One of the basic doubts that women, who want to cope with menstrual disorder, have is settling appropriate proportions of macro nutrients. There's a lot of information that low intake of fat leads to deregulation of menstrual cycles. Whereas, carbohydrates are indispensable to sustain proper levels of leptin and triiodothyronine. In this article I will deal with macro nutrients and, just like I promised, I will offer solutions making it possible to reduce releasing stress hormones during intensive workouts.
You should definitely read:Fitness shape and menstrual disorders – part I
Low intake of carbs contributes to lowering the level of more biologically active thyroid hormone – T3, i.e. the mentioned triiodothyronine. You can also find more detailed information concerning this subject stating that decreasing the consumption of carbohydrates under 120g a day leads to disability of thyroxine (T4) conversion into T3. And now you need additional explanations.
Hypothalamus monitors the levels of thyroid hormones and, on that base, it releases thyrotropin-releasing hormone (TRH), which later stimulates hypophysis to produce thyrotropin (TSH). When the levels of thyroid hormones are low, hypothalamus (through TSH) sends strong signal to the hypophysis to “let know” the thyroid that it should increase the production of thyroid hormones. Thyroid mainly produces T4. Thyroxine is a less active form of thyroid hormone – to be exact 5 x less active than T3. The level of T3 increases mainly thanks to conversion in various organs and tissues, such as liver, skeletal muscles, brain and intestines. Thyroxine can be also transformed to an inactive form – reverse triiodothyronine (rT3). Curiosity: about 20% of T4 is converted into T3 in intestines – because of that, taking care of intestinal microflora is important in a context of keeping T3 on appropriate level .
Going back to the main topic – majority of studies concerning the influence of carbohydrates on the levels of thyroid hormones were done in the 70s-80s. It sometimes happens that the conclusions are made without second thought. However, those studies have many limits, which are worth mentioning when creating the guidelines. First of all, in some part of those studies, the main source of fat in high-fat diets (poor in carbohydrates) were cheap, refined plant oils rich in omega-6 fatty acids [2, 3, 4]. Well, the studies were done in the 70s-80s – at that time margarine, soya and corn oil were perceived as more healthy alternatives than butter, eggs or coconut oil. The problem is that nowadays (fortunately) some opinions have been revised and the main sources of fat in low-carb or paleo diets are butter, eggs and coconut oil – poor in omega-6 fatty acid.
Second of all, the diets were often poor in calories [5, 6, 7, 8]. For example, in one of the studies it was proven that the consumption of carbohydrates in the amount of 120g a day or less contributes to lowering the level of T3 . That particular study is often the base of a common conclusion, that the consumption of carbohydrates should not be lower than 120g/day. However, it's worth paying attention to details – three kinds of diets were checked: 360, 645 and 1200 kcal and the volunteers were obese.
Third of all, the studies mentioned above were usually short-term [10, 11, 12, 13]. In case of diets with limited amount of carbs, proper adaptation to using new energy substrates needs time (at least few weeks). In one of few studies, or even the only one, where the very low-carb diet was properly balanced, the increase of total and free thyroxine (FT4) was noticed, as well as no changes in collecting T3 – unfortunately, the total and free triiodothyronine (FT3) was not measured .
There's one more thing – according to one of more interesting hypotheses, lower level of T3 may make the processes of ageing slower and prolong life . Dr Luigi Fontana from the Washington University in St. Louis, who is one of the main scientists measuring the influence of calorific restrictions on life span, was one of the researchers who studied this issue. In one of the experiments, Dr Fontana showed that long-lasting (3-15 years long) calorific restriction (1779 +/- 355 kcal/day) with adequate supply of proteins, vitamins and minerals among healthy slim men and women causes lowering the levels of T3 and FT3, and, what's important, it does not cause lowering the levels of T4 and FT4, or the growth of TSH and rT3. In the discussion, the authors paid attention to the fact, that among patients with ESS (euthyroid sick syndrome – when the levels of thyroid hormones decreases because of reasons not connected with the functioning of thyroid, e.g. as a result of decreased conversion of T4 to T3) the inflammation processes are common, which directly influence the level of T3 (it decreases). Interesting, isn't it? Stronger inflammation processes may have various reasons: inappropriate profile of intestinal micro flora, autoimmune diseases, infections, high level of body fat, insulin or leptin resistance – yes, that's right, high level of body fat may contribute to lowering the levels of thyroid hormones, although, majority of the obese complain that they suffer from opposite situation.
Going back to main thought of the text – there is no strong evidence proving that limiting carbohydrates has negative influence on the level of thyroid hormones, fosters the deregulation or makes it harder to bring back the monthly cycle. In some situations it is impossible – I will come back to that matter later on.
In the previous part I mentioned that strategic increase of carbohydrates intake 1-3 times a week (the best would be on training days) may have positive influence on increasing the level of leptin. The solution is worth trying, but I am not in favour of using it in each case. Unfortunately, we don't know if the growth of the level of leptin caused by short-term higher consumption of carbohydrates is permanent, how it influences the levels of other interesting for us hormones and what happens in such situation with the sensitivity of tissues on leptin.
In order to lower the risk of occurrence of menstrual disorder, you should supply at least 1 g of fat per 1 kilogram of body weight. Such advice often appears on fitness forums. It should be considered as sensible. Unfortunately, the range of studies checking this matter is limited.
The most interesting study can be that one done by the scientists from The Norwegian School of Sports Sciences . In this experiment, the intake of macro nutrients among long-distance female runners who have regular menstruation and those with menstrual disorder was compared. The level of luteinizing hormone was over two times lower in the group of women with menstrual disorder (accordingly: 7.6 vs 2.9 IU/L). Significant difference was also noticed in the amount of supplied energy and fat consumption. Women with regular menstruation supplied 2914 kcal and 98 g of fat/day (1.7 g of fat per 1 kg of body mass) with the training volume of 7.5 hours a week. In case of women with menstrual disorder, the consumption was following: 2365 kcal and 61 g (1.1 g of fat per 1 kg of body mass). On the basis of the results it's hard to state whether the lower (although, in general, not that low) consumption of fat in the group of women with menstrual disorder was the key factor – the difference in the supplied energy is also clear. I will also pay attention to the fact, that women with regular menstruation consumed much more mono-unsaturated and saturated fatty acids. I would consider including those acids in diet as important. Good sources of these acids are: extra virgin olive oil, avocado, coconut oil, butter, eggs, fatty fish, almonds and macadamia nuts.
Additionally, many studies done on men point out that higher consumption of fat (about 40% of supplied energy), especially mono-unsaturated and saturated fatty acids contributes to higher level of male sex hormone – testosterone .
Macro nutrients and the “available” energy
Significant limitation of the consumption of carbohydrates and fats may lead to considerable decrease of the supplied available energy and make proteins the dominating macro nutrient in the diet, which means trouble. I already mentioned it in the previous part and I will write it again – lowering the amount of the supplied available energy below 30 kcal per 1 kg of lean body mass leads to disability of releasing luteinizing hormone. At the same time, bringing back regular monthly cycles in most cases needs increasing available energy over 45 kcal per 1 kg of lean body mass.
Before I go to conclusions, I will present the result of one more research . Female volunteers started menstruating after 6 months of implementing a supplement containing macro nutrients in a liquid form (360 kcal; 54 g of carbohydrates; 20 g of proteins; 8 g of fat; 300 mg of calcium; 100 IU of vitamin D; 0.4 mg of vitamin B6 and 1.2 µg of vitamin B12) – a portion of it 30-60 minutes after workout or at any moment on non-training days. To make it short – the used intervention occurred to be very effective. I will pay your attention to details: the participants were engaged in endurance effort (for about 7 hours/week). Before the trial, the amount of the supplied available energy for them was ~37 kcal per 1 kg of lean body mass, so it was higher than the “minimal” amount allowing proper release of LH. Whereas, after introducing the supplement, the available energy was close to the advised one, when the aim is bringing back the monthly cycles ~45 kcal per 1 kg of lean body mass. Due to the intervention, the volunteers observed slight increase of body weight (+1.6 kg). Their level of body fat before the trial was not that low (~22%) and, as a result of the intervention, it only rose to ~24%. The time, after which the participants regained their menstruation, depended on the period of time without menstruation before the trial – for women without menstruation for longer than a year this period of time lasted six months. In few other studies it was confirmed that increasing the amount of available energy contributes to restoring the reproductive functions [19, 20] – in one of those attempts, apart from increasing the supplied energy, the training volume was decreased (introducing one day free from workout)  – this way also lets you increase the available energy and such procedure is worth considering in many cases.
Short summary: In majority of cases, restoring regular monthly cycles needs larger amount of the supplied available energy. In order to set optimal proportions of macro nutrients, individual approach is necessary. Low insulin sensitivity manifesting in a form of the feeling of languor after meals including large amount of easily digested carbohydrates, as well as strong inflammation processes, are circumstances which should cause the decrease of the amount of carbohydrates and not the increase. Whereas, the symptoms of hypoglycaemia, which are quite common, such as weakening, dizziness, strong feeling of hunger after long breaks between the meals – may suggest higher supply of carbohydrates in diet. There's usually no need of introducing basic changes in the proportions of macro nutrients, because they are good for us for other reasons – they let us sustain good mood, high physical efficiency and supply proper amount of micro nutrients – vitamins and minerals.
Speaking of which, I will pay your attention, once again, to something very important – calorific restrictions are often accompanied by inadequate supply of vitamins and minerals – lack of them may directly cause the monthly cycles disorder. In this context, my attention was drew some time ago to the observations done by Dr John Berardi – one of the most reputed experts in fitness. He noticed that introducing high-quality vitamin-mineral complexes to the diets of fitness and figure female contestants, who stopped menstruating during the preparation period, gives the opportunity of restoring regular monthly cycles without the change in the supply of calories.
“I was amazed when we experimented with this. We tested removing and reintroducing the multvitamin/multimineral a few times. When the vitamins and minerals were in, periods returned. When they were out, menstruation stopped.”
It suggests, that the bigger problem may sometimes be deficiency of the key micro nutrients, than high energy deficit. The important micro nutrient are, among others, fat-soluble vitamins (D, K2, A and E), group B vitamins, folate, copper and zinc. The increased supply of some micro nutrients may be also useful when removing the consequences of lack of period. The compounds, such as magnesium and calcium are among them.
Meals around training time
Some time ago the experts I appreciate – Alan Aragon and Brad Schoenfeld – published an interesting article concerning before or after training meals . The main aims they set were: 1) revising literature concerning the influence of the time of supplying macro nutrients on the effort adaptation, and 2) creating recommendations, which would let maximize the anabolic response to exercises. For more interested individuals, here's the title of the publication: “Nutrient timing revisited: is there a post-exercise anabolic window?” The recommendations included in this article are following: in order to maximize the muscle proteins synthesis, you should provide 0.4 – 0.5 g of proteins per 1 kg of lean body mass both, before and after workout. The second recommendation – when doing typical strength workouts lasting 45-90 minutes, the break between meals before and after workout should not be longer than 3-4 hours. Depending on a diet, the meals around training time should be completed with carbohydrates and/or fats. The necessity of carbohydrates in those meals is questioned in that publication. I think it's right, taking under consideration the results of available studies. To be clear, there's nothing about malignancy of carbohydrates before or after workout – only their necessity is questioned.
The question is – whether the recommendations mentioned above are appropriate for women, when their aim is to prevent from menstrual disorder or restoring regular periods. The answer for the first question is positive. Unfortunately, the other aim sometimes (especially when workouts last longer than 60 minutes) needs the supply of carbohydrates and proteins in a liquid form during training. Why? Women with functional hypothalamic amenorrhoea (comparing to women with regular periods) usually have higher level of cortisol before and as a response to physical effort – I wrote about it in the first part of this cycle. Such procedure gives the opportunity of removing this problem. From the practical point of view, if 1-2 hours before and after workout there are meals, and the workout lasts 90 minutes, I suggest a drink containing: 15 g of proteins (or 10 g of BCAA) and 30-45 g of carbohydrates in a form of maltodextrin or glucose (per 500-750 ml of water).
To sum up
I suppose, that within these three articles, I was able to include quite a lot of precious tips – would I like to add anything? In many cases, reducing stress through mental exercises may be very beneficial – you can use mindfulness or Heartmath. I can notice positive influence of such exercises among people I work with, as well as on myself.