road? Um, I’m thinking, you know, high school coaches, college, college coaches, that kind of, how can people, um, get a hold of you all and faster to, to continue to learn more, but also to just, you know, reach out if they need or if they can help.

Dr. Emily Kraus (37:29):

So this is a great opportunity to give a huge plug to our clinical research coordinators, Abby McIntyre, and, um, Ellie, Ellie diamond. And they are phenomen. They helped build our website, um, basically from a template and through the website, faster dot Stanford EDU. Um, we have a lot of information as far as, um, the research projects that we’re currently working on. And we’re gonna use that platform or use that website to, if there are opportunities to recruit coaches or for certain studies, as well as, um, opportunities to get involved. Even within our team, we have some summer under summer undergrads, um, through Stanford that we’re taking on on the summer. And we get a lot of, um, outreach of people that wanna get in involved in, we would love to take on, um, and have this massive army or whatever you wanna call it. Um, big squad of, um, faster, um, researchers, um, like in the field and in the wild. And maybe, maybe that’s in like 3.0 4.0 or in a year or two, but that’s, um, that the website is where you can get a lot of resources far as what we’re up to, um, as well as our Instagram, which is Stanford faster.

Corrine Malcolm (38:40):

Yeah. And we’ll link all that in the ness. Megan, is there anything, any other ways that people can reach out or get involved if they’re curious about this stuff?

Dr. Megan Roche (38:48):

No, I echo Emily’s point. She summarized that fantastically. I think though, if you could have taken the response that we got in the first stay that we launched faster and showed it to the female athlete population, we’d be really excited about the trajectory of women’s sport and sport in general, because the messages we got were like, so kind excited, wanted to be involved, like wanted to support a more inclusive and diverse environment and for female athletes. And I just, I was sitting there like, oh my gosh, this is so cool. And there was some way that we could publish them anonymously, but there’s a lot of interest out there. I think this field is growing so much in addition to the work that we’re doing, seeing work, pop up all over the place in different directions. And it’s just inspiring to be a part of that. And, um, yeah, I think Emily did a great job highlighting that.

Corrine Malcolm (39:31):

Awesome. Um, I’m really kind of impressed. I didn’t say awesome and amazing everything word this entire podcast, cuz that’s my default setting. Um, so we’re doing great, but if people were interested or like have enjoyed this conversation, which I’m hoping they have, I’m sure they have, is there a book or podcast or content that you’d recommend they pick up? Like if they, if they want to, self-educate more something that would maybe click in the same kind of pattern. Is there, is there any, any kind of content out there that you’d send them to outside of the faster sphere? The pressure is on

Dr. Megan Roche (40:05):

The pressure is on, I can think of a few. So I try to send people to, um, Instagram accounts or science or books where they can actually like reach out and get dedicated help to, um, I know too amazing, um, nutritionist that are well versed in red and the FEMA athlete triad. Um, one is fueling forward, Matt M um, she does a great job to producing infographics on, um, a lot of these topics. Um, and the other is Kylie van horn. Um, at fly nutrition. She actually is a, she is a nutritionist, um, and RD that writes trial runner magazine and, um, disseminate a lot of this information. I feel like in ways that are easy to understand, um, strong scientifically. So I think both of them, um, incredible role models and leaders in scientific experts in sport.

Dr. Emily Kraus (40:51):

Yeah. And I think I, I don’t wanna butcher this website, but I think it’s period of the period has a lot of really good, um, just kind of menstrual cycle based research, both for athletes and, and everywhere or every for athletes and, and non athletes. Although I feel like everyone is an athlete to, to some extent and they have a lot of, um, research or resources as far as website and links and, um, different, different just basic information about menstrual cycle menstrual cycle.

Corrine Malcolm (41:17):

Awesome. And then I’m gonna, once I told you, I was gonna say it awesome. That’s my segue every time. Okay. Um, at least I’m learning something about myself. I’m gonna kind of combine this last question because you are, you, you, the two of you do a lot of stuff. You are athletes, you are researchers, you’re physicians. Um, it’s really cool that you can encompass all this. And I think Emily’s already gotten this question once, so hopefully she’s ready for this the second round. Um, but I always like to ask people this, like what, um, what do you like, is there something that, you know now as, and this could be your physician hat on your researcher, on your athlete hat on that, you know, now that you wish your younger self let’s say even five or 10 years ago knew new, then like, what is, what is, what is that thing?

Dr. Megan Roche (42:04):

I think I’m gonna go with something that I think I could apply across almost everything I do in life. So I’m back home right now and Philadelphia recording the podcast. I, I live in Colorado and being back here has reminded me just how intense I was growing up. So I came like into life with this like fiery intensity that I applied to everything. And I think over time it put, I, it allowed me to put like so much pressure on myself and to nearly burn out and almost everything I’ve been doing. And I think it took a long time to how to inject elements of play into everything I do and just making things fun. So we have a lot of fun in our faster meetings. Um, it’s been something that like our, our faster slack is a lot of jokes, a lot of joy. So, and I do the same. I’m in running too. I think I throw some airplane arms when I’m descending on mountains. And that element of play, I think, has been key for just remembering why we do all of this and for finding the love of it and creating community too, along the way.

Dr. Emily Kraus (43:03):

Yeah. I feel like last time I probably shared something about, um, maybe my, my bout of iron deficiency where I almost needed, um, blood transfusion. So, um, there’s that, there’s that moment and happy to share that again, but you could probably find it in a couple of other podcasts, um, as far as my own, um, just, and I was in med school at the time of all the times when I feel like I had this information and was actively learning and understanding my own impaired physiology, but I also, I think I echo, um, Megan, I was a pretty, um, intense, intense kid as well. And I think giving myself a little grace more often and, and not striving for like, understanding that, um, striving for perfection really isn’t, shouldn’t be the goal and, and really like self-improvement and, and really kind of changing that narrative and finding ways to, um, encourage others as opposed to always compare myself to others are probably two things that, um, my younger self could have, could have list heard a few times throughout every stage of med school, high school, college,

Corrine Malcolm (44:11):

Yeah. Run running or career or whatever it is. I think that those, yeah, some, some self-compassion some grace and some, I don’t know, avoidance of comparison send both to others and to your previous selves. I know that I struggle with that all the time, particularly when you’re coming back from injury, you’re like, am I faster? Am I slower? Um, it’s hard so that I think hopefully everyone can take that in and apply it to their next training cycle or, or their next professional meeting or whatever it is. Um, I think that’s all I have for y’all today, which is great. Cuz I know you have another meeting to get off to. I just wanna thank you both so much for coming on the podcast and sharing a little bit about what you’re up to and we’ll continue to update, um, our audience with everything that faster does moving forward, because I think it’s incredible. Um, and I think it’s gonna benefit a very, very wide, um, swath of the athletic population.

Dr. Megan Roche (45:03):

Thank you so much, Karen, also a big, awesome tier. So that’s like my go-to work and everything. So I feel like we’re, we’re awesome twins at this point and I’m honored because if I can be a twin with you, it’s like it’s, it’s a good life. So thank you for this. Thank you for like elevating the conversation.

Dr. Emily Kraus (45:18):

Yep. Echo Megan. Um, I think I would, we would love to hop on another time if you’ll you’ll have us with updates when we’ve got some, some research or some new news and um, these conversations are, are awesome and, and we’re just grateful to have you as part of our faster community.

Corrine Malcolm (45:38):

Wonderful. We will have you on the pod, down the road again, to give everyone an update for now, uh, signing off. We’ll talk to you all soon.

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