MEDICINE 3.0 | EP 6 | Unpacking Women’s Hormone Health with Catherine Isaac, MD
MEDICINE 3.0 | EP6 | Unpacking Women’s Hormone Health with Catherine Isaac, MD
🎙️ New Episode Alert: Unpacking Women’s Hormone Health on Medicine 3.0 Podcast 🎙️Excited to share our latest episode featuring Dr. Catherine Isaac, our expert on female hormones at Bionic Health. We delve into women’s hormone health, particularly around menopause, highlighting the knowledge gaps and the transformative power of hormone replacement therapy (HRT).
Key Takeaways:
Understanding the broad age range and varied symptoms of menopause.
The critical role and benefits of HRT beyond conventional uses.
The necessity for improved healthcare provider training in women’s hormone health.
Join us for an insightful discussion that broadens the narrative on menopause and empowers through education.
Beyond the Stereotypes: Identifying and Treating Eating Disorders in Adults
In this episode of Medicine 3.0, Dr. Catherine Isaac sits down with Dr. Rebecca Berens, a board-certified family medicine physician and founder of Vita Family Medicine in Houston, Texas, to explore a topic that is often misunderstood and underdiagnosed in clinical practice: adult eating disorders.
While eating disorders are typically associated with adolescence, they are increasingly present—and frequently missed—among adults. Dr. Berens brings a unique perspective to this discussion, blending her clinical expertise with personal lived experience and a deeply weight-inclusive approach to care.
Reframing What We Think We Know
As Dr. Berens explains, most clinicians and patients still carry outdated stereotypes of what an eating disorder "looks like." These misconceptions often lead to missed diagnoses, delayed treatment, and harm caused by well-intentioned but misinformed care.
Among the key takeaways:
Many individuals with anorexia are not underweight
Binge eating disorder is the most common eating disorder in the U.S.
Disordered eating is widespread, normalized, and often undetected in primary care settings
Disordered Eating vs. Eating Disorders
One of the central themes in this episode is the distinction between disordered eating and diagnosable eating disorders. Disordered eating often exists on a spectrum and may not meet strict DSM-5 criteria, but still carries serious physical and psychological consequences. This includes chronic dieting, food avoidance, excessive “clean eating,” or rigid fasting practices that disrupt daily life.
Dr. Berens shares simple screening tools like the SCOFF questionnaire to help clinicians identify high-risk behaviors and initiate conversations that are compassionate, non-judgmental, and clinically useful.
Medical Complications and Misdiagnosis
Eating disorders don’t just affect mental health—they can compromise multiple body systems. Dr. Berens details how restrictive eating patterns, binge cycles, and purging behaviors can lead to:
Osteopenia and osteoporosis
Sarcopenia (muscle loss)
Amenorrhea and hormone disruption
Bradycardia and orthostatic hypotension
GI symptoms frequently misdiagnosed as IBS
She also emphasizes how many common conditions, including ADHD and PCOS, intersect with eating disorders in ways that are frequently overlooked.
Creating Safe, Weight-Inclusive Care
The episode challenges providers to move away from weight-centric care and toward a more individualized, evidence-based model. Dr. Berens outlines how to:
Avoid re-traumatizing patients through weight-based messaging
Shift clinical conversations toward health behaviors, not body size
Build trust with patients who may have avoided care due to weight stigma
Recommended Resources
Dr. Berens shares helpful tools for clinicians and patients alike, including:
The Musculoskeletal Syndrome of Menopause: A Conversation with Orthopedic Surgeon Dr. Jocelyn Wittstein
"Why do my joints suddenly hurt?" "Is this frozen shoulder connected to my hot flashes?" If you're a woman in your 40s or 50s experiencing mysterious joint pain, you're not alone—and it's not just aging. In this eye-opening episode of Medicine 3.0, host Catherine Isaac delves into the hidden connection between menopause and joint pain with Dr. Jocelyn Wittstein, orthopedic surgeon and sports medicine specialist at Duke Health. They uncover the surprising truth about the "musculoskeletal syndrome of menopause" that affects millions of women but remains largely unrecognized in clinical practice.
Understanding Musculoskeletal Changes During Menopause
As women transition through perimenopause and menopause, the decline in estrogen levels triggers significant changes in the musculoskeletal system that many women—and even healthcare providers—may not recognize as being connected to hormonal shifts.
Dr. Wittstein explains that these changes fall into three main categories:
Increased Inflammation: Women experience more painful, inflamed joints and an accelerated rate of arthritis development. A prime example is frozen shoulder (adhesive capsulitis), which almost exclusively affects women aged 40-60.
Accelerated Bone Density Loss: During menopause, the rate of bone density loss increases from 1% to 2% annually, significantly raising the risk of osteoporosis and fractures.
Muscle Mass Challenges: With declining estrogen levels, it becomes more difficult to maintain and build muscle mass, leading to sarcopenia (muscle loss).
The Menopause-Arthritis Connection
Dr. Wittstein describes what she calls "menopause arthritis" as existing somewhere between mechanical wear-and-tear osteoarthritis and purely inflammatory arthritis. The combination of aging joints and increased inflammation creates a unique scenario where women have a 30% higher risk of developing osteoarthritis around age 50—a risk men don't experience until about age 80.
Estrogen receptors exist in the synovium (the tissue lining joints), and studies show that estrogen withdrawal increases inflammation while estrogen therapy can reduce joint pain and inflammation. Interestingly, Dr. Wittstein notes that even though 77% of women in the Women's Health Initiative reported joint pain, and hormone therapy reduced both the number and severity of painful joints, joint pain is not currently an FDA-approved indication for menopausal hormone therapy.
Frozen Shoulder: The "50-Year Shoulder"
Frozen shoulder deserves special attention as it disproportionately affects women during the menopausal transition. Dr. Wittstein explains that this condition:
Usually occurs without injury or trauma
Begins with aching that progresses to significant pain and stiffness
Can take up to two years to resolve completely
Is so common in menopausal women that some cultures have termed it the "50-year shoulder"
The condition is so strongly associated with hormonal changes that when Dr. Wittstein sees a man with frozen shoulder, she screens him for diabetes, as that's typically the only context where men develop this condition.
Treatment Approaches
For frozen shoulder, Dr. Wittstein emphasizes early intervention:
Steroid injections into the joint can be "magical" when administered within the first three months of symptom onset
Physical therapy may worsen symptoms if attempted during the painful inflammatory phase
For severely "frozen" shoulders that limit daily activities, surgical intervention may be necessary
Dr. Wittstein also discusses the complex relationship between menopause and musculoskeletal health, emphasizing two factors under individual control:
Exercise: A balanced approach that includes:
Strength training (resistance exercises) to support muscle and bone health
Cardiovascular activity for heart and brain health
Impact exercises (like jumping) to stimulate bone density
Balance training to prevent falls
Diet: An anti-inflammatory approach focusing on:
Minimizing red meat, fried foods, and processed foods
Including at least 25 grams of fiber daily from whole grains
Consuming a variety of fruits and vegetables for their antioxidant properties
Incorporating omega-3 fatty acids from fish, walnuts, and chia seeds
Resources for Further Learning
For those looking to learn more about maintaining musculoskeletal health during menopause, Dr. Wittstein recommends:
The Complete Bone and Joint Health Plan - Dr. Wittstein's own book co-authored with registered dietician Sydney Nitskorsky, providing comprehensive guidance on nutrition and exercise for bone and joint health.
The M Factor - A recommended film about menopause that provides additional context and education.
Ortho Info - A patient-friendly resource from the American Academy of Orthopedic Surgery offering guidance on various orthopedic conditions.
The Takeaway
This episode highlights how the musculoskeletal impacts of menopause remain underrecognized despite affecting millions of women. Dr. Wittstein's expertise sheds light on why women experience particular joint, bone, and muscle challenges during this life stage and offers practical strategies for maintaining musculoskeletal health through the menopausal transition and beyond.
By understanding these connections and taking proactive steps with exercise, nutrition, and appropriate medical interventions when needed, women can better navigate the musculoskeletal challenges of menopause and maintain mobility and function for years to come.
Episode Timestamps
For easy reference, here are key moments from the conversation:
02:33 - Definition of musculoskeletal syndrome of menopause and its three main categories
05:27 - Explanation of menopause arthritis vs. other types of arthritis
10:07 - Dr. Wittstein's explanation of frozen shoulder
12:14 - Why frozen shoulder predominantly affects women
24:03 - Treatment options for frozen shoulder (steroid injections)
31:41 - Discussion about muscle loss during menopause
33:11 - Connection between muscle mass and bone density
39:42 - Explanation of hip bursitis and prevention strategies
45:21 - Anti-inflammatory diet recommendations
48:41 - Resources for further learning about musculoskeletal health
Listen to the full episode of Medicine 3.0 with Dr. Jocelyn Wittstein to learn more about managing musculoskeletal health during menopause.
Optimize Your Fitness Journey with Performance Testing
In this insightful episode of the Medicine 3.0 podcast, Bionic Health advisors Kelly and Anna dive into the world of performance testing and how it can revolutionize your fitness journey. Whether you're a seasoned athlete or just beginning to incorporate exercise into your routine, establishing a baseline through comprehensive testing provides invaluable data to guide your path toward optimal health.
Why Performance Testing Matters
Performance testing gives you a clear picture of where you stand across multiple fitness domains. As Anna explains, "We recommend it to get a baseline of where our members are at currently in their fitness. They get percentiles, and that's helpful to get a knowledge of where they're at and where they should go."
This data-driven approach transforms abstract fitness goals into tangible metrics that can be tracked and improved over time. By establishing these baselines, your Bionic Health team can create truly personalized recommendations tailored to your specific needs.
What to Expect During Testing
The comprehensive performance testing protocol at Bionic Health includes:
VO2 Max Testing - The gold standard for measuring cardiorespiratory fitness, conducted on a stationary bike
Strength Assessments - Including bench press and leg press for maximal strength evaluation
Muscular Endurance Tests - Push-ups and dead hang measurements
Hand Grip Strength - An excellent indicator of overall body strength
Mobility Assessments - Evaluating shoulder, hip, ankle, and knee mobility
Vertical Jump - Measuring power, which tends to decline most rapidly with age
Many members feel nervous about performance testing or believe they need to "train before they train." Kelly and Anna emphasize there's no need to worry—the purpose is simply to establish a starting point. "There's really no pressure to get any certain score right off the bat," Anna reassures. "It's just getting more information that's valuable for how to improve looking forward."
The Science Behind VO2 Max
The VO2 Max test measures how efficiently your aerobic system uses oxygen during maximal exertion. This data helps determine your personal heart rate zones for training, allowing for more precise workout programming. As Kelly explains, the test also provides insights into metabolic flexibility—your body's ability to switch between different energy sources during exercise.
Tracking Progress Over Time
Most members who return for follow-up testing see significant improvements across multiple metrics, particularly in VO2 Max and bench press strength. The recommended retesting frequency is every 6-12 months, allowing sufficient time for meaningful changes to occur while keeping you accountable to your fitness goals.
Beyond the Numbers
Performance testing isn't just about achieving high percentile rankings—it's about optimizing your health for longevity and quality of life. As Anna notes, "A lot of our members join Bionic with the goal of aging comfortably and being able to do the things that they love long-term."
Even members who regularly strength train often discover opportunities for improvement in their programming. The testing process frequently reveals needs for more strategic progressive overload or better balance between different fitness domains.
Take the First Step
If you've been hesitating to schedule your performance testing session, Kelly and Anna have one clear message: don't wait. The valuable information gained from these assessments will help you work more efficiently toward your goals, whether you're just starting out or looking to optimize an existing routine.
"Performance testing is valuable for all of our members," Anna concludes. "It gives a lot of valuable information on how to improve in all of these different areas... we can really work with you one-on-one to slowly add in training or adjust to your specific goals."
Ready to establish your fitness baseline? Contact your Bionic Health advisor today to schedule your performance testing session.
Podcast Timestamps:
00:08 - Introduction and welcome 00:58 - Overview of performance testing benefits and protocols 03:53 - VO2 Max testing explained 09:53 - Using heart rate data for personalized training zones 12:50 - Strength and grip testing protocols 16:25 - Importance of mobility for healthy aging 18:55 - Vertical jump testing and power assessment 20:06 - Plyometric training discussion 23:55 - Recommended frequency for retesting 25:19 - Balancing different training modalities 26:42 - Final thoughts and encouragement for members 29:05 - Closing remarks
