Friday, February 21, 2025
My Story: The Beginning of Perimenopause and How I Dealt With It
If you're like me, maybe you’ve been going through the issues that arise during perimenopause, but didn't recognize that's what was happening. You might not have known the reason you aren't sleeping well at night, having difficulty feeling comfortable in mild to moderate temperature changes, have GI bloating, or a slew of other things that may actually be associated with perimenopause. Or, perhaps you’ve noticed your body's ability to train the way you did last year is just not the same. Yep, another issue related to perimenopause.
Recognizing the Signs of Perimenopause
I didn't recognize the signs, even though I work with women and tell them about this stuff all the time. Can you believe that? Why did this happen? Why did I not know when it was happening to me that it was perimenopause and not just stress related, or as many people say, it's just in your head. Yep, women are given that response so often it's infuriating.
I didn't realize the issues because I was so focused on other things, as so many women are. I didn't have time to really feel into my own needs. And when I did, all I had time for was catching up on sleep, or trying to. Another perimenopause related symptom is difficulty getting to sleep and or staying asleep, I had the latter.
The Dismissal of Women's Symptoms in Healthcare
All this started for me near the end of 2022. It started with irregular periods. Irregular in both amount of time they would last, to amount of blood loss, to the increasing pain getting so bad I was getting migraines, vertigo, and nausea from them. I just figured it was because I wasn't sleeping well. So I ignored it. I did mention to my doctor my lack of sleep issues, and I was just told to take some melatonin. I was NEVER asked about any other symptoms, nor did menopause come into the conversation.
A year later, summer of 2023, I was noticing my body getting smaller. And not in a good way. I've always been lean but muscular. My muscles were getting smaller with the same amount of lifting and training. To top it off, I was having debilitating hot flashes, to the tune of a dozen or more a day, and they were so bad that I would pack extra clothes with me to work to change when I needed. What the hell! This was when I knew something was wrong. Again I went to my doctor, and again I was never asked further questions, nor was I told it might be perimenopause. Keep in mind I was 45 at the time, so well within the range for it to start. Instead this time I was told to take black cohosh (supposedly for the hot flashes) and keep taking melatonin. I never did take melatonin, just too many possible side effects.
Searching for Answers: My Journey to Understanding
At this point it has been over a year of suffering. I had enough of no one caring, and no one with knowledge to help me. At that point I met with a friend of a client. Unbeknownst to me this person just happened to be involved with Midi health. After meeting with her, I filled out one of their intake forms and made an appointment. This was the beginning of some major positive changes and much relief.
At first I was resistant to taking hormones. Not because of any fear of cancer, but instead I feared how much it would cost to go on this, and what if the US took away my ability to access the hormones. I didn't want to have to go backwards. So my goal was to see if doing more conservative things would help me. During the next 10 months, we tried several different protocols to deal with the hot flashes, inability to sleep, brain fog/memory issues, anxiety and muscle loss. It just wasn't working. I also passed the point of no period for 12 straight months and was now considered to be post menopause.
What Are My Options?
I'd had enough and chatted with a new amazing health care professional who understood me and my issues. We did a full blood panel. I'm telling you they took 12 vials of blood. I learned that in addition to my hot flashes, muscle loss, and memory issues, I also had high cholesterol (high on the bad stuff and low on the good stuff), low iron, no estrogen or testosterone, and had huge platelets that were causing my lightheadedness and a couple other things. At this point it was time to make a decision on hormones to help even all those issues out, or take nasty medications that have so many other side effects it makes your head spin.
Hormones, Nutrition, and Strength Training: A New Approach
I've now been on a low dose of estrogen and progesterone for 6 months in addition to daily creatine, BCAA's, no processed food (super hard to do), more protein, Omega3 and Iodine, and have had a complete end to the hot flashes. Yay, no more multi outfit days, unless I'm riding, running and lifting. I've also stopped losing muscle mass, but not yet put any on. My brain fog is nearly gone, and I'm sleeping again.
We will do another blood test in 3 more months to check in on the cholesterol and other issues, but for now I'm feeling back to normal. Or my new normal. I'm still training hard, and in fact am lifting more than I have been in the past, 180 pound deadlifts and 160 pound squats. I'm also putting out more power on my bike and in my runs because of my extra time in the gym.
Advocating for Yourself: Finding the Right Support
If you're like me and are having trouble with not feeling yourself, don't let a doctor tell you you're fine and just take melatonin or whatever they try to pass off on you. Look for someone else, someone with the training and knowledge in peri and post menopause. You wouldn't go get a coach that only coaches soccer to train you as an endurance sport athlete, so why get a doctor who isn't trained in your needs to care for you?
Sunday, January 19, 2025
Diet Culture and Women: How Not To Get Caught up in the Crap
I've been working on a presentation on Women and Diet culture for a few months now, and am nearing the finish. In my final review of the nutrition presentation, I noticed a few key points that kept popping up.
They are: You are more than your physical appearance. Don’t believe anything that comes out of the research unless it specifically says the research was done only with women, or specifically for women. You absolutely do need to eat MORE. I'm just going to leave those there for you to mull over. Moving on...
Most “influencers” are using outdated information, or information that was ONLY tested on men for their get thin, or get ripped schemes. I’m not saying don’t follow them, but maybe enjoy their enthusiasm, and realize that what they are selling you either only worked on them or one of their clients and they are trying to apply it to everyone else to make a quick buck. Why do you think so many fitness influencers come and go? Now if you look for the ones that aren’t touting some magic pill, or one way to solve all your problems, then you just might find someone who will share some helpful information.
Just remember that no matter what your goals are, they are yours and will need specific interpretation for you to succeed. Seek help, and ask questions. At the end of this I have listed several places you can get help if you are having trouble.
What is Basal Metabolic Rate (BMR), and why it’s not accurate
In order for BMR to be measured it needs to be done so under very restrictive circumstances while you are awake. This requires that a person's sympathetic nervous system is inactive, which means the person must be completely rested.
The following set of variables are all reasons why BMR is NOT the best way to determine your caloric needs, especially when you like to move.
Muscle Mass – Aerobic exercises, such as running or cycling, have no effect on BMR. However, anaerobic exercises, such as weight-lifting, indirectly lead to a higher BMR because they build muscle mass, increasing resting energy consumption. The more muscle mass in the physical composition of an individual, the higher the BMR required to sustain their body at a certain level.
Age – The more elderly and limber an individual, the lower their BMR, or the lower the minimum caloric intake required to sustain the functioning of their organs at a certain level.
Genetics – Hereditary traits passed down from ancestors influence BMR.
Weather – Cold environments raise BMR because of the energy required to create a homeostatic body temperature. Likewise, too much external heat can raise BMR as the body expends energy to cool off internal organs. BMR increases approximately 7% for every increase of 1.36 degrees Fahrenheit in the body's internal temperature.
Diet – Small, routinely dispersed meals increase BMR. On the other hand, starvation can reduce BMR by as much as 30%. Similar to a phone that goes into power-saving mode during the last 5% of its battery, a human body will make sacrifices such as energy levels, moods, upkeep of bodily physique, and brain functions in order to more efficiently utilize what little caloric energy is being used to sustain it.
Pregnancy – Ensuring the livelihood of a separate fetus internally increases BMR. This is why pregnant women tend to eat more than usual. Also, menopause can increase or decrease BMR depending on hormonal changes.
Supplements – Certain supplements or drugs raise BMR, mostly to fuel weight loss. Caffeine is a common one.
Energy Availability (EA)
Since BMR isn't good, how do we calculate what we need to eat to be healthy? Have you heard of Energy Availability (EA), Exercise Energy Expenditure (EEE) and Low Energy Availability (LEA)? These factors take into account YOUR current fitness level and the varying amounts of energy you need per day depending upon your exercise program for that day.
The equation…
EA = Dietary Energy Intake (kcal) - Exercise Energy Expenditure (Kcal)
Fat Free Mass (kg)
When we talk about EA, we need to understand its parameters, which are constrained by Low Energy Availability (LEA). Low Energy Availability can creep up after as few as 3 days, and the symptoms are: fatigue, menstrual irregularities, mood changes, frequent illness, injuries, decreased libido, GI issues, poor concentration, decreased bone density, reproductive disfunction. If these are all the issues that occur when we are in LEA, then why are you continuing to eat too little, causing you to have to take meds to assist with mood, libido, bone density? When all you need to do is eat better.
In EA calculations, research shows that for the average sedentary “normal” weight woman, the target is at least 45kcal/kg of FFM per day. I don’t like when they use normal, but that what the scientists have described this as for now.
An example of a 68kg (150lb) woman with 25% body fat (51kg FFM). She would need to eat at minimum 2,295kcal in order to stay out of the LEA category. Anything lower than an intake of 2295 kcal per day (when exercising) puts this person at risk for all the negative side effects of LEA.
Places to Look for Correct Research Based Nutrition & Fitness for Women
However places like Midi Health, NAMS (North American Menopause Society) now called the Menopause Society are working to break down the barriers to research on women and ALSO bringing up to date information to you through well educated people who really care about women's health.
Last, if you are looking for an app to help you track your cycle, or even if you are post menopause but want daily suggestions of what you should/could be doing, the WildAi app is great. It's owned and run by an amazing group of women who know their stuff. Plus it's not publicly traded so there is no need to fear the period tracking in their app, that information stays with them.
References
They are: You are more than your physical appearance. Don’t believe anything that comes out of the research unless it specifically says the research was done only with women, or specifically for women. You absolutely do need to eat MORE. I'm just going to leave those there for you to mull over. Moving on...
Interesting Fact: I was just skimming through some research and found once again that women perform best in a fueled state*. In fact, this recent study on endurance trained females found that in just two weeks of under fueling (in this study was about 1700 calories a day - not too far from most diets) had reduced power output in a 20-minute time trial by 7.8% and time to exhaustion by nearly 19%**. These are some pretty disturbing numbers if you ask me. If women ate what was needed, their ability to work harder, longer and more effectively would begin to go up, but I'll get to that later.
So instead of trying to focus on losing weight this year, I challenge you to Pledge to make 2025 the year you form a healthy relationship with food and fueling. Meaning specifically how you fuel your workouts!
The Crap We are Told
So instead of trying to focus on losing weight this year, I challenge you to Pledge to make 2025 the year you form a healthy relationship with food and fueling. Meaning specifically how you fuel your workouts!
The Crap We are Told
Let's talk about social pressure on women to look a certain way, at the expense of their health. Where did that come from? Men. Yep I know I may have hit a nerve, that's good, truly think about it. Modern medicine was created around the male body and it’s specific physiology. What is physiology? The body's systems and how they work. Ya know the chemical stuff, hormones, cardiovascular systems, nervous system, etc. We all know that men and women have different amounts of each of the hormones that control all bodily systems, so why would we then believe that everything that science says works for men should therefore work for women?
For those of you who were around in the 80’s, oh man there was crap being slung…low fat diets became all the rage and jazzercise and all those cardio classes were huge. Why, to “help” women become skinny. But did you know that skinny isn’t necessarily healthy either.
What is healthy? Healthy isn’t what we look like on the outside, but what the systems on the inside are doing. You hear talk about diabetes, heart disease, high blood pressure, high cholesterol, right. Well those health markers matter way more than what we look like. I know so many women who on the outside look “skinny” but have terrible health markers and they hare on so many medications to try and help. Oh and by the way most of them don’t exercise, and don't eat healthy. I also have a lot of friends who don’t look skinny but have perfectly healthy health markers and do eat well and exercise regularly.
Myth vs Reality
For those of you who were around in the 80’s, oh man there was crap being slung…low fat diets became all the rage and jazzercise and all those cardio classes were huge. Why, to “help” women become skinny. But did you know that skinny isn’t necessarily healthy either.
What is healthy? Healthy isn’t what we look like on the outside, but what the systems on the inside are doing. You hear talk about diabetes, heart disease, high blood pressure, high cholesterol, right. Well those health markers matter way more than what we look like. I know so many women who on the outside look “skinny” but have terrible health markers and they hare on so many medications to try and help. Oh and by the way most of them don’t exercise, and don't eat healthy. I also have a lot of friends who don’t look skinny but have perfectly healthy health markers and do eat well and exercise regularly.
Myth vs Reality
Women are Not Small Men TedTalk, the research has mostly been done on men...until recently. Have you heard of Dr Stacy Sims? She studied women's physiology at Stanford, and now currently leading researcher on women's physiology. When she was at University studying, her professors would constantly say things like, "We don’t study women", and "Let’s throw their data out" or "Why do you want to study women? We don’t know enough about men.". It wasn't until her pushback that women really started to get true information on how to train especially through their monthly cycle.
Most “influencers” are using outdated information, or information that was ONLY tested on men for their get thin, or get ripped schemes. I’m not saying don’t follow them, but maybe enjoy their enthusiasm, and realize that what they are selling you either only worked on them or one of their clients and they are trying to apply it to everyone else to make a quick buck. Why do you think so many fitness influencers come and go? Now if you look for the ones that aren’t touting some magic pill, or one way to solve all your problems, then you just might find someone who will share some helpful information.
Just remember that no matter what your goals are, they are yours and will need specific interpretation for you to succeed. Seek help, and ask questions. At the end of this I have listed several places you can get help if you are having trouble.
What is Basal Metabolic Rate (BMR), and why it’s not accurate
Instead work with Energy Availability (EA). “The basal metabolic rate (BMR) is the amount of energy needed while resting in a temperate environment when the digestive system is inactive.” In such a state, energy will be used only to maintain vital organs, which include the heart, brain, kidneys, nervous system, intestines, liver, lungs, sex organs, muscles, and skin. This means that for most people, upwards of ~70% of total energy (calories) burned each day is due to their general body upkeep. Physical activity makes up ~20% of expenditure and ~10% is used for the digestion of food (thermogenesis)***.
In order for BMR to be measured it needs to be done so under very restrictive circumstances while you are awake. This requires that a person's sympathetic nervous system is inactive, which means the person must be completely rested.
The following set of variables are all reasons why BMR is NOT the best way to determine your caloric needs, especially when you like to move.
Muscle Mass – Aerobic exercises, such as running or cycling, have no effect on BMR. However, anaerobic exercises, such as weight-lifting, indirectly lead to a higher BMR because they build muscle mass, increasing resting energy consumption. The more muscle mass in the physical composition of an individual, the higher the BMR required to sustain their body at a certain level.
Age – The more elderly and limber an individual, the lower their BMR, or the lower the minimum caloric intake required to sustain the functioning of their organs at a certain level.
Genetics – Hereditary traits passed down from ancestors influence BMR.
Weather – Cold environments raise BMR because of the energy required to create a homeostatic body temperature. Likewise, too much external heat can raise BMR as the body expends energy to cool off internal organs. BMR increases approximately 7% for every increase of 1.36 degrees Fahrenheit in the body's internal temperature.
Diet – Small, routinely dispersed meals increase BMR. On the other hand, starvation can reduce BMR by as much as 30%. Similar to a phone that goes into power-saving mode during the last 5% of its battery, a human body will make sacrifices such as energy levels, moods, upkeep of bodily physique, and brain functions in order to more efficiently utilize what little caloric energy is being used to sustain it.
Pregnancy – Ensuring the livelihood of a separate fetus internally increases BMR. This is why pregnant women tend to eat more than usual. Also, menopause can increase or decrease BMR depending on hormonal changes.
Supplements – Certain supplements or drugs raise BMR, mostly to fuel weight loss. Caffeine is a common one.
Energy Availability (EA)
Since BMR isn't good, how do we calculate what we need to eat to be healthy? Have you heard of Energy Availability (EA), Exercise Energy Expenditure (EEE) and Low Energy Availability (LEA)? These factors take into account YOUR current fitness level and the varying amounts of energy you need per day depending upon your exercise program for that day.
The equation…
EA = Dietary Energy Intake (kcal) - Exercise Energy Expenditure (Kcal)
Fat Free Mass (kg)
When we talk about EA, we need to understand its parameters, which are constrained by Low Energy Availability (LEA). Low Energy Availability can creep up after as few as 3 days, and the symptoms are: fatigue, menstrual irregularities, mood changes, frequent illness, injuries, decreased libido, GI issues, poor concentration, decreased bone density, reproductive disfunction. If these are all the issues that occur when we are in LEA, then why are you continuing to eat too little, causing you to have to take meds to assist with mood, libido, bone density? When all you need to do is eat better.
In EA calculations, research shows that for the average sedentary “normal” weight woman, the target is at least 45kcal/kg of FFM per day. I don’t like when they use normal, but that what the scientists have described this as for now.
An example of a 68kg (150lb) woman with 25% body fat (51kg FFM). She would need to eat at minimum 2,295kcal in order to stay out of the LEA category. Anything lower than an intake of 2295 kcal per day (when exercising) puts this person at risk for all the negative side effects of LEA.
Places to Look for Correct Research Based Nutrition & Fitness for Women
The following list is of the most important people and companies I use to get my information and help direct me to proper studies to read. Leading the way for the new era of information on women is a former teammate of mine, Dr Stacy Sims. She led the charge to have women be recognized as necessary in research and to have our voices head on the field and off when it comes to training and nutrition protocols. Her coauthor of the book ROAR is Selene Yeager, noted columnist since the 80's, who even now talks about the crap she used to spew. Selene is also the host of an amazing podcast in its 5th year, Hit Play Not Pause, and they talk about everything women's sports, health, nutrition, you name it they talk about it. Then there is Midi Health, an online medical system that is covered by most insurance companies, the doctors there are ALL specifically trained in everything female hormone related from puberty, through childbearing years, to perimenopause and post menopause. They know their stuff, and they helped me where my doctors and gynecologist couldn't.
Most doctors are taught NOTHING about menopause and perimenopause, and only a little bit about women's health when it comes to getting and staying pregnant. Also, your OB/GYN knows NOTHING about peri and post menopause, because like I said earlier they aren’t taught anything because medicine was and still is based around health for men and then just applied to women.
However places like Midi Health, NAMS (North American Menopause Society) now called the Menopause Society are working to break down the barriers to research on women and ALSO bringing up to date information to you through well educated people who really care about women's health.
Last, if you are looking for an app to help you track your cycle, or even if you are post menopause but want daily suggestions of what you should/could be doing, the WildAi app is great. It's owned and run by an amazing group of women who know their stuff. Plus it's not publicly traded so there is no need to fear the period tracking in their app, that information stays with them.
References
*https://feistymedia.acemlnb.com/lt.php?x=3DZy~GDIVqGdEpF8ywDJgOad23_Wid~ykMY2XnjFVnSf75BAz0y.zuhs1I2njN-~jNYwXnjGIU
**https://feistymedia.acemlnb.com/lt.php?x=3DZy~GDIVqGdEpF8ywDJgOad23_Wid~ykMY2XnjFVnSf75BAz0y.zuhs1I2njN-~jNYwXnjGIk
*** Johnstone AM, Murison SD, Duncan JS, Rance KA, Speakman JR, Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine1. Am J Clin Nutr 2005; 82: 941-948.”
**https://feistymedia.acemlnb.com/lt.php?x=3DZy~GDIVqGdEpF8ywDJgOad23_Wid~ykMY2XnjFVnSf75BAz0y.zuhs1I2njN-~jNYwXnjGIk
*** Johnstone AM, Murison SD, Duncan JS, Rance KA, Speakman JR, Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine1. Am J Clin Nutr 2005; 82: 941-948.”
Additional Places for Amazing Information
Podcast from Hit Play Not pause: January 17, 2024: Weight Loss Drugs and Active Menopausal Women with Jody Dushay
Podcast from Hit Play Not Pause: January 31, 2024: Ditching Diets for Good with Pam Moore
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