PCOS : what is it and what the heck to do about it.

Polycystic Ovarian Syndrome (PCOS) has become so UBER COMMON in our world. I would simply love to do a study on how many women actually ovulate each month in 2019 when compared to how many women ovulated each month in 1819…I think the results would be astonishing. PCOS truly is a ‘disease’ of the modern age. I use the term ‘disease’ with caution because really what PCOS is most of the time is an imbalance of hormone levels (most importantly insulin) which is most often triggered by the influence of modern day life: stress, poor sleep, diet, exercise and also epigenetic changes (more on that another time!) Here’s a quick rundown of what PCOS is all about and how you can fix it.

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Polycystic Ovarian Syndrome (PCOS) is a broad term for lack of / delayed ovulation, absent or irregular periods, excess androgens, blood sugar imbalance, and of course, polycystic ovaries (multiple follicles). 

Not all follicles produce eggs that will be ovulated. Follicles are, in essence, “baby eggs” that are immature and not large enough to become a dominant follicle, and only dominant follicles are ovulated in a normal menstrual cycle. In PCOS, a mature, dominant follicle rarely develops, if it develops at all.

And it’s not just the lack of dominant follicles that is problematic; it’s also those multiple “baby follicles:” they can produce estrogen, which can lead to estrogen overload, and this estrogen can get “aromatized” into testosterone, driving androgen excess.


Up to 70% of anovulatory cycles (aka you do not ovulate) are related to PCOS, which is generally diagnosed with blood testing for hyperinsulinemia, elevated blood sugar, androgen and sex hormone levels or with ultrasound to detect multiple follicles. Ultrasound alone is NOT a good way to diagnose PCOS, however, as many women without PCOS have multiple follicles. PCOS needs to be diagnosed with blood work and ultrasound.

While the typical PCOS sufferer is overweight, PCOS can happen to all types of women - 20-25% of cases are in lean women with BMI under 25.

PCOS is incredibly paradoxical: it may be over-diagnosed, under-diagnosed, or misdiagnosed depending on the woman and the practitioner. When it is properly diagnosed, there is a very poor clinical understanding of how it should be managed. Many functional medicine practitioners, including me, have found great success helping women with PCOS using a whole body-mind approach - much like the Core Four in my Baby Making and Beyond program

Signs You Might Have PCOS

  • Skin issues. Acne or hair growth on your chin or upper lip are signs of excess androgens, a marker for PCOS.

  • Hair thinning or hair loss. This is also a sign of excess androgen production.

  • Irregular periods without ovulation (no temp rise when you chart your BBT), a sign of overall hormone imbalance, often driven by androgens.

Blood Work & Ultrasound Testing

  • This is the most important step! Get a full blood sugar and hormone panel that includes progesterone, estrogen, testosterone, DHEA, LH, FSH, prolactin, AMH (anti-mullerian hormone), HbA1C, fasting insulin, cholesterol, and a full thyroid panel. If your practitioner is not willing to order these tests, find a new practitioner or order labs directly.

  • Blood work will likely show low progesterone; high testosterone, DHEA, LH, and AMH; high- to borderline-high HbA1C; and thyroid irregularities.

  • Ultrasounds are used to check for follicles are done in ADDITION to blood work. With PCOS, there are often 12 or more follicles within the ovary, with a diameter of 2-9 mm and/or ovarian volume 10 cm3 or greater. This many follicles do not mean you’ll release multiple eggs; follicles in PCOS are not mature and don’t develop into an egg that gets ovulated.

Common Causes

  • Elevated insulin, insulin resistance, and androgen excess. This is the primary cause of PCOS and should be the target for your treatment strategies. Insulin resistance (IR) occurs when your body’s cells become resistant to the effects of insulin, which is supposed to move glucose (sugar) into the cells when the body senses a rise in blood sugar. In IR, your cells don’t soak up all that glucose - so it stays in your bloodstream, resulting in chronically high blood sugar. The elevated insulin drives the overproduction of almost anything, including an ovarian enzyme called cytochrome P450c17α that increases androgen concentrations in the body. At the same time, if your body stays in this state for too long, the pancreas, which is responsible for making insulin, eventually gets worn out and stops making enough insulin. This is when Type 2 diabetes can develop.

  • Inflammation caused by blood sugar imbalance and high insulin. Inflammation is also a marker for PCOS.

  • A diet heavy in processed foods. This drives high blood sugar and insulin levels without providing adequate nutrients to the body.

  • Uncontrolled stress levels. Cortisol and other stress hormones increase blood sugar and make it harder for glucose to get out of your bloodstream and into your cells. It also makes you crave more sugar. This also applies to exercise stress, which can also lead to hypothalamic amenorrhea due to suppression of the HPA/HPG axes. Learn more about this good stuff in the Hormones and Fertility Modules of Baby Making and Beyond.

Risks Associated with PCOS

  • Infertility because you stop ovulating

  • Should pregnancy occur despite uncontrolled PCOS, there is an elevated risk for gestational diabetes, preeclampsia, and problems with breastfeeding.

  • Depression and mood imbalances

  • Possible increased risk for metabolic disease

  • Liver inflammation

Treatments for PCOS

While drugs are available to address some of the causative factors for PCOS, we also advocate a whole-body approach centered around blood sugar balance. Be sure to read our lifestyle and supplements section and find a practitioner who can help guide your treatment plan.

Drugs prescribed by your caregiver

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  • Metformin is a drug that works by lowering blood sugar and improving the cells’ sensitivity to insulin, which helps insulin levels decrease. This can increase fertility, making it a miracle drug for many women with resistant PCOS. Always take B12 with metformin, as it will decrease your B12 levels.

  • Oral contraceptives are often used to treat PCOS, but they do not address any of the underlying causes like insulin resistance or high stress. They can also deplete certain nutrients critical to a healthy pregnancy, like folate. If your provider offers this as the only solution, consider finding a new provider for a second opinion.

Supplements

In addition to our baseline supplement recommendations found in Baby Making and Beyond, the below supplements might be a worthy addition to your protocol. As always, talk to your provider before adding these into your plan.

  • Melatonin + myo-inositol. Several studies in women undergoing IVF have demonstrated the effectiveness of this combination. The sweet spot seems to be about 3 mg of melatonin (taken nightly as a chewable or drop) combined with 2-4g of myo-inositol.

  • Myo-Inositol. Taken alone, this member of the B vitamin family supports healthy insulin regulation within the body. Women with PCOS seem to be deficient in the insulin signaling pathway (inositol- containing phosphoglycan mediators), which seems to be implicated in the development of insulin resistance. (Papaleo E et al 2009)  Inositol is also important for healthy ovulation and follicle formation, so this is particularly good for women with PCOS who would like to conceive.

  • Choline. Inositol works with choline to help with the proper utilization of insulin in the body.

  • Berberine. This compound is thought to improve insulin sensitivity by upregulating insulin receptors and stimulating glucose uptake in the cells. It might also improve acne, another common complaint in PCOS. Berberine can act as an anti-microbial, which might harm the balance of your gut bacteria if taken for extended periods of time (see below for why).

  • Proboitics: In women who are overweight with PCOS, studies have shown that the gut microbiome actually plays a pretty significant role in PCOS ( due to diminished microbiome diversity) . Take a solid probiotic and alternate strains every bottle.

  • Other nutrients. Ensure you have enough Vitamin D, magnesium (we like topical magnesium or the form magnesium glycinate) and zinc. A practitioner will help you decide what levels are right for you.

A note about maca and Vitex: I can almost always tell if someone has been taking Maca or Vitex when I look at a hormone profile. I’ll see someone with high DHEA who is depleted across the board in estrogen, progesterone, cortisol, and melatonin. Maca is most often the culprit. Maca seems to raise DHEA levels and androgen hormones more than dominant female hormones, like estrogen and progesterone. Meg has also seen Vitex exacerbate PCOS.

Diet & Lifestyle

Refer to the Core Four Nutrition section in Baby Making and Beyond for expanded recommendations, and focus on the following:

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

  • Higher protein and fiber, and lower sugar and carbs. Eat plenty of protein and lower-carb fiber-rich plants, and incorporate some starches that feed gut flora and improve insulin levels.  (Bindels et al. 2017)

  • Organic and grassfed when possible. Watch sourcing of your animal products. Organic and grassfed likely contain fewer exogenous hormone contaminants and fewer potentially inflammatory fats.

  • Focus on an anti-inflammatory foods. Watch your consumption of excess Omega 6 fats from modern processed foods. It may also be appropriate to reduce nut and seed consumption. Reduce or eliminate processed foods, simple sugars and ALL alcohol.

  • Not keto, I repeat, not Keto, but lower-ish carb. Full-on keto can raise cortisol levels, so we’d only recommend this approach with the guidance of a health professional. Eliminating processed carbs, grains, and the highly carb-rich plants, like sweet potato and higher-carbohydrate fruit, might help.

  • No calorie restriction or dieting. Consider consulting a nutritionist or health care provider who can help you figure out how much you should be eating.

  • Intermittent fasting. Fasting for short periods of time can improve insulin sensitivity in some women, but we recommend consulting with a practitioner first to ensure it will help you. If you feel absolutely miserable while fasting, it’s probably not the right solution for you. In this case, you can simply choose a 12-hour daily “eating window” (first bite or sip of anything that’s not water starts the clock; keep your meals and snacks within that 12 hour window), AND/OR try small and frequent (5-6) protein rich meals during the course of the day to help re-sensitize your cells to insulin and keep blood glucose regulated. Experiment and see which approach works for you.

  • Cinnamon. It’s delicious, and several studies suggest it helps improve blood sugar response.

  • Get your hormones and stress in check. Test for and correct thyroid and adrenal issues, ensure your exercise is appropriate and your stress is managed, and make sure you’re sleeping.

Sometimes the best thing you can do is just chill out and watch the sunset……..

Sometimes the best thing you can do is just chill out and watch the sunset……..

Estrogen isn't the enemy. Why Estrogen Dominance isn't always the issue


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As we get set to FINALLY launch our first public module called Hormones and Fertility (other modules include Pregnancy, Birth and Postpartum) in the Baby Making and Beyond series, I find myself really thinking about the BIG picture when it comes to women’s health and hormone balance. Writing this program with my partner in crime Liz Wolfe has been such an inspiring journey and I’ve learned so much more than I thought I ever would about women’s health and hormone balance. These are things they don’t teach you in school and things that Dr. Google just won’t tell you…..because I don’t think there has yet to be a program like ours that’s really taken a truly holistic viewpoint that’s is rooted in scientific evidence and balanced with true anecdotal experience. Baby Making and Beyond is not trying to sell you a special supplement or a magic snake oil, but instead, arm you with the tools you need to make your own informed choices and support your own health in a way that’s balanced and practical. This first module is really made for EVERY WOMAN. It’s rich in nerdy science and overflowing with practical advice….so if you’re struggling with hormone imbalances, head over to the Baby Making and Beyond website and check it out :)

That being said, let’s chat about ESTROGEN! Estrogen is frequently demonized in our hyper-focused overly obsessed culture. Everywhere you turn these days it feels like women are talking about the dreaded ESTROGEN DOMINANCE. If you haven’t heard about it, Estrogen dominance is essentially a term used to describe a state of excess estrogen to progesterone ratios. This means, in theory, estrogen could be normal or even LOW..it’s all about ratios and if progesterone is all but 0, any amount of estrogen will cause this state of dominance.

A quick google search will give you a fast list of symptoms it can be blamed for including:

  • Decreased sex drive

  • Foggy thinking, memory loss

  • Fatigue

  • Trouble sleeping/insomnia

  • PMS

WHOA! With a list like that, no wonder estrogen dominance seems to garnish so much attention! There is no denying that women across the western world are suffering in record breaking proportions, but, what if there was more too this than simply having too much estrogen.

It’s my strong belief that estrogen ISN’T THE ENEMY here. Estrogen is responsible for so many important functions within in our bodies including:

See, not all bad!! @jadeteta

See, not all bad!! @jadeteta

  • Sensitizing our cells to insulin, thus lowering blood glucose and preventing insulin resistance (a cause of diabetes, PCOS and obesity)

  • Supporting our healthy bone density

  • Signalling to the pituitary gland that it needs to make LH (luteinizing hormone) which triggers ovulation and resulting progesterone production in the ovearies.

  • Protects our brain aka is neuroprotective and helps prevent things like Alzheimer’s disease, Parkinson’s disease and stroke. This is especially important in the hippocampus, cerebral cortex and striatum.

  • Helps to regulate our mood

  • Keeps our skin soft, triggering collagen production

  • Helps to keep our vaginas healthy and lubricated (Um, yes please)

So….as you can see, estrogen is doing a lot of GOOD in our bodies and needs to be celebrated not vilified. So, why do so many women struggle with these less than desirable symptoms?

Well, as you’ll learn in DEPTH in our Baby Making and Beyond program, estrogen dominance is really all about a state of IMBALANCE within all of your ‘Big 4’ hormones which include cortisol, estrogen, progesterone and thyroid hormone. There is a powerful cascade effect that occurs when one or all of these hormones fall out of balance. For example, sometimes this doesn’t have to do with having TOO MUCH estrogen, but too much cortisol which may be inhibiting ovulation (maybe by not having ENOUGH estrogen) and then causing a lack of progesterone. When that progesterone is low, it cannot oppose the estrogen’s effect on thyroid binding hormone (learn about that in BMB too!) and causes thyroid levels to plummet too (but in essence there is NOTHING wrong with your thyroid)…..see where I’m headed here??

What to do

THE NUMBER ONE THING TO DO HERE IS :

Step back, take a look at your whole life…..assess all aspects of your health. We teach you how to do this in Baby Making and Beyond’s Core 4 (Sleep,Stress, Movement, Nutrition & Supplementation)

In the situation I mentioned above, t’s common, and something I’ve even done as a practitioner to simply say well, if progesterone is low, let’s give you some progesterone….WAIT, STOP, why not simply address the root cause of the low progesterone which is 90% of the time related to STRESS.

How I mange my stress :)

How I mange my stress :)

If you have to prioritize one thing, make it STRESS REDUCTION . Stress is toxic to our hormones and our fertility. Women in particular are also much more biologically sensitive to stress than men are. Stress is a total epidemic in our society, which is likely why things like estrogen dominance are getting so much attention these days. It’s critical to find a stress management plan that works for you. In the BMB program we have an entire module dedicated to stress management. Personally, I use good nutrition, rest, movement and meditation as my medicine. Since doing this I no longer take any supplements for hormone balance (I used to take DIM/CDG ect). I find that my lifestyle change has had a much greater effect than any supplement ever could. If you’re having a hard time managing your stress levels, reach out. There are lots of us out here ready to arm you with some powerful tools to help you cope.

There have also been some interesting studies lately about the types of LANGUAGE we use (both when talking to others and ourselves) or are exposed to and both or cortisol and progesterone levels. This is another reason to always practice gentle loving kindness in your life both towards yourself and towards others. If you are surrounded by negative people, consider changing your people. If your partner is negative or says things that make you feel rejected, sad or hurt, talk to them about going to therapy together or help them to understand the power that language has on your mind and body. People are capable of great change when they are motivated to change.

While stress reduction will really arm you with most of the tools you need to rebalance your hormones (remember this takes 3 months MINIMUM), there are some supplements and dietary modifications that I’ve talked about on previous posts that can help too. Working with a practitioner who understands all of this and having appropriate testing done is CRITICAL to really target your treatment plan and get to the meat of the issue for you.

Good luck! If you’ve re-balanced your hormones, feel free to share what you did in the comments below.



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 have a tip top 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. 

My top pick and 100% Baby Making and Beyond approved

My top pick and 100% Baby Making and Beyond approved

- 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

- Has a combination of Vitamin A from BOTH retinol and retinol palmate (Learn the details about why this is in Baby Making and Beyond) and talk to your provider about elevated or reduced need for vitamin A

- 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

NUMBER ONE VERY BEST: Seeking Health Optimal Prenatal - Not cheap but awesome ingredients and a correct blend of vitamin A sources. If you have low iron, this is pretty much the only thing that is missing.

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 the entire childbearing cycle (aka prenatal-postpartum)

If you’re too nauseated to stomach a prenatal

This happens and don’t worry, there are some options:

Seeking Health Protein Powder: This is my ideal choice. It can help stave off nausea with its high protein content and gives you all the nutrients you need. Great for Vegans.

Seeking Health Chewable: Same formula (more or less) as the Optimal Prenatal capsule but chewable

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 until your nausea clears.

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 wellness clients and book your consult today.  

 

Guest Interview with Brittany Aäe from Magnetic North

Guest interview with Endurance Coach Extraordinaire Brittany Aäe


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Brittany is a friend of mine, and current co-collaborator on a number of new projects. If you've been following my IG lately you may have noticed that my practice has been evolving. I've been focusing more on the nutrition and lifestyle needs of the female athlete, pregnant athlete and active women looking to maintain hormone balance or achieve a pregnancy. Brittany is such a great addition to my team of co-conspirators. She has a TON of experience coaching women and pregnant athletes and is an all around awesome human. I hope you enjoy learning more about her. Check her out on her own page at Magnetic North 

 

Tell us a bit about your background and what inspired you to study the pregnant and postpartum athlete?

I am an endurance coach and creative making my home on the wily riverbanks of the čwáx (Chewuch). I founded Magnetic North in 2012. My daughter, Rumi Wren, will be two in May.

Throughout my twenties I had two careers: one in the research, implementation, and evaluation of large-scale public health programs on four continents and one as a mountain athlete. Even after leaving my corporate job for my small business, I still love diving into PubMed on a rainy day. In autumn and winter 2009 I lived in the Kumaoni Himalayas conducting primary research on rural home birth outcomes and broke 20,000 feet for the first time. Pairing my experiences at altitude and my research on the physiology and cultural environs of birth turned out to get me thinking in a revolutionary way about the pregnant body at work. I am also a trained doula.

During my 2012 speed climb on Aconcagua my then-partner Chad Kellogg and I were stuck at Camp II in a windstorm and had a lot of time to talk. He mused about how the initial ascent to altitude and the first trimester of pregnancy have similar symptoms but that the athlete and the preggo approach those symptoms differently. We talked about how I could do pregnancy differently when we had children. Where a high-altitude climber knows altitude will feel crappy at first, they know that with good nutrition, rest, and strategic training their bodies will acclimate ultimately increasing their athletic performance after returning to sea level a pregnant woman often assumes that she has no control over her symptoms and that her body can never adapt to the rigorous physiology of pregnancy.

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When I first became unexpectedly pregnant I was living in the back of my Subaru climbing, running, and fishing the mətxʷú (Methow). I was broke AF and didn’t know Rumi’s dad well so I had a choice: I could either adopt a victim mentality and quit what I loved to do, making excuses that the baby made me stop, or I could transmute the difficult experience into my medicine. Thinking back on my decade of public health research, my conversation with Chad in the tent that day, and knowing the kind of example I wanted to set for my future child, I chose the latter. I am so glad that I’ve been able to inspire and inform other pregnant athletes and the professionals who support them.

 

You have a strong understanding of the biology of training and pregnancy. What are the positive outcomes of strenuous exercise on both mom and baby during pregnancy?

Given my unique background coupling public health research and endurance athleticism, I was able to unearth evidence supporting a radical hypothesis: Pregnancy is the greatest performance enhancement known to (wo)man. I took a list of performance enhancements that elite athletes experience and cross-referenced them with the physiologic phenomena the pregnant body experiences and the results not only confirmed my hypothesis. The miracle of science totally blew my mind.

Every performance enhancement sought by professional athletes who dope comes naturally to the pregnant woman - some even to the sedentary preggo. Beginning at eight weeks pregnant, the maternal heart remodels itself to contain more blood in each stroke. The kidneys in the pregnant athlete have a higher filtration rate (which is also why you pee a lot when you’re pregnant) which has the lovely side-effect of being unpumpable while rock climbing. The hormone relaxin, that we’ve been conditioned to believe only leads to unstable joints, is actually an effective vasodilator - even more effective than most doping drugs. The plasma levels in the maternal body increase by 50% or more. The pregnant body is more resilient to exercise in heat as a result. The fetus sends its mother an extra boost of stem cells to help her repair injuries or after a hard training session. In the well-trained athlete, the slow increase in weight throughout pregnancy functions as a custom progressive weight vest which, after birth, leaves the athlete with outsized musculature to perform her mountain tasks.

For the baby, less evidence is available. Anecdotal evidence is below on my own experiences birthing a capable, strong, healthy baby the day before her due date. The midwives postulated that my ultra-endurance pregnancy allowed Rumi and me to share a joyful physiologic birth at home rather than a surgical birth in the hospital.

I have shared the science behind these shocking realizations about the pregnant body on my website and coach pregnant and postpartum athletes using this evidence. Science is the antidote to misogyny.

What effects did pregnancy have on YOUR athletic pursuits?

I am even more feral inside and more connected to the more-than-human. I’m smarter, more efficient, more discerning with how I spend my time, and more self-assured. I trust my body and my intuition completely. Physically speaking, I recover more quickly, have a better understanding of how to engage my deep core muscles, my hematocrit two years postpartum remains as high as it was after my speed climb on Aconcagua - 45. I climb harder grades, I run faster and farther, and I’ve become the coach I always dreamed of becoming. I had always dreamed of setting an only known time before becoming pregnant and I did it when Rumi was 1 on the Kettle Crest Trail. I am leaner, stronger, and more serious about my mountain practice. No fucking around for this mama.

Anecdotally, the sport project I was working on when I got pregnant proved impossible for me to send through the spring and summer. In the months before becoming pregnant I’d climbed it obsessively over thirty times, every time whipping at a different spot - I was nowhere near ready to send it. But during the first trimester of my pregnancy something shifted. I don’t know if it was my mind or the new flood of plasma making me invincible, but I crushed it. When I clipped the chains on my project at nine weeks pregnant I felt like I could take another lap on it without fatiguing. I found a similar level of high performance in all of the other sports I engage in during pregnancy, continuing them until going into labor at the climbing gym at forty weeks pregnant


Were there any challenges-- physical, emotional or social-- that you faced while maintaining an athletic lifestyle through your pregnancy?

Yes. The biggest challenge was certainly maintaining my innate sense of what was right for my body and my baby. I had a small core of supportive loved ones who believed in me but no one told me “You should run/climb/ski while you’re pregnant!” I had to come up with the motivation myself. No one believed that I could run ultras while I was pregnant - which I did twice. No one else thought I’d send my sport climbing project while I was pregnant - which I also did. No one gave me permission to take a solo running road trip down the West Coast from six to eight months pregnant - I gave myself that permission. Rumi’s dad and I had known one another for six weeks (yes, six weeks) when I got pregnant so we worked long and hard to get to where we are now as caring co-parents. I also struggled with prenatal anxiety based on the unplanned nature of my pregnancy; my mountain practices served as medicine.

How did maintaining high levels of fitness throughout pregnancy affect your labor and postpartum experience?

First, I can’t imagine being able to successfully birth Rumi at home after thirty-eight hours of labor, twenty-seven active, and then push for four and a half hours if I wasn’t already an ultra-endurance athlete. Every time my cervix expanded, my strong abs made me puke. I vomited twenty or thirty times through the course of labor but I knew how to keep fueling specifically to keep me going based not on calories expended or actual hydration but based on this wild evolutionary thing our bodies have with sugar. Our feminine-power-denying culture posits birth as an incomparably painful, difficult, and unpredictable experience but that’s not what I experienced - I felt quite prepared for the ‘giving up’ necessary to birth because I birth myself on every solo ultra and alpine climb. My many simultaneously arduous and joyful days in the mountains gave me an excellent template for the experience of giving birth. I was able to pace myself, able to frame the productive pain of birth as yet another piece of information during an exciting experience while also being present for the other sensations involved in birth such as courage, triumph, connectedness, curiosity, gnosis, and gratitude. Rumi and I birthed like bosses.

Rumi was born a few hours before her due date at seven pounds and, because of the massive amounts of deliciously-oxygenated blood I gave her throughout my ultra-endurance pregnancy, her cord was a size usually associated with an eleven pound baby. This sturdy cord allowed me to push hard for over four hours without negatively affecting her vitals - ultimately saving us from an emergency surgical birth. After she was born the cord continued pulsing nourishing blood for over an hour and I lost less than a sixth of the blood my midwives usually saw a woman lose during birth. Rumi was immediately able to control her head and use her hands; she breastfed ably within an hour of being born. Rumi continues to be an intelligent, athletic, and funny toddler who currently measures in the 75th to 90th percentile for height and weight.

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During the postpartum experience my uterus shrank from even with my ribcage to even with my pubic bone within an hour of birth. This quick involution prevented postpartum hemorrhage and sped healing. I was immediately able to walk comfortably on my own after birth. There were only four days between my final pregnant climbing session (during which I went into labor) to my first postpartum lead falls. I took my last pregnant run and first postpartum runs five days apart. My postpartum bleeding stopped completely within five days of Rumi’s birth. My midwives agreed that I had completed the recovery that takes the general population about eight weeks in the span of five days. Like I always say: I’m not only an expert at moving fast and high in the mountains; I’m an expert at recovery. My level of fitness and mental resilience developed over the last decade of elite athleticism allowed me to be completely present with the intense and beautiful experience of birthing my baby.

You have done research on how the blood volume increase that occurs naturally in pregnancy. You refer to this as “natural blood doping.” Can you briefly elaborate on this natural phenomenon and its benefits. What else is happening within a woman’s body during pregnancy that make her stronger athletically?

Performance enhancements of any sort, whether sleeping in an altitude tent or taking performance-enhancing drugs, feels bad. Just like the first trimester of pregnancy, any sort of legal or illegal doping stimulates the body into a different balance of plasma, hematocrit, and/or stem cell activity. The difference between the performance enhancement of pregnancy and the ones that non-pregnant athletes use is the mindset.

As I mentioned before, when a climber first ascends to altitude they expect to feel unwell. Rather than languishing in AMS and feeling resigned to crappy performance the entire time they are up high, they apply evidence-based acclimatization strategies to their practice in order to bring their performance up to a higher level than before going to altitude.

Pregnancy, according to the evidence, is a uniquely powerful time for the athlete. To unlock the potential inherent in all pregnant athletes requires a shift in mindset away from a symptomatic experience to a challenging but rewarding experience for both mom and baby. I am happy to dive deep into the research with any curious mama or birth professional. Find more information on my Coaching page.

Your athletic pursuits include ultra-running, rock climbing, and backcountry skiing. Can you provide our readers with one tip in how to continue pursuing each of those sports while pregnant?

Ultra-running: Think of your power as a runner during pregnancy like you might think of a diesel truck: Takes a while to warm up, sputtering and coughing, but once it gets going it is completely unstoppable and unbelievably durable. You’ll have torque and endurance that you never believed were possible.

Rock climbing: You may experience un-pumpability. With all the extra plasma and higher glomerular filtration rate, many pregnant climbers find that they are unable to get pumped. Climb steep, climb long.

Backcountry skiing: Get someone to help you unbuckle your boots in the third trimester. Other than that skiing is surprisingly normal during pregnancy.

Overall: Develop an internally-informed, self-sufficient sense of what is right for your body and your pregnancy. By releasing expectations, your high performance may surprise you.

Through your research and experience, what has inspired you most about the maternal athlete?

Fetomaternal microchimerism. Us uterus-havers evolved to gestate, birth, brachiate, and run - with each of those ultra-endurance feats supporting our performance in the other.

Interested in learning more??

Check out her pregnant athlete e-course and stay tuned for more info about our collaboration "Training With Your Menstrual Cycle: Troubleshooting and tips" 

Yes, you can be too "fit" to get pregnant- Bustle Feature

If you've been struggling with either Hypothalamic Amenorrhea or having a hard time trying to conceive, check out this featured article I was recently  interviewed for on Bustle. So many women struggle with this and it's time we have our voices heard :)

https://www.bustle.com/p/yes-you-can-be-too-fit-to-get-pregnant-8979283

Meg 

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).  You can also check out the Hormones and fertility module of Baby Making and Beyond, it’s a gem.

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

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  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 check out Baby Making and Beyond.

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.