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Women have always trained hard. The science surrounding how they fuel, recover, build bone, and respond to training has had a lot of catching up to do.

In this episode of The Ready State Podcast, Kelly and Juliet sit down with Dr. Kate Ackerman, a triple-boarded physician, former elite lightweight rower, and co-founder and president of the Women’s Health, Sports & Performance Institute (WHSP), to explore what changes when female physiology becomes part of the research question from the beginning.

Kate traces her work back to her own experience making weight as an athlete, then unpacks the evolution from the Female Athlete Triad to Relative Energy Deficiency in Sport (RED-S), including how underfueling can affect hormones, bone, cardiovascular health, injury risk, and performance. She explains why bone health begins much earlier than most people realize, how iron status should be evaluated in athletes, and why RED-S deserves attention in postmenopausal women, too.

They also dig into menopause research, strength training, GLP-1s, and WHSP’s mission to answer the questions women themselves say matter to their health and performance.

• How low energy availability and RED-S can affect bone, hormones, cardiovascular health, injury risk, and athletic performance and why RED-S can occur in both men and women.
• Why adolescence represents such an important window for building bone density, with roughly 90% of peak bone mass accrued by age 18.
• What athletes, parents, and coaches should understand about iron and ferritin, including why one lab value rarely tells the whole story.
• Why RED-S can matter after menopause, even when menstrual-cycle changes can no longer serve as a warning sign.
• How WHSP is approaching unanswered questions around female athletes across the lifespan, from adolescent health and pregnancy to menopause, strength training, hormone therapy, and performance.

(00:00) Intro: Dr. Kate Ackerman & the Future of Female Athlete Health

(04:35) Kate’s journey from collegiate rowing to lightweight competition

(06:04) Making weight, underfueling & Crystal Light cereal

(09:30) Extreme weight-cutting tactics in lightweight rowing

(12:05) When losing your menstrual cycle was a “badge of honor”

(12:44) The Female Athlete Triad & Kate’s experience with menstrual loss

(15:43) Kate’s unconventional path into sports medicine

(16:33) Becoming triple-boarded in internal medicine, sports medicine & endocrinology

(20:50) Understanding the Female Athlete Triad & RED-S

(21:10) Why Kate calls osteoporosis a “childhood disease”

(23:01) How low energy availability affects health & performance

(24:49) RED-S warning signs for parents, coaches & athletes

(29:16) Why WHSP was created & the research gap in female athletes

(30:26) Building a one-stop medical model around the female athlete

(33:33) Moving from reactive healthcare toward prevention & performance

(39:06) Iron deficiency, ferritin & what athletes should know about their labs

(41:26) Why ferritin alone doesn’t tell the whole story

(43:53) WHSP’s research across the female lifespan

(44:51) Menopause, hormone therapy & the questions we still need to answer

(47:16) Strength training, bone health & better markers for RED-S recovery

(48:47) What the Boston Marathon study revealed about underfueling & performance

(53:06) What female athletes say they actually want researchers to study

(55:10) RED-S in postmenopausal women

(56:43) What RED-S can look like without a menstrual cycle as a marker

(58:26) GLP-1s, underfueling & muscle loss

(1:01:02) Strength training research for postmenopausal women

(1:02:16) Kate’s vision for the future of female athlete health

(1:05:34) Infinite Shelf: Ted Lasso & The Nightingale

Huge thanks to our sponsors, BEDGEAR, Momentous, and LMNT.

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Juliet and I just got back from Vancouver and 27 straight days of back-to-back conferences. The shift at the YPO Health Summit from two years ago was striking. The conversation has moved from mitochondrial supplements to something more basic: are you doing the fundamentals? We call this third wave fitness, and it finally feels like we are cresting into it.

Romania's football federation just introduced a Black Card for youth soccer, and it is unlike anything we have seen before. Referees can now permanently end games because of how parents and spectators are behaving. No rematch, no restart, just over. There are also silent game days where adults cannot cheer or coach at all. The whole platform is built around joy, respect, and optimism in youth sports. With Outplay finished and heading to shelves next fall, we are paying close attention.

EC Synkowski's A Good Nutrition Book dropped October 1st. We wrote the foreword to the book because her work and thinking around nutrition have been genuinely transformational for us.

And finally, the University of Liverpool just published the longest randomized trial ever run on diet drinks. The results are going to surprise you, or at least give you permission to enjoy your crispy Diet Coke in peace. We have opinions, a bedazzled can, and an unhinged passion that we can't totally explain.

• Why the YPO Health Summit felt fundamentally different this year and what the return to basics actually looks like in high-level wellness spaces
• What first, second, and third wave fitness means and why the shift matters now
• What's in EC Synkowski's A Good Nutrition Book and why the 800-gram challenge changed how Kelly and Juliet think about nutrition
• How Romania's Black Card system works for youth soccer sidelines and whether something like it could take hold in the US
• What the longest randomized trial on diet drinks found about weight loss and potential harm

(00:00) Intro

(00:24) Empty nesting and an overbooked fall

(01:43) YPO Health Summit Vancouver: the back-to-basics shift

(05:01) First, second, and third wave fitness

(06:32) Rope flow for 100 CEOs, forgotten anniversaries, and 16 years of Mobility WOD

(08:21) Outplay: manuscript submitted

(11:06) EC Synkowski's [A Good Nutrition Book](https://a.co/d/0519vMrI) and the [800-gram challenge](https://thereadystate.com/trs_podcast/ec-synkowski-sustainable-nutrition/)

(13:38) Romania's [Black Card](https://www.nytimes.com/athletic/7586821/2026/09/12/football-black-card-referee/) for youth sports sidelines

(19:15) The diet drink study and the Diet Coke debate

(25:21) Wrap

View This Week's Show Notes

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What if the fitness metrics you’re obsessing over aren’t telling you what you think they are? HRV. VO2 max. Resting heart rate. Zone 2. Wearables have given us more data than ever… but do you know how to use it to inform your training?

In this episode of the Ready State Podcast, Kelly and Juliet Starrett sit down with renowned strength and conditioning coach Joel Jamieson to cut through the noise around cardiovascular fitness, recovery, and resilience. Drawing on more than 25 years of experience coaching UFC champions, Olympic athletes, special operators, and professional sports teams, Joel explains why a higher HRV isn’t always “better,” what Zone 2 training is really trying to accomplish, and why your aerobic engine matters even if endurance sports aren’t your thing.

They also explore how to balance low, moderate, and high-intensity training, practical ways to measure whether your conditioning is actually improving, and why stress outside the gym has to factor into how you train. The takeaway? Better fitness isn’t about chasing a perfect score – but about understanding what your body can handle, how well it recovers, and how to train accordingly.

• Why a higher HRV doesn’t always mean you’re better recovered
• What Zone 2 training is actually trying to accomplish
• Why cardiovascular fitness is important for improving resilience
• How to balance low, moderate, & high-intensity conditioning
• Why stress outside the gym should influence how you train

(00:00) Intro: Joel Jamieson on HRV & Conditioning

(03:33) The HRV Problem for Midlife Athletes

(05:13) What Is HRV?

(09:41) The Evolution of HRV Tracking

(13:32) What's a Good HRV?

(16:18) Morning vs Overnight HRV

(20:49) Why Higher HRV Isn't Always Better

(24:00) HRV, Resting Heart Rate, & Heart Rate Recovery

(26:50) Chest Strap vs Wrist-Based HRV

(29:33) How to Improve Your HRV

(34:10) How Fast Cardiovascular Fitness Declines

(37:53) Training Intensity Zones Explained

(43:30) Low, Moderate, & High Intensity Training

(45:59) Why Low-Intensity Training Builds VO2 Max

(48:33) Is VO2 Max Testing Worth It?

(51:04) The Cooper's Test

(55:09) How Fast Can Conditioning Improve?

(59:55) Team Athletes & Recovery

(1:01:46) Life Stress, HRV, & Training

(1:04:00) Lifestyle Sets Your Gym Limits

(1:05:21) Infinite Shelf

Huge thanks to our sponsors,Momentous, LMNT, and BEDGEAR.