Hypothalamic Amenorrhea Update

 Relaxation and stress reduction is KEY for your recovery. 

Relaxation and stress reduction is KEY for your recovery. 

My HA story has been a LONG one. Almost 11 years in the making. That being said, since I first reported that I got my cycles back in August 2017, I can say with confidence that they have stuck around. Month after month, they are slowly getting shorter (they started about 50 days long and are now about 28-30) and ovulation is happening much more consistently which is awesome. Unfortunately, most of my hormones are still struggling to regain balance (this is common) and it's caused me to take a few big steps back to take a dose of my own medicine and care for myself. I decided to take a break from full time baby catching (I'll still be doing nutrition & wellness consults and travelling as a rural locum midwife) but I won't and simply cannot have the stress and circadian rhythm disturbance of being on call 24-7 anymore. I'm hoping that this is the missing piece of the puzzle for me and serves as a good reminder that women who have had HA will ALWAYS be more sensitive to stress. It's important to learn this early and make some good changes to help support your healthy body. 

HA (Hypothalamic amenorrhea) is a beast truly a beast. Recovery for every woman is unique, challenging and filled with multiple ups and downs. For some women, monthly cycles and hormone balance can return in a matter of months, for others, it can take years. HA happens for a variety of reasons. Some women get it by chronically starving themselves with diets and exercise and others, especially athletes, get it by finding themselves in a state of chronic caloric deficit caused by high levels of training and sports. Some women are more sensitive than others to this (as was my case) and as a result, their cycles disappear, bone mass diminishes and overall vitality suffers. Bummer.

 #goals These ladies are going to rip it up. They don't care what their dress size is.

#goals These ladies are going to rip it up. They don't care what their dress size is.

I've had a number of messages from women who have been recovering from HA and are really struggling with the added weight they had to put on to re-gain their cycles. So many of you have asked if I lost weight after gaining the necessary fat mass restart my cycles? The answer is NO and honestly, for the first time in my life, I couldn't give a damn. If I had read this 6 or 12 months ago I would have thought to myself "that's nice for her but there is no way I'll ever be okay with these extra 20 lbs". Well, let me tell you, in time, you will and if you aren't please reach out and ask for some help. I have some wonderful strategies to help you to truly love and accept yourself. Life is far to short and precious to waste on being obsessed about a number on the scale or jean size. Nobody ever sat on their death bed at the age of 90 thinking "I'm so glad I fit into those size 0 jeans" and if they did....well I'm glad they found their happiness :) but I would rather focus my life around experiences, love and connection. 

There are a few great podcasts that dive into the science behind how the body recovers from HA .For me, learning about the physiology behind the body's changes and adaptations has been very helpful and fostered a sense of loving kindness for my wonderful body.  

Podcasts:  Minnesota Starvation Experiment   weight set point theory

Many HA experts say that you need to just "walk and do yoga" to get your cycles back AND you need to continue this  keeping activity very limited for months and years after recovery. While cutting out heavy exercise may be necessary to first regain your cycles, for me, this was never an option. The activities I do truly make me happy. They are how I socialize with my tribe, how I feel connected to my planet and how I feel most connected to myself.  So, while yoga and walking may be okay for some, for many of us gals with HA and in the mountain community, it just isn't an option. These days I'm focusing on how it makes me feel. If I'm tired, I rest (no debate) but when I feel good I've been training at the climbing gym, lifting, running, ski touring and for the first time in eons I'm seeing some muscle growth and fitness gains (prior to this it felt like my guns were disappearing no matter what I did). It feels good to feel stronger again. When I look in the mirror at the gym (come on, we all do it!), for the first time in my life I find that I don't criticize myself, instead, I just witness my body and internally high five myself because it just did 30 pull ups 20lbs heavier than last year and shit balls, that's strong.

 Healthy bodies can ski their hearts out. I have never felt stronger on the skin track. Fuel = fire

Healthy bodies can ski their hearts out. I have never felt stronger on the skin track. Fuel = fire

If you do some reading about the weight set point theory you'll learn that everyone has a range of sizes that suits their unique genetic make up. After HA, you'll likely trend on the high side of this number or possibly even move above your previous set point. This is a brilliant adaptation to help the body SURVIVE.  For me, I'm at the weight I was at in high school when I felt a little chubby. This is probably necessary for my body to feel safe, produce hormones it needs and feel like it has a little bit of reserve just incase a 'famine' hits again. You know what, that's totally ok with me. My body wants to be healthy, it works just as it's meant to and we have these things called stretchy jeans and yoga pants....which makes it easier :) 

I've also had messages from women who are fearful their partners won't find them attractive at their new size. Well, let me tell you, the vast majority of men may find your new HEALTY body more attractive. Your partner should respect your journey, changing body and movement towards health and longevity. If they don't, well then, in my own words, they can "fuck right off". Get a new partner, the guy or girl you're with has their own issues you need to surround yourself with positivity. 

Finally I've been blessed to be able to work with so many women who are doing such good work to find balance again and learning a lot about their bodies and themselves along the way. I've had an overwhelming number of new clients who struggle with HA and I'm really enjoying the work I'm doing with them. I'm happy to report that so far, since January 90% of the women I've worked with have seen their cycle return! If I could do a backflip I would! This is so huge and it simply melts my heart to be able to help others find their health, balance and fertility again. I'll be featuring some of  their on my IG so stay tuned. 

The magic of Soy Isoflavones for fertility

This is an insanely geeky but awesome post .....you have been warned

SOY?  Over the past 10 years, the tiny little soybean, has gotten some bad press in the real food / Paleo world but, when used correctly, soy can be an AMAZING tool to help women with irregular cycles or absent ovulation conceive or regain their ovulatory cycles again. 

In many real food communities (paleo/ whole 30/ keto) , soy is labelled as a food that should be avoided or outright banned from our kitchens.

Why? This is partially due to the predominance of GMO, non organic farming practices but it's also due to it's high phytate content, status as a thyroid blocker and potent phytoestrogen content. Phytoestrogens, when consumed regularly can wreak havoc on the hormonal system and for some women, can even cause infertility when consumed in high levels daily

Briefly, phytoestrogens are a variety of estrogen found in plants. Other foods that contain phytoestrogens besides soy include flax, and in lesser quantities chickpeas, hops and even olive oil. Unfortunately, phytoestrogens do not exactly resemble the body’s natural estrogen. Soy can preferentially bind to and transactivate estrogen receptor-β (ER-β) — rather than ER-α — mimicking the effects of estrogen in some tissues and antagonizing (blocking) the effects of estrogen in others. This makes the effect they have on health complicated and very unique. Phytoestrogens can disrupt the natural estrogen balance in the body causing or worsening a pre-existing hormonal imbalance OR enhancing or re-balancing a system that is out of whack. If you think you may have a hormonal imbalance, consider working with a  practitioner skilled in this area or send me a message. This is what I do :) Hormone imbalance is A HUGE topic and worthy of it's own post (or three). 

Let's get back to using soy for FERTILITY....

Snapshot from a healthy cycle  At the beginning of your cycle (day 1), you naturally have low levels of estradiol (E2) and progesterone. These low hormone levels keep GnRH (the hormone that signals your body to produce LH and FSH)  pulses from your hypothalamus to a minimum. This small amount of GnRH results in low FSH (follicle stimulating hormone)  production by the pituitary and follicles in a resting state. As the cycle continues day by day, E2 declines further. It is this sharp decrease that triggers the removal of the “negative feedback” control that E2 has been exerting on the hypothalamus and pituitary, and the FSH levels now rise. The increase in FSH starts the process of dominant follicle selection, and the journey to ovulation. 

Women don't ovulate for a variety of reasons. PCOS, obesity, low body fat, Hypothalamic Amenorrhea, stress or travel can all cause a disruption of the hormonal cascade that leads to ovulation. When you think about it, ovulation every month really is somewhat of a miracle! It can also be used as an important barometer for health and wellness in a woman. 

An Ovulation Jump Start

Frequently prescribed oral medications like Clomid or Femera (Letrozole in Canada) essentially mimic the decrease in E2 that normally occurs and work to block the estrogen receptor sites. Your hypothalamus then senses a reduction in E2, which increases the GnRH pulses, leading to a rise in FSH and the start of follicular growth. Soy isoflavones, act much like Clomid by binding to the E2 receptor in your hypothalamus, preventing natural E2 from binding. Remember from above, when FSH is high, follicles grow, mature and start producing their own estrogen which then rises and helps to trigger ovulation. Booya! 

Who should and should not try Soy Isoflavones? 

Talk to your care provider first before doing anything that may affect your hormone balance. If you cycle regularly and ovulate regularly then DO NOT TAKE SOY ISOFLAVONES. You may actually cause an imbalance in your body that never existed in the first place.  

If you have PCOS and don't ovulate, this may be a good option for you, talk to your care provider first. If you are recovering from Hypothalamic Amenorrhea you have to have done some work already (eating more, putting on body fat, resting and re-activating your hypothalamus). For this to work, you need a functioning hypothalamus. If you are coming off birth control and have irregular ovulation, this may also be a good option. 

How to use soy isoflavones

SoyIsoflavoneComplex.jpg
  1. Buy organic/ non-gmo soy isoflavones in 40-50mg tablets 
  2. Wait for day 3 of your cycle (that's 3 days after you start bleeding). Don't count days you spot before your period....really wait for an awesome flow. 
  3. Take 100-200mg of the isoflavones in the morning from days 3-7, just like you would take Clomid
  4. Get ready to roll! Starting on day 10 of your cycle, watch for an LH surge using OPK , taking your temps and watching for fertile cervical mucus change. Many women find they ovulate sooner after taking soy. Eg, normal ovulation on day 18 but day 14 on a soy cycle.
  5. Do not take Soy with other common fertility boosting herbs like VITEX or MACA. The can actually counteract each other negating the benefits of both.
  6. During this time, REST, NOURISH and RELAX. Practice some gentle loving kindness with your body and give it the message that it is safe to bring a baby into the world. Eat well and take some folate or a prenatal vitamin, if you aren't already. Try to encourage your body with some daily meditation. I am in love with this new app called Expectful
  7. Have a LOT of sex (giddy up), especially around the time you get your surge and the days following. Most women ovulate within 24-48hrs after a positive OPK
  8. Support your natural progesterone levels with diet, supplements and lifestyle changes. If you need help with this, send me a message or wait for another post on that soon. 

Does it work? 

It's next to impossible to find any studies that have looked directly at SI use for ovulation induction. There are several studies that discuss its effect on ovarian hormones when taken in high doses as a part of the diet as well as its use in treating bone loss and hot flashes in older women. If you know of any studies that may be relivant, please share! 

While formalized studies may be lacking, anecdotal evidence is very strong. If you google "soy isoflavones for fertility", you will come across HUNDREDS, maybe thousands of women who have successfully conceived after using them. Take home message, it's totally up to you if you want to try soy. For some, if used correctly, it could be the golden ticket to parenthood and save you thousands in expensive fertility medications and treatments. 

 

 

 

How to choose a good Prenatal Vitamin

One of the most common questions I get from readers and clients is, "What prenatal vitamin should I choose"?  I've avoided answering this question for a while because it's hard to give specific brand name recommendations when there is so much to choose from and product availability varies tremendously depending on where you live. That being said, this week I'm going to offer a launching point for women. You'll find a much more in depth answer to this question on Baby Making and Beyond but for now, here's a great place to start. 

Why do I need a Prenatal if I eat a real food or clean Paleo diet?

This is a great question. Some women do decide not to take a prenatal combination, which is cool, but there are some things that are important to consider:

- Pregnancy (and while breastfeeding) is a time with increased, some might say insane, nutrient demands. We quite simply just need, LOTS of essential micro nutrients to support the body's process of creating a new life. Most diets, even the best, can't provide all you need. The good news is that most of the time your baby will get what he or she needs by depleting you of nutrients. If you aren't replenishing your stores, you can, and will become deficient. This is especially true if you are having multiple babies  2-3 years apart or less.

 If only all farms could look like this :) A view from a home visit a few years back. 

If only all farms could look like this :) A view from a home visit a few years back. 

- Soil and food quality just isn't what it used to be. Even the cleanest of diets won't provide all of the nutrients you need for optimal fertility and pregnancy. The carrots our grandparents ate are not the same as the ones we find in the grocery store today, even the organic heirloom rainbow ones. A Scientific American article looked at several different studies which demonstrated time and time again that from 1975 to 1997 average calcium levels in 12 fresh veggies dropped by 27%, iron levels by 37%, vitamin A by 21% and vitamin C by 30%. 

- The stress of our modern busy lives and athletic pursuits depletes all of us of essential micronutrients. Stress and high cortisol will drain you of several critical fertility and pregnancy nutrients like B- vitamins (including folate), vitamin C, zinc and magnesium. 

- If you've are a recovering vegan/vegetarian, have had a history of food restriction, over exercise or spent much of your life (like most of us) eating a standard american diet, you are nutrient depleted. It takes many years to correct these imbalances.

What to look for in a Prenatal Vitamin

- Steer clear of drugstore or mainstream brands of prenatal (centrum, costco ect). They are made with synthetic vitamins that are not well absorbed or utilized well by our bodies and may even be harmful. For example, synthetic vitamin E can cause congenital heart defects in babies and DNA damage in mamas. 

- Look for a brand that lists Folate (5- methyltetrahydrofolate) not "folic acid" especially if your have or suspect you have MTHFR or other methylation issues as you won't be able to utilize the synthetic form of this B-vitamin. While high dietary FOLATE is associated with a reduced risk of breast cancer,  a high rate of FOLIC ACID consumption or supplementation has been suspected in promoting the progression of breast tumours in some women and can reduce the expression of beneficial tumor suppressor genes while increasing the expression of HER2 (breast cancer promoting genes). High dose folic acid supplementation can also mask B12 deficiency which could put you at risk for preterm labour. Baby Making and Beyond will have lots more on this critical difference. Folate must be sourced from real food so a "raw or whole food" like brand will usually have folate not folic acid in it. 

- Look for the inclusion of both Vitamin K1 and K2

- Look for choline in your prenatal  

- Look for synergistic combinations of vitamins with cofactors to aid in absorption and assimilation. These may include fruit powder extracts, enzymes or herbs.

- Ensure they don't contain soy, gluten or dairy and look for 3rd party testing and verification. 

 

Meg the Midwife's Favourite Prenatal Vitamin

 

Innate Response Baby and Me.  I love the ingredient list and in my mind this company is legit. This is a new formulation as of 2016 and it works great for pre-conception- postpartum. 

Seeking Health Optimal Prenatal - Not cheap but awesome ingredients 

Smarty Pants Prenatal- For women who have lots of nausea and can't stomach a traditional prenatal vitamin OR who are sensitive to iron (this is iron free). If this is all you can get into you, it's a good option.

Runner Up:

Thorne Basic Prenatal. Thorne's Basic Prenatal provides the active forms of folate (5-MTHF) and vitamin B12 (methylcobalamin) for optimal tissue-ready use. Basic Prenatal also contains well-absorbed iron bisglycinate, which meets a pregnant woman's increased need for iron while being easy on the stomach and non-constipating. Several of Basic Prenatal's ingredients (including vitamin C, vitamin B6, and vitamin K) have been demonstrated to benefit "morning sickness." Basic Prenatal is manufactured with the purest possible ingredients and without the additives and coatings usually found in mainstream prenatal supplements. This supplement doesn't contain K2 so it's important that you get your K2 from your diet or from another supplement. 

Vitamin Code Raw Prenatal- This one is significantly more affordable than some of the others and has some decent ingredients. If budget is a concern for you, I'd stick with this one. 

Knowing what supplements to take during pregnancy can feel complicated. Prenatals are a good place to start but in order to optimize your health, you may benefit from taking a few other things (such as calcium, DHA ect), it's best to talk to your functional medicine practitioner about this or become one of my nutrition and wellness clients and book your consult today.  

 

My Struggle with Hypothalamic Amenorrhea (HA). How I got my period back.

If you follow me on Instagram you may have noticed my post last week where I welcomed back my monthly visitor (this is what my grandmother would say) after a 10-year absence. I’ve kept pretty quiet about my struggle with HA. To be truthful, admitting my illness made me feel like an imposter and a fraud. How could someone whose job and life revolved around helping women find and nourish their own fertility be infertile and unhealthy herself?

I’ve helped countless women in my nutrition practice regain their cycles and balance their hormones. I’ve also supported hundreds more in my job as a midwife though their pregnancies and in the early months postpartum. Yet here I was, no period, no cycles, in fact, I had hormones in general (aside from cortisol). Sick, tired and at my wits end something had to give.

 

How did I lose my cycle?

 I lost my cycle 10 years ago directly following the sudden death of my fiancé. I was in a busy midwifery residency, which on it’s own was stressful, but when I lost my partner I had to find ways to cope that would allow me to feel like I had some sort of control over my life and simply keep going.

IMG_2975.JPG

I’ve always loved mountain activities like rock climbing, backcountry skiing and trail running. So, while in the final years of my residency, I took it upon myself to stay as “fit as possible” ,  to enable myself to enjoy the sports I loved and be fast and strong enough to keep up to all my mountain guide and professional athlete friends. The thing was, I wasn’t a professional athlete, I was staying awake for 30+ hr stretches regularly catching babies and instead of sleeping and resting to recover I would run 15- 30km. While this genuinely did feel GOOD, it resulted in over exercise, under fuelling and a general lack of relaxation in my life.

Some people call what happened to me a “female athlete triad”, but essentially what it means is you are sending your body the signal that all is not well. You force it to go into a state of self-preservation. With a lack of fuel and an abundance of stress hormones (like cortisol, which is produced during excessive exercise and a hard job where you often don’t sleep), your body prioritizes survival and shuts down reproduction because it fears that a pregnancy would not be able to be sustained.

 Sometimes tragedy can be a blessing in disguise 

Sometimes tragedy can be a blessing in disguise 

            In October 2016 I had another terrible climbing accident that left me in a cast for 8 weeks and kept me away from midwifery for almost 8 months. Although I tried to exercise during this time, being in a cast and in terrible pain forced REST on my body. I also experienced regular predictable sleep, for the first time in 12 years. I ate the same but overall, my calorie deficit was reduced and my body’s hormonal systems WOKE UP! I started to have all the symptoms of PMS (sore breasts, cramps, bloating). My body was starting to grow ovarian follicles, which produced precious ESTROGEN. This surge of estrogen stimulated my body to start holding onto body fat again.

 Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Get psycked to buy new clothes...and belts:) For the record, I'm now ANOTHER jean size larger than I was here and I give zero fucks about it. 

Over the course of 8 months I gained about 15lbs and went from a body fat of 16% to 24%. My body did this despite any modifications in my diet and despite my resumption of a high level of activity. My body wanted to survive and heal. For most women to regain their cycles they need to overshoot their previous weights and body fat percentages by an average of 5 lbs and 3-5% hitting a new “set point “ of sorts. It’s worth noting that a fertile BMI ranges anywhere from 21-24 and fertile body fat % ranges from 22-26%. If you’re below this, I’m sorry to say, but 90% of you will have to gain weight to regain your cycle.

Recognizing that my body was taking charge of it’s own health and fertility, I finally decided to pay attention and support my body’s valiant efforts to recover a cycle, hormonal health and my own precious fertility.

How did I do it?

There are lots of ways to get your period back. Some things will work better for others but these are the things that worked for me.

Get properly diagnosed

Hypothalamic amenorrhea isn’t something you should “self diagnose”. It could me a symptom of a much bigger issue. Approach your primary care provider and find a good functional medicine specialist to work with you to diagnose the cause of your lack of period. Here are the tests you should be asking for:

1.     Blood Hormone Levels: Estradiol, progesterone, LH, FSH, testosterone, cortisol, prolactin and b-HcG. Most women who have HA have: Low estrogen, low to absent progesterone, low LH, low FSH, low testosterone, high cortisol.

2.     Thyroid hormones: TSH, T3/T4, TPO antibodies, Reverse T3

3.     Blood nutrient levels: B12, Vit D, Iron and ferritin

4.     DUTCH urinary hormone panel. This is a GREAT test that I did and I now offer to patients. It helps diagnose problems with hormone pathways and tests for not just hormones but also hormonal metabolites

5.     Ultrasound: To check for excess cysts (when combine with high testosterone this may indicate PCOS) and test for uterine thickness.

 

Diet:

1.     Move less and eat more: Reduce and aim to eliminate your caloric deficit. If you need help calculating your calorie and nutrient needs you can use an online calculator.

 Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

Never restrict when recovering. This organic vegan chocolate ice cream (with magic shell) was a key part of my recovery :) 

2.     Don’t restrict any macronutrient: You need carbs, fats and proteins to be healthy and produce hormones. Trust me I tried everything (low carb, high carb, keto, high protein)  but in the 3 months preceding my period returning I found that I was intuitively eating a balanced diet of about 33% fat 33% protein 33% carbs

3.     Eat clean, well-sourced, organic and nutrient dense foods: These are better absorbed and will cause less stress in your body. An anti-inflammatory diet is best. If you need help finding the best diet for you, send me a message. 

4.     Let go of foods and drinks that may cause stress to your body: While I’ve never been a big caffeinated coffee drinker thanks to a CYP1A2 enzyme gene) one of the biggest things I did was give up coffee (opting for organic Swiss water process). If you suspect food intolerances or if your digestion isn’t top notch, I’d encourage you to work with a practitioner to tease out what could be triggering your symptoms. All forms of stress should be eliminated in the body. I recently started working with a woman who lost her cycle and regained it by dietary modifications alone! It’s an important piece to the puzzle.

Exercise:

Move less: You’re going to have to mellow out a little bit or a lot. While some women have to give up exercise 100%, honestly, I didn’t completely. Much of the research I’ve come across suggests that giving up exercise completely (aside from short gentle walks and yoga) may help your period return faster but what really makes a difference is having a higher percentage of body fat sustained and maintained over multiple months. This sends signals to your hypothalamus that there are enough resources available to sustain a pregnancy.

How you choose to get there is up to you. But seriously, have a solid look at your workout routines and ask yourself if they support your body and goals or are causing more harm than good.

 Sometimes the best activity is  rest  and spending time with the people you love

Sometimes the best activity is rest and spending time with the people you love

Supplements:

I’m a firm believer in “smart supplementation”. I don’t like to over supplement and I think that there is no real one size fits all approach to adaptogenic or hormone balancing herbs. If you’d like help finding what may work for you please send me a note. I was continually testing my hormone and nutrient levels using DUTCH testing and blood analysis to ensure smart supplementation. Here’s what I tried and here’s what you can try too.

1.     Vitamin C: Supports your body’s response to stress

2.      Magnesium: Supports progesterone levels and reduces stress

3.     Acetyl L-Carnitine: Supplementing with acetyl-l-carnitine (ALC) restarted menstrual cycles in 40% to 60% of women with HA in two studies. This compound has been shown to affect serotonin, dopamine, and beta-endorphins, reducing the impact of those molecules on the hypothalamus resulting in higher luteinizing hormone (the hormone you need to ovulate). This did seem to help me.

4.     Maca root: This seemed to boost my estrogen levels and accelerate fat gain. For me, I think it caused a state of estrogen dominance and increased my bad estrogen (yes there is good and bad kinds). I’d use this adaptogen with caution. See how it goes for 3 months and re-evaluate.

5.     DIM: I treated my estrogen dominance with DIM. This compound found in gassy veggies like broccoli and cauliflower helps promote healthy levels of good estrogen and clears unhealthy bad estrogen (as long as your liver is strong). This may only work if you’ve already increased your estrogen levels by increasing your body fat levels AND you have maintained a higher body fat for at least 3 months.  Please don’t try this unless you’ve put on a healthy amount of weight.

6.     Calcium diglutamate: This supports your livers processing and clearance of hormones. 500mg is best for most. 

7.     Vitex- If you lose your cycles it may be due to an increase in a hormone called Prolactin. If it’s high, Vitex may work for you. This wasn’t the case for me but I tried it anyway ;) 1000mg is best for most. 

8.     Probiotics: A healthy gut is a cornerstone of a healthy hormonal system. Alternate strains regularly for a robust microbiome.

9.     Sustained Release T3: After years of HA and a high stress job, my Reverse T3 levels were sky-high. Taking a sustained release T3 (prescribed to me by my naturopathic physician) helped me clear my high RT3 and was the final missing piece to getting my period back. Please ladies, have ALL your thyroid levels checked (TSH, TPO antibodies, T3/T4 and FT3). It can be a game changer.

Lifestyle:

1.     Learn to say no:  Over the past year, my blog hasn’t gotten as much attention. I’ve been taking more time to myself to really focus on getting well. Sometimes you just have to simplify. Have a good look at what you can say “no” to in your life and just say “no”.

2.     Sleep your ass off:  Your body is stressed and in a negative energy balance. Sleep is the MOST effective way to recover and rebuild. If you have struggled with insomnia and poor sleep while you’ve had HA, many women find that once you put on some body fat you’ll sleep like a baby again. I certainly did.

3.    Stress less: I’ve taken up a solid meditation practice. It only takes 10 min each day and has changed the way I think, feel and even breathe.

4.    Care for yourself. Get a massage, spend time in nature, Netflix and chill …..if it feels good do it and make sure you do it every damn day.

5.    Acupuncture:  Give it a try, there are several studies that support its use for both stress reduction, hormone balance and fertility. I found it uber helpful.

Coping with your changing body:

1.     Buy new clothes: seriously, tight clothes are such a huge trigger and for me totally ruined my day and made me feel so bad about myself. Sell your tiny sized clothes and use the money to buy some well fitting duds. Most women, myself included, go up 2 sizes when recovering.

2.     Change the way you think about your body.: This one is hard but essential. Your body is trying to survive. It’s trying to get back into balance and be healthy. Resist the urge to pinch your fat or have negative thoughts when you see your body change…..instead, just witness it. Your body is the vessel for your soul. It’s beautiful and dynamic. This is temporary and is the birth of a new normal. If you can’t think of anything positive to say, simply try to witness your body changes without judgment. Be like Switzerland and stay neutral.

3.     Say, “Fuck it” to what people think (including yourself): This needs no explanation. You’re getting healthy; I think you’d be surprised to find that most people, if they understood what you were doing would look at you with admiration not criticism. Often times we are our own worst critics. So perhaps we really need to say “fuck you” to our own self judgment.

4.     Join a support group.:There are countless online forums and FB groups for women coping with the same things as you. Reach out, you’ll be surprised to find that you’re not alone. Ask for help from your loved ones. Reach out. You're not alone! 

This is just my journey. I'm always happy to share. Everyone's journey is their own. If you need support or help, feel free to send me a message

 

The B Vitamins

If Vitamin A was "awesome", vitamin B is "bad ass". Seriously, vitamin B is HUGE! It's way to big to cover all the in's and out's of this complex and rather incredible vitamin, so, I'm going to give you the 'coles notes' version of why vitamin B is so important to include in your fertility, pregnancy and postpartum diet. 

The B vitamins are water soluble, meaning that you pee out what you don’t use and you also don't store excess in the body like you do with fat soluble vitamins. Roughly translated, if you have a high concentration in your diet you'll pee neon yellow AND because they aren't stored in your tissues you need to eat them often to ensure you have enough to fuel your body's demands. Good thing they are found in some delicious things! 

You need more Vitamin B when: 

 Leafy greens and liver.....chock full of B-vitamin goodness

Leafy greens and liver.....chock full of B-vitamin goodness

  • You have a history of taking Oral Birth Control or any other synthetic hormone
  • History of Smoking or high alcohol use
  • High caffeine consumption
  • Have a  diet high in refined or processed foods
  • History of antibiotic use
  • Have a genetic mutation, such as MTHFR
  • Are a Vegan or Vegetarian
  • Have a history of dieting or are an athlete
  • You're trying to become pregnant :) 

Quick Facts about B-Vitamins:

There are 8 commonly known B vitamins. These vitamins are usually found together in foods and require similar co-enzymes to be best absorbed and utilized by the body. Some of the vitamins can be made in the body by the healthy bugs in our guts, while others cannot be synthesized in the body and must be obtained from our diet. B- vitamins need to be in their "active" forms before they can preform metabolic tasks in the body. Vitamins are converted from their inactive to their active forms by a process called methylation. Methylation is aided by enzymes (that you make or consume) and is dependent on a intricate pathway of chemical reactions. Some people, like those with MTHFR, have a deficiency in one area of the pathway making their conversion of inactive to active B - vitamins more inefficient thus increasing their need. You can read more about that in an old post here or check out our section on MTHFR in the upcoming Baby Making and Beyond. 

The low down on each B-Vitamin and why you need it in your fertility and pregnancy diet!  

  1.  Vitamin B1 Thiamin: Found in decent amounts in lean pork. Thiamin produces acetylcholine and is key for nervous system health. Choline is a critical nutrient for a growing baby's brain and nervous system development. You'll learn all about my love of Choline in my next post. C for choline.  
  2. Vitamin B2 Riboflavin: Often found in liver, fatty fish, eggs, nori and sunflower seeds.  B2 helps metabolize fats and carbs in your diet. Vitamin B2 promotes fetal growth and a healthy nervous system.
  3. Vitamin B3 Niacin: One of the most stable B vitamins, it can be easily manufactured in the body by the amino acid tryptophan. B3 is found in liver, fish and poultry (all which happen to contain tryptophan!) It's important during pregnancy to produce new DNA (building blocks of new cells) as well as help us stabilize our blood sugars (key for hormonal health).
  4. Vitamin B5 Panthotheic Acid: Panthothenic acid comes from the Greek word (ever see My big fat greek wedding, if so, insert smirk, if not watch it, hilarious) Panthos meaning "everywhere". As you guessed, deficiency is uncommon, it's hard not to find B5 in whole foods.  Vitamin B5 is a great anti-stress vitamin and helps chill out the adrenals. Having a balanced adrenal system helps you stabilize your progesterone levels. KEY for fertility and pregnancy. 
  5. Vitamin B6 Pyridoxine: Easily found in whole foods, the highest concentration is found in organ meats, egg yolks, fish, poultry and walnuts. Dark leafy greens also contain large amounts. A general rule Meg follows is: anytime there is an excess of estrogen more B6 is required. B6 is one of the ESSENTIAL vitamins that will help protect you against nausea and morning sickness during pregnancy (more estrogen during this time).  There is also a much greater need for B6 when you've been taking birth control pills (again, a high concentration of estrogen in your system). B6 helps fight depression, mood swings, skin conditions and aids in detoxification. The list is pretty much endless. Bottom line, get your greens and eat some liver every now and again. 
  6. Vitamin B7 Biotin: Biotin is both a co-enzyme and a B-vitamin. It's found in small amounts in most foods but mostly produced by our healthy gut bacteria. Deficiency can be caused by insufficient gut bacteria (like if you have taken antibiotics) or when women consume egg whites without the yolk, particularly if egg whites are not totally cooked. Avidin, a protein in raw or under cooked egg whites binds to biotin in the stomach and decreases it's absorption. Biotin helps metabolize fats and help the body form new tissues and new little people. It helps with healthy nails, hair and skin. Some experts believe that the crusty, kind of gross skin condition, Cradle cap, in infants is caused by a biotin deficiency. If your baby struggles with this, supplementing them with a probiotic may help. 
  7. Vitamin B9 Folate: From the latin folium meaning 'foliage' folate is abundant in dark leafy greens. Folate needs are higher prior to conception to aid in the growth and development of a healthy neural tube in the first few weeks of pregnancy. Deficiencies a pregnant woman can result in neural tube defects such as spina bifida in her baby. It's important to get folate in it's active form, especially if you have any form of MTHFR. Look for folate vs folic acid on your prenatal vitamin. Folic acid is a synthetic derivative and not the best choice. Folic acid supplementation in large doses over long periods of time has recently been tied to breast cancer.  
  8. Vitamin B12 Cobalamin: B12 is found in most animal proteins. Vegans and Vegetarians are at the highest risk for deficiency as there aren't really any good sources of B12 in their diets There is a common misconception that it's possible to get B12 from seaweed, fermented soy and brewers yeast. Not totally true. These plant foods actually contain B12 analogs called cobamides that actually block intake and increase the need for real B12...YIKES! Low B12 levels is a big deal. It's associated with anemia and has also been strongly linked to recurrent pregnancy loss and placental abruption.  B12 is as important as B9/Folate if you ask me. It works with B9 to help give you energy, prevent anemia, guard against neural tube defects and significantly aids in brain and nervous system development. 
 Here you can see two delicious taco meals. Mine is chock full of  B12 goodness  from braised bison and spicy beef tongue. Evan who is a vegetarian, has no B12 in his meal. I win. I love him despite his "deficiencies". 

Here you can see two delicious taco meals. Mine is chock full of  B12 goodness  from braised bison and spicy beef tongue. Evan who is a vegetarian, has no B12 in his meal. I win. I love him despite his "deficiencies". 

So there you have it...Big, bodacious vitamin B for fertility, pregnancy and beyond. Want more info or need help fine tuning your fertility, pregnancy or postpartum diet? Want to learn how to test for MTHFR and other methylation challenges?  I can help. I'm now taking consults again! Finally :) Click the big button above to book your first consult. 

The Real Deal on Vitamin A

Vitamin A is awesome (get it "A"wesome?) that vitamin A is the first one because in my mind, it is one of the most important micronutrients not only to help you boost your fertility and prepare for pregnancy, but also during pregnancy and breastfeeding. So, let's explore the wonders of this over achieving vitamin. 

The Scoop on Vitamin A 

Vitamin A is important for many key functions in the body. These include: 

  • Eyesight
  • Hormone Balance and Fertility  
  • Thyroid function
  • Bone growth and skin health
  • Cell differentiation and multiplication
  • Immune Function (viruses and bacteria seem to retreat in the presence of high vit A)
  • For your growing baby specifically:  Vitamin A is important for the development of the neural pathways between the brain and sensory organs and in the development of the nephrons in the kidney.
  • Vitamin A deficiency is also associated with pregnancy loss...needless to say, it's an important part of a healthy diet. 

Two Types of Vitamin A

 Liver is one of the very best sources of vitamin A

Liver is one of the very best sources of vitamin A

Retinoids (Reteinol Esters): Derived from animal sources. Retinoids are found in the liver of any animal and in smaller quantities in egg yolks,  butter and cream from grass fed cows. 

Carotenoids:  AKA Beta-carotene. Vitamin A derived from plant sources. Think carrots, winter squash, pumpkin, sweet potatoes, cantaloupe. Basically, if it has an orange hue, it's probably rich in carotenoids. Carotenoids must be converted by the body into retinol in order to be used by the body. This is kind of tricky for the body to do and is a pretty inefficient process. This process can be even trickier if you suffer from a hormone imbalance, thyroid condition, it can be effected by food preparation and cooking methods and also if don't have enough fat in your diet or if you have digestive problems. Babies also don't convert well (another reason to feed your infants over 6months liver).  

Vit A in a Nutshell

  • Fat soluble Vitamin. This means it must be consumed with a fat to be properly absorbed.
  • Both Retinol Esters from animals and Beta Carotene from plants must be converted by the body into Retinoids. Once converted they are stored in the liver as Retinol Esters. This  is why liver is such a rad source of Vit A and also why high doses of vitamin A retinol, when taken in a concentrated form, can cause birth defects months after discontinuing them. High potency topical skin serums are known for this. 
  • Traditional cultures around the world seem to instinctively know the the benefits of proper vitamin A consumption. In fact, liver is found in the diets of almost every tribal group around the world, from the Canadian Inuit to the Maori in New Zealand. Many cultures even make special efforts to ensure pregnant women consume liver regularly. They instinctively know that vitamin A is critical for the health and wellbeing of our growing babies and is an KEY part of there development. Weston A Price has a great article that goes into the details about why Vitamin A is so critical for fetal development. Take home message....CONSUME LIVER in reasonable amounts! 

Vitamin A Toxicity in Pregnancy

The fear about Vitamin A toxicity in pregnancy over the past 20 years is something that commonly worries women whenever I suggest regular  dietary liver consumption. Here's the deal.....In 1995, a small study based in Boston found that high does of vitamin A could cause neural tube defects. The issue with this study is that it only looked at higher does (25,000 IU+) Vitamin A consumption from SYNTHETIC sources (retinol & retinol esters).  Follow up studies from several sites in Europe concluded that doses up to 30-50,000 IU in pregnancy from REAL FOOD sources were very safe, in fact, potentially beneficial to pregnant women. Sadly however the FDA did not change it's message and the public was once again misinformed.

Retinol Sources and Levels

  • High-vitamin cod liver oil 230,000IU /100g
  • Regular cod liver oil 100,000IU /100g
  • Duck liver 40,000IU/100g
  • Beef liver 35,000IU/100g
  • Goose liver 31,000IU/100g
  • Liverwurst sausage (pork) 28,000IU/100g
  • Lamb liver 25,000IU/100g
  • Egg Yolk 1,442IU/100g
  • Pasture Raised Butter 2,500IU /100g (this level varies greatly depending on diet of cows)

The US  and Canada currently recommend 5,000 IU per day . From the work of Weston Price, we could guess that the amount of Vitamin A in primitive diets could have as high as 50,000 IU per day. Current  recommendations from a variety of sources hover around the  10,000 IU-25,000IU level when obtained from a modern diet rich in daily grass fed butter, eggs from pastured animals and beef, lamb or poultry liver several times once a week. If you're not eating liver adding a 1 tablespoon of fermented cod liver oil can help. You can also take liver capsules, which are also a great source of b-vitamins. Solgar, Vital Pastures and Radiant Life all make good products.  

What's a Pregnant Paleo Mama to do?

Lambs liver...one of the milder livers. It makes great meatballs and pate spreads.

  1. Always enjoy your vitamin A sources with a fat. Vitamin A is fat soluble and needs fat to be properly absorbed.

  2. Enjoy liberal amounts of butter from grass fed cows and egg yolks. 

  3. Enjoy liver from grass fed animals once or twice a week to ensure you have a good supply of retinoids. Unless you are consuming Polar Bear or walrus liver, a serving or two of liver per week is not likely to cause any trouble. If you find the flavour of liver to be strong, try chicken liver, duck liver or lambs liver. They are milder. I have a great lambs liver meatball recipe ! It's easy to hide a few ounces of liver in meatballs, burgers or meatloaf. If you're feeling adventurous you could also try one of  Liz's Liver Smoothie Shots I'm going to give this a go this week....keep your eyes out for me on Instagram giving this a shot...literally. Ha ha. 

  4. Consume beta-carotene rich foods to your hearts content. Yumm squash (I am a squash addict) 

    • Always consume vitamin A rich food with a FAT. This helps you absorb to absorb the nutrient. This gives you full permission to slather your yam or kabocha squash liberally with grass fed butter or coconut oil. 

  5. Make sure you are getting enough Vitamin E in your diet

    • Vitamin E is necessary for the absorption of Vitamin A. Vitamin E can be found in: spinach, turnip, chard, sunflower seeds, almonds, bell peppers, asparagus, collard greens, broccoli, kale and brussels sprouts.

  6. Pregnant or planning for pregnancy? I'd give your high dose Retinol skin creams a miss to reduce the chance of toxicity. Try a vitamin C skin serum instead to achieve a beautiful glow!