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Alright, friends. Thanks for your patience with this post. If you haven’t read Part 1, I want you to stop, go read it, and come back. This will all make more sense, I promise.
I’m going to break today’s post into a few categories: Lifestyle, Diet, and Supplements. These are not medical suggestions, because again, I am not a medical professional. They are the things I would tell my friend sitting in my living room, things that have worked well for me, and ideas that have good research to back them up. As always, I trust that you will do your own due diligence, talk with your own doctor, and use wisdom in implementing anything new (my full disclaimer here). Many of the suggestions are geared towards women who are in their childbearing years, and/or dealing with the fluctuations of pregnancy and postpartum. This is simply because this is the area in which I have the most personal experience.
Lifestyle
I’m starting with lifestyle, because we often jump right to the trendy fixes of diet and supplements, without addressing the thing that’s driving the stress bus. In my experience, if you’re struggling with stress driven hormonal havoc, there will probably need to be some component of dietary and supplement support, but, without dealing with the underlying stress you’re slapping very expensive band-aids on the problem.
Stress
Last week’s post showed a clear connection between ongoing chronic stress and hormonal mayhem. This can feel incredibly unfair, especially if the stress is outside of our control (think: caretaking, PTSD, childhood trauma, medical conditions, living with the constant onslaught of knowledge of crises we have no control over).
However, it really is important to give yourself some tools to work with the stress — specifically some body-based ways to calm your system down. For many people working with a counselor who’s knowledgeable in something like EMDR, or brain spotting can be a great place to start, but sometimes I think we make things really complicated, needing to understand every little thing. Our bodies are intelligent, and while they’re not foolproof indicators of what’s going on, they give us information that shouldn’t be ignored. Think about what happens to your body in a stressful situation. What are your “tells”? Do you clench your jaw? Hunch your shoulders? Does your sweat change? Does your breathing get shallow? Do you feel impulses to do certain things around certain people? The impulse of our body in a situation provides valuable information about what is going on. Many of us are conditioned to ignore our body’s signals, which then requires them to keep getting louder (I often liken this to a small child who’s being ignored — they WILL escalate). If we can start to listen to the small things, it starts to build a bridge towards a more whole version of yourself. If you’ve dealt with long term chronic pain, or gotten good at deprioritizing your own needs, this is a muscle that might need strengthening. I still often find that when I stop to take some deep breaths, then scan my body, I am shocked by how much pain and tension I’m carrying. While it seems so small, anything you can do to bring your body back down to a rested, safe, state continues to impact your hormones down the line. Addressing these patterns will require work and maybe some hard choices, but since this is often the driver of hormonal dysfunction it’s an important piece. All the other components support this, but without addressing it at all, it may continue to feel like you’re putting bandaids on a problem.
“Great, Annelise,” you say “I have no idea how to do this”.
I get it. I didn’t either. Enter, counseling with a trauma informed counselor, years of listening to podcasts, lots of reading1, and a lot of in-the-weeds practice which could most easily be summed up by the words, “can you notice that?” It sounds simplistic, but beginning to notice and tend to the sensations in our body with curiosity is the foundation to developing a better working relationship with your body and actually knowing what you need.
Exercise
I’m going to say something that might be unpopular. If you are a woman who’s under a fair amount of life stress, not sleeping consistently and potentially under eating, your exercise routine might be adding to the problem. Specifically, exercise that I would call “chronic cardio” — long distance running, long sessions on the elliptical, lots of HIIT workouts, high intensity boot camps, etc… Anything with a lot of intensity and repetition. These are most often the workouts that are touted for burning a lot of calories. And, I totally get it. You feel great when you’re done, it’s what you’re “supposed” to do to lose weight, and you’re maybe even a little addicted to your endorphins. You don’t feel right without your fix.
However, I want you to run through this checklist and answer these questions:
Are you sleeping at night? How’s your sleep quality?
Are you relying on caffeine and sugar to get through the day?
Are you losing muscle mass? Do you regularly feel puffy and inflamed?
Are you experiencing any signs of overtraining? How’s your libido? Are you irritable?
Do you feel anxious if you don’t exercise for a certain amount of time?
Are you sore for multiple days after a workout, or do you deal with nagging injuries?
Please don’t hear me wrong, I’m definitely not saying “don’t exercise” but the type of exercise really matters. For women, my personal opinion is that strength training is non-negotiable because it builds muscle mass, sensitizes your body to insulin2, and increases bone density, which is important to do before you hit menopause and estrogen decreases3. I also think some sort of mood-boosting cardio or flexibility can be great — barre4 and walking are my personal favorites. The main thing is that you want the exercise to be enjoyable and to leave you feeling energized, not depleted. Thirty minutes, 3-4 days a week could really be adequate, especially if you’re already active (and if you have small children I know that you are). You do not have to go to a fancy gym. You do not even have to leave your house.
The problem with the chronic cardio is that it elevates cortisol, and if you’re already dealing with elevated cortisol, or if it’s so low you can barely get yourself through a workout, you’re going to make things worse. It’s like flogging a very sad racehorse to make it go faster5. I think people tend to go to two extremes with exercise — they overdo it, or they don’t do it at all. Know which category you fall into and don’t use my words to excuse your bad habits :) If you’re not moving at all that’s a problem. If you’re cardio-ing yourself out of a menstrual cycle that’s a problem6 If you’re truly struggling to tolerate any exercise please, please, please ask your doctor to run a full thyroid panel, get a copy of the tests yourself, and compare them to functional ranges. Exercise intolerance can be a sign of thyroid dysfunction, but overtraining can also drive the active level of thyroid hormone down, leading to hypothyroid like symptoms.
One last quick note is that if you are pregnant or breastfeeding, relaxin is at play— you’re more prone to injury because your joints and ligaments are hormonally impacted. My PT told me that the relaxin impacts your joints for twelve weeks after birth, and impacts your ligaments and connective tissue for several months after you’re done breastfeeding. If you’re concerned about long term health and things like prolapse, it’s really wise to do the rehab work to ensure you’ve got enough strength and stability to handle your exercise load.
Food
I’m not using the word “diet” here, because I think anything you’re thinking of as a short term diet is unlikely to benefit your hormones in the long run. Your food choices do have the potential to make a huge impact on your hormones, but rather than give you a list of things to avoid, I think it’s more helpful to focus on important things to add.
Protein
My goal in life is to become a protein influencer. If I could get sponsored by a meat stick that would be great, but no one’s reached out to me yet. If you’re going to take one thing from this post, let it be this one:
20-30 grams of protein before 10 AM
Does this seem arbitrary? Why breakfast? Why so much?
Well, in my experience, if I start the day off with level blood sugar, the rest of my day goes so much more smoothly. I am less likely to be irritable, anxious, sleepy, or reaching for sugar all day. And because I’ve put some intentional effort into caring for myself, it sets the tone for the rest of the day. The 10 AM rule is a personal one, but what I find is that it prevents my blood sugar7, from crashing, which means I’m not cruising into the 11 AM hour with a massive headache wondering why I’m suddenly snapping at everyone in the house.
From a research perspective, protein helps promote insulin sensitivity, provides adequate raw material for hormone synthesis, encourages satiation, helps train a healthy circadian rhythm (morning protein specifically), maintains muscle mass and could help to improve mood, due to the importance of protein in producing neurotransmitters. Your body has a certain amount of amino acids that it needs to function, and some hypothesize that we continue to eat until protein needs are satisfied, even if that means “overeating”. There’s no replacement for these essential amino acids!
Adequate Calories & “Gentle Carbs”
What does “adequate” mean? Well, I don’t know what you were exposed to as a teen, but I read a lot of the “health” magazines offering 1,200 calorie meal plans. Thinking about this now makes.me.want.to.scream! Women, you need to EAT. Real food. Especially if you are pregnant, especially if you are breastfeeding. Please hear me when I say, calories in vs. calories out for weight loss is the biggest load of horse you-know-what we’ve ever been fed.
It’s not that if you consistently eat past the point of fullness, or go to town on a lot of junk food that it won’t impact you. Of course it will. We all have common sense. But to look at someone and assume that because they are “overweight” they can’t be healthy, or to assume that because someone is “skinny” they are healthy, is so reductionist. If your body is constantly in fight-flight mode, pumping out cortisol, your thyroid is malfunctioning8, your hormones are out of line and you’re insulin resistant, then it’s going to be more complicated than just burning more calories than you eat. Not to mention the fact that we know women’s basal metabolic rate changes throughout their menstrual cycle, so calorie needs are not static anyways!
Remember how we talked about your hypothalamus? It is constantly checking to see whether it’s safe to reproduce, and if it determines that it’s dealing with a famine (even if it’s self imposed — biology doesn’t care about diet trends) it can shut your reproductive machinery down. A place where this issue of inadequate calories comes up often is in female athlete triad, which is where you have a combination of amenorrhea (lack of period), bone density issues, and low energy availability (caused by intentional or unintentional under eating). However, you don’t have to be an athlete to develop hypothalamic amenorrhea! Depending on your individual brain chemistry, the point at which your body determines it’s in danger might be different, so a combination of too much exercise and too little food can stop ovulation, but so can an extremely low carb diet.
So, how do you quantify, “enough”? I don’t like throwing numbers around, and I will never encourage counting calories, but it’s going to be most likely a minimum of double that 1200 number we have permanently emblazoned in our brains. 1200 calories is what my toddler eats in a day, okay?
If you’re dealing with some level of HPA axis dysfunction, which I’d argue most women are, carbohydrates are important for calming the nervous system and producing happy hormones. When I say carbohydrates, what I’m specifically taking about is starch — potatoes, sweet potatoes, plantains, rice, gluten free grains, or sourdough bread and whole grains if you tolerate gluten. Ideally these are as unrefined as possible, but honestly? If you have to choose between a potato chip and candy, I’d take the potato chip. Especially if you find your sleep quality is suffering, try incorporating some of these lower glycemic starches alongside your protein and see what happens.
Blood Sugar
Okay, so I’ve just told you to eat carbohydrates, and now I’m going to say… But watch your blood sugar. This one is very person dependent. If you’ve got insulin resistance or any measure of metabolic dysfunction, then you might need to be more careful with carbohydrates. How do you know? Do you know your fasting glucose? Do you know what your A1C is? Do you have high blood pressure? What's your fasting insulin? What’s your waistline measurement?
The main thing with managing blood sugar is that you want to keep it balanced throughout the day. Protein and fat are both amazing for stabilizing blood sugar, and a good rule of thumb is to avoid naked carbohydrates. I find the easiest thing to remember is simply, protein first. If I want to eat sweet potato fries, or a bag of chips, or whatever, that’s fine. But protein first. Switching the order in which you eat things can really help, with studies showing a reduction in post meal glucose readings when the participants ate protein and fat before the carbohydrates.
Why do we care so much about insulin, and insulin resistance?
The body tightly regulates blood sugar levels, because the brain requires a certain level of glucose to function. Insulin is produced as needed to keep blood sugar levels in a good range, but the system is flexible, or at least it is in someone with good insulin sensitivity. When you eat a bunch of refined carbohydrates or sugar, your blood sugar rises quickly, then your body needs to pump out insulin to bring the blood sugar down rapidly. The sudden drop in blood sugar causes a spike in cortisol, which generates more cravings for sugar. Large influxes of sugar send your body on a roller coaster ride, and the extra insulin is transported with glucose to be stored in cells . Eventually, if this pattern repeats often enough, the cells will lose their ability to take in insulin, the receptors actually change shape, and the insulin and glucose both have to keep circulating in the blood stream. So, what is supposed to be a finely tuned balance of energy intake and insulin production results in a body that’s storing insulin in fat cells, but is unable to use it for energy effectively. The levels of insulin and glucose are now higher and circulating in your blood stream9. These same fat cells then also produce more estrogen, which is why PCOS and perimenopause can be so challenging from a weight loss standpoint10.
You could go get a continuous glucose monitor, you could try to test your post meal glucose… there’s all sort of things you *could* do, but the sensible solution is probably the boring, difficult one. You really need to reduce your sugar intake (or think about timing it strategically — a walk after a higher carbohydrate meal works wonders), eat protein with every meal, and prioritize fat and fiber over refined carbohydrates. Boring? Yes. Effective? Also yes.
FAT is phat
The very simple synopsis of this point is this. The current low fat guidelines were made by some guy in the 1960’s who didn’t really understand how cholesterol worked. They were adopted with no research to back them up, and then anyone who tried to debunk the hypothesis was shut down and couldn’t get funding for studies… thus, we’ve had many years of thinking fat is the bad guy when it’s actually fundamental for our health.11
Hormones are made from cholesterol, and your brain contains the majority of the body’s cholesterol. You need cholesterol for hormonal and brain function! Not to mention that cholesterol markers are extremely misunderstood, and often not impacted by dietary cholesterol. Where do you get cholesterol? Primarily animal fats like eggs, full fat dairy, fatty meats, organ meats, BUTTER, tallow, lard, etc…
Fat is your friend. This doesn’t mean everyone should go keto, but it does mean that a low fat diet is going to be a hot mess for your hormones. Plus, fat makes things taste good. For the love of all that is good, just fry the whole egg in butter.
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