In the world of fitness, there’s a lot of discussion about how much you train, what kinds of training you do, and what your pre/post-workout nutrition looks like. Many athletes and avid exercisers do well preparing for their sport or excelling in their own personal fitness goals, but struggle with inner battles. These inner battles are often times the individual’s mental struggles about how they look. They may feel too bulky, fat, or disappointed with their body composition. Unfortunately, these inner battles are often not discussed amongst those engaging in exercise.
Coaches may push the athlete further into this struggle by suggesting that if they lose weight they may perform better at their sport. Personal trainers may provide an individual with a nutrition program that is far too low in calories or carbohydrates to support their level of fitness. The media portrays images of what a lean athlete “should” look like, which is often airbrushed and unobtainable by most people. All of these things can send an active individual into a tailspin and become out of control with their energy intake/energy output. For women, this could lead to a condition called the Female Athlete Triad.
The Female Athlete Triad is a syndrome of three interrelated conditions that exist on a continuum of severity. These conditions include:
- Energy deficiency with or without disordered eating
- Menstrual disturbances/amenorrhea
- Bone less/osteoporosis
As a dietitian, this is something that I often look for in the clients that come to see me. They are often times over-exercising and under-eating because that’s what they are told to do to lose weight. Sometimes it’s voluntary, but other times the individual has no idea that they aren’t eating enough. No matter what end of the spectrum the individual is coming from, the end result is a state of imbalance that can ultimately lead to less than desirable health outcomes, including infertility.
I’d like to share with you a case study so you can see how this type of scenario acts out in real life. I’ve personally battled with the Female Athlete Triad for years and was able to overcome it through natural lifestyle changes. The case study below is actually my very own struggle. The lifestyle changes discussed are ones that I personally used and help many of my clients use to overcome the triad.
CASE STUDY
Patient
- Female
- 26 years old
- Overall in good health
- Struggled with an eating disorder in high school and college
- On the birth control pill for 10 years
Exercise:
- 45-60 minutes of high intensity cardiovascular training + 1 hour of hiking up and down hills, 6-7 days a week
Diet:
- Vegetarian, low calorie (1500ish/day) for 5 years, then switched to a very low, calorie/carb Paleo diet (<50 grams of carbs/day) while still doing the high intensity training
Sleep:
- 7 hours a night, started to have “hot flashes” in the middle of the night due to hormone imbalances
Stress
- Very high! Moving every couple of years, military family, getting master’s degree + working multiple jobs
Doctor’s diagnosis:
- Possible Polycystic Ovary Syndrome? Different doctors told me different things.
- Hypothalamic Amenorrhea (loss of menstruation consistent with the Female Athlete Triad). This is a condition where your hypothalamus and endocrine system are not communicating properly. This is often due to inadequate calories/carbohydrates, over-exercising, and severe stress.
Doctor’s suggestion:
- Go back on birth control pill to resume cycle.
- Discuss fertility treatment options when I want to get pregnant.
- Eat more food (possibly add in Boost/Ensure protein drinks) and exercise less.
This was very frustrating. I was being told multiple different things from the doctors I was seeing, but they all wanted to give me hormones. Some suggested that I restart the birth control pill; others thought I should do bioidentical hormone therapy. They were all very doubtful that I could take care of this on my own.
I decided that my body could heal itself. I went on to treat the hypothalamic amenorrhea on my own by doing the following:
What I did:
Exercise:
- I cut back to 3 strength based (not cardio based) exercise sessions per week. I used the other days to do a light yoga session and/or took an easy walk around the block (not uphill).
Diet:
- I upped my calories to at least 2000/day and added back in more carbs to get me to at least 100 grams/day.
- I added in lots of sweet potatoes, plantains, and winter squash to provide my body with nutrient-dense carbs that didn’t spike my blood sugar or cause inflammation like other more processed grains (breads, crackers, cereal, etc.).
- I focused on having a clean source of protein (pastured raised eggs/poultry, grass-fed beef, wild fish/shellfish, wild game), healthy fat (coconut oil, avocados, raw nuts/seeds, olive oil), and vegetables at all of my meals.
- I followed a paleo style template to heal my body. This meant I cut out legumes, grains, and dairy, which tend to be more inflammatory foods and can disrupt optimal digestive function and hormonal balance.
Sleep:
- I made sure to get 7-9 hours a night. This was a commitment and rule that I followed, even on weekends. Slowly the “hot flashes” went away.
Stress:
- I managed to significantly cut down on my stress by quitting some of the jobs I was doing and saying “no” to additional projects that came up.
- I added in daily meditation by using an app called Headspace. I would meditate about 10 minutes in the morning before starting my day.
- I practiced yoga about twice a week, but kept the intensity low.
- I also went to acupuncture twice a week.
Supplements:
- I started taking hormone balancing herbs (such as maca and vitex), adrenal support supplements, did a comprehensive detox, started taking supplements for preconception care (prenatal vitamin, more fish oil, etc).
I worked on adding in these lifestyle changes over a period of 1.5 years. It took me awhile to do this all on my own. That’s why I highly recommend individuals dealing with it to contact a practitioner to support them along the way. It’s a mental and physical challenge and most people need support and accountability. After I got all of the lifestyle changes in check, it took about 6 months before I saw my cycle return. It had been nearly 2 years since I had a regular cycle.
After I regained my cycle, I got pregnant in just one short month. I’ve gone on to have the easiest pregnancy I could imagine! All of the common pregnancy side effects (morning sickness, food aversions/cravings, aches, pains, and fatigue) never showed up. I honestly didn’t even feel like I was pregnant during my entire pregnancy. I had great energy, stable moods, and was able to do pretty much everything I was doing prior to getting pregnant. I credit this to all of the work I did to regain my cycle including: eating a real food diet rich in high quality fats, practicing daily stress reducing techniques, getting daily movement and adding in strength training, focusing on quality sleep, getting acupuncture, and using targeted supplements.
(To learn more about Stephanie’s story, please visit: http://rockyourhormones.com/beat-hypothalamic-amenorrhea/)
For the female athletes that are out there dealing with a loss of period or irregular cycles, please don’t ignore these signals. A healthy body is a fertile body, regardless of whether or not your goal is to get pregnant.
For the personal trainers, parents, or coaches out there, please discuss the female athlete triad with those individuals in your life who may be dealing with this. I have a questionnaire that I’m happy to provide you with and am happy to support you with this in any way! It’s important to catch these signs/symptoms as soon as possible. A great resource is the FemaleAthleteTriad.org.
To learn more about me, please visit: www.rockyourhormones.com. I provide nutritional consultations to individuals over the phone/Skype. I also work with other health professionals and personal trainers to help them find solutions for their client’s health struggles.
In good health,
Stephanie Greunke, MS, RD, CPT, WHE
Stephanie Greunke is a Fit For Birth expert who has completed the Pre & Post Natal Corrective Exercise Specialist course. She is a registered dietitian with an integrative approach to wellness. She has a master’s degree in nutrition and health promotion, a certification in holistic wellness, and a personal training certification.
In her private practice, RockYourHormones.com, where she sees patients locally, at Shine Natural Medicine in Solana Beach, California, and around the world through phone and Skype consults. Stephanie also works with other health professionals and personal trainers to help them find solutions for their client’s health struggles.
Her primary passion is women’s health focusing on fertility, optimizing health during pregnancy, and supporting women through their transition into menopause. Her own health struggles and experience working with naturopathic doctors has opened her eyes to a whole new world of medicine. She focuses on the underlying factors that are promoting the particular health problem instead of treating labs and the number on the scale.
Stephanie teaches a wellness course at UCLA. She enjoys educating and empowering individuals to be their own health advocate. Stephanie works with her clients to make sure they understand why they are making certain changes, so that the changes aren’t quick fixes, but solutions for life. Her ultimate goal is to not only help people rock their hormones, but rock their life.