HPN 28: Oral Contraceptives Impair Lean Mass Gains, Plus: Deep Dive Into Mental Health and Menstrual Recovery For Athletes, Coaches and More

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Welcome to episode 28 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

All things summer & healthy balance

• Julie and Tawnee life updates, with Julie’s approach to healthy 50k training (more sleep, more food!)

Responding to criticism

• In the spirit of transparency, Julie and Tawnee share some feedback they got after the last episode (HPN 27) including some criticism. We are open to and appreciate all comments and critiques sent with love, as we continue to strive to do better for our community.

More on birth control & female athletes

New study looking more into oral contraceptive effects in women

• The study: Oral Contraceptive Use Impairs Muscle Gains in Young Women by Riechman, Steven E.; Lee, Chang Woock
• Shortly after our last episode discussing “coming off the pill and supporting your natural cycle for female athletes” a new study was published so in this episode we do a followup discussion sharing the findings in this new research and what it means for female athletes.

Important points and stats

• “To the best of our knowledge, this study is one of the few, and to date the largest, to directly examine the effect of OCs on lean mass gains in response to a standardized RET program designed to promote skeletal muscle hypertrophy in young healthy recreationally active women.”
• “According to recent and historic reports, approximately 14 million women between the ages 15 and 49 use OCs in the United States, which are the leading contraceptive method in the younger, athletic (14–28) population (13,26).”
• “In addition, 82 percent of sexually active women in the United States had used OCs at least once (26), and OCs are commonly used for nonbirth control purposes, such as management of menstrual cycle, alleviation of premenstrual syndrome, and treatment of acne (13,19,26).”

What they did

• Examined the effects of OCs on muscle responses to a standardized resistance exercise training (RET) program.
• Two groups of young healthy women (18–29 years old, non-OC: n=38, OC: n =34) underwent 10 weeks of whole-body RET (3 days·wk, 3 sets, 6–10 repetitions, at 75% of maximum strength, 13 exercises). Measured DHEA), DHEA sulfate (DHEAS), IGF-1, and cortisol levels.

What they found

• OC impairs muscle gains but no differences in strength gains.
• Non-OC gained 3.5% lean mass vs. OC gained 2.1% lean mass.
• Plasma concentrations of DHEA, DHEAS, and IGF-1 were significantly lower, and cortisol levels were higher in the OC group before and after training.

Unintended consequences?

• Many women with amenorrhea or hormonal irregularities have cortisol dysregulation (e.g. HPA axis dysfunction), particularly too high cortisol. And this study shows that the OC use was correlated with increased levels of cortisol within the body.
• Meanwhile anabolic hormones were lower in OC users—not a desirable outcome for most female athletes.
• Takeaway: trying to fix something but creating a problem elsewhere.

Why did absolute strength remain the same between groups?

• “A possible explanation for this result would be that the absolute magnitude of the difference in muscle mass gains was not sufficient to induce strength differences. Muscular strength gains in a short-term training program involving untrained individuals are predominantly affected by neurological adaptations rather than changes in lean mass. Thus, it is suggested that these energy efficient neurological adaptations early in an RET program were minimally affected by OCs.”

Type and makeup of OC matters

• The type of progesterone, specifically the androgenicity, made a difference in gains or lack thereof too.
• The level of androgens in OC inhibits the anabolic hormones DHEA, testosterone, insulin, and IGF-1, which seem to be the big driver in impairing muscle gains. Higher androgenicity led to less gains.

Study limitations & takeaways

• Not much nutritional data taken during this study nor tracking of menstrual cycles.
• If you must be on an OC, look for one with low androgenicity.
• Or perhaps look for a lower risk alternative like IUD.

Morgan asks:

Former pro athlete, finally fixing hormones

For well over 10 years I have not had a period, at least not a natural one. About 8 years ago, the governing body of the professional sport I was an athlete with had us take birth control to “fix” the issue. I have competed, raced, and trained at a professional (multi sport) level for almost 20 years and I feel like, at 35, I can’t continue down this path. For my 35th birthday, I decided to devote my full heart and energy to healing both my body and mind.

So my question is, if an athlete came to you would you say NO TRAINING, NO FORMAL EXERCISE, until you get a period and healthy body weight back? Or would you suggest a few days a week of easy, short duration work? I really like lifting weights and any activity outdoors ( I live in Colorado) but I would love your opinion. If I was your sister…how would you advise this next year of life?

What the Coaches say:

• Tawnee begins by adding extra insight that Morgan shared, looking at the dynamics of the US Team she was a part of, including treatment of the female athlete triad and stigma around missing periods and eating disorders, all of which have had lasting negative effects on Morgan.

To train or not to train (in the more traditional sense)?

• Yes, take a year off from formal structured training.
• But exercise for health and wellness is fine, all while listening to your body to guide you and not exceed the healthy limits or boundaries you need during this time.
• Also: IT WILL VARY, CHANGE & EVOLVE. Sometimes you can do a little more and sometimes you drastically need to scale back and just rest. Getting more in touch with your body and truly listening to what it’s saying helps you navigate this.
• Connect with your body—this may be hard when you’re used to overruling what your body says in order to reach higher levels of performance especially at an Olympic level that Morgan was and had so many eyes watching her expecting her to perform—this took her out of her body and made it a lot about others’ expectations rather than her own needs.

The art of finding joy and letting go (with movement and exercise)

• Joy
• Do the things you love. The things that bring you great anticipation and excitement because stress doesn’t stand a chance in that environment. Just be extra supportive of your body during and give yourself full permission to turn around if you’re feeling off. Play. Be silly. Live with full permission to experience joy right now, not when you reach a certain goal. Right. Now.
• Letting Go
• Where do you find the most resistance? Could be food, could be exercise, could be another behavior you aren’t willing to address. Start there. Start slowly—ask for support, identify it, seek to understand it, and then try to begin the process of leaning into it until you’re through to the other side
• This quote from a friend whom I may have shared with you at one point. I was feeling stuck and overwhelmed by change — “maybe the wall isn’t there to stop you, maybe it’s there for you to lean on.”

Are logging workouts ok?

• It depends on how you as an individual handle that, mentally. If you can log workouts without it having being wrapped up in self-worth or something that can contribute to anxiety, obsession and fear of missing a workout or “not doing enough,” than this should be ok. But if it becomes an obsession and make you feel badly or like it’s defining you, especially if you don’t like what you see, then abandon it in this season.

Reconnect with your body

• Ask yourself: “How do I feel in my body?”
• The more we start to get IN our bodies and learn, feel our bodies the more we can listen to them, observe positive change, establish healthy exercise patterns. Understand that it’ll fluctuate.
• Continuing some level of exercise is crucial for mental health and a natural anti-depressant. Just ensure healthy, proper boundaries that make it about wellbeing, not training.

What can we do as coaches, humans, loved ones?

• Normalize the language of “period and menstruation.”
• Ask ourselves: What can we do to help female athletes not feel the stigma and shame if they don’t’ have a period. How can we uplift women around us to feel comfortable in their bodies regardless of its shape or condition.
• Change the narrative that “not having a period is bad” (many women let themselves believe that they are therefore a bad person if they don’t have a period). Not having a period is not “bad” it’s just not as efficient.
• Build relationships with young girls/teens that are rooted in trust and respect so they begin to open up and then later on in life, are able to share things more readily with people. They’ll be able to talk about the hard stuff instead of internalizing it and thinking it’s not okay to talk about. We need to talk about it!! And they need to see that it is OKAY. And that there is NOTHING WRONG WITH THEM.
• If you’re a male coach and are uncomfortable, hire a female to create a relationship with the girls on that level and have that woman speak about this stuff.
• Collegiately and after: Surround yourself with people who are open and uplifting. If none of those people are on your team, seek out positive mentors on social media until you are able to choose with who you spend your time.
• Bottom line: Everyone involved can and needs to do better and this starts with communication, education, acceptance, no shaming. We can feel so isolated, alone, scared, unworthy when we aren’t menstruating as a female athlete. End the stigma. We all have the power to help.

Anonymous asks:

How to love my new body?

Thanks for tackling my question from about a year ago now. I wanted to give you a bit of a life update as your podcast really was a pivotal point for me in my healing and health journey.

Since I wrote to you back in April last year, I began to notice symptoms  hypothalamic amenorrhea – it really never affected my performance in triathlon so I let it go on for a long time as, frankly, I always felt really fit and fast in workouts – I never had major fatigue or other negatives that are listed as common. The symptoms that I did start to notice and that made me check myself was my over-obsession with the food I would put in my body, it was this constant need to be affirmed by people that I “looked” fit, and then there was my attitude and mood! I felt like I had the shortest fuse in the world. My husband would joke with me and instead of me receiving it as a joke, I’d blow up and get angry or throw a fit. I was becoming a terrible person to be around. My mood flipped in a second and I felt like my loved ones would tip-toe around me – but hey, I looked fit so all was good right? (insert face palm emoji here! haha)

Anyways, after listening to your podcast and then doing my own research on HA, working with a dietician, reading No Period Now What, and really changing my training (less volume and WAY less intensity) – I can say I am now fully in recovery (is that the right word for it?). I’ve had three periods (kind of regular?) over the last few months and have gained over 20lbs. I had these high hopes that when I reset my hormones and gained some weight that I would immediately see better bike power, faster run times, better mood, etc…while my mood has improved and I definitely feel more stable and like my old self again, my performance has taken a hit. I also just feel really big. I have this layer of fat on my whole body that makes me question my identity as an athlete some days. My run times have slowed significantly and while my bike numbers are going up that isn’t really translating to speed – you know watts per kg and all… anyways, clearly i still have some mental work to do but I wondered if you had any tips on accepting and loving your new body as it changes? Also does it ever stabilize? I feel like I am on a pendulum and swung to the other extreme. Just hoping to find balance in the middle but fully recognize that takes patience. With races around the corner (my first one St.George 70.3) I am hoping to gain a bit of confidence back but really would love to hear your thoughts on what it was like for you after seeing body changes, did it take some time to rebound?

What the Coaches say:

Identity & Presence

• Julie shares a narrative of a recent postpartum mom she knows well who always identified as the athlete and now has experienced anxiety as “less fit” in her postpartum healing phase.
• We are not alone here.
• Dealing with an identity, especially one that we have “lost” in some form, is difficult to deal with mentally.
• Lesson: You are so much more than “the fit athlete.” You have core values that have nothing to do with sport. Fully accept yourself as you are right now. You are worthy and complete. You are loved. Treat yourself as you would a dear friend you love.
• Don’t put things off an wait for another now. Live in the now. Experience now. Don’t wait for that thing you’re hoping you might achieve.
• Bodies change in different seasons.
• But for the recovering female athlete who feels like her body is all over the place, generally speaking weight will likely stabilize and find homeostasis on the healing journey assuming one’s baseline of health is well.

Ego

• Ego stories and ego reactions are that which your ego is feeding you. You are not your thoughts (i.e. you are not your ego or the thoughts/stories it feeds you).
• Instead of punishing yourself with internal dialogue, talk to yourself like a loving parent and pose compassionate thoughts and questions
• Ego grasps on to this identity that is based in past experiences
• When letting ourselves be ruled by that we get fixated and obsessed with these thoughts
• We become reactionary and defensive and unable to deal well with the here and now, i.e. reality.
• Finding comfort in your body now takes practice. Finding peace with what is takes practice.
• Carve a path for a new normal.
• Ego is so fixated on the past, leading us to ruminate over what we were and ego stories beat us up. Recognize that we are not those awful thoughts our ego tells us. We don’t have to be dictated by that.
• The key is creating new meaning around new experiences. This is uncomfortable.

Getting un-stuck

• Why do we get stuck and feel unable to have the self-compassion that we know we need?
• Because it’s uncomfortable and ego tries to step up to help us avoid that discomfort. But overrule that and allow the discomfort to just be.
• Shift our awareness to the now, not the ego stories of the past.
• We can choose new responses.
• Choose new beliefs.
• Harsh thoughts, bad thoughts don’t fully go away, we just get better at managing them and less fixated on them. We can choose to respond differently. Choose a different narrative.
• Start with a celebration.
• You are tremendously brave for taking the journey back to health, celebrate, don’t shame yourself. You are complete just by being alive. You are worthy just by being human.
• Give yourself positive affirmations.
• Say out loud “I am worthy.”

Choosing different: A new kind of training

• All this is brain training and specifically RETRAINING the mind and our habits and patterns. It takes practice just like sport. Constant, consistent, dedicated practice. It’s ok if it’s not perfect and linear, nothing ever is.
• If it feels awkward, funny, weird—this is a sign of positive progress. You’re doing something different that feels weird at first and that’s ok!
• Be gentle.
• It takes time. Decades of conditioning that we have to undo and change.
• You are just a listener of those thoughts; they are not who you are.
• Bottom line: Change is hard but change is possible. Change beliefs. This takes time. You have the power to do it. Practice. Patience. Noting the successes along the way, however big or small. Being grateful for this gift of personal evolution.

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