HPN 23: Recovered From Amenorrhea? How To Maintain Healthy Hormones, Why It’s Important To Keep Your Period, and Mindfully Monitoring The Phases of Your Cycle with Complementary Training and Fueling Practices; Plus – Inside Tawnee’s Recent Bloodwork!

November 6, 2020
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Welcome to episode 23 of Holistic Performance Nutrition (HPN) featuring Tawnee Gibson, MS, CSCS, CISSN, and Julie McCloskey, a certified holistic nutrition coach who you can find over at wildandwell.fit.

On this episode:

Intro:

Tawnee & Julie discuss Tawnee’s recent InsideTracker blood test with her InnerAge 2.0 results – a brief analysis of findings by Tawnee and Julie.

  • This study and this Inside Tracker blog as it relates to elevated levels of AST and ALT (liver enzymes) in those who exercise heavily. Did Tawnee’s difficult weight workout affect her results? Other factors with AST and ALT, and also the importance of looking at trends (and what Tawnee’s trends show over the past 10+ years of blood tests).
    • Inside Tracker is recommending her AST be 10-24 and ALT 6-16.
  • Does a slightly high creatine kinase (CK) also support the too-hard exercise theory? 
    • “Physical exercise or strenuous sporting activities can increase blood creatine kinase (CK) levels… CK levels respond to marked changes in the amount and intensity of exercise. Thus, CK levels may increase significantly after unusual and eccentric types of exercise. This primarily applies to strength and speed-strength exercise stress (4)…. Marked increases in CK activity in the blood are often associated with an increase in aminotransferases; here, glutamic oxaloacetic transaminase (GOT)/aspartate aminotransferase (AST)—because of its higher muscular activity—shows a stronger response compared with glutamic pyruvate transaminase (GPT)/alanine aminotransferase (ALT). Gamma-glutamyl transpeptidase (GGT) remains unchanged (3).” Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904530/
  • Gamma-glutamyl transferase (GGT) vs AST/ALT as cited in the Inside Tracker blog: “While GGT is more specific to overall liver health … ALT and AST are also found in significant quantities in skeletal muscles. When muscle is damaged, such as in response to exercise, AST and ALT are released from the  muscle and their concentration in the blood increases …  Creatine Kinase, an enzyme found in our muscles, is another marker of muscle damage that follows the same pattern as AST and ALT after strenuous exercise.”
  • Why Tawnee is not worried about her cholesterol results:
    • Previous Endurance Planet episode on Steps to Healthy Cholesterol Levels
    • The bigger picture: Tawnee eats a super clean diet, her HDL:TG ratio is 1.09 (low risk is <2), HDL is over 69 (over 50 ideal for women), CRP is <1 (0.3), LDL:HDL ratio should be under 3:1 and hers is 1.8. No homocysteine on this test but last year it was 6.2 and <7 is ideal. Also, Tawnee’s blood sugar levels/glycemic control this year have generally been fantastic. 
    • LDL-C doesn’t tell the whole story so Tawnee would want to look at LDL-P and apoB to understand more. LDL-C over 160 is considered high risk, hers was 130.
    • Interesting from recent Robb Wolf’s podcast, Healthy Rebellion Radio: “new paper.. really interesting machine learning looking at the relationships between LDL cholesterol and diabetes risk. People with low LDL are at an exceptionally higher risk for type 2 diabetes and poor glycemic control. Now, what wasn’t entirely clear was is having higher cholesterol levels protective of this? That wasn’t entirely sussed out, but it’s one of these things where we have this narrative where it’s like, “Oh, man, the lower the LDL cholesterol, the better,” and that’s not necessarily the case.”
  • Tawnee’s InnerAge 2.0 is 31.6 (her biological age is 35.6). There are 14 markers are used to calculate inner age for females (18 markers for males). For females it includes:
      1. Albumin (Serum protein) 
      2. Basophils % (Immune cells) 
      3. DHEAS (Sex hormone) 
      4. Eosinophils % (Liver enzyme) 
      5. GGT (Liver enzyme) 
      6. Glucose (Blood sugar) 
      7. Hemoglobin A1c (Blood sugar) 
      8. LDL (Cholesterol transporter) 
      9. Lymphocytes (Immune cells) 
      10. Monocytes % (Immune cells) 
      11. RDW (Red blood cell width) 
      12. Triglycerides (Fats for energy storage) 
      13. TIBC (Iron-binding capacity) 
      14. BMI (Body mass index)

Adriana asks:

Planning your training (and nutrition) around a period

I have recovered from amenorrhea (thank you for your awesome advice, it definitely helped me along the way!) and now want to make sure my period stays healthy and normal, and that I can plan my training with my cycle to maximize my training with my hormones. Of note, I’m 29 years old, 5’5 135(ish) lbs, and it took awhile for my period to normalize but now it’s pretty steadily 26-28 days per cycle and I do feel worse in the 4-5 days before it starts. I’m mainly a runner but starting to get into more triathlon training — I’ve done plenty of marathons and not sure how long I’ll take it with triathlon but would like to eventually do an Ironman. 

Also, I am not on any special diets but am wondering if there’s a style of eating that complements each phase of the menstrual cycle that you guys would recommend, like should we give into all the sweet/carb cravings before we start our period or would lower carb low sugar help alleviate PMS like symptoms?

Thanks for your work especially for the ladies out there!

What the coaches say:

  • For starters, refer back to this EP podcast Tawnee recorded with Dr. Stacy Sims a number of years ago for a lot of wonderful, specific details and advice: The Everything Guide for Female Athletes – How to Navigate Your Menstrual Cycles, the menopause Years, Cortisol and Stress, Nutrition Needs, and More 
  • Primer on periods and phases: Follicular phase (Days 1 to ~14)
    • Low hormones. You feel stronger and exercise feels easier. Women also access carbs more easily during this time. A good time for HIIT. 
    • Week 1: Anti-inflammatory foods to help with the added inflammation of menstrual week:
      • Fish, fruits, veg, nuts and seeds, herbs, ginger tea
    • Week 2: Our extroverted, go get ‘em week! Can make some serious “gains”
      • An increase in protein would be beneficial to support your added intensities
  • Luteal phase (Days ~14 to 28-40ish/end of cycle)
    • Build to the high-hormone phase, PMS, and generally not able to perform as well. Reduced reaction time, coordination off (hormonal related joint laxity). Women burn more calories during this time (5-10% increase in metabolism).
    • Progesterone is catabolic, and with both hormones high, it’s harder to access amino acids. So an increase in protein here would be helpful!
    • Lower total body sodium; be sure to preload your long workouts and salt your food!
    • Week 3:  Get in protein, especially before a workout. Go into workouts fueled. For the longer sessions, eat carbs during a workout. Eat more resistant starches to help with your gut bacteria and hopefully, alleviate any constipation that an increase in progesterone and estrogen can cause
    • Week 4: PMS; hormones are at their peak. Avoid fried foods, processed foods, and anything that you know causes inflammation in your body. Increase antioxidant-rich foods and calories because you’re building a new organ (endometrial lining). 
  • Watch for luteal phase defect (short second phase). This can be more common in endurance athletes and/or those who’ve recovered from amenorrhea and shows that progesterone levels may not be optimized, can be tied into overtraining, underfueling and/or other hormonal things like low thyroid. Source: https://pubmed.ncbi.nlm.nih.gov/12972877/ 
  • There are too many nuances to female physiology and cycle to draw blanket conclusions on how we should fuel. No one size fits all. And the research is rather inconclusive and/or contradictory and lacks the quality type of RCT that we want.
  • High hormone phase (luteal phase):
    • Traditional knowledge shows us that we have a harder time utilizing carbs/glucose so intensity may feel more difficult.
    • Higher oxidation of lipids and lower oxidation of carbohydrates in the luteal phase during submaximal efforts at an intensity higher than 50% VO2max have also been demonstrated in other studies [61, 62, 63]. 

Overall recommendation:

  • Don’t overthink it–the main goal is to get in enough calories overall and not dip into prolonged periods without fuel (e.g. IF) and/or a chronic hypocaloric diet trap. This is always goal #1. Eat to train, don’t train to eat! 

Cheryl asks:

Gaining weight & your period

Hello Tawnee and Julie! (Lucho won’t want this one. Sorry, Lucho)

Thank you for putting out high quality podcasts. I actually went back and listened to all of the ones I could find. I think I’ve picked up tidbits from all of them!   I really enjoy the addition of HPN and look forward to each new episode. That’s where my question is directed today. I’m a 41 year old female competitive runner. I also dabble in IM and enjoy that at well.  For running, my main focus is the marathon, and my PR is 2:53. I love running fast endurance events. I work with an endurance coach and my training fluctuates between MAF, Daniels, and honestly probably every other method that’s out there. We keep it interesting. 🙂 So, I haven’t menstruated since Dec 2017. I‘m 5’6” and currently weigh 110-112. My weight hovered between 120-125 for over a year and a half before I made a concerted effort to drop weight for my OT attempt. I did not menstruate when I was at 125 and obviously not now that I’m much lower. I have a few questions that I don’t think have been directly answered on the podcast before. If they have, I apologize and please point me to the correct show. 

First, should I care that I haven’t menstruated?  

I’ve had multiple (probably around 5) DEXA scans since 2018 and my bone density is great. I keep monitoring it because I know that is one of the biggest concerns with not menstruating. I also have two beautiful children and am not looking to have anymore.  Also of note, is that I’m not hungry.  Getting down to this weight was a challenge, but now that I’m here it just feels natural. I get full and don’t want to eat anymore.  What else should I be concerned about? The rest of my questions are contingent upon the answer to the first. 

If I should care, how do I begin to healthily gain weight?  

Again, I greatly appreciate your podcasts and I’ve learned so much from all of them. Thank you for brightening my days and making all of us better athletes and humans. 🙂

What the coaches say:

  • Every woman wants to have their period; it is a great marker for overall health, energy, mood, cognition, sex drive, sleep, etc.
  • Higher levels of progesterone promote more restful sleep via an increase in GABA., also aids in lowering anxiety and restlessness
  • Low hormones also inhibit sleep quality, sexual health/libido, and can contribute to increased anxiety, stress, etc. Source: https://pubmed.ncbi.nlm.nih.gov/31403123/
  • There are important potential long-term health complications to be aware of for women with amenorrhea; they include a higher predisposition to heart disease and cognitive diseases in later years of life. Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374026/; https://pubmed.ncbi.nlm.nih.gov/8375531/
  • “A lower daily fat intake and lower percentage of total energy from fat were associated with increased injury risk among competitive female runners.” Source: http://jissn.biomedcentral.com/articles/10.1186/1550-2783-5-1
  • Stress fracture is associated with low energy balance and amenorrhea. Source: http://www.ncbi.nlm.nih.gov/pubmed/16089273?dopt=Abstract
  • A good DEXA scan doesn’t necessarily mean that bone health is good, too. 
    • From Anya, “Great to know that she does not currently have clinical osteopenia, but what we don’t know (maybe she does if she had a DEXA prior to the onset of amenorrhea) is the change in bone density that may have occurred. If she started with relatively higher T scores (Z scores are better when looking at bone density because it is matched to your age group, bone DEXA scans are read as standard deviations from the norm), then they may still look “normal” but the bone is not being remodeled optimally.”
    • They may look “normal” but her bones aren’t remodeling optimally. Most likely her estradiol is low which is needed to inhibit bone breakdown. Low estrogen, lots of bone breakdown
  • If you cannot eat more then you need to reduce your training.
  • You have to want it, and you have to go out of your way to make it happen. It will be uncomfortable.
  • UCAN Almond Butter (see link at the top of the page).

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