Research About Menopause: What's Real and What’s Marketing?

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through postmenopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25mg of CBD and 25mg CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over-the-counter solutions, whether for sleep or migraines, can ruin gut health, and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by healthcare providers worldwide and backed by thousands of happy customers, many of whom come from our Flipping 50 community. There is zero THC, so it's non-habit-forming. It's made by a trusted family-owned company that we all can feel good about. Third-party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code FLIPPING50. That's FLIPPING50. Just go to flipping50.com/blueskycbd. We'll put that link in the show notes and you'll find it everywhere on Flipping 50 at My Favorites. What are you waiting for? Good night. Research about menopause right now is finally beginning to really get its moment. Or is it? What's something you can trust and what's stated as science-based, science-backed? What can you trust? And what should you question? Think of this as a crash course in Research 101. In fact, I think that was a required course my first semester of grad school, up at a million years ago. The content is as important or more today when you have influencers talking about studies, in fact sponsoring their own backup their products, they want to confirm this is the only program that did this, or this is the only product that did that. And sometimes they're sponsoring their own with no third party actually looking at it. You see both experts and influencers online and are left to sort out one from the other by yourself. This episode is designed to give you a leg up. I'm Debra Atkinson. You're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness in menopause and beyond before you knew to ask them. The goal to help accelerate your results with science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman, and it's not just about you but the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert, and an international speaker, to founder of the first and the only exclusively made-for-menopause and beyond fitness membership in the world. Every week I interview experts behind the scenes and the science of optimal hormone-balancing fitness and longevity and share answers to our community's questions so you can have the vitality and the energy that you want, need, and deserve. Okay, let me just start by saying you're gonna want to take notes and It dawned on me that there is so much here that potentially if you all begged and you said this would be really helpful to have a handout, I would create one. I thought about it and then I thought, who really wants that handout and are they going to really use that handout? I don't know that that's the case. So instead, I'm going to give you the spoiler alert for this in 1 minute. Stay with me. Here are questions that we're going to answer today. How do I know if a source is credible? What determines what is a peer-reviewed journal? Are all studies on, say, PubMed or ScienceDirect peer-reviewed? Are all studies from Google Scholar, which is AI, is that peer-reviewed? And what makes some research studies better than others? In this short— well, not so short— podcast, it will be like a Webster's Dictionary. So there's going to be a lot of vocabulary here about research so that you can filter news regarding research about menopause or anything else for yourself. The spoiler alert is this, and I'll give it to you, so listen closely. The gold standard in health research is research that are interventional, meaning there's been some hypothesis made and we're gonna tweak something. Maybe it's a protocol, a medicine, a drug, a treatment, and see what happens. That's interventional. We're changing something. It's randomized. Meaning the selection process and who ends up maybe in what group is random. A double-blind, meaning the subjects as well as the researchers don't know who was in what group. Were they a part of the treatment group? Did they receive the placebo, which is like a sugar pill, or did they— were they in the control group? So generally, it's double-blind, means nobody knows. So there's probably a lot of name tags in the back room. Somebody of course knows, but not the main researchers, so they won't be influenced by what their hypothesis was potentially. And then there are placebo-controlled studies, and as I mentioned earlier in the example. Placebo means some were given a placebo but not told they were. Some were given the exact protocol that we were hypothesizing this works and not told that they were. And then we see what happens. So everybody has the same treatment and the same mental approach, and we see what happens. Now, historically, just a buster here, placebo has been proven to work. So for you and for me, you know, thinking that whatever you are doing health habit-wise is helping you get whatever result and outcome you want could prove to be somewhat beneficial. Or even I'll say this. If it's actually not proven and might actually take you in the opposite direction. There's a chance that it might not, based on your belief about it. That's pretty powerful stuff you and I could do. All right, so the spoiler alert again is the gold standard in health research are those studies that are interventional, randomized, double-blind, and placebo-controlled studies. To get all of those things in one study is pretty expensive, I will warn you. So many studies are not all that, I'll say. So in the planning stages, and then in the results and the discussion— and you remember how this goes, right? From 7th grade, you had to write up your own. They told you exactly what it was you were going to do, and you just had to follow directions. But in a way, you were doing some of the things we're talking about today. Studies are meant to be done so very specifically, so A to B to C, that they could be replicated. And that is one of the things that is important about a study, so that if positive results were had, somebody else could replicate that study and get the same results. But there are different terms that you need to know. We're going to give you a lot of them. One is reliability. When people are planning their studies, then, and discussing also in results and discussion, these things are going to be determined. Reliability— usually something is more reliable if you're hearing about it and there are at least 3 independent studies not linked together Not the same researchers looking at something and then something else, but different labs, different schools, different institutions conducted similar studies, giving the same results. So the findings are very similar. That's reliability. That would be very high. Relevant. Is it relevant to you? That's always what you and I need to ask. Back in 2013, There was a study that came out talking about exercising in a fasted state would burn more fat, but it was like sumo wrestlers who were eating like 5,000 calories a day, and half of it, 50% of it, was fat. That has not much relevance to you and I, probably, who probably been under eating if we had to pick one or the other, under or over eating. Probably not getting 50% fat. And so we have to say, wait, but we're also not male, and we also don't start with— I hate to even guess what a sumo wrestler's body composition is, so I won't go there. But is it relevant to you? That's a really important question. But we could also go back to the high-intensity interval training discovered back in the '90s called Tabata. Now, that was done on elite male cyclists in their 20s who were working at extremely high percentages and throwing up between sets. You know, how relevant to, to us was that, that we should do high-intensity interval training? But we all adopted it. Now we've learned a little bit more about how to do that safely. Next up is recency. So usually when studies can be included, for me as an author, the contributing to places like Sharecare, and back in the day when there's— this was a thing, Huffington Post, to other incredible magazines. Prime Women is one. I'm blanking what— Doctors Don't Tell You, there it is. Other digital newsworthy pieces, when you are asked in certain cases or you're presenting— when I present internationally at fitness and health conferences, they will take studies that are within the last 10 years. So there are some exceptions to the rule here, and that is that, let's say studies from, you know, 1990, you know, and there hasn't been a new one because it is now so widely accepted that there were probably some prior to 1990, but nothing really since because it's been the basis for what we do believe. And, and we don't need to repeat, repeat, repeat because it's It's just a foundational piece that, that we now almost take for granted, although I hate to use that term. So recency is important, within the last 10 years, but there probably are some piggyback studies. There are always things when you're on a site and you're looking at a credible one, you can always see cited by, and that's what we're looking for. If you find a study that wasn't or isn't very relevant. If I create courses for myself or I create them for someone else, it's important that I go back. I authored a course in 2019 or 2020, you know, today what was 10 years relevant then is no longer, so I've got to go back and update it. Validity is about how well the findings apply to those people who are not in the study? So let's say in the shape of the, or in the form of the Tabata, how much is that gonna be valid for you and I? Now that you could say is also relevant to us, but yes, we wanna burn fat. So we would say this to those not in the study. So discussion is about communicating things that might interfere with it being applicable to a diagnosis or a protocol or a treatment. So might not apply— something applies to someone who has breast cancer, might not apply to somebody who doesn't. Somebody who doesn't have breast cancer, you know, certain things may not apply to them. So you've got to look at what's the validity to anybody outside of the study who tried the same thing, might not get the same result. Confidence level— there's always this aim for 95% confidence level, and it requires a result across a large number of subjects to show it. So I'm going to get to number of subjects in a minute because that's also something you want to consider. So confidence level, meaning 95%, we've got to have a large group of people studied to say with confidence this is going to apply to a lot of us. Because let's say there's only 12 people in the study, there can't be a lot of confidence about that. It's just not a big enough pool of people. However, if there's millions, you know, that also gets skewed. There's a sweet spot. So sample size, a good maximum sample size is often about 10% of the population. The population, by the way, that we're studying. As long as it doesn't exceed 1,000 people. So depends, right? It all depends on what it is we're studying. So between 100 and 1,000 people, larger than 30, less than 500 is what other sources say. So there's a lot of discrepancy depending on which institution is talking about what's a good sample size. So it's important that you realize there's some incongruency even here. So realize that too small, not enough, you know, that might be the first hint in there's a beta trial, there's a beta group. And then the more you have, so when we first started, and this is not a research study, but the instance is the same. When we first started truly doing testing for certain programs that I would then offer on a regular basis, year and month after month and year after year. We would— I was testing 4 weeks of a program and then 6, and then I tried 7, and that was 9, and then there was 12. And it was like all over. I tried it, tried it, tried it. Which got the best result? Where was the most positive result? Where people stayed with it, stayed engaged, Got results, didn't fall off the bandwagon. It wasn't so long attention spans were lost. So that's a similar example, not, not research-based, but you kind of get the idea. And at first, a beta group might have been 12, you know, and then you're like, okay, this is working, let's expand it. And then we're going to get 100, we're going to pull 100 people into this, and then we're going to take 350 still working, still pretty good results, and we see about the same percentage go all the way through, be super diligent, falling off the bandwagon and looking for what else can I do, right? So there's that— we're looking for that sweet spot so that we have enough to be representative of the population. What you should expect in most studies, which is also probably a source of frustration sometimes because it feels like I can't even— I can't absorb that. I need to read it 5 times to know what that meant. Like, I have to have my encyclopedia, my dictionary over here, and I'm reading over here. I sometimes felt like that in grad school when I was trying to read through something at first, but it's written for professionals. It's written for professionals and practitioners. So it isn't written for, you know, you and I in lay terms if we are simply pursuing fitness or whatever the industry might be. Author's names and a contact. So there usually is a lead researcher where they will be stating questions can be sent to, and that email address is included. There's a bibliography included. It is a big part of the research and writing at first, the beginning and the opening of a study of my, you know, you can call it a dissertation if you want to, but when you write that, it's that review of literature that already exists and all of those things are documented there and you are forming a hypothesis based on this piece and this piece and this piece. So it is also ideally a peer-reviewed journal. Now, how do you know that it's a peer-reviewed journal? What I want to do is come back to that, and we will offer you something special right here. So what you're going to have to do is— I'm going to hope that we get some pictures in this post— that we go to the journal and you're— you can't go to the article. So if you click on the article, you know, it's gonna look legit in a lot of cases, but you actually have to go to the journal where it's published. Now, there are a couple of journals that you and I know, we just know, like JAMA, Journal of American Medical Association, peer-reviewed, hands down. Right? We all know that one. The Obesity Journal, the Menopause Journal, and these are potentially also peer-reviewed. But what you would do is if you found an article or somebody had quoted an article— and this is just a great example for homework, by the way, and I will, well, post this for you so that you understand— as an example, there was a recent study posted by JAMA, Journal of the American Medical Association, in July 2024. It's not going to fall directly in current research about menopause, but it was that older adults, average age of 71, who lifted heavy weights for 1 year retained their strength for 4 years after the weight training was discontinued, while those that were doing moderate weight training— and actually they had them doing tubing and had them doing bodyweight exercises did not retain the strength. So this was a randomized longitudinal study. And so as is reported, it will tell you sometimes what it is, but what we know is they looked at them through time in that 4-year follow-up to see what happened with their strength. So they were checking in with them to see what their measure of strength was. That's a longitudinal study, like periodically over time, the same group, we're checking in with them again to see what happened. So a couple other examples will come up for that. So just so that you know and understand. Hey, it's Debra Atkinson. Can you think of one person who would benefit from this episode? Will you pause right now and share it? Send it directly to an individual or share it to your social media. This is how we, you and I, get a movement going and surround ourselves with women who are doing and thinking exactly what we want to do and think. The greatest work we have to do is in believing that it's possible, believing what it can look like. Now, in 10 years, in 20 years, and beyond. We are the first generation that collectively will strength train our entire lives, and that can change the way we all age. When you surround yourself with other women who are creating strong futures, we all win. So two additional terms to know in regarding research about menopause: qualitative and quantitative. And, and I'm guessing quantitative is going to come relatively easy, so I'll start with qualitative. That is more description and descriptive. It's more loosely gathered data that might be polls and surveys and interpreting the responses without necessarily giving percentages or statistics. And this might also come from a review of literature where you're not actually conducting studies, but you're talking about studies and gathering them up, filtering which ones will we look at, and then discussing that pool of studies and what the body of those together collectively found out. What are common denominators about the research methods, results? Quantitative is based on numbers. It's going to result, for instance, in a percent of muscle loss on average every decade, or over 80% of people describe libido issues in menopause. Mixed involves both, so there's qualitative— there'd be discussion and description— and quantitative provided. There are so many types of studies, starting with also observational and interventional. So observational studies are We're just looking at it. We're watching effects of habits and beliefs or events and how they affect certain outcomes. Smoking, for instance, affects heart disease, right? A study that reported an association between increased meat eating and cancer at one point, the study was though conducted based on a survey where participation was compensated. Now, often participation in such studies, you know, they're motivated by the ease of collecting, say, the $20 for reporting their habits, but they may be, you know, consuming hot dogs, right, or bologna and spam, unlike you who are probably choosing other options, maybe organic, grass-fed, grass-finished options. So you have to look at, hmm, all right, that's observational. And we just kind of collected the information about what their habits were and then what was true for them. And did we come to the right conclusion? That's the question. The headlines on something like that, saying eating meat causes cancer. Guess what? I mean, that's going to get the media a lot of views, a lot of clicks, and a lot of engagement. Interventional studies on the opposite side. So observational, just kind of watching what happened. Interventional, as I mentioned earlier, just as it sounds, it provides some kind of imposed change to subjects. So Providing an example on research about menopause, a study published in the Obesity journal on postmenopausal women in a weight loss program divided groups into long sleepers and short sleepers. They compared the results of the weight loss program and kept everything the same. So both groups did the same exercise, they did the same, had the same diet, they follow the same program. They asked them not to change anything else. It was just the sleep that was the variable, that was the differentiator. So they knew any difference in result was because of the sleep. By the way, are you sitting on the edge of your seat? I have shared this one before. I just wanted to share that for an example, but I will not keep you guessing. So the long sleepers— by the way, both groups lost weight. The program proved to be effective, but the long sleepers lost more weight, and more of the weight they lost was fat weight. They retained muscle as well, better than the short sleepers did. So there's that. All right, so let's look at types of research about menopause or longevity, strength, whether we're talking about any of that. There's longitudinal versus cross-sectional. Now longitudinal, I remember, or do you remember in the opener, that's one of the gold standards. So when we see we have a group of people, we've done some kind of intervention with them, or maybe observational, but what we saw, we checked in with them periodically over time to see Is this change continuing to go? Are they retaining the strength? Are they continuing to gain bone density over time? Cross-sectional, on the other hand, is a little bit different. That's looking at different segments of people at one time. So snapshot of lots of people versus one group over time. In research about menopause, perhaps none is more well known than the Nurses Health Study. It's a longitudinal observational study looking at the effects of certain habits over time. And some of Dr. Lauren Fishman's studies on 12 yoga poses that have a positive impact on bone density, those also have been longitudinal studies showing an increase of bone over time. Some were also retrospective, meaning they looked at, okay, were you somebody who practiced yoga more frequently than every other day? Which is a very interesting way to say it. They didn't want to say every day because that would have ruled out 99% of people because nobody does something every single day. But they could say on average more frequently than every other day. And then they got those people who, okay, I missed a day, right? And because we all do. So just so that you know, that's the way it's stated in the study, but it was looking back retrospectively, again in a poll, to say what happened to you from your first DEXA scan to the next over this time. New studies that would take specific poses and see which of those were most beneficial, those will be perspective. Like, there's a hypothesis that you might guess corpse pose, in case you're not familiar, where you're lying on the ground with your arms out and just— you get to close your eyes if you want to and go to sleep. That probably is not going to be as valuable as, say, tree pose or warrior pose or moon pose. That would be the hypothesis. When it comes to bone density, but they don't know that based on the research. They would just be estimating or, or hypothesizing until there was actually a study. So prospective studies will look at— let's measure the difference between this and that. There's then active treatment versus placebo studies, so where all people receive the treatment versus just some people actually receive the actual drug or treatment and others receive a placebo. So remember in the opener, the spoiler alert told you that placebo-based studies are actually the gold standard. So it's nice to know, okay, is this a real thing or isn't it? And yes, I think still we have to consider people who think they're doing the right thing, that they're getting the drug or they're getting the whatever it— our minds are a powerful thing. And so if we believe it, you know, there may be some truth to that. But when you have a group who actually is getting it versus a placebo, now you really know what is happening better. So where the actual protocol tested is resistance training exercise, and the placebo also does resistance training, but without the protocol. Maybe they're just told to go and do it and they don't do anything organized and they just watch random videos on YouTube. Huh. Go, go figure. All right, let's talk about control group and just what that is, just to be sure. So control group is generally the same population, same demographic as you might be studying. So say it's postmenopausal women diagnosed with osteoporosis, a control group would be given nothing. So they're just— we're going to look at, do they, say, have bone density increase, decrease, or stay the same when we don't interfere at all? And maybe you've chosen women who were non-exercisers prior to the study, but the other group of subjects is getting a protocol that they're going to use, or maybe they're getting calcium supplements instead. So depending on what you were testing, the control group is the measure that they're a subset that doesn't have the treatment or follow protocol. Open versus blind or double, double-blind study. So with an open, everybody knows who's in which group. So if we were going to say you're the placebo and you're actually getting the, the medicine that will be helpful Everybody would know. So the subjects and the researchers would know exactly, oh, this is that group, da da da. But in a double blind, neither the subjects nor the researchers know which is which. So again, it's more valid. You don't have researchers trying to maybe micromanage or control what is going to be happening. So that's an important distinction to make, that when no one knows, everybody is treated exactly the same. Randomized control versus case control, another way to consider it. But if you remember, how's, how's your memory at this point? There's a lot of terms floating around. Randomized control versus case control. So randomized is slightly better, right? So that it's like picked out, we're not controlling, okay, I want you there, I want you there. So just so that you have a good idea of all of the variables. No longer is conducting a study or getting one published for that matter an easy thing. But what you wanna remember about those peer-reviewed journals is this, that when someone has been published, they have gone to a peer-reviewed journal. So if you're in academics, you know that they need to be peer-reviewed journals because that's part of why you have tenure, because you're doing that. And you will be your submission for publication, so you don't just automatically get it submitted because you apply, but you go before a board who all review it. And they're looking for all of these things that we've just mentioned. You know, what's the reliability? Is it relevant? Is it recent? Is it, is there validity to this? What's the confidence level, the sample size? And they're determining all of that. And if they have any issues with the discussion, You know, they're coming back to the authors, and often it's not a one-person show. There are multiple authors, generally sometimes from different institutions, publishing a study together because there are experts in bone density in Australia and, you know, in Iowa for that matter. So all over the world, people are, you know, coming and That's how good research actually winds up being published, that you're getting influence from wherever you are at a certain institution. And then if you leave, you're getting exposed to a new way to think about things from a new pool of people. And for all of us, that's really good news. For all of you, hopefully this is really good news, and that you are knowing now at least what to question and where to look and how to know. So going on PubMed Those are not all peer-reviewed journals. ScienceDirect is. So ScienceDirect is actually, if you've ever come across, I'd be surprised if you have not, but ScienceDirect studies are a division of a pool of peer-reviewed journals. And ScienceDirect just makes them easy for, it's a good name really, it's a very good name to get the ScienceDirect. In a way that you can understand it in a user-friendly format. So it's not only what did the study say, but is what does this mean for me? What do I do with it? What's my practical application? Or do I want to do anything with it? So that is there for Google AI, Google Scholar, you know, and if you've noticed in the last few months, our experience Googling anything has changed dramatically. You're not getting shown individuals anymore, like a published article from Flipping 50. We're getting shown AI. So we're not in control anymore, by the way, you know, and maybe that's good and maybe that's bad. If you go to something like ChatGPT or one of the other search engines and you use Scholar, for instance, which is an AI-generated piece, you need to do your homework and due diligence because it is not yet, although it's well intended, it is not yet all peer-reviewed journals that, that they're using. And I have still found, although I haven't done a lot of reaching there for references for any articles or any master classes, I found that at first when I was using the beginning this year, I had to look up every single one of them because they looked legitimate. They looked really good. Some of them were not even journals, or they were journals but there was no such article, even though they listed the page numbers and went to great lengths. It's almost to fake it. There wasn't anything to actually be found by plugging the same link and content and site citation into, say, PubMed or any other search journal. So you have to do your due diligence and know, should I really believe this or not? And in fairness, you know, if we publish anything or create anything with the assistance of AI, we're letting that be known. We want you to know, you know, we have a chatbot on Flipping 50 and it's helpful. You know, it's a chatbot, but you know it, right? It's not my face. It's not my voice. We're not trying to pretend it is, and it probably not going that route. But there are videos— I just got one today from a friend, actually a colleague— and I landed on a thank you page for something, and I looked at that and I was like, that's not really you. It's just slightly off, you know. And it's certainly a time saver, a weekend, I'll do it right now. You know, they just created that. Her team created it. She didn't have to spend the time doing it. But, you know, in my humble opinion, that is something that needs disclosure. We need to be disclosing that to people. That's just my opinion. So you will always find out from me if that's true. If I struggle to interpret a study or something that's coming out, I will let you know and let you know that here's where I'm at in my own personal decision-making. Because like you, studies about menopause are very important to me, and I will let you know, you know, where I am with my stance, the questions that I'm asking, what I'm doing to look for more information, and what meanwhile I am planning to do in terms of taking action or inaction. As a decision-making process. So you will find the notes for today if you want. And again, if you're listening still, you have a lot of endurance, by the way, and you are thinking, you know, a cheat sheet would be really helpful and come in handy. You can find the show notes at flipping50.com/research about menopause., and I thank you so much for being here. Thank you for listening. 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