Sports Science Dudes

Episode 10 - Evidence Based Means You Still Have to Think with Nicole Rakowski PhD

Jose Antonio PhD

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0:00 | 30:52

Welcome And Guest Overview

SPEAKER_01

Welcome to the Sword Science Dudes. I am your host, Dr. Jose Antonio, and my special guest today is Dr. Nicole Rakowski. She has a PhD and she works in the health, longevity, and performance field. She's an IFB professional, uh muscle and fitness contributor, which I actually used to work there as well back in the 90s. So that's probably way before you. A two times uh TEDx speaker and a New York City journal, top 40 under 40 honoree. Um her work sits at the intersection of sports science, body composition, hormone optimization, peptides, longevity, performance health, and discipline transformation. So that's that's quite a mouthful there, Nicole. I mean, that's a lot.

SPEAKER_00

I appreciate that. It's taken years to go, that's for sure.

SPEAKER_01

And I always say, hey, if you worked hard to get it, you might as well tell people about it because you know you worked for it. So that's why the PhD, it's good to know. You know, I always say you worked hard for it. So let people know you earned the PhD because it's hard to get to. So in fact, that's what I wanted to segue into first.

A PhD Built For Systems Thinking

SPEAKER_01

Your PhD is actually not in the classic exercise science field. So tell the audience how you decided to go into that field and what it was like to earn a PhD in that field.

SPEAKER_00

Yeah, I think that's a very great question. So my PhD is very unique in that it's in actually in health management. So there is, you know, I did my undergraduate in life sciences, you know, did the biochemistry, the organic chem, anything you can sort of think of when it comes to biology and the sciences, kinesiology, really loved human body operated. And then as I moved in to do my master's, I wanted to move a little bit more into having some background within the business healthcare aspect of things. So I ended up doing my background um in my, sorry, my master's degree in global health, but I specialized in health management. So a lot of the courses that I did were basically uh MBA courses. So it's almost like a congruent MBA global health degree. And then after that, I did my PhD in health management, which really helped shape the way that I think about optimization. So I do not look at health as a collection of, you know, isolated hacks, but really it allowed me to look at everything as a system in level. And in healthcare, you know, the best outcomes rarely come from, you know, this one dramatic intervention. It comes from alignment, right? The right information, the right care, the behaviors. So really this took into all of this into account when we talk about resource allocation, where we talk about governance structure, when we talk about systems from the holistic perspective. So it really helped to mirror the clinical foundation that I had within the sciences and then mirroring it and pairing it with more sort of the background. And it really taught me to ask some of those deeper questions. You know, what is evidence-based? What is sustainable? What are the risks? What are we monitoring the outcome for? What happens when something goes wrong? And are we actually improving health or are we simply just creating, you know, or chasing a metric?

SPEAKER_01

Well, what is actually, no, it's a

Defining Evidence Based Practice

SPEAKER_01

good question. What is, when you hear the word evidence-based, because it's used a lot in our field, um, you go on social media and there's almost arguments about, well, what I'm telling you is evidence-based. What you're saying is not evidence-based. So, so how do you frame that when you're seeing how other people talk about it?

SPEAKER_00

I think that's also a very great question. So, to me, evidence-based does not mean, you know, blindly following one study or repeating whatever is popular online. It means looking at the totality of the research, the quality of that research, the real world outcomes. And I always like to think about it as like the individual person that's in front of you. So evidence is one part of a decision, but you also need clinical judgment, context, personal goals, risk tolerance, and ongoing monitoring. Something, you know, may show promise in one study, but that does not automatically mean that it's appropriate, safe, or even effective for everyone. So I think that evidence-based practice really requires that intellectual honesty. You have to be willing to say at the end of the day, you know, we know this, we think this, or we do not know this yet. And those are very different statements. So for me, being evidence-based or talking about that word means making the best possible decision with the strongest available information while, you know, continuing to measure, to question, and adjust as new evidence emerges, because what was once, you know, applicable 10 years ago is nowhere near, you know, on the same sort of spectrum today.

SPEAKER_01

Yeah, you know what's interesting about the whole evidence, I'll call it call it the evidence-based community, is oftentimes it's only referring to scientific studies. Um and if there's no studies on it, then even what some would call anecdotal evidence, others would call it real-world evidence. I would call it, you know, if you're in the sports realm, this is what coaches do. They are basically making decisions without all the evidence. They're just saying, okay, this will seem to work for this individual, whether you're coaching someone to run faster or lift more weights. Um, because, and I always tell students this, you're not going to find studies that will cater to everything you do, either as your own athlete. I mean, you don't have to be a professional athlete to call yourself an athlete, or in terms of the advice you give to someone else. Like, for instance, you're in you're in the bodybuilding physique world, and I see these constant arguments online as to the best way to train for hypertrophy. And when you look at those studies, and they're highly limited, they tend to be very short term, four weeks, eight weeks, maybe if you're lucky, 12 weeks. And yet you've been training how many years? Oh my gosh, more than 15.

unknown

Right.

SPEAKER_01

So, so here you are trained 15 years. I don't really lift, I do mostly paddling, but I've been training since I was a kid. How does how can you actually apply an eight to 12 week study to someone who's been training for 15 years?

SPEAKER_00

I think that's uh an amazing way, right? And it's and it's funny because you have a lot of these individuals that are actually running these studies that have not done

When Studies Fail Experienced Lifters

SPEAKER_00

the training themselves, right? But they're interested in the topic or they're interested in the athletes themselves. So I think one limitation in this part of it is exactly where experience, context, and individual response truly matters. So, you know, evidence-based thinking is that you are not always going to find a study that perfectly represents the individual in front of you, right? Which I kind of mentioned. And I loved your example of hypertrophy training because there is a constant debate online about the optimal number, as you mentioned, right? Of sets is a huge one, repetitions, training frequency, rest periods, where we talk about exercise selection and proximity to failure is also a really um interesting that keeps coming up. But, you know, I I've been training again for more than 15 years. My body has given me a much larger personal data set than a short-term study ever could. So it that, you know, it doesn't mean that I ignore the research, but I think at that point, research gives the principles, it gives us patterns, and it gives us a strong starting point to some things that you may not have already known, but it cannot account for every person's age, injury, history, um, you know, the biomechanics, recovery capacity, psychology, the genetics, and just the ability to execute a program that's consistent, right? So there's also a big difference between what produces a measurable result in a controlled study and what produces the best result for an experienced athlete over many years. So I believe in combining the best available research with long-term observation, but also that practical experience and honest measurement outcomes, because evidence should guide the process, in my opinion, but it should not erase individuality. So the most scientific approach is not blindly following a study, it's about forming your own hypothesis and applying it responsibly, monitoring that response and then adjusting based on what actually happens.

SPEAKER_01

Yeah, no, I think that's a good point. And the idea that any study could capture, you know, what individuals go through in terms of years of experience or coaches go through in terms of years of experience. Studies just don't capture that. And I think that's where, quote, the evidence-based crowd kind of lose me. And here, I mean, I'm a scientist and I've looked at the data. I actually used to do work in skeletal muscle hypertrophy. But when you get into studying these things, you realize how severely limited a lot of these types of studies are, especially training. Training studies are super, super limited. And one of the things I will bring up to scientists who study, whether it's training to improve Max VO2 or training to improve muscle hypertrophy, I always, you know, the first thing I ask is, can you tell me who actually trains like this?

SPEAKER_00

Yeah.

SPEAKER_01

Like nobody, nobody does.

SPEAKER_00

Yeah. Exactly. And I think that research, you know, again, is incredibly valuable for identifying, you know, general principles, challenging bad assumptions. But as you mentioned, like to me, it becomes a problem when people use the one study to dismiss the experience of someone who's again spent thousands of hours applying, measuring, failing, adapting, and refining. Right? A study tells us what happened on average under specific conditions of a particular group, but you know, again, for a very limited period of time, but does not automatically tell us what is best for every individual. Right. So that's that's really, you know, the smartest approach is not the study says this, therefore everyone must do it. You know, it's here is what the research suggests. Now let us apply it, monitor the individual response and intelligently based on that going forward.

SPEAKER_01

Right. And obviously, if you know the principles of training, then that's what you use as your guide. Um, but never use a study as like um, as I guess is like the Bible of what you have to do.

SPEAKER_00

The end all be all, right?

Creatine Myths Women Still Hear

SPEAKER_01

Like it's exactly not talking, sort of switching topics, talking about something that has a lot of studies, it's creatine, right? I think there's now over 600 studies. And what are your thoughts vis-a-vis how women view it? Do they fear gaining weight? What's your experience with that? Because this is a category where actually there's so many studies on creatine now that I'm always shocked when people will make claims. In fact, there was a physician online who said creatine will kill you. I mean, that's how funny it's gotten. It's like, wow, it'll kill you. My God, I'm gonna know a lot of people who are gonna die then. So, so what are your thoughts and experience on creatine vis-a-vis how women view it?

SPEAKER_00

Yeah, so you know, I always tell some of my friends when we're talking about this, like 10 years ago, when you were taking whey protein or creatine, it was like hush hush. It's like, oh my God, that person over there is taking creatine, right? It was seen as almost like the steroid tabloid sort of image as to like, you know, the creatine is the worst thing that you can possibly take for your body. But I think that creatine is a perfect example of how women have been conditioned to confuse gaining weight and gaining fat. Like the moment when we hear you, you may gain a pound or two, many immediately decide that, you know, they don't want to do it. But we have to ask, you know, what kind of weight are we also talking about? Because creatine helps draw a lot of water into the muscle cell. And that is not the same thing as gaining body fat. And it does not automatically mean looking puffy or bloated. So, you know, I always tell my clients that particularly with the loading phase, some people may experience a small early increase in body weight from water retention. But in fact, having that better, you know, hydrated muscle can actually contribute fuller more athletic appearance if that's what someone's going for. But more importantly, I think that creatine can support that repeatedly high-intensity effort and help you train more effectively. When it's combined with something like Rubens training, right, which is something I do every single day, the evidence supports the benefits from the strength perspective and potentially, you know, that additional muscle development. Although women remain less extensively studied than men, I'll say that. And the magnitude of benefit varies between individuals. But I always tell women to not let the scale become the sole authority on whether something is actually working. Because if your weight is increasing slightly, but you are stronger, you're performing better, you're, you know, retaining or building lean tissue, and your body composition is improving, then why would we automatically label that negatively? You know, the scale cannot tell you whether that weight is fat, a normal normal scale I'm talking about, you know, whether it's muscle, water, glycogen, information, or even just simply the contents of your digestive system. But it it only tells you your relationship with gravity at that particular moment, right? But my my preference is also to creatine simple, right? Creatine monohydrate is basically the form with the strongest research behind it. Um, you know, typical maintenance, I would always say for individuals is three to five times per day. And you don't need an aggressive loading phase to eventually saturate the muscles.

Sports Nutrition Built Around Men

SPEAKER_01

Now, when you say the supplement industry, has the supplement industry failed women in a sense that most of the marketing, at least initially, was towards men? Because men were the purchasers of supplements. I mean, if you go back to when I was writing for these magazines back in the 90s, I was writing for muscle and fitness, flex, um, muscle media 2000. There's an old one. A lot of the it was targeted towards men because they're the ones who men they'll take anything. I mean, they don't care. If it puts muscle on, they're taking that.

SPEAKER_00

Yeah, exactly. What can I do to get bigger doubts, right? I'll take it. I mean, yeah.

SPEAKER_01

Um, but how do you think the supplement industry, in a sense, has it failed women, or is it just women or just late to the game in terms of embracing supplements?

SPEAKER_00

Yeah, so I don't think that the supplement industry has historically failed women. Like when we sort of take a look at it, but I think, you know, what's been going on is for decades, sports nutrition was largely, you know, research, formulated, packaged, and marketed around the male athlete, as we sort of mentioned. And women were often given the same product in a pink container, you know, with the language focused on becoming smaller, lighter, or less hungry rather than, you know, stronger, more powerful, or better supported through different stages of life. So I think that's really where the biggest transition has sort of gone from, in my opinion. But I also think that part of that failure started upstream with the research. Like women were historically underrepresented in clinical research and meaningful inclusion in, you know, when we talk about the states, like federally funded stuff was not actually written into the United States law until it was the early 1990s. And, you know, here I am. But I was born in 1992, and it was actually 1993 that it really didn't start coming into play. So women were also underrepresented in areas of sports and exorcist science, huge. And that really means that products and recommendations have often been built from male-dominant data. And then, you know, it was generalized to women, you know, taking off a few grams and a pounds here or there. But creatine is one of those great examples because it was marketed for years as something for male bodybuilders who wanted to become bigger. But now we're having a much broader conversation about its actual relevance, right? For female athletes, that muscle preservation. Um, and I think where it becomes interesting is because now we're talking about stuff that interests women. Whereas for men it didn't back in the day, you know, healthy aging, different hormonal life stages. And this woman didn't suddenly become useful for women. We just finally started asking better questions about women, right? So women are not simply smaller than men. Um, you know, there's hormonal changes, there's menstruation, there's pregnancy, there's perimenopause, menopause, there's, you know, we talk about iron status, we talk about body composition, which pressures, you know, all these deserve-focused research rather than just assumptions. So, you know, maybe to some extent the industry has failed women, but not, I wouldn't say only by leaving them necessarily out of science, but by speaking to their insecurities instead of their potential, right? So I think that's where the new era should go is not to just sell more supplements to women. It should just understand women better.

SPEAKER_01

Yeah, I think, well, I think there's a couple things going on. One, there's the way women view supplements in general, that's sort of different than the way men do. I mean, I don't I think that's just I guess that's the way we're brought up differently. Uh, and then you're right, women they the idea of gaining weight typically is not something they want to do. If you say, hey, if you take this, you're gonna gain five pounds of muscle. And they're like, I don't even know if I want five pounds of muscle. So I think there's we sort of view it differently. Um I know since uh I I've looked at the data, NIH data. So this is non-exercise science, this is health medical data. If you go back 20 or 30 years, actually, since I think at least the year 2000, there's there's actually been more money spent studying women going back 20 years. So it's changed quite a bit. So now it's certainly changed so that we have now there is data specifically looking at women and women's health and whatnot.

Training Principles Versus Female Specific Claims

SPEAKER_01

Now in the exercise sciences, it's really kind of interesting because you will see social media influencers trying to make it seem like men and women are so different that they should train differently, meaning there's a male way to train and a female way to train, even though even though there's really no data to show that there's a male or gendered, there's not a gendered way to train. And I want your thoughts on that because I see that a little bit. And then actually I see it from PhDs who are saying there's a way to train that maybe is female specific, when in fact, let's say if you're training for hypertrophy, the principles are the same. I mean, other than the fact that men start with more muscle mass, uh the principles are the same. So, what are your thoughts on that?

SPEAKER_00

Yeah, very interesting point. I like the the way that you also tied in when we talk about social media influencers, right? And it's like, you know, I think the distinction is important because the foundation principles of training are not male or female, as you said. But the context I think in which those principles are applied can differ. So, and again, I think you know, most women, when we talk about um, you know, eventually, or essentially men were sold performance, get bigger, stronger, faster, more muscular. For women, we're sort of still selling, or social media influencers are selling that, you know, you need to weigh less, eat less, take up less space, essentially.

SPEAKER_01

So, you know, little people.

SPEAKER_00

Yeah, exactly. Women need to be, you know, smaller. But I I think, you know, I don't agree with that in terms of, you know, there's different ways to train for there's different ways to train for different body body parts. There's no, I don't think there's any black for white, or there's no gray zone within that. But the core principles of building muscle are the same. Like you need progressive overload, sufficient training volume, adequate intensity. You need the recovery, nutrition consisting in the same time. Like there's no set values or ways to follow that. It's like, you know, women don't need as much recovery, or men need, you know, more nutritional pronutrients and so forth. There's there's not a female version of mechanical tension and a male version of mechanical tension, right? Muscle response to stimulus where where differences may matter is in the application, right? Again, we take a look at a woman's menstrual cycle, pregnancy history, menopause, you know, we some of those things we talked about. But frankly, you know, men also have enormous individual variation. Men may require more different programs than a men and a woman do. So I think we need to be careful because I do think that there's more research that's needed, maybe from the women's perspective, but more research should lead to better individualization, not the assumption that women are a completely different species who need, you know, pink dumbbells, they need lighter weights, an entirely different method of building muscle. The principles are universal and the programming should be personal.

SPEAKER_01

I like how you said uh there's no male or female uh was it mechanical tension, which Exactly, right?

SPEAKER_00

Like today, I'm gonna go to the case.

SPEAKER_01

I have a feeling someone's gonna use that and say, you know, there's a female specific mechanical tension that you need to train. I can I I swear to God, that's gonna happen one day and I'm gonna laugh.

SPEAKER_00

Right? Like I'm gonna wake up one morning and say, like, you know, I feel more strong today. I'm gonna do the male mechanical tension for them. That doesn't happen.

unknown

Yeah.

Enhanced Games And The PED Overton Window

SPEAKER_01

Now you and I, um, you and I attended the enhanced games. And I guess from a sort of a from a cultural standpoint, um if you go back to the 70s, 80s, go back before you were born. Let's do that, Nicole. And then we'll just keep going each decade. The use of any kind of performance enhancing aid or drug has always been frowned upon. Um and I guess some people view it as cheating. Um, but my view has always been, you know, it's your body. I I mean, personally, I don't care what people take, it's your body if you want to get bigger using performance-enhancing drugs or supplements, uh, it's totally up to you. However, the fact that there was an event in the United States where at least some of the athletes were openly using some of these drugs, to me, it uh it opened what's called the Oberton window. It made it so that it was okay to talk about it now, whereas before it's like talking about it, you know, you would in this in essence be looked down upon. So and I think part of the backlash is that performance enhancing drugs, at least in the United States, people think bodybuilding. Bodybuilding, bodybuilding, even though distance cyclists they're all I mean, they may actually use more drugs than bodybuilders. Cyclists are going to kill me for saying that, but I think that's true. Um, if you look at the history of the Tour de France. Um, so what do you think bodybuilding? Because I think a lot of the backlash is because it came from bodybuilding. What can bodybuilding teach us about you know being honest about drug use, the the risks, and also how to optimize it?

SPEAKER_00

Yeah, I think that's a great, um, great question. So, and as you mentioned, right, uh, like a lot of people sort of look at bodybuilders and say, like, the drugs started here, these steroids started here. We look at Iron Generation, we look at, you know, these different uh huge muscle men like Ronnie Coleman and Arnold Schwarzenegger and some other very publicly sort of stating, you know, what they took and how long that they've been taking it for, right? It's it's created this persona, this stereotype that bodybuilders do this. There's no other, I mean, as you mentioned, the Tour de France and so forth, there's other ones as well. But I think that um, like to me, enhancement itself is not the greatest problem. Like, I like I want to I I start with body, bodily uh autonomy. Like I believe adults should have the agency over their own bodies, but I I do not think that the conversation ends with it's my body, so I can do whatever I want. The real questions are to me, like, are you informed? Are you being medically monitored? Do you understand you know that medical supervision can reduce certain risks, but cannot make enhancement risk-free, right? And and are you being honest with the people against who are you competing? And that's what made the enhanced game so culturally significant, because this one openly permitted performance enhancement within its own rules, right, instead of pretending it did not exist, right? So it also generated an enormous backlash from organizations like you know, Wada and traditional sporting bodies. And that's largely because of concerns around the athlete health, the fairness, the coercion, and the message that it sent to younger athletes. And I think that those concerns deserve to be taken seriously, but the event did something else. It like we meant it made enhancement speakable, right? And I think for generations, performance-enhancing drugs, as we mentioned, you know, were basically quarantined within bodybuilding. Like no one else did that unless you were a bodybuilder. And people looked at bodybuilders and said, like, that is where enhancement happens, as though other elite sports were somehow untouched by the pharmacology aspect of it. But um, but it was more like that relentless pursuit of competitive advantage. But I think that the enhanced games really forced that conversation into mainstream. So it did not make performance enhancing drugs safe. It's not like the enhanced games said, okay, now we can all do it.

SPEAKER_01

Right.

SPEAKER_00

It did not resolve every ethical problem, but it removed the pretense, right? It created a setting in which the rules were explicit and the audience knew what it was watching. No doses were, you know, initially sort of disclosed to the public, but that's where bodybuilding has some important to teach us about honesty. Because bodybuilding itself has often operated as an open secret, is what I always like to say it, right? Everyone can see extraordinary physiques, but athletes can be rewarded for audio, you know, allowing audiences to believe that those results came exclusively from chicken, rice, and broccoli and supplements and hard work, right? And the hard work is absolutely real, but sometimes the full story is not being told. So to me, enhancement itself is not the greatest moral failure, but deception is actually something, right? And your body belongs to you. But the rules of a shared competition do not belong only to you. So I think that bodybuilding teaches us that secrecy does not eliminate enhancement, it eliminates the accountability. When people can't speak honestly, you know, use mood of the underground and education becomes harder, and athletes may rely on the locker room advice, which they've been doing for years. Social media, you know, there's many, many, many unqualified sources rather than just having that meaning of meaningful medical care as

Outrage Monitoring Harm Reduction And Fairness

SPEAKER_00

well.

SPEAKER_01

Yeah, I think what I find puzzling is there are there are people in my in my field who you know who do research and exercise in sports science and sports nutrition who were sort of in an emotional way vehemently against the idea. Like they couldn't believe that they would openly get athletes who were willing to take whatever drugs you know were provided and then compete in you know an athletic event. And I guess I've always been I I find that puzzling that in a way they they personalized it, meaning there's something going on in Las Vegas, you don't know any of these people, right? And yet it's it's it's a personal affront to you. And for the life of me, I can't figure out why it's a personal affront. And maybe you might have thoughts on that.

SPEAKER_00

Yeah, and and when you say personal affront, like I I want to expand on that a little bit, like in terms of you're talking about each of the athletes particularly.

SPEAKER_01

No, meaning these people as scientists, it's almost like they're insulted by the fact that these athletes are willing to do these things to run faster, swim faster, lift more weights.

SPEAKER_00

And I'm thinking, Yeah, yeah, why do you care? So I I think honestly, and this is my personal opinion, is that you know, the enhanced games, you know, it's not like it made enhancement okay. I think where people have the issue with it is that it made it harder for society to pretend enhancement was already was not already part of you know elite human performance. I I think that's sort of where it comes down to is, you know, many people have also devoted their careers to researching performance enhancing substances, substances and were always of one mindset that we're fighting for sort of one direction. Um, and you know, now studying something that is obviously not the same as endorsing it, right? That's a big area as well, is the connection and the thought of, you know, how much money is this actually generating for individuals for different companies, right? So a researcher can investigate drug use precisely because they believe it's dangerous, but there's also valid concerns about long-term health effects, normalization. So I think for individuals that have been, you know, within the research field for a very long time, and and you know, let's say they have one very specific direction about, you know, what does this mean for normalization? What does this mean for normal audiences? Now it sort of takes everything that they've built over the years and sort of they feel like it sets them back a little bit, right? Because they feel that it cannot make these substances completely safe or eliminate every knowing. So I get that some of those concerns are legitimate, but I think, you know, there's a little bit of a playing field where people can take it too far. But the academic debate itself, I think, recognizes both sides. I think, you know, proponents argue that not acknowledging existing enhancement could create opportunities for better monitoring and harm reduction. But we also have those critics, right? That, you know, an event openly rewards drug use can normalize risk and create co-oppression. So I think that's, you know, you you cannot simultaneously just say that this is happening everywhere and represents a serious public health concern and then become completely outraged when someone creates a space in which it can finally discuss honestly. I think that's a big issue.

SPEAKER_01

No, I think you you you you explained it well. Um I my feeling has been, you know, we'll be able to get data, hopefully, to see what happens in terms of you know, uh the health parameters that these athletes have pre, you know, pre and post uh using these drugs. And to me, information is always a good thing. And I think that's that's a big positive coming out of the enhanced games. Now, um short on time.

Where To Follow Nicole

SPEAKER_01

Uh, I want you to tell the audience where they can get more information on you, or if you're presenting at a conference, or where will you be? Because I know you're not in the USA. Um where are you exactly?

SPEAKER_00

Right now I'm situated in Antigua, originally from Toronto, but I'm in the states constantly traveling for um muscle and fitness for uh for different muscle opportunities, fitness opportunities, you know, um consulting on different projects, being the expert when it comes to um different aspects of longevity. So but individuals, if they want more information, they can uh honestly, Instagram is probably one of my greatest sources right now of uh media. So it's at DR Dr. Nicole Rikowski.

SPEAKER_01

Awesome. Well, you know, I get into my academic duties and go to a faculty meeting. And so I do appreciate your time, Nicole. This was a great conversation, and hopefully, maybe it's I absolutely love that today.

SPEAKER_00

I'd be loving the conversation support. So many other topics and support.