In part 1 of this women’s health post, I talked about the importance of nutrient density, diets, carbohydrates and the need to talk to your female clients about premenstrual syndrome (PMS), polycystic ovary syndrome (PCOS), insulin sensitivity, pregnancy and breastfeeding. The unrealistic media images and social pressure to look a certain way comes at a cost to our health, happiness, and longevity. Women need to be especially careful because their hormones can be particularly sensitive to lifestyle factors such as diet, exercise, sleep, and stress. The overuse of specific diets and training methods can create serious hormonal issues in women and impact fertility.
We all know that being overweight is not healthy, and it has negative impacts on our hormones. Weight loss, without a doubt, is the number one goal many women, and men, are seeking. The basic principle of weight loss is to "train more and eat less.” By creating an energy deficit, the aim is to burn fat and improve body composition. But at what point do we start breaking down lean muscle mass (slowing down metabolism)? At what point do we start applying more stress than the body can handle? At what point do we f*ck up our hormones? As personal trainers and coaches, we can help our clients improve their hormonal function by supporting their bodies from a functional health perspective (The 5-Pillars of Sustainable Health). To do this, we must be asking the right questions and checking in with our client’s health regularly.
Start with gut health?
It’s a little scary to think about how many people have digestive problems: bloating, gas, constipation, diarrhea, leaky gut, GERD, IBS, SIBO, SIFO, etc. have become the norm in modern society. Gut issues are not normal, and if unchecked, they can lead to further complications. Do you talk to your client about their gut health? How often do they go to the bathroom? What does their stool look like? Don’t ask for a photo. Do they experience gas, bloating, or any discomfort?
Our gut is connected to our neurotransmitters and our hormones, and when things start to go wrong in the gut, we begin to see other systems in the body break down. The gut microbiome is part of our immune system and our detoxification system - if the gut is not functioning optimally our immune system and detoxification system is affected. Estrobolome is the connection between the gut microbiome and estrogen metabolism [1].
An imbalance of gut microbiome species (gut dysbiosis) can have detrimental impacts on detoxification, especially the clearance of excess hormones such as estrogen. Fixing the gut should be the number one priority of any nutritional programme, as everything is linked to the gut. Both male and female clients will struggle to achieve any weight loss or performance goals if their gut is not functioning correctly.
Research is currently investigating gut bacteria species that can up-regulate estrogen metabolism and other species that can down-regulate estrogen metabolism. This is interesting because it has the power to reduce the risk of developing estrogen-related diseases such as endometriosis, polycystic ovary syndrome, breast cancer, and prostate cancer. [1,3,4]
How stressed is your client?
Stress is often the elephant in the room when it comes to healthy hormones. Both exercise and diet are a stressor that can be used to help the body adapt in a positive way (Eustress). However, when the accumulation of stress adds up (physical exercise, diets, work stress, relationship stress, toxic stress, poor quality sleep, etc.) the effect can be negative (Distress).
On a scale of 1 (very low) to 10 (very high), how are your clients stress levels?
On the same scale, how is their sleep quality and quantity (7-9hours per night)?
Hypothalamic pituitary adrenal axis (HPA axis) dysregulation, also know as adrenal fatigue, has a direct influence on the ovarian-thyroid connection. Regular stress management activities should be part of daily practice, including meditation, breathing exercises, yoga, tai-chi, listening to calming music, laughter, watching a movie, spending time with loved ones, and being in nature.
Note: Very-low-carb diets can often help with weight loss and particularly neurological problems, but they’re not great for people with thyroid issues because insulin is required to convert T4 to T3, the more active form of thyroid hormone. If you’re on a very-low-carb diet, insulin levels will be chronically low, and that will decrease the conversion of T4 to T3. This has been shown in a number of different studies. Metabolic syndrome is associated with inflammation, insulin resistance, and hormone imbalances, including PCOS in women, and those hormonal disruptions can be a common underlying cause of pituitary dysfunction, poor conversion of T4 to T3, high or low thyroid-binding globulin, and thyroid resistance.
Stress management and recovery are critical for our hormones, health and happiness. The most important thing to do to support normal hormonal function is:
Make sure the digestive system is functioning correctly
Promote healthy blood sugar management
Improve liver and gallbladder detoxification
Reduce inflammation
Support the hypothalamic-pituitary-adrenal (HPA) axis
What is toxic stress?
Environmental toxins are another endocrine disruptor (they f*ck up our hormones). Plastic containers, cosmetics, chemicals in our food, water and air, household cleaning chemicals, and medications are full of chemicals that can have estrogenic effects on both women and men. Buying non-toxic body and home cleaning products, using glass or stainless steel containers to store food, buying organic, avoiding soy, and not handling shopping receipts (one of the most significant sources of BPA) can help to improve our hormones. High levels of toxic exposure can lead to weight gain and chronic diseases.
Dietary insoluble fibre binds to excess estrogens in the gut and can help with detoxification. Insoluble fibre can be found in fruits and vegetables like dark leafy greens and berries. Female clients will be glad to know that chocolate is high in insoluble fibre. Coconut flour is also an excellent gluten-free insoluble fibre.
Soluble fibre promotes healthy gut bacteria and butyrate production. Yes, your gut bacteria can produce butyrate. Butyrate has anti-inflammatory effects, increases insulin sensitivity, and may delay the development of neurodegenerative diseases. It may also be helpful in the treatment of diseases of the colon such as Crohn’s, IBS or ulcerative colitis. Stephan Guyenet has written an excellent blog post describing the benefits of butyrate and other short-chain fatty acids on the maintenance of healthy gut integrity [8]. Butter is 3-4% butyrate, the richest known dietary source.
Insoluble fibre is not fermentable by the gut bacteria, except resistance starch. Soluble fibre is fermentable by the gut, and this is why it's important for digestive health. Clients with digestive issues such as SIBO or SIFO may not be able to overeat soluble fibre without feeling bloated. They should consider a low-FODMAP diet and work with a Functional Medicine Practitioner or Integrative Doctor to fix the gut.
Are sleep fundamentals in check?
Circadian rhythm also impacts our hormone production, and having a regular sleeping pattern is critical. Going to bed at the same time each night and waking up at the same time each morning has positive health benefits. Exposure to sunlight in the morning and limiting blue light exposure in the evening is beneficial to our circadian rhythms.
Should women be cutting calories?
Eating disorders are more common in women than they are in men. As trainers and coaches, we need to address body image concerns, especially with female weight loss clients. This may not be in your scope of practice, but you want to make sure your female weight loss clients are not heading towards an eating disorder. If you think they are then you should ask them and encourage them to speak with their doctor or therapist to get the appropriate support.
It's not uncommon to see clients lose weight by cutting calories and increasing their physical exercise. It’s also not uncommon to see them reach a certain weight and then stall. What went wrong? Are the initial calorie deficit and training volume not enough? Should we cut more calories and do more training (i.e add more stress)? It's critical to understand that the stall in weight loss is likely related to a change in metabolic rate and hormone balance. Depending on the individual, now might NOT be the best time to increase stress levels. An increase in calories and a change in training methods can allow the body to recover, potentially leading to further weight loss. By increasing calories for a short period of time, eating to maintain weight or even eating to gain weight, we can light a fire under the metabolic system and improve hormone balance, which can lead to more fat loss.
Cycling a calorie deficit on and off can often lead to a much happier, healthier and leaner client. Cycling accumulation and intensification training phases can also have positive affects. Two major hormones that are affected during a women’s menstrual cycle are progesterone and estrogen. The follicular phase is the first 1-14days, and this is when estrogen levels are rising and progesterone levels should be normal - emotion and mood are in check. Day 14 is usually when ovulation occurs and estrogen levels peak while progesterone starts to climb. The luteal phase occurs during day 15-28 when estrogen is dropping and progesterone is on the rise. This is when females emotions and mood can quickly change.
During the follicular phase, most women will feel better by increasing their calorie intake and upping their carbohydrates. During the luteal phase a slight calorie deficit, a lower carbohydrate intake, and an increase in fats can be experimented with. The exact amounts will depend on the individual and other lifestyle factors such as age, height, weight, activity level, and goals. Female clients can start to experiment with different macronutrient ratios at this time and keep a journal of how they feel so comparisons can be made.
Should women go low-carb?
In the first post, we talked about the importance of women eating enough calories and getting adequate nutrients. Calculating calorie intake is pretty standard, but selecting macronutrient intake is often something many personal trainers and coaches don’t fully understand. For example, should we be recommending very-low-carb, low-cab, moderate-carb or high carb-diets to our female clients? The above paragraphs about a woman’s menstrual cycle should give you an indication that the macronutrient percentages could change depending on the time of the month. It can become very complicated and some clients may not have the time and energy to stay on top of it.
A very-low-carb diet might be useful for an overweight (BMI>25.0) sedentary women with blood sugar management issues. BUT, this does not mean that a woman who is at a healthy weight should follow a very-low-carb diet, or even a low-carb diet, to lose weight. These are two different women with individual hormone levels, hence their nutritional needs are different. A woman who is not overweight and has no blood sugar management issues would look, feel and perform much better on a moderate, to even high-carbohydrate diet, especially if they’re exercising regularly or during their follicular phase.
Side note: Some women will experience mood swings, insomnia, anxiety, depression, fatigue and other symptoms when on a very-low-carb or even low-carb diet. Long term low-carb diets can lead to thyroid issues and fertility problems.
As mentioned previously, cycling a calorie deficit can be a great way to increase metabolic rate. Cycling between a low-carb and a moderate to a high-carbohydrate diet can also be a great way to break plateaus in weight loss. Long-term low-carb diets can harm our hormones and our gut health, which can lead to inflammation and weight gain. Another reason why cycling carbohydrate intake makes sense.
For women who are exercising regularly (4+ times per week) the ideal carbohydrate range should be between 25-50% of calories depending on the menstrual cycle, age, weight, height, goals and the training methods.
Should women be fasting?
There is some evidence to suggest that intermittent fasting is not a good idea for women as it can cause hormonal issues [5,6]. Some women who try intermittent fasting experience missed periods, metabolic disturbances, and even early-onset menopause. There’s evidence that intermittent fasting when done properly, might help regulate blood glucose, control blood lipids, reduce the risk of coronary disease, manage body weight, help us gain (or maintain) lean mass, reduce the risk of cancer, and more.
Women of reproductive age often experience adverse effects from intermittent fasting. Women’s bodies are biologically built for fertility and reproduction. Extended periods without food tell the body that now isn’t a good time for reproduction. When food is scarce the female body can shut down the reproductive system to conserve energy and to prevent pregnancy in a time of famine. But fertility isn’t the only concern. Women need to consider that estrogen and progesterone do more in the body than simply support pregnancy. Estrogen helps us with metabolism, weight loss, mood, anxiety and stress, energy, bone density, and cognitive function, to name just a few.
Side note: Men seem to experience better glucose tolerance and greater insulin sensitivity when they are intermittent fasting. In a time of famine, our ancestors would need to hunt for long to find a meal. Fasting seems to boost testosterone levels in healthy men.
Intermittent fasting can be a very powerful tool for weight loss when used correctly. An overweight sedentary woman with insulin resistance might see fantastic results from intermittent fasting. She might not. Women who are not significantly overweight, who are exercising regularly, and are not insulin resistant should be very carful about fasting. Intermittent fasting is a stress. If a woman is already experiencing high amounts of stress, which most people are, the overload can push them over the edge and lead to some very undesirable results.
How do a woman’s hormones impact training?
At certain times of the month, female hormones are primed to lift heavy. At other times of the month, female hormones are primed for a higher volume of training. Working in alignment with your client’s hormones can help them improve their strength, fitness, body composition, and health.
Follicular phase (days 1-10) ~ Dominant Hormone: Estrogen
Increase pain tolerance and endurance
Increase in strength training, a good time for low volume and higher intensity
Insulin sensitivity is higher, eat more carbohydrates
Steady sate cardio @low-intensity
Luteal Phase (days 11-20) ~ Dominant Hormone: Progesterone
Fat metabolism increase
Increase in training volume
Increase in high-intensity interval training (H.I.I.T)
Insulin sensitivity is lower, eat fewer carbohydrates and increase fat intake. Increase magnesium and glutamate to reduce sugar cravings. Cinnamon is also useful for blood sugar management.
Menstruation (days 21-28) ~ Low Estrogen and Progesterone
Focus on more parasympathetic activities (Yoga, breathing, meditation, massage, etc.).
I sound like a broken record, but “more is not always better,” and this applies to training. The correct amount of training will promote insulin sensitivity, weight loss, and normal hormone production. Too much training or not enough training can lead to hormone blood sugar problems, weight gain, and hormone imbalance. As personal trainers and coaches, we have a responsibility to promote sustainable health and longevity over body image and weight loss goals.
Where to start with weight loss for women?
We’ve already covered a lot in terms of calories, nutrient density, carbohydrates, gut health, training, sleep and stress. If weight loss is the client’s goal, a calorie deficit of 10-20% is enough. Cutting more calories is not going to speed up weight loss, and it could have negative hormonal impacts. Cycling calories is also recommended to maintain metabolic rate, hormonal balance, and gut health. We are emphasising real whole nutrient-dense foods such as leafy greens, oily fish, eggs (especially the yolks), organic organ meats (liver, kidneys), organic meat (especially the fattier cuts), fresh herbs, fibre, loads of fruits and vegetables. Minimising the intake of alcohol and promoting a healthy liver function is also essential.
If you like to know more about a sustainable diet that is good for you health and good for the environment you might like to sign-up for our sustainable diet programme.
Reducing inflammation is critical and avoiding food like grain (including flour), gluten, industrial seed oils (vegetable oil, canola oil, corn oil, cottonseed oil, margarine, soybean oil, sunflower oil, safflower oil, grapeseed oil, etc.) and processed sugars. A diet high in omega-3 fats, herbs and spices, soluble and insoluble fibre, organic meats fruits and vegetables, nuts and seeds is going to be the best option for most people. TSTM is a very strong supporter of the Paleo diet because it removes a lot of common food sensitivities and includes a lot of nutrient-dense real whole foods.
Nutrient density is always important; another reason why a Paleo diet is a good option. Women especially want to focus on adequate intakes of vitamin A, vitamin D, vitamin K2, zinc, B6, magnesium, B12, folate, choline and omega-3.
A healthy weight for women will vary and weight loss goals should be secondary to sustainable health. If a woman starts having irregular periods or experiences amenorrhea, it may be the body telling her that the calorie intake is too low or the weight loss is excessive. Ignoring the signs can have devastating impacts on the reproductive system and the long term health of our clients.
REFERENCES:
The Gut–Hormone Connection: How Gut Microbes Influence Estrogen Levels, Chris Kresser 2017
The Intestinal Microbiome and Estrogen Receptor-Positive Female Breast Cancer. Maryanna Kwa, et al. 2016
Estrogen-gut Microbiome Axis: Physiological and Clinical Implications. James M Baker, et al. 2017
Intermittent Fasting Dietary Restriction Regimen Negatively Influences Reproduction in Young Rats: A Study of Hypothalamo-Hypophysial-Gonadal Axis. Sushi Kumar, et al. 2013
Sex-dependent Metabolic, Neuroendocrine, and Cognitive Responses to Dietary Energy Restriction and Excess. Bronwen Martin, et al
Colonic Health: Fermentation and Short Chain Fatty Acids. Julia M W Wong, et al. 2006
Butyric Acid: an Ancient Controller of Metabolism, Inflammation and Stress Resistance? Stephen Guyenet 2009