Carbs: my #1 frenemy.
Some of you may have read last week’s post on stealth calories and now think that we just want you to eat junk food all the time. Not true. For many of us the goal is not to put on mass. I see this more commonly with women than men, including myself (no one ever accused me of having a ‘frail’ frame!). Those of us blessed with female physiology are often faced with quite the following problem: a constant struggle against impending weight gain. As a weightlifter who wants to increase the weight on the bar but not on the scale, my goal with food has been to find the perfect formula that fuels increased muscle mass while allowing me to remain within my 69kg weight class. The easy simple advice? Just avoid carbs. Problem solved! Yippee! I thought so, too, except for the resulting hormonal issues that then followed the pairing of heavy resistance training with a dearth of carbohydrate-intake.
This (long, but information-packed) post in our “Good Calories, More Calories” series is aimed at women who enjoy a high-protein/low-carb diet. Men, this is written for the ladies, but there’s no reason for you not to read it, as well. The basic summary of the following post is this: too few carbs = starvation mode = loss of reproductive function. No one wants that.
Look, low-carb diets are all the rage (Atkins, Keto diet, 21DSD, …note that a Paleo/Primal diet is NOT one I categorize as “low-carb”), I get it, I’ve DONE it, it’s WORKED and I felt GREAT. These diets work by limiting your carbohydrate intake initially in the form of grains and refined sugars, and then as you get more and more strict in the forms of most — or all — fruit and starchy vegetables. You shed pounds and have this renewed sense of energy and clarity as your body survives off of fat and ketones. The bottom line, however, is that putting the body into a long-term state of ketosis is a bad thing. Why? Why is it bad to go relatively carb-free when you’re trying to eat a strict high-protein grain-free diet? Isn’t that the optimal diet eaten by elite Crossfitters the world wide? When the female body is deprived of a significant source of energy (such as carbohydrates), the body goes into “starvation mode”, and one its primary reactions is to shut down reproductive systems (because, hey, if you can’t feed yourself properly then how can you feed a baby?!). In layman’s terms this means you lose your period.
Part 1 will begin with my own background story about how I realized I was not eating the way I needed to be. Part 2 will delve into the science of it all (or what I understand of it, at least, since — and I cannot stress this enough — I am not a scientist). Part 3 will come back to how I learned to adapt my diet in order to feed my body properly and how it’s working so far. Part 4 will offer tips on how to make sure you keep your hormones happy given your daily fuel. Skip ahead to any part you wish to read, or just read the above summary.
Part 1: Background Story
When I was 18 I had severe amenorrhea and dysmenorrhea (went without a period for many months at a time and then had one 7-10 day super heavy painful period). It wasn’t fun. It wasn’t healthy. My gynecologist prescribed low-estrogen oral contraceptive (or “the pill”) for me in order to regulate my periods. **FLASH FORWARD 10 YEARS** I decide to not renew my birth control and see how my body reacts after 10 years of steadily regulated menstrual cycles thanks to modern science. (I had been Crossfitting and eating a Paleo-ish diet for 3 years and in the best physical shape of my life. I hoped this meant I’d have regular-ish periods all on my own.) Who knows what the pill had been hiding all that time? After 2 months off it I hadn’t had a period, but I expected that might happen as my body adapted to the change of needing to try and self-regulate, and after coming from an irregular menstrual cycle; I didn’t really know what was “normal” for me. During the last couple months of 2012, I was still Crossfitting 5-6 days a week, eating pretty Paleo (I was living in Greece, so Greek yogurt was a daily thing) complete with a post-wod meal of apple or sweet potato and the like. I’d say 40% of my caloric intake came from (good) carbs.
In December 2011 I returned to the States, and switched my training goals to become a weightlifter. This meant I went from a 5-6x/week Crossfit lifestyle to an exercise regiment of primarily heavy resistance training 4-5x/week (snatch, clean & jerk, squats) and metabolic conditioning to only once/week. The switch to lifting affected the way I ate, as well. My diet, which was still based on Paleo/Primal principals, transformed: increase in protein, increase in fat, dramatic decrease in carbs. This wasn’t a conscientious decision, I was just trying to listen to my body. My body said “hold the sweet potato, please, and add more salmon to that salad.” I chose berries over bananas. I was training seriously for my first National competition, so I was also serious about eating strict Paleo — no cheats from grains or sugar (except the occasional dark chocolate) and no alcohol.
I felt and looked amazing. I got stronger. I got leaner. I had loads of energy. I did not, however, have a period.
August 2012: 11 months without a single period.
I have questions for my gynecologist. I wasn’t satisfied with the “here take the pill” quick fix to hide the symptoms. Did you know that the pill can block androgens, including testosterone? Seems relevant. I wanted to know why my body wasn’t working properly. I wanted to find the source of my problem and do some proper maintenance. Sadly, the doctors seem baffled by my weightlifting/no running/meat-eating lifestyle, and the internet (because the internet knows everything) did not yield a whole lot of information. What the internet DID teach me was that I am not alone. There are comments and forums full of women with similar stories to mine lamenting the lack of information and support. The best source I’ve found to address it: Paleo for Women. That’s ONE website. One. Thankfully, Mark’s Daily Apple has begun to address the gender discrepancy, as well.
Blood work showed that I had elevated testosterone. Combined with a lack of period this meant a diagnosis of PCOS. This is a diagnosis of exclusion. The primary recommendation for women with PCOS is “exercise and eat healthy” and “get on the pill”. Oookay, what else is there? Besides going back on the pill (which I did briefly, by the way, and it was AWFUL), there are always more tests to run. Turns out there was another variable: my cortisol was elevated.
December 2012: Both my testosterone and cortisol levels were elevated. As for my other tests results… Estrogen levels: normal. Blood pressure: better than excellent. Cholesterol: high, but impeccable ratios (and a triglyceride count of 45).This is the point where I became a conundrum to the gynecologists and thus an anomalous puzzle for the endocrinologists.
The endocrinologist was the first person to take into account my lifestyle as a factor. By “lifestyle” I mean the fact that I eat a high protein/fat low-carb diet and do heavy resistance training a few times a week as my primary exercise. He came in to the room and told me “I think your body is starved.” “…but I eat! I eat a lot! I’m not calorically deficient!” “Your body is starved of energy from carbohydrates.” I had no argument.
It turns out I put my body into a constant state of ketosis for about a year; and though my body felt great (slept well, recovered well, progressed well), my reproductive system went into starvation mode and basically shut down. If the female body thinks it’s starving and can’t feed itself, it’s definitely not going to try and make a child.
Part 2: She blinded me with SCIENCE!
Hormones, Ketosis, Menstruation, OH MY!
**Please note: I am not a scientist. I have my degree in Classical Archaeology. I do not pretend to be an expert in what I am about to say. The majority of my knowledge regarding this subject spurned after an interest in it developed after my self-discovery and repeated trips to the doctor. (If anything I mention here is incorrect or misinformed, PLEASE tell me so that 1) I can learn something, and 2) I can correct it here.)**
Before we get to the dangers of KETOSIS, let us first look at how testosterone and cortisol play a role in a woman’s body.
When a woman who eats a Paleo-inspired diet transitions to weightlifting, it’s very likely that she will not eat as many complex carbohydrates as when she participated in more metabolic conditioning exercises. She will most likely find an incredible hormonal shift resulting from the dramatic shock to her body of decreased carbohydrates and increased stress factors (hello, heavy weights). The main result is that they are going without their period for quite a while. After some testing they’ll probably find increased testosterone levels, and possibly increased cortisol. The former often results in an off-hand diagnosis of PCOS with the ‘treatment’ being hormonal birth control, with no regard to any cause for the symptoms.
A diagnosis of PCOS is more common than you might think, and it’s not 100% understood. There is no ’cause’, but the general ‘prescription’ is “exercise, eat healthy, and get on a hormonal contraceptive in order to regulate your period.” I received a diagnosis of PCOS because of two things: 1) no period; and 2) elevated free testosterone levels. It’s a diagnosis of exclusion.
What reasons would I have for increased testosterone as well as increased cortisol?
Well, for one thing, my lifestyle as a weightlifter. For two, my life as a grad student (limited sleep, deadlines forever). But I had high testosterone before I even started Crossfit (way before weightlifting) and it’s only natural to think that the high protein diet coupled with heavy resistance training should lend itself to a healthy dose of testosterone production, and possibly elevated cortisol.
How would any of this affect my menstrual cycle?
First let us define (briefly and concisely) the menstrual cycle: the menstrual cycle is a complex interplay between hormones secreted from the pituitary gland, and the hormonal responses of the reproductive organs over the course of approximately one month. Progesterone peaks and then falls, and the falling of progesterone triggers the shedding of the endometrium in blood flow during what we commonly call week 1.
Increased testosterone level means there is an imbalance in the endocrine system. After the ovulation phase progesterone rises and prepares the body for any expected pregnancy. Just before the progesterone peaks, the testosterone peaks. Problem was, my progesterone never rose as it should. The progesterone acts as a stabilizer for reproductive behavior. Since the progesterone never rose to finish the menstrual cycle as it should, the testosterone remained perpetually high.
Increased stress can wreak havoc on your fertility system.
Due to elevated cortisol levels, insulin levels may rise, and testosterone levels rise right alongside it. This is because insulin directly stimulates testosterone production in the ovaries. This is bad for reproduction because a proper balance between testosterone and female balance needs to be maintained in order for proper reproductive signalling and tissue development to occur. In many women elevated male hormone levels are caused by high insulin levels (this was not my case, but it is for many). Often reducing the insulin will also reduce the testosterone.
Not producing enough progesterone = imbalance in hormones = endocrine system out of whack. Homestasis shifts.
…but WHY would this happen? How do carbohydrates play a role? How could an increase or decrease in one macronutrient the entire reproductive system?
Energy is a wonderful thing. Your body literally survives and hopefully thrives on it. Energy comes most easily from carbhodyrates and fats, but also from protein. When you are ingesting only the bare minimum energy your body needs to maintain and survive, it will surrender other functions in order to stay alive. After all, survival is the number one priority. Reproductive capabilities is one of these things your body is will to sacrifice in order for self-preservation. And guess what else about nutrient deprivation? It’s a stress factor (hey, cortisol, heyyy). Chronic nutrient restriction comes in 3 forms:
1. Overall energy (caloric) restriction — consistently consuming significantly less energy (in the form of calories) than you expend (through activity and in basic metabolic functions).
2. Significant restriction of particular macronutrients — consistently consuming little to no fat, and/or protein, and/or carbohydrates.
3. Mild to moderate restriction in a context of other stressors — like doing #1 or #2 in the middle of an also stressful life, disrupted sleep, heavy training load, etc.
Since reproduction is not necessary for survival of the individual, rerouting energy to the things you need to survive until you are no longer stressed (threatened) should occur. After the stress/threat is lifted, normal menses can resume and the reproductive cycle continues.
—chew on that—
Okay, so back to ketosis. What is it? Ketosis is, in the most general sense, an absolute restriction of carbohydrates. Depriving your body of that simple energy source (glucose) from carbs forces it to find energy from fat acids. However, the brain can’t use all of the fatty acids for energy. When the liver glycogen stores are depleted, the body produces ketones (which the brain CAN use) and those become your primary energy source. The brain starts burning ketones in order to more directly use the energy from the fat stores that are being depended upon, and to reserve the glucose only for its absolute needs, thus avoiding the depletion of the body’s protein store in the muscles. It sounds like a no-brainer diet for any athlete who wishes to lose a lot body fat while maintaining muscle mass and not risking caloric deprivation.
How do you know if you’re running on ketones? The average person needs at least 25-50g of carbs a day in order to avoid ketosis (but this varies according to the indivdiual). Keto strips are one tool, but if your urine is cloudy/filmy and smells like sourdough, that’s a pretty good sign, too. It only takes about 48 hours of a low/no-carb diet until your body starts running on ketone fuel.
Ketosis certainly counts as #2 in the list of nutrient deprivation. And now we come full circle. Though happy with my diet of veggies and meat, I was in a chronic state of ketosis. While this might be fine for some people (such as men), having it affect how I functioned as a woman was not okay.
Part 3: My Life With (Good) Carbs
Thus I embarked on the “eat more carbs to fix my body” quest, and consulted a few friends in the fitness world. Turns out there is a lot of confusion about women and nutrition out there. There is very little to go on, and the little there is isn’t always consistent. What IS consistent is the revelation that “what works for men doesn’t really work for women”, such as IF, carb back-loading, etc. This is generally speaking, of course, since each individual is different. I can only really talk about myself, but I like to think my own story and experiences (good and bad) can help some of you out there figure things out, or at least provide a starting point.
The first thing I did was go full sail with the “eat more carbs” mantra and found myself with a spoon in the Ben & Jerry’s almost every night. I gained weight, so I lost weight, I bought starchy vegetables and bananas and come March I had my first period without the help of hormonal birth control since I was 18. Hallelujah! Some of you might think “why on earth would your rejoice about the absolute discomfort that comes with bleeding once a month?” Good question. But I was freakin’ elated. My body WORKED. It was finally doing the thing it was built to do. I continued to incorporate carbs into every meal and two months later found myself with period au naturale #2 — period #3 came 28 days later — a textbook menstrual cycle!
What do I know? I know that even though I maintain a size 6/8 and around 20% body fat, I still struggle against weight fluctuation (more often up than down) and feel the urge to go as low carb as possible in order to avoid bloating or excessive gain (this conception is most likely misguided). What else do I know? I know that since February I have had a total of six periods. I can almost predict them now (35 day cycle on average). Still not sure if I’m producing enough progesterone on my own (testosterone is still slightly high but progesterone blood tests are on the way); what I know is that for now I’m flushing my system and being healthier because of it. This, to me, is more important than anything else.
Have I figured it out? I like to think so, but I’d be lying if I said I was an expert at packing in the carbs. I’ll admit it is a challenge to eat more carbs than my body desires. I’m sure could go a month eating nothing but salad and meat and my body would feel amazing, but the havoc I’d be wrecking on my endocrine system would still be there. When I’m honest about my average intake I know it lies around 75g/day. If I ever decided to return to regular Crossfit-style workouts instead of pure resistance training, I’m sure I’d easily increase that to 100-125g/day. If I regularly eat more than 100g/day of carbs regularly, I just don’t feel right. I also will likely gain a little weight and need to adjust things. However, too few carbs and I risk going back to being in a state of ketosis. It’s a fine line for me. Remember, this is just me! We’re all different (yay for individual biochemical physiology), and what does or does not work for me might be different for you. But if you’ve read this far, it’s likely because you are a girl who has maybe gone through something similar and found no answers or help.
Part 4: Incorporating Complex Carbs
Tricks for sneaking the carbs onto the plate and into the belly.
The main trend of my meals is this: protein source, add veggies, adjust fat depending on need, add (complex) carbohydrate source. Veggies (especially cooked) will provide carbohydrates, but it’s just not enough. The sweet potatoes, squash, berries and larger fruits are good for you; they won’t make you fat. These carbs aren’t the enemy. These carbs are your friend. Embrace them. Invite them over for meals. Put them in your belly. Help the endocrine system be its best.
I don’t always remember to do it, either. More often than not I catch my plate looking like this:
What did I eat today? Breakfast of 6oz of chicken with mustard and 5 walnuts. Fish oil and vitamins. Espresso with cream (breve). Post-lifting protein shake (Elite Gold Emblem, Chocolate) with cinnamon. Dried mango strips. Snack of apple with almond butter. More coffee (hey, I’m writing my dissertation, okay). Dark chocolate. More dried mango strips. Dinner of a cup of sauerkraut with 8oz turkey kielbasa sauteed with sliced green pepper and onions in coconut oil with paprika, ginger, garlic, and cumin. Fish oil. ZMA. Lots of water all day long. For dessert I munched on a bunch of green grapes (I do prefer to get my carbs from non-inflammatory foods, because, hey, I’m worth it). Is that a ton of food? No, not at all, but it’s just an example of today and by no means a general blanket statement of how I always eat.
PRO-TIP: eat the carbs first so you don’t fill up on protein and veggies and then skip the carbs because “I’m just not hungry anymore.” Ladies, we NEED carbs. Ketosis is the devil in disguise; in the end, it is not our friend.
My favorite major carb sources: sweet potatoes (fried, baked, thrown in a scramble), squash (eggplant, spaghetti squash,, acorn squash, butternut squash… experiment!), root vegetables (beets, carrots, turnips), plantains (fried, naturally), apples (sliced with almond butter, or baked with cinnamon), bananas (any way), dried raisins/cranberries/mangoes (either in a salad, or as a snack after lifting).
My favorite hidden/mini carb sources: cooked veggies (leafy greens, broccoli, asparagus, brussels sprouts), avocados, pickled cabbage, chia seed pudding made with coconut milk (it’s as easy as chia seeds in coconut milk), berries, honey.
These are all really easy to add a few carbs to your quotidian meals. Pick one from each category for each meal, and you’ll be able to maintain a Paleo-ish lifestyle while avoiding ketosis.
And at the end of the day…. if you think you slacked off on the carb intake, a late night snack of a frozen banana with coconut butter or apple slices with almond butter and raisins never hurt anybody.
One size does not fit all. Experiment with your diet and carbohydrate intake. Read up on the science (though thorough metabolic and endocrine testing in a weight training population of women is lacking.) Maybe get some lab work done (especially if you realize it’s been months without a period and you happen to be a woman who tends to eat more meat and veggies over anything else). Experiment, see what works for you. You, after all, are not me.
Am I saying you should NEVER attempt a super low-carb diet? No. Your carb needs are dependant upon your situation and goals. Short-term low carb approaches are fantastic for leaning out. It’s an excellent short-term way to lose body fat without becoming calorically deficient. But I wouldn’t recommend making a long-term habit of it. The moment your body starts craving carbs and begging you to go on an all day binger of sweet potato fries and baked acorn squash with dried cranberries and nutmeg, listen to it. Get back on the (complex) carb wagon and help your endocrine system do its thing.
The studies out there regarding ketosis and high protein/low-carb diets do not take gender into account — or, more the case, they only have males as test subjects. More often than not an online search for ketosis leads one to diet information advocating it as a great way to get lean and shredded. However, fitness and nutrition sites are starting to catch on to the need for more specific attention to how gender affects nutrition and performance advice for trainers and athletes. Recently, in April 2013, this blessed (but long) article came out , focused on women, hormones, homeostasis, and the dire need for carbs in our diets — but it came too late (for me)! Following this came an article on optimal leaness by the Poliquin Group that, while encouraging carb restriction, warns women about the dangers of going without a carbs. Well, shoot, I’d already figured that out the hard way. Still, it makes some great points.
Finally, in closing, I’d like to direct your attention to this online article that just came out highlighting the role of gender and how it, and all its hormonal differences and glory, applies to strength training and fat loss. It is complete with some gems such as “female athletes who need to replenish glycogen must experiment with carb intake guidelines to identify the optimal dose because recommendations tend to be based on male physiology”, “be cautious with calorie restriction because restricting calories too much can lead to high cortisol production and inhibit fat loss” and “experiment with glycogen replenishment protocols to ensure you are getting enough carbohydrates. Remember, most guidelines are based on male’s glycogen refueling needs, which may be greater than women’s”.
…you read this far? Thanks! Now do us both a favor and go nosh on something delicious.