Hypothalamic Amenorrhea and How To Exercise

I get asked this question A LOT. Especially since Sarah Wilson kindly posted my story on her blog. I think, inherently, we are all a little voyeuristic. A little pervy. Wanting to know the intricate details of other peoples’ lives. Or perhaps we just want a little guidance or confirmation that we are doing the right thing. Either way, I have decided to share how I approached exercise as I was healing from hypothalamic amenorrhea.

Peeping Toms in Tokyo, 1951. Image via pinterest by sahua d

First, know this: hypothalamic amenorrhea (also referred to as the Female Athlete Triad) is often a result of over-exercising and/or under-eating, which leads to an overall negative energy balance for an extended period of time. The body senses that you are, essentially, starving and says “Righteo, no energy for reproduction, then” and bids farewell to your monthly lady holiday.

So, taking this into account, you can see that exercise is perhaps contraindicated in the treatment of hypothalamic amenorrhea. Right? Right! 

Chronic exercise = no good. BUT movement = good!

Prior to actually deciding to do something about my infertile situation, this is what my exercise looked like: 

• Monday: Body Attack (1hr) followed by Body Pump (1hr). I might have walked ~1/2 -1hr too
• Tuesday: Maybe a walk, maybe a weights session (maybe both), maybe a cardio session
• Wednesday: Body Attack (1hr)
• Thursday: Body Step (1hr), ½-1hr walk
• Friday: Body Attack (1hr), weights (1hr)
• Saturday: Body Step (1hr) – every second Saturday
• Sunday: Body Step (1hr)

Holy crap. I am exhausted just looking at all of that! So much time wasted in the gym! Granted, it was my job, which made it more “legitimate”, I suppose, albeit no less damaging to my health and fertility.

I realised that this was unsustainable and would leave me in my infertile state if I were to continue. 

Yes, thank you for your wisdom, Albert. For a while, I was insane. I thought I could just throw herbs and vitamins at the situation and it would sort itself out. But, after spending thousands of dollars (literally), I realised this approach was no bueno. So here is what I did…

I progressed quite gradually, and it helped that it coincided with my dietetics placement, so I had an excuse to no longer teach a lot of my classes.

Stage 1

• Monday: Body Pump
• Tuesday: Walk
• Wednesday: Weights (functional training 1hr)
• Thursday: Yoga
• Friday: Weights (functional training 1hr)
• Saturday: Body Step (every 2^nd weekend)
• Sunday: Body Step

 A considerable change, but probably not enough. Cue stage 2.

Stage 2

• Monday: Body Pump
• Tuesday: Walk/yoga
• Wednesday: Weights (8 minutes – YES, you read right EIGHT minutes – 8 sets of 3 clean and presses; sets 1 min apart)
• Thursday: Walk/yoga
• Friday: Walk/yoga, maybe a Tabata session (4mins of cardio)
• Saturday: REST
• Sunday: REST

Although it was tough (mentally), I stuck to this routine for quite some time (until my period returned), gradually adding in more yoga (vinyasa/yin/hatha NOT bikram/ashtanga) and taking out the Body Pump. As I have previously mentioned, I found the yoga incredibly beneficial to the healing process as it allowed me to focus more on my body’s ability, rather than its aesthetics.

So, now that my cycle is getting back on track, how do I exercise? Well, it depends. I try and get outside as much as possible for a gentle walk/hike, as I now live in the nature-lover’s playground:

Image by Lake Wanaka Tourism

But if it is raining outside, and I feel really good, and my stress levels are low, my week might look like this:

• Monday: Weights (1hr - 10 min mobility warm up, 30 min weights, 20 min stretch/yoga)
• Tuesday: 1hr yoga
• Wednesday: Body Pump
• Thursday: Tabata
• Friday: 1hr yoga
• Saturday: Hopefully the rain has stopped by now and I can go for a hike!
• Sunday: Rest

Note: I do at least 30 minutes of yoga every day in the morning. It grounds me and sets me up for an awesome day.

Now please note, this was MY journey. This gives you a general idea of what worked for me. It may or may not work for you. Listen to your body. If you have exercise/stress/lack of food-induced amenorrhea, then you probably need to pull right back on the exercise to start with, then take baby steps along the way, depending on how everything is tracking along.

If this is all too overwhelming for you, I get it. My hubby (who is a PT and peak performance coach) helped keep me on track. Everyone needs someone. Feel free to shoot me through an email via my website if you would like to book a consultation for some more structured, personalised guidance that will help you get your sexy back.

Final note – as always, be kind to yourself. x

Should we eat more fat? Time Mag says yes!

I’m sure, by now, many of you have seen the recent time magazine cover telling us to “Eat Butter”. In case you missed it, here it is:

You’re probably expecting me to jump around and say “Haha! I told you so!”, while I do a little Irish jig, because, well, I did tell you so a couple of years ago in this post. However, I’m not going to do that. Oh wait, did I just do it? Oops!

What I actually want to do in this post is cover off the key points from the Time article and see how we can apply this and that perhaps we do not need to eat MORE butter. Yes, I am going to play the Devil’s advocate!

OK, let’s dive in. Here are the salient point from the article:

• In the 1980’s, dodgy science reported that high intakes of saturated fat increased your risk of heart disease. The USDA took note, created dietary guidelines that recommended avoiding fat, and subsequently a whole realm of low fat foods were produced
• Fat intake decreased, junky grain-based carb consumption increased, the prevalence of chronic disease (heart disease, diabetes, obesity) was on the rise
• In the mid-1990s, Dr Walter Willet found that if people replaced foods high in saturated fat with carbohydrates, there was no reduction in heart disease. Go figure! More people then started to question the role of fat
• The Mediterranean Diet began to take flight as the heart-healthy diet, with its preponderance of poly and monounsaturated fats (note – these were from nuts, seeds, fish, olives and olive oil NOT refined vegetable/seed oils)
• Arrogant wanker quote of the year** from Dr Robert Eckel, past president of the American Heart Association (AHA) – “When you replace saturated fats with polyunsaturated  and monounsaturated fats, you lower cholesterol. That’s all I need to know”. This kind of closed-minded, egotistical view is what is stifling the health of the world. We need to put our egos aside and be open to new evidence and admitting when we were wrong. This is the nature of science!
• A 2010 meta-analysis (a study of many relevant studies) found that there was no significant evidence of an association between saturated fat and increased risk of heart disease. These findings were further supported by another study this year
• Saturated fat increase LDL cholesterol AND HDL cholesterol, which negates the heart disease risk
• Refined carbs stimulate the production of insulin, which drives fat storage
• Low-carb diets have shown potential in helping with diabetes and obesity
• Increasing meat may have environmental consequences. Read why I disagree HERE (the Allan Savory vid)
• Some experts are concerned that if we spread the message that saturated fat is fine, this may increase unhealthy habits and instead, we should focus on whole, real foods

**Time Magazine did not call this dude an arrogant wanker. That was me being on my soap box 

Now for my thoughts on the situation.

First off, I think it is awesome, and long overdue, that this information is out in mainstream media. And it is only fitting that Time Magazine publish this, considering they were the catalyst for everyone freaking out in the first place with this cover in 1984:

I whole-heartedly agree that we should not avoid saturated fat. The research clearly does not support the thinking that this nutrient increases the risk of heart disease. HOWEVER I think there are a few things we need to be wary of

1. Healthy, “risk-free” saturated fat does not mean party pies, sausage rolls and pop-tarts.

Saturated fat from REAL FOOD is what we are talking about here, peeps, so do not use this research as a license to go and feast at McDonald’s or your local 7/11! Instead, enjoy real-food sources of saturated fat, such as:

• Meat and organs (choose grass-fed, which is also a great source of omega-3 fatty acids)
• Chicken (again, free range and organic is best)
• Egg yolks
• Fish (31% of the fatty acids in salmon are saturated)
• Olives (YES they are actually 13% saturated fat!)
• Nuts (macadamias are highest in saturated fat of all nuts)
• Coconut and coconut products (the main fatty acid, lauric acid, has been shown to increase HDL/”good” cholesterol, and is also the predominant fatty acid in breast milk)
• Dairy products
• Avocado (23.5% of fats are saturated)

Note that those foods that we often associate with being good sources of poly- or mono-unsaturated fats (e.g. salmon, nuts, avocado, olives) are actually also good sources of saturated fat? That is because these fatty acids never exist in isolation! We need to start thinking of WHOLE foods, rather than their individual constituents.

2. Carbohydrates are not the devil

Image by Fonda LaShay, via pinterest

When the original research came out regarding fat causing heart disease and making us fat, we all went gung-ho and took the stance of “the less fat we can have in our diet, the better”.  We know this is not true. We need fats for the optimal functioning of a number of bodily processes, such as hormone production, health bone metabolism, cell membrane integrity, satiety, immune health and more.

What concerns me is that people will take the “low-fat=no-fat” attitude and apply it to carbohydrates, going extremely low carb, or cutting them out altogether. While this may be beneficial for some (such as those suffering from epilepsy, pre-diabetes or un-medicated diabetes, or even obesity), this does not mean it is the best choice for everyone. I made the mistake of going too low-carb for too long. Learn from my mistakes and be mindful that you need carbs for a few things:

• Carbohydrates feed the good bacteria in our digestive system. If we go too low carb, they can be starved, creating dysbiosis and digestive problems
• Carbohydrates provide bulk to the stool to help with passing a bowel motion, and we are all aiming for the perfect poop, right?
• Carbohydrates help with the conversion of the inactive (T4) to the active (T3) form of thyroid hormone, thus helping fuel metabolism. Go too low carb and you may find yourself in a bit of a weight pickle as your thyroid stops working as it should
• Carbohydrates prevent the body from relying on the adrenal glands and cortisol to keep blood sugar levels in balance, thereby limiting the likelihood of adrenal fatigue
• Carbohydrates help to refuel muscle glycogen stores after an intense workout, and prevent the breakdown if muscle

There are more, but I think you get the point. Carbs can be useful. How much you need is dependent on your lifestyle and individual situation. If you are active and/or stressed, you may need slightly more. If you are sedentary and/or chilled out, maybe a little less will suit. Play around with it and see how you feel!

All in all, I recommend that you avoid low-fat junky “foods” and not fear fat, while also being mindful that some carbohydrate-rich foods (such as sweet potato, potato, parsnip, beetroot, rice, a little fruit and even quinoa or legumes, if tolerated) are also great sources of vitamins, minerals and antioxidants, and can help our body to function at its peak. Do I think they should be the bulk of our diet? No. But they should not be demonised, either.

Moral to the story – eat real food. If it needs an ingredients label, or if you don’t know what all of the ingredients are, don’t eat it. Simple. Don’t get caught up in the minutia – life is too short!

What are your thoughts on this whole dealio?

Are you eating enough?

It is rare that I will get a client who is eating too much food. Often, it’s the other way around. Which makes sense, given what we have been taught about weight loss. It’s simple, really: 

“Eat less. Exercise more”.

Hmm. OK. My job (in terms of weight loss clients) really should be obsolete then, right? If it really were as simple as eating less and exercising more, most of my clients would be Kate-Moss-thin. But they aren’t. Some have just a little bit of stubborn fat that they would like to lose (for aesthetic reasons), others have more that they need to lose (for health reasons). All are exercising their butts off. Too much, in my opinion. All are not eating enough.

So simple, yet so easily forgotten. 

I was taught at university that if an overweight person comes to me and their food record shows they are consuming fewer calories than they are burning, then they must have been lying, because they should be losing weight. How f-ing arrogant of us to assume this. It truly breaks my heart to see people who are literally broken from trying so hard to lose weight using the traditional “eat less, exercise more” dogma”.

I agree. Ridiculous indeed.

So why is fat loss so hard?

Well, it is complicated, and I am the first person to admit that I do not have all the answers. As I mentioned, if weight loss were easy, we would not have an obesity epidemic that is running out of control.

What I do know is that when you consume too few calories, shit is going to hit the fan. Let’s back up a little for some weekly science….

Your resting metabolic rate (RMR) is an estimate for how many calories you would burn if you lay in bed all day (sans hanky panky). Your RMR represents the minimum amount of energy required to keep your body functioning – your heart beating, your lungs breathing, your reproductive system functioning, your thyroid gland humming along nicely, controlling your metabolism and body temperature. Let’s put this into practice and see what some numbers look like:

To calculate your RMR, you can use something called the “Schofield Equation”. While this equation does have some flaws, it provides a pretty decent estimate.

For me (and any other female in the 18-30 age group), the following equation would be used to get my RMR:

{(0.062 x weight (kgs)) + 2.036} x 1000 = 5,942kJ per day (divide by 4.28 to convert to calories)

So my minimum calories that I should consume, based on me staying in bed all day is 1388. MINIMUM! This is not taking into account any sort of exercise, folks.

Let’s say I decide that I am going to walk a little each day. My estimated energy requirements then go up to 2,082kcals per day! Just to do a little wandering here and there.

What is really concerning to me is that I have clients consuming around 1300-1500 kcals per day who are training at high intensity, for long durations, every day of the week. A rest day for them would involve a slow run, rather than a fast one. And this is not just females, it’s the fellas too.

What’s the problem with eating too few calories?

Image by Sara Thurley via Pinterest

When you have insufficient calories on board to fuel basic bodily functions, those functions will slow down. Your brain will recognise this lack of fuel and signal to the thyroid gland (in your neck) that energy needs to be conserved and to slow everything down.

Your thyroid gland controls all of your metabolic processes and your body temperature. If it slows down production of thyroid hormones, your metabolism will slow down, your heart rate will drop and you may struggle to keep warm. What happens when your metabolism slows down, people? You guessed it! Weight loss resistance!  If you are, essentially, starving, do you really think your body is going to give up its fat stores easily? Or do you think it is going to hold on to every last morsel to feed your vital organs (and to keep you warm). (PS have you checked out the Thyroid Sessions yet? They are awesome!)

If this wasn’t bad enough, your adrenals are probably going to kick into gear to help you survive (especially if you are doing high intensity exercise and don’t have enough carbs in your diet). This means cortisol is going to ramp up and give you a nice little pooch around your tummy that you can’t shift, no matter how many crunches you do (as a side note, crunches are not the best exercise for a lean mid-section, so just stop it).

In my opinion, troubles with weight loss are the least of your worries if you are chronically under-eating and over-exercising. I have spoken (at length) about how this can lead to Hypothalamic Amenorrhea (click the labels below this post to read more about this topic), but what about the other consequences, not just impacting the ladies:

• Compromised bone density
• Brain fog and inability to focus
• Decreased performance (in all forms of exercise, including the bedroom)
• Vitamin and mineral deficiency
• Low energy
• Increased risk of heart problems
• Poor memory
• Skin breakouts
• Hair loss
• Cracked and brittle nails 

Not pretty, right? Moral to the story – eat more and eat well! Or, exercise less. You choose. But don’t do nothing, or you could end up in some ugly (literally and figuratively) places. It might be useful to track your daily food and exercise, using something like “My Fitness Pal” to get a better picture of whether you need a slap in the face with a juicy steak.

Thanks, Ryan. Much appreciated. 

Melissa Ambrosini - self-love guru

Melissa Ambrosini is a glowing (literally) example of health, in every sense of the word. I am so honoured to be able to share this interview with you all. I hope she inspires you (as she has me) to show yourself a little more lovin'. 

1.    Please tell us a little about who you are, what you do and how you got here.

I help people become the best version of themselves. I am a writer, a speaker, a blogger, a coach, and a self-love teacher. I empower women to take control of their health and life, and to live the life of their dreams.

I had adrenal fatigue, thyroid problems, high levels of mercury, serious PMT, depression, loads of mineral deficiencies, an eating disorder, adult acne, eczema and a serious case of cold sores all over my face, mouth and even down my throat. What the hell!

Hit the rewind button and I was travelling the world, living the ‘dream’. In between dancing at the Moulin Rouge and working on TV shows such as Packed to the Rafters and Home and Away, I was partying my pants off in places like London, Paris, and New York. I thought I had ‘made it’. People would say to me. ‘You’re so lucky. You have everything!’ At the time, I really thought I did. My happiness was measured by the next gig, the size of my bank account, model boyfriends, and designer handbags. But, the truth was: I felt completely lost, scared, and empty.

I was running on adrenalin at a million miles an hour, working way too much, burning myself out, and living in a constant state of stress. Not surprisingly, I was suffering anxiety and severe panic attacks. To make matters worse, I was practically living off champagne, appetizers, and four hours of sleep a night.

It probably seems inevitable that my body would crash and burn! The thing is: I ignored not just one but several bright, BIG, red, warning signs. There was the time I fell down the stairs, almost breaking my back and snapping my ankle. I’d been in and out of hospital half a dozen times that year. My doctor was on speed-dial and the constant cycle of antibiotics and other medications was literally what was keeping me going. It was NOT fun. But, still, I didn’t pay attention.

It wasn’t until I was lying in a hospital
 bed that I hit rock bottom and found
 my light bulb moment. I realised something BIG had to shift. I
 remember saying to myself, 

“I created
 this. I am the one who got me here. So, I am the ONLY person who can get me 
out!” 

There, in the hospital, surrounded
 by all the medications that had been keeping me going, I decided enough was enough. I took a vow. I vowed to stop looking outside of myself for happiness and well-being and start creating it from within.

This journey has been a truly fulfilling experience. Yes, there were some tough moments. But, now, I feel more connected, grounded, content, and loving than I could ever have imagined. My definition of success, like happiness, is no longer defined by my external world. These days, it all comes from within me and that has given me unimaginable freedom and joy in my life.

2.    How do you practice self-love each day?

Everything I do in my life comes from a place of love. I no longer do anything that is driven by fear. For example: in the past I would eat processed junk food to fill emotional voids. 

Now, I eat to nourish my body and soul because I love myself.

When you choose to live a life from love, every decision comes from love. This includes: the work you do, the people you choose to surround yourself with, how you move and treat your body. These are all a reflection of either love or fear.

I talk a lot about how to flex your self-love muscle in my eBook 12 Steps to Wellness. When I work one-on-one with women, we really exercise this muscle so that is becomes ingrained. 

3.    I read that you battled body issues in the past. If you could go back and speak to your younger self, what would your advice be?

Don't compare yourself, gorgeous.

4.    What is your nutrition philosophy?

To me, wellness and health aren’t just about what you put into your mouth. It's a mind, body, and spirit alignment and connection. You can’t have one without the other. You can’t be eating organic food without dealing with your emotions. It all comes hand-in-hand. I believe it’s a complete holistic approach. 

It doesn't matter how much broccoli you eat. If you’re not dealing with what’s really going on emotionally for you, you will create your external world to reflect that back to you.

There’s a big difference between people who have “healthy habits” and people who embody a healthy lifestyle. The person with the healthy habits goes to the gym, eats relatively well, still parties, deprives her body, calorie counts, and doesn’t make self-care a priority. The person who embodies a healthy lifestyle lives, eats and breathes wellness. Self-care is at the top of her “to do” list. Local markets on the weekend are a joy. Exercise is done for fun not to lose weight, and their happiness is a reflection of their inner peace. I teach people how to dive into the latter. I am not into quick fixes, diets, or detoxes. I am about helping you embark on your own path to wellness journey.

My food philosophy:

I believe we should all be eating how our ancestors ate. 

1. Chemical and pesticide-free, so all-organic and local fruit and veg (in season) where possible. Every time I eat, I give thanks to my food and where it has come from. Do you know where your food first started and how it got to your plate? I invite you to think about that.
2. All organic, grass-fed and grass-finished animal products are a non-negotiable for me. I will not put any meat in my mouth if I don't know where it has come from.
3. Wild or line caught seafood only.
4. Loads of clean, filtered water, herbal teas, fresh juices and smoothies, coconuts, and Kombucha.
5. No processed foods, sugar, refined carbs, dairy, soy, gluten, Trans fats, MSG and alcohol. I believe our bodies don't cope well with breaking these down.
6. Conscious eating. I practice and teach conscious eating. Being present whilst you eat is extremely powerful. Try it!
7. I see food as medicine and not something to fill emotional voids or to do out of habit or boredom. If there is something emotionally going on, I sit with it and dive into the feeling. I don't go and suppress it with food.
8. I choose foods that I know have been made with love and care, not something that has a longer shelf life than I do.
9. I subscribe to the Melissa Ambrosini diet. What do you subscribe to? Everyone is different. What works for me may not be right for you. So I invite you to tune in with your body and feel what it’s craving.

5.    If you could choose just one food, for health and taste, what would it be and why?

Can I say a drink? I love green smoothies. I could live off them! ;) 

(Go HERE for one of Melissa's green smoothie recipes)

6.    Please tell us about your Babes not Bears event.

My Babes not Bears event was all about self-love and giving people the tools to combat their inner mean girl (aka ego). I shared a lot of my own personal stories and struggles and gave them tangible ways to bring out the best version of themselves and to live the life of their dreams.

It was LOADS of fun.

Thanks so much Melissa! You are an amazing inspiration to us all. 

You can this gorgeous girl at: 

Her Website

Facebook

Twitter

So friends - how are YOU going to incorporate more self-love into your day?