Nuance Over Hot Takes

The internet keeps forcing women’s health into two extremes: science says one thing, your body feels another, and somehow you’re supposed to pick a side. We don’t buy that. We walk through why scientific communication breaks down online and how “helpful” wellness content can quietly become predatory when it turns nuance into binary rules, fear-based lists, and one-size-fits-all programs. 

We dig into the menopause metabolism and fitness debate, including why many women feel like their body is unrecognizable even when studies suggest metabolism does not automatically crash with menopause. We connect the dots between real symptoms and real outcomes: joint pain that changes how heavy you lift, insomnia and mood shifts that change effort and recovery, and subtle behavior changes that can lead to weight gain or weight redistribution. We also talk about estrogen conversations and why the pendulum swing from “never” to “everyone should” misses the middle where most evidence-informed choices live. 

We also use cycle syncing as a clear example of how something can be objectively unnecessary for many people while still being subjectively useful depending on how you feel across your cycle. Finally, we break down survivorship bias plus relative risk and absolute risk so you can spot misleading health claims and ask better questions without feeling gaslit. If this helped you, subscribe, share with a friend, and leave a review so more active women can find evidence-informed support.

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Transcript

Welcome And Scope Of Show

SPEAKER_00 0:07

Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Farvin. I'm a public school physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in prostate, powerlifting, or weightlifting, pregnant, post-part-up, or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise. Whether you're a recreational exerciser or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey. We're gonna talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist, and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get excited. Hello everyone and welcome to the Barbell Mamas podcast.

Why Nuance Beats Certainty

SPEAKER_00 1:11

Christina Previtt here, and today I want to go on a little bit of like an extended rant about scientific communication and why I think it is just so important to embrace nuance and individualization when we're talking about taking research and putting it into clinical practice. You all see if you have listened to the podcast for any amount of time, how I think that this is really important, right? I, you know, this is what the evidence says. Here's the variation, here are some of the signs and symptoms you may experience for you to be able to say, I want to continue deadlifting really heavy up until delivery, or I don't. And that allows us to feel evidence-informed where we get to blend the research with what is happening in your body or as providers in clinical practice.

Wellness Marketing Turns Predatory

SPEAKER_00 2:05

I have been really watching two spaces that are quite contentious and heated in the women's health spaces. One is menstrual cycle and cycle sinking, and I feel like we're kind of hitting the tail of that debate that's felt a little bit settled. And then this is raging or just starting to rage around the menopause space when it comes to like metabolism and fitness. Many of these arguments or disagreements are less in the medical management of things like menstrual cycle disorders and peri-to-postmenopausal symptoms, genital urinary syndrome, menopause, but rather health behavior in women's health. I want to start this conversation by saying that the wellness space, I believe, many times starts as trying to be helpful and maybe unintentionally or intentionally can turn predatory in a lot of different ways. Because we are taking nuanced information, turning it into yes, no's or this is a line, or this is safe and this is unsafe comment guide for my free download that then tries to get you to buy a bunch of things. And because we are looking for virality of content, or because we're trying to sell something, unfortunately, staying to the standards or letting some of those standards slip a little bit tends to happen and then gets compounded over time.

Menopause Estrogen And Online Extremes

SPEAKER_00 3:43

Menopause right now is having a huge moment where we have seen with them getting rid of the black box label on estrogen, that there's just this huge discussion happening online about management of estrogen. And we've seen the pendulum swing from don't ever use estrogen to everyone should be using estrogen. And again, the answer is somewhere in the middle. But because we are seeing this like pipeline of like women who started doing women's health specific content when they were pregnant and then postpartum, and now are getting into their 40s and transitioning into menopause and now are putting out menopause programs. We're starting to have a lot of this debate. One of the debates that was really sparking my interest as somebody who clinically works with those in peri-to-postmenopause, from literally in their 40s and are starting to have perimenopausal symptoms to being in their 80s and being 30 years past menopause, is this disconnect that was happening with what the research scientists were saying and what many of my clients were feeling. And this is where I kind of want to weave this context and then kind of just talk about the this bridge between research and clinical practice.

Metabolism Claims Versus Real Symptoms

SPEAKER_00 4:56

When we are talking about body composition in peri-topostmenopause, so many women will say, this is a body I don't recognize. I have not changed anything, and I feel like I am having all this waking or weight shifting, and I do not even recognize this. And for some of my avid exercisers, this becomes a really big problem too, because then I see a lot of women under fueling really significantly, and then they start to really feel like trash. And so then the researchers are coming in and saying, actually, nothing changes. Like your metabolism does not change when you're in pre-toper to post-menopause, and therefore it's just a calorie deficit. And this is meant to be really empowering of like, hey, like there, there's nothing that is inherently going wrong. And I'm putting that in air quotes, when you're in menopause, that will change your capacity to lose weight. However, sometimes the messaging can feel very dismissive, especially in menopause, I feel, because menopause is a group that tends to have their complaints dismissed. And so when researchers come in and they say, hey, this is this is not a thing, then the person that is listening to that will is like, then why do I feel so bad in my body? Why am I doing everything possible and I'm still not seeing the positive benefit that I normally would or I had in the past or I have before I transitioned into menopause? This creates these two buckets. And we kind of see this in postpartum too, and we kind of see this in pregnancy too of, you know, you tell me I can do this, but I feel this, or I shouldn't be doing this, and I feel this way. And so these camps are kind of far apart. Where the nuance comes in, and then I think is really important, right? Is

Pain Sleep And Behavior Drive Change

SPEAKER_00 6:56

for example, in the research on metabolism, it is constant. Your metabolism stays the same if your muscle mass stays the same. If you are going through menopause, joint pain tends to go up without an injury. Insidious onset of joint pain increases significantly from pre-toperenopause and stays from peri-to postmenopause. And so if you're having more pain, then how heavy you're going to go in the gym is going to be less. And so you might lose muscle mass, which might make you feel like your metabolism is changing. In perimenopause, uh, insomnia and depression are more common rage, cognitive fog issues. And so if you aren't sleeping, what is an eight out of 10 effort after a bunch of really trashy nights of sleep in a row is not going to be the same as if you are fully rested. Again, there's a lot of parallels here with postpartum, right? And so then, you know, you may be putting in the same effort, but your objective split times or your timing or et cetera is not that great. When we are tired, we also tend to gravitate towards carbohydrates to try and wake us up. And so we may be unintentionally overfueling for some of us, right? And so it might be these little tiny shifts in behavior that cause us to put on two, three, five pounds. And if you were a person that your weight gain used to be in your hips, you maybe didn't notice it as much in your belly, menopause shifts that weight distribution. So now you're more likely to put it on in your middle. And now you're really noticing a difference in how your body looks in the mirror. Researchers then are right where your metabolism didn't change. However, it's not really telling the true story. And this is kind of where our quantitative research of averages, plus or minus standard deviations, there's like a loss in human translation or this loss of feeling of putting this to a lived experience when we think about the qualitative experiences of the person that's in front of us,

Cycle Syncing And Lived Experience

SPEAKER_00 9:19

right? And this is why the menstrual cycle syncing picked up so much steam, right? Where they were saying, hey, respect where your hormones are. And the researchers were saying, well, you don't have to cycle sync your workouts. And objectively, that is true. Um, but subjectively, how you feel across your cycle really does influence your athletic performance, your exercise behavior, et cetera. So if you feel like trash in your pre-menstrual to menstrual period of your cycle, then you are going to change your behavior during that time. And that might be an extended period of time when you're in your peri-to-menopause transition. So again, this was something where, you know, the scientists were saying one thing, and then people were marketing to the lived experiences of others. And because that lived experience is so visceral, right? Like we're we're in it every day and you're frustrated with it every day. If this is someone that, you know, is experiencing this, it creates this dissonance or this kind of conflict within yourself of the researchers are saying one thing, but this influencer is really speaking to my lived experience. They are talking the same language. And bonus points of that influencer is in my phase of life because they're in it. They're in the trenches, they understand what it feels like. And, you know, sometimes the researchers who are male or younger, um, they can be dismissed. They're what they're saying can be dismissed because people who are in menopause or postpartum is like, come to me when your baby isn't sleeping, or come to me when you're in menopause. You know, I'm in uh aging, right? So I work with a lot of people between 50 and 70. And, you know, sometimes people will say to me, like, wait till you're in your 70s, Christina, you know. That is very real, right? Because that social cohesiveness piece of understanding the shared lived experience of somebody who is in the same phase of life as you is such a powerful thing. And unfortunately, that is leveraged as a marketing tactic in the menopause space, right? And so, like, add another layer to this. And some of our gynecologists for menopause, people like Mary Claire Haver, are talking about how estrogen can be a wonderful treatment for things like weight loss, or I guess for weight gain to cause weight loss. And the researchers are saying, hey, like estrogen doesn't do anything. And so many women in her comments are like, yes, this helped me. Talking about contextualizing a person's experience with, you know, things like sleep and pain, estrogen supplementation can help with insomnia. And so, no, estrogen is not directly causing you to lose weight. It is not directly preserving muscle, but it may be making you feel better. And so you can go back to engaging in a type or a style of exercise that you used to engage with more regularly before you became symptomatic in menopause.

Bridging Research And Clinical Reality

SPEAKER_00 12:26

And so this brings up a really interesting point that I really love to grapple and struggle with as a clinician researcher, right? I have held on to my clinical practice, coaching, and in-person treatment for a really long time, despite the fact that I spend the majority of my time in education and in research. Why? Because I think that clinical to person bridge in research is so important. And the higher up in research you get, the less you actually talk to the patients in your studies because you have students that are doing it for you, right? And so I believe that one of the big gaps, and I've been thinking about this a ton. I've been trying to write a whole like uh Substack about this and all this. There's lot, there's things that are lost, right? So when we are thinking about a research study, we're thinking an average, right, is what's reported. And we have plus or minus movement around the mean. So some people will respond more and some people will respond less. And what that means for each human is that not every human is going to improve the average amount. Some will improve more and some will improve less. But when we don't really communicate that well, this is where people can feel like the research isn't backing up their experience. They're feeling very dismissed in their complaints. And when I'm teaching or when I'm trying to think through a study, I always feel like I have my research hat and then I have my clinical hat. And sometimes they fight with each other, right? And this menopause example was a perfect one. Another one is, you know, you have this perfect protocol in an exercise study that is implemented. The lift more trial for osteoporosis is one of them. It was eight months, two times a week. And most people, if they're going to PT, are not going to be able to have insurance coverage for that long, right? Is an example of it's not feasible or you don't have the equipment or nobody, nobody has the time, or whatever. And this is where it's super important. And research is starting to embrace this, is to have stakeholders at the table. Meaning, doing a research study without talking directly to the person it's meant to be helping is potentially missing really critical pieces to the puzzle. And so I feel so honored that I am doing pregnancy research and I have pregnant athletes on my schedule now. It's funny because I always joke that you are either pregnant postpartum or in menopause or older, um, because my PhD is in aging, my postdoc is in pelvic floor dysfunction, and I'm circling around pregnancy and postpartum. And so kind of big takeaways and and why I'm going through this example. For if you are not a researcher or a clinician and you are just, you know, a person and you're seeing this uh this data because the research says one thing, it is telling us a trend in the data, and it is not a guarantee, right?

Averages Variation And Feeling Dismissed

SPEAKER_00 15:48

Um, this is why things like survivorship bias is so preyed upon in social media, right? I have drank raw milk for five years and I've never gotten an issue. I've never had an issue. Yes, our evidence says that you know you have a higher risk and it's like whatever, three to four times higher risk. That doesn't mean that everybody gets sick. It's that the risk is higher. So heat your milk. Like that's the recommendation in public health, right? And survivorship bias is what happens when people make health decisions based on the fact that they were not the one that got sick. This is where relative risk comes in, and there's a push towards explaining as absolute risk as well for people who are going from research to clinical practice. Here's what I mean. So relative risk is the percentage change in risk for doing or taking away a health behavior, right? Risk of fetal alcohol syndrome if you drink in pregnancy, risk for infertility if you have marijuana in your preconception window. That is not to say that, you know, we say marijuana is bad for fertility. That does not mean that everybody who did marijuana before getting pregnant or while trying to get pregnant is not going to get pregnant. It's decreasing your chance by X percent. That would not mean, though, that I would go online and say marijuana has no influence on fertility. I got pregnant the first month and I was smoking every day before I got pregnant, right? But that type of survivorship bias is often manipulated or expressed online, especially for people sharing their experience and using that as an education point for others. Where the tricky part comes, right, is for scenarios that have very small increases in risk. And that is where there's been kind of a bit of a push to start expressing things as absolute risk versus relative. So, for example, with the estrogen and breast cancer, right? And I'm making these numbers up, please don't hold me accountable to these. So if it was saying, you know, if you went through menopause, your risk of uh breast

Survivorship Bias And Risk Basics

SPEAKER_00 18:08

cancer is one in a hundred. And then if you take hormone therapy, it now becomes two in 200, two in a hundred, then you are now doubling your risk of breast cancer with hormone therapy, right? Which is true. One to in a hundred to two in a hundred is doubling your risk. However, the numbers are so small that if you would have shared that as people who are not on hormone therapy have a one in one hundred risk, and people who are on hormone therapy have a two in one hundred risk. That risk calculation would feel very different for a lot of people. And that is why expressing it that way is often seen as sometimes more beneficial or sharing both numbers. And that's where a lot of people can sometimes feel duped when they are led to believe that risk is really high for a certain health behavior, and then they find out that those numbers are quite small, um, and why it's important to kind of have a full picture. The last thing that I want to kind of speak to around this conversation is that science literacy really matters in health decisions. And unfortunately, most people do not have science literacy. And I do not mean this as a negative, but as something to caution against. My PhD was in high load resistance training in aging, right? So I became, I'm very much an expert in resistance training prescription across the lifespan. I work in geriatric practice where I see a lot of people, you know, 60, 70, 80 plus. I feel very comfortable, you know, in that space. And I am very much an expert in small pockets of areas. However, one of the things that and the biggest takeaway for me for my PhD was learning how science is done, learning the ins and outs of science and how it goes from basic science in cells in labs and petri dishes into human trials into the community, and then going through for FDA approval or whatever if it's medication. Understanding that scientific method, our levels of evidence, what p-values are, comparisons, external and internal validity and generalizability, and all these other big terms that kind of like, you know, get thrown around in the science spaces. That part becomes hugely important. And when you have a person who is giving health information, and I include many health providers in this, I have seen many physical therapists, chiropractors, physicians, um, you know, nutritionists, RDs, doulas, obstetricians, like I have seen this happen in all sorts of healthcare providers. Um, when you don't understand what the method is saying,

Relative Risk Versus Absolute Risk

SPEAKER_00 21:07

or you don't understand your reporting on one study and not realizing how that study contributes to the body of literature as a whole, your odds of spreading misinformation become really high. That is why I try really hard not to expertise drift on my page, right? I talk pregnancy, postpartum, menopause, pelvic health, and geriatrics. Like those are kind of my arenas. And I do not often deviate from that. And it is because it's very easy for that drift to happen. And I want to make sure that I'm doing my due diligence to anything that I put on my page and the amount of time that I stress and worry about misrepresenting data is also quite high. And I want to make sure that I'm not making any errors. And so, as a consumer, the first thing is that it is okay to question. I love when my clients ask me where did that come from? Right. I am not offended. I am also very okay with saying I don't know. Right. Not with what my information is. I would tell you I don't know instead of giving you an answer. I would give you an understanding of what I know and what I don't know and what is bringing me to that decision. Right. So, you know, I'm not going to know everything in clinical practice. And so I'll say, you know, in my clinical experiences like this, I'm not really sure where the evidence is on that, but this is kind of what I'm thinking. And then I say all the time, I'm your GPS, not your driver, right? I'm here to guide you. Um, but you are making the decisions, you are making the calls when it comes to your healthcare experience. And so sometimes I'm a bit of a backseat driver. I'm a bit more forceful with my recommendations, especially from a safety perspective, if if that's something that we need to consider. Um, but I can't make you turn left. So I think that's important. So question everything. Know that one person's lived experience isn't going to be your lived experience. That there is always variation around the mean whenever research is being talked about. So if it does not fully fit into your lived experience, just know that there are lots of ins and outs factors that can be controlled for in a research study that in real life is just variation that changes how you are responding to something, right? And then thirdly, um I just think it's really important, and I'm saying this more for my providers who listen to this, that we are careful to give the information about what the research says without saying it in a way that makes individuals feel like their lived experience is being invalidated or gaslit. And especially, you know, kind of in menopause in particular. This is an area where a lot of women have reached out to providers to feel like they were not listened or heard. I guess it's true in the menstrual cycle too. I shouldn't just say especially in menopause, because it's kind of true across women's health. Um it is something that we want to be considerate of. All right, everyone. I hope you have a wonderful week. Cannot wait to talk to you all next week. Let me know what your thoughts are,

Science Literacy And Expertise Drift

SPEAKER_00 24:15

and we'll see you all next time.