HPN 27: Coming Off The Pill and Supporting Your Natural Cycle (For Athletes), The Best Time To Eat Iron-Rich Foods With What To Avoid For Better Absorption
May 21, 2021
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Welcome to episode 27 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:
Training & Life Updates From Julie & Tawnee
- Tawnee shares how and why she paused her ultra-endurance goals to better manage overall stress and life’s demands, and what went into her decision-making process.
- Also: the new goals that Tawnee has adapted that better serve her in this season of life—a lesson she’s learned in minding your health and wellbeing after years of trial, error and mistakes.
- Julie shares her 2021 goals, which include a 50k that she’s been dreaming of doing, and her approach to training while still working through her Achilles issues.
- How and why Julie is taking on a more structured plan to help keep her in check and feeling good, including 2 days off from running after each run she does.
Part 2, Q&A:
Jessica M. asks:
Discontinuing oral contraception combined with training/hormones
Hi HPN! I really enjoy the podcast. My question is regarding quitting oral birth control (the pill) after over 12 years of continuous use and how that may play into training and hormonal changes.
I am a 32 y/o female and have been on the pill for 12+ years now. I started the pill simply for birth control (no other reasons like wanting to skip periods, or to prevent cramping or anything else) and had normal periods before starting. The past few years as my training volume has increased (now around 60-90 miles/week average depending on where in the block I am) I have noticed my periods getting lighter and lighter to the point where I have “normal” bleeding for only one day or so during my cycle (about 1/2way thru the placebo pills in the pack) and occasional spotting in between. I didn’t think much of this but recently have begun to wonder if birth control is hiding the fact that perhaps my cycle would be irregular (or even non-existent?) without it. My bloodwork is normal at last check (iron, b12, etc), but i’ve never had any hormones tested. I always seem to walk the fine line overtraining, although I think I am getting better at taking it easier when my body feels like it needs a rest, but am wondering if perhaps hormones would be playing some role in this.
The past few months I have been starting to consider discontinuing the pill. I don’t want children (in my current situation I don’t need to worry about this), but am more curious as to what my actual cycle is like or if hormonal balance (or imbalance) is an issue with the higher mileage I have been doing in recent years. I really like the regularity of my periods on the pill but am worried that maybe I’m just masking an underlying issue.
Can I still accurately test my hormones (I’m thinking DUTCH test or something similar) while on the pill to make sure everything is in line? Is there a specific time to take bloodwork to get the most accurate assessment? Just wanted to get your thoughts on this — discontinuing the pill vs staying on it and assessing hormones etc during training.
Thanks for everything you do!
What the coaches say:
Some potential downsides to the pill
- May cause stomach, gut and digestive issues – e.g. candida, dysbiosis, etc.
- Could deplete nutrients.
- Jessica says her B12, iron, etc, are normal but is she optimal? We discuss blood lab reference ranges and why normal may not tell the whole story or mean you’re doing ok.
- For example: Antioxidants, B vitamins, selenium, zinc can be depleted on the pill.
- Can negatively affect thyroid.
- Increases risk of depression.
- The pill doesn’t balance your REAL hormones, it just suppresses them and replaces them with synthetic ones
- When on the pill, you don’t necessarily get the health benefits you actually want from natural hormones.
- The bleed on the pill is a withdrawal bleed not a real period (and you’re not ovulating either).
- Spotting is generally normal on the pill.
Training and hormones
- 60-90 miles per week is a lot, anecdotally we see more breakdown in athletes beginning to occur when consistently putting in 70+ mpw, both injury risk and hormonal depletion/health issues.
Testing hormones while on the pill
- What Precision Analytical says (ie DUTCH test, which Jessica is interested in doing):
- “Women on birth control pills have suppressed estrogen and progesterone. If you wonder why their progesterone and estrogen levels are low – they are supposed to be when you’re on the pill!”
- “You can test the Dutch Adrenal while on the birth control pill however testing the sex-hormones has diminished value.”
- “The birth control pill (ring and implants) stops the FSH and LH surge from the pituitary to prevent an estrogen rise and ovulation (thus progesterone production) from the ovary.”
- Stopping the pill abruptly won’t just fix things for accurate testing.
- Precision analytical encourages you “have 3 full menstrual cycles without any pill, ring or implant use before testing to ensure the hypothalamic-pituitary communication with the ovary is back on track as best as it can be.”
- Blood testing
- Also best to do after you’re off the pill.
- Day 2-4 – this is the best time to test FSH and LH, i.e. the brain-ovarian connection/communication; hormone levels/results are how the ovaries are responding to messages it’s getting.
- Test of fertility, ovarian reserve, etc.
- The pill stops FSH and LH surge from the pituitary to prevent an estrogen rise and ovulation (thus progesterone production) from the ovary. (Source: Precision Analytical)
- Estradiol and progesterone – test both around days 19-22 of a 28 day cycle.
- Progesterone levels are highest 5-7 days following ovulation.
- Helpful to get estradiol/estrogen levels in relation to progesterone during the luteal phase especially if estrogen dominance symptoms or PMS issues.
- For athletes- this is the time to do your DUTCH and/or blood.
Some female philosophy
- It’s personal
- YOU are the only person who truly understands your body and what it needs. YOU are the only one who can determine whether or not the benefits of taking the pill outweigh the risks
- We totally encourage and support any woman who’s ready to get off the pill or any oral contraceptive.
- Let your body adapt back to its natural state, support it appropriately, and listen/take action on its cues. It’s time to reconnect with your beautiful self!
- Why do it?
- Bone health!
- Cancer risk, cognitive decline.
- Because having a natural cycle is HEALTHY and a SUPERPOWER.
- To reconnect with ourselves, live in harmony with nature, and work with our bodies instead of against them.
- To reestablish trust.
- Exogenous hormones compromise so much and they down-regulate your muscles ability to recover.
Coming off pill – a process & practice in patience, listening to your body
- “Hormone imbalance, inflammation, digestive disturbance and as well as others symptoms. These last for an average of at least 4-6 months after coming off the pill.” – Dr. Jolene Brighten, author or Beyond the Pill.
- Athlete specific:
- If training with a lot or volume and/or intensity, this may impact the return of a normal cycle and monthly period, must monitor closely.
- Hormones may not bounce back as quickly as one would hope. This could be for many reasons including an energy imbalance, overtraining, overstressing the body, and any of the things that contribute to typical hypothalamic amenorrhea.
- The question is: If you are seeing a hormonal imbalance and/or amenorrhea, are you willing to make the changes and do the work to heal hormones? This would include things like less training and possibly revising your nutrition, along with overall stress management.
- Things you can do to help:
- Morning morning BBT to track ovulation/cycle phase.
- Extra B6 (100mg/day) for luteal phase defect.
- Also for luteal phase: extra Mg glycinate and Vitamin C.
- Consider a B complex supplement for total HPA axis support (we love Thorne’s Stress B Complex).
- Extra Omega 3 fatty acids for hormone production.
- Vitex for hormone balance, especially progesterone.
The science of the pill and periods for female athletes
When is the best time to eat iron-rich food?
I did an IT test and my iron levels are borderline low (in their “needs work” category). I have some great recommendations on what foods to eat–although open for more suggestions–and feel ready to fix this issue before it gets worse (trying to avoid iron dropping into their “at risk” category and/or anemia).
So my question is: WHEN is the best time to eat iron-rich foods or take an iron supplement? Is there an optimal time to help better absorb iron? The thing is, I feel like my diet is pretty rich in iron foods anyways (I eat red meat every week, etc) so I was thinking maybe there’s something I’m doing wrong here.
Second question is: Is there anything to take or avoid taking with my iron food/supplements? I’ve read some things online about coffee being bad for iron, but am going to look to you guys to give us the lowdown on what the research and science says here!
Lastly, how, if at all, does exercise affect iron absorption? Does eating iron foods after a hard workout help boost iron?
Thanks for your insight!
What the coaches say:
- Inside tracker found that “50% of females under the age of 50 have suboptimal ferritin levels.” (And only 2% had too high of iron!)
Optimal time to eat & absorb iron?
- In the morning
- Hepcidin is lowest at this time making for better absorption rates.
- Iron supplements should ideally be taken on an empty stomach for maximum absorption, e.g. ideally first thing in AM. However, if this causes upset stomach you can take with a light meal preferably one with Vit C to enhance absorption.
- Or: Can also take ~1 hour after drinking coffee (see below) or 2-3 hrs after a meal, before eating again.
- Don’t take directly after exercise, this can negatively affect absorption of iron as well. Wait till rested.
- Can take things like PerfectAmino Amino Acids, etc, directly after exercise while empty stomach.
- Avoid having it with calcium, i.e. 300mg or more of calcium rich foods (eg one cup of skim milk)
- Avoid having it with oxalates (spinach, kale, parsley, beets, nuts)
- Avoid having it with grains and legumes unless properly prepared (soaked and sprouted)
- foods containing phytic acid/phytates can lead to 50-65% reduction in iron absorption with these (whole grains, beans, nuts, seeds, soy proteins)
- Avoid having with coffee, tea, chocolate, i.e. tannins and polyphenols
- Up to 60% reduction in absorption with tea and coffee, chocolate, herbs.
- The tannins in coffee and tea may bind to iron and block absorption
- Inhibition of food iron absorption by coffee
- Best to take or eat iron one hour after coffee not one hour before.
- “A cup of coffee reduced iron absorption from a hamburger meal by 39% as compared to a 64% decrease with tea, which is known to be a potent inhibitor of iron absorption.”
- Effect of tea and other dietary factors on iron absorption
- “From these calculations we conclude that the presence of sufficient amounts of iron absorption enhancers (ascorbic acid, meat, fish, poultry, as present in most industrialized countries) overcomes inhibition of iron absorption from even large amounts of tea. In individuals with low intakes of heme iron, low intakes of enhancing factors and/or high intakes of inhibitors, iron absorption may be an issue.”
- Heme iron is less affected by the polyphenols of coffee and is less bossed around. You’ll get more iron absorbed from steak and coffee than veggie scramble and coffee.
- Avoid having it with excess FIBER
- “Excess insoluble fiber can bind to minerals such as zinc, magnesium, calcium, and iron, preventing the absorption of these vital nutrients.”
- Eggs can reduce iron absorption by up to 28%.
- For optimal absorption eat “all meat meals” with some fruit and supplement with that meal.
- Eat with a vitamin C-rich food; and/or 500-1000mg vitamin C.
- Eat with a food containing heme iron.
How to increase ferritin/iron and troubleshooting
- Avoid coffee, tea, high fiber, dairy, eggs, chocolate and calcium supplements 2 hours before and after a “meat meal”
- Eat your red meat, dark meat, venison with a green salad or fruit for vitamin C. Take iron supplement with this meal. (source)
- If blood values remain low despite detailed attention to all of this, may need to assess gut health and/or gut dysbiosis that could be preventing proper absorption of not only iron but other nutrients and minerals.
- Also check stomach acid, too low?
Iron content in common foods (via Cronometer)
- 3oz beef liver is 6mg of iron
- 3oz ground bison/buffalo 2.7mg
- 3oz clams is 2.3mg
- 3oz mussels 3.4mg
- 3oz oysters 5.7mg
- 3oz tuna 1.3mg
- 3oz wild salmon .5mg
- 3oz beef is 2.3mg
- 3oz leg of lamb 1.9mg
- 3oz venison 3.8mg
- 3oz chicken breast .9mg
- 3oz turkey leg 2mg
- 3oz ground pork .6mg
- 1 egg .5mg
- 3oz Tofu 1.8mg
- 3oz tempeh 1.8mg