#13 RED-S and the Female Runner with Dr. Kate Ackerman MD MPH

Dr. Kate Ackerman, co-founder and president of the WHSP Institute (Women's Health, Sports & Performance) and head doctor for US Rowing, joins the show to walk through one of the most important and least understood topics in women's endurance sport: Relative Energy Deficiency in Sport, or RED-S.

When Dr. Ackerman made the US national rowing team during her first year of medical school over 25 years ago, she opened her sports medicine textbook and noticed something strange — women were a chapter. A single chapter. Every protocol she was training under had been studied in men. That gap shaped her entire career, from founding work in the female athlete space to helping the International Olympic Committee design the RED-S clinical assessment tool used today.

In this episode, Steve Gonser sits down with Dr. Ackerman to unpack how the field has evolved — from the original 1990s Female Athlete Triad to the broader, system-wide picture we have now. They walk through the science of what's actually happening when energy availability drops: the body's caveman-era survival logic, the reproductive system going first, and the cascade through thyroid, cardiovascular, GI, cognitive function, recovery, and ultimately performance. Performance is the framing Dr. Ackerman has found resonates with athletes who don't yet care about osteoporosis or missed cycles.

The conversation then walks the full female athlete lifespan. Adolescents going through peak height velocity before peak bone mineralization, and why that window is so vulnerable. The social media feeds quietly reinforcing thigh-gap culture for teen girls while the rest of us scroll past entirely different content. Postpartum runners trying to chase a pre-baby body while breastfeeding pulls calcium directly from bone. The bone density arc — 90% of peak bone mass built by age 18 — and what that means for everyone after. Why runners' linear, single-plane loading doesn't build bone as well as multi-directional movement does, and why even elite male cyclists end up with osteoporotic bones. And finally, perimenopause and menopause: the symptom cornucopia, the GLP-1 question, the supplement noise, and the lifestyle levers that actually move the needle.

Throughout, Dr. Ackerman makes a clear point: women have real questions, the answers are starting to come, but the space has filled with people on Instagram calling themselves experts. Knowing where to look — and which clinicians, dieticians, and resources are actually credentialed — is half the battle.

If you're training through your 40s, raising a young athlete, navigating perimenopause, or trying to make sense of why your body is responding differently than it used to… this episode is the framework you've been looking for.

Connect with WHSP Institute:⁠

https://www.whspmedical.com/institute⁠⁠

https://instagram.com/whsp_institute⁠

Connect with Dr. Ackerman:

https://www.instagram.com/drkateackerman/

Connect with RunSmart:⁠

https://instagram.com/runsmartofficial⁠⁠

https://runsmartonline.com⁠