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Vitamin D deficiency has consequences well beyond bone health.

Vitamin D is gold.

Vitamin D is so important to the body, immune cells, brain, colon, breast, and other cells have the ability to also activate it locally when required. Although labelled a vitamin, calcitriol (bio-active vitamin D) acts more like a hormone within the body. It is involved in many essential functions well beyond bone health. Vitamin D is critical for inflammatory modulation, hormonal and immune functions as well as cardiovascular, mental health and pancreatic function. The active form of vitamin D interacts with receptors in the intestine, bone, brain, heart, immune cells and skeletal muscle. Vitamin D functions as a modulator of up to 1000 genes involved in cellular growth and protein synthesis.

Vitamin D plays an important role in an athlete’s health, training and performance.

Studies show it may even be necessary for optimal muscle function and performance as muscle performance is impaired by suboptimal vitamin D status. Deficiency induces atrophy of fast twitch muscle fibers, impairs calcium uptake and prolongs time to peak contractile tension and relaxation. Studies also show Vitamin D deficiency may delay rehabilitation from injury.

In sporty pregnant women, low vitamin D levels are linked to pre-eclampsia, gestational diabetes and adverse pregnancy outcomes. Vitamin D also plays a part in regulating insulin, blood sugar balance and thyroid hormones. Research shows that a deficiency of vitamin D is associated with a high risk of thyroid antibodies, which are found in individuals with autoimmune thyroid disorders.

Vitamin D is most commonly known in the athletic community for its influence on bone health and prevention of bone injury. Vitamin D influences bone health by upregulating expression of genes that enhance intestinal calcium absorption, and reabsorption by the kidneys along with increasing bone-building cell activity. Studies show calcium absorption significantly increases when vitamin D levels are sufficient. Calcium absorption is reduced to 10-15% with low vitamin D levels and stress fracture risk significantly increases.

Typically, 80% of our vitamin D is obtained from the sun and 20% from food sources.

Signs of Vitamin D deficiency

fatigue and tiredness
lower back pain
recurrent colds and infections and poor immunity
stress fractures
heaviness in the legs
recurrent injuries
muscle pain, weakness, poor muscle contraction and relaxation
mental health issues, low mood, seasonal sadness and depression
hormonal imbalances and PMS
anaemia and low iron
pale floating stool
photosensitivity

According to Sunsmart Australia, one-third of Australians are low in Vitamin D.

10 Reasons your vitamin D is low

Vitamin D can be made by our body when skin is exposed to sunlight through a complex activation process, however, what many people fail to realise is that this process doesn’t always occur efficiently or reach levels required for optimal health. Vitamin D production may vary depending on the time of day of sun exposure, season, cloud cover, smog, latitude, skin pigmentation, age, and sunscreen use.

We often see patients with low levels of vitamin D despite being out in the sun daily. There are several reasons why vitamin D levels drop despite sunlight exposure.

1. As vitamin D is fat-soluble and stored in fat cells, individuals with low body fat, may be disposed to vitamin D deficiency as their storage tank is smaller.

2. Activation and production of vitamin D are inhibited by magnesium deficiency, inflammation, and excessive use of sunscreen.

3. Individuals with any form of malabsorption issues, liver or kidney issues, coeliac’s disease, Crohn’s, vegans, and thyroid issues can be prone to deficiencies.

4. Anyone with a history of anaemia should also be aware of the bidirectional influence between iron and vitamin D. The activation of vitamin D in the kidneys requires iron-containing compounds ferredoxin reductase and ferredoxin. Iron deficiency may therefore contribute to the inactivation of vitamin D. Vitamin D deficiency may also be associated with higher hepcidin (a pro-inflammatory mediator) in the liver. Hepcidin will elevate ferritin stores and down-regulate intestinal absorption of iron from food and impair storage iron release. Hundreds of athletes have used our handy anaemia tool to help determine the likely risk of having low iron or anaemia.

5. Diets containing limited seafood, eggs or dairy such as vegan diets may also reduce vitamin D intake.

6. Insufficient direct UVB exposure (due to smog, cloud cover or latitude), early- or late-day training, indoor training, geographic location further away from the equator and sunscreen use (SPF of 15 lowers vitamin D synthesis capacity by 98%).

7. Disruption to the microbiota and gut inflammation may also affect the availability of vitamin D.

8. In addition some individuals may find it difficult to increase their vitamin D levels if they have low antioxidant status.

9. Medications such as anticonvulsants, corticosteroids, cimetidine, theophylline, statins or the weight loss drug orlistat.

PATHOLOGY TESTING

As a general guide, Osteoporosis Australia recommends most people should have levels of at least 50 nmol/L at the end of winter, which means people may have higher levels during summer (60-70 nmol/L). However, in order to maintain optimal health, athletes should aim for serum levels over 90 nmol/L ideally between 100 and 130 nmol/L.

Treatment

Daily sunlight exposure on your skin especially on large areas such as the back, chest, legs and arms (25-60 minutes in winter) without suntan cream, is a great way to keep levels topped up. Athletes living in southern states of Australia and New Zealand need 30 minutes of direct skin exposure (springtime) on large areas of skin such as back, arms, chest or legs closer to midday. Athletes living closer to the equator may require 15 minutes before 10 am. During this time avoid putting sunscreen on, then for the rest of the day, cover up. Lunchtime exercise with as much skin exposure as possible (within decency) is a great way to give yourself a vitamin D fix, especially in winter months.

Get tested biannually- before winter and again in spring.

Consume vitamin D-rich foods on a daily basis such as oily fish like cod, salmon, sardines or tuna, egg yolks, sun-dried mushrooms, and fortified milk, butter and fortified cereals. Some individuals may benefit from cod liver oil which also contains vitamin A and essential fatty acids.

When levels are low, take a quality supplement in the correct dosage range and a probiotic. Certain probiotics such as Lactobacillus rhamnosus LGG and Lactobacillus plantarum enhance levels synergistically.

Obtain adequate magnesium-rich foods such as spinach, pumpkin seeds, almonds, black beans, oyster mushrooms, avocado, figs, yogurt or kefir and banana. Chocolate also contains magnesium.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

Mineral and heavy metal testing can help to gain a better understanding of what metals may be impacting on health and what minerals are required to increase to enhance performance and overall health. Optimal nutritional balance is essential for the function of every cell and system in your body. Obtaining feedback on mineral absorption is just one of the benefits of mineral testing for athletes.

Mineral testing provides a wider perspective on an individual’s overall health status than just urine, blood or stool pathology testing alone although it is always useful to use both tests in conjunction with each other. Mineral testing can be used as an early detector of subclinical issues and provide useful guidelines in terms of how to best support the body when annoying symptoms such as fatigue, insomnia and digestion issues persist.

In clinical practice, test results are always accompanied by a thorough assessment of your overall health and nutritional intake to provide meaningful context to data and to give you a clear understanding of where and how deficits may be occurring.

A mineral analysis may provide insight into your current health status, identify potential areas of concern and provide suggestions around dietary and supplemental measures that may improve your health now and prevent issues in the future.

Mineral testing for athletes- useful insights

Mineral testing provides a snapshot of how the body is utilizing the nutrients obtained from your food and provides an analysis of 13 key minerals. Trends in nutrient deficiencies or excessive mineral levels may indicate poor activation and non-beneficial storage of nutrients.

To demonstrate this point, let’s take a look at calcium. Calcium will be maintained within a very narrow range in blood serum due to its life-supporting roles in managing heart rate, nerves, and muscle function. However, in a mineral analysis high or levels of calcium may be observed. Low levels of calcium may indicate poor absorption, inadequate intake or other nutrient issues such as low vitamin D, while high levels may be suggestive of low vitamin B6 and poor calcium utilisation in the body.

High calcium levels may also contribute to underactive thyroid issues with symptoms such as weight gain, fatigue, low blood pressure and poor mood. Early detection of calcium issues is vital for the prevention of bone issues such as osteopenia, fractures, bone spurs, kidney stones and thyroid issues.

Mineral testing for athletes provides an analysis of how the body is utilizing 13 key nutrients obtained from the athlete’s diet. Longer-term patterns in nutrient deficiencies or excesses may indicate poor activation and non-beneficial storage of nutrients.

To demonstrate this point, let’s take a look at calcium. Calcium will be maintained within a very narrow range in blood serum due to its life supporting roles in managing heart rate, nerves, and muscle function. However, in a mineral analysis high or levels of calcium may be observed. Low levels of calcium in mineral testing for athletes, may indicate poor absorption, inadequate intake or other nutrient issues such as low vitamin D. High levels in mineral testing for athletes, may be suggestive of low vitamin B6 and poor calcium utilisation in the body.

Significance of mineral testing for athletes

A clinical understanding of how an individual metabolises and utilises nutrients can be obtained through various mineral ratios included in a mineral test. Just some of the ratios contained in the mineral analysis report are outlined below:

Immunity: Low zinc in relation to high copper levels may indicate a susceptibility to viral infections such as colds, cold sore outbreaks or poor wound healing. Zinc is critical to immune cell function and digestion and hydrochloric acid. Reduced digestive function and symptoms such as bloating, diarrhoea, malabsorption and low nutrient levels may also be observed in patients with low zinc.

Iron deficiency and anaemia: As discussed previously in relation to immunity, ceruloplasmin is a protein carrier shared by zinc, copper and iron. If zinc, copper or iron are too high, they may inhibit the absorption of the other minerals. For example -high levels of copper may be observed in women taking the oral contraceptive pill or through drinking water carried in copper pipes. High copper levels may contribute to iron deficiency anaemia and present as shortness of breath, lethargy, dizziness and exercise fatigue.

Poor liver detoxification: Molybdenum is a key nutrient required for liver detoxification and is frequently low on test results due to reduced intake of foods rich in molybdenum such as legumes. When molybdenum is low in relation to sulfur an individual may experience sluggishness, fatigue, skin issues, and poor recovery related to reduced sulfation detoxification pathways in the liver.

Blood sugar control issues: Manganese and chromium are key nutrients required for blood sugar control. When manganese is low in relation to chromium an individual may experience energy dips, especially after meals, sugar cravings and dizziness or sweating related to poor blood sugar control and fluctuating insulin levels.

Hormone issues: Minerals play a key role in hormone modulation. When iron is low in relation to copper, individuals may complain of fatigue, poor recovery, weakness, loss of libido, irregular periods and hot flushes due to a pattern of low progesterone or testosterone.

Adrenal gland insufficiency: During times of stress, the adrenal gland utilises larger amounts of sodium and magnesium. When sodium levels are low in comparison to magnesium the adrenal gland may be underperforming as it is highly sodium dependent to produce key hormones such as cortisol.

General muscle tightness: Calcium and magnesium are required for bone health and muscle and nerve function. Stiff muscles, bladder issues and immobile joints may present when there is an issue between the ratio of calcium and magnesium in the body.

HEAVY METAL BURDEN
This form of testing may also identify heavy metal burden on the body. Despite a clean lifestyle, individuals can present with unfavourable levels of mercury, arsenic, lead, tin or aluminium largely due to living in a modern environment where exposure to heavy metals occurs on a regular basis.

Contrary to popular belief, heavy metal accumulation does not necessarily occur from occupational exposure. Frequent exposure arises from pesticides; additives and the tinning of foods; dental fillings; drinking water; products and materials used in homes and offices; personal care products and cosmetics.

Heavy metals are neurotoxins and may over time contribute to a plethora of health issues such as thyroid, reproductive and mental health issues, and cancers. Heavy metals displace other key minerals such as zinc, selenium and iron. The presence of these metals may also be indicative of other functional issues such as reduced liver detoxification pathways.

Practicalities of mineral testing for athletes

Mineral testing looks at long-term trends (over 2-3 months) and can be very useful when symptoms or health issues are ongoing and underlying contributing factors are yet to be identified. Athletes also find mineral balance results useful before they launch a new training campaign as a measure of nutritional status and as a preventative measure against deficiencies that may inhibit performance.

Mineral testing does not require a blood draw and can be conducted in the privacy of your own home. Test results generally take 2 weeks and are reviewed during an extended consultation.

For further information or to order a test kit email contact us or book in for your initial consultation.

Photo of seed products useful for seed cycling during the menstraul cycle for women

Before we get stuck into the detail, let’s do a quick recap on how seed cycling supports hormones.

Female hormones are regulated through complex signalling and feedback mechanisms. Signals are received and then transmitted by the hypothalamus part of the brain out to the pituitary gland, adrenal glands and then ovaries (the HPAO axis). In times of change or increase physical or emotional stress of any kind, the HPOA axis can become dysregulated.

Symptoms such as longer or irregular menstrual cycles, hot sweats, increased PMS, mood changes, fatigue, changes in bleeding and reduced ability to handle training intensity may appear. These symptoms frequently occur when there is no known structural or functional issue with the ovaries.

In order to reduce symptoms, some women reach for pharmaceutical medications without understanding or being aware they have the potential to further dysregulate long-term hormonal balance and deplete nutrients such as zinc and magnesium.

In addition to medicinal herbs such as Chaste Tree, Schisandra, Kudzu or Rhodiola, seed cycling may provide subtle hormonal support by boosting estrogen levels in the first part of the cycle and progesterone levels in the second part without the possible side effects of other medications.

THE PROCESS

Seed cycling supports hormones by providing nutrient rich foods in the form of seeds at different times of the menstrual cycle.

How to seed cycle
Preparation
Combine ¼ cup of each of the following seeds nominated to the two phases of your cycle. Take your seeds (according to which phase of your cycle you are in) and whiz them in a coffee grinder to break the seeds down into a meal-like consistency. Make 2 separate jars of seeds.

Follicular phase day 1-14 of your cycle (or until ovulation)= flaxseed + pepitas (pumpkin seeds)
Luteal phase day 15-28 of your cycle (or post ovulation) = sesame + sunflower seeds

Dose: 1-2 tablespoons of combined ground seeds daily.
How: Add seeds to smoothies, on top of breakfast oats, avocado toast, coconut yogurt or as a garnish on savoury soups, salads or scrambled eggs. Seed cycling biscuits or brownie mixes are also a great option. Choose whole, organic seeds instead of pre-ground seeds where possible.
Storage: Store ground seeds in an air-tight jar in the fridge to preserve their essential fatty acids from oxidation.
Duration: Most women need to allow 3-4 cycles before expecting changes to occur.

An easy way to ensure you have the right seeds across the month is to purchase a seed cycling kit.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

Do you want to know more about Robust Immunity?

Before we dive into how to maintain robust immunity in athletes, let’s do a quick recap on how our immune system works.

The immune system is a busy network throughout our entire body including cells, vessels, lymphoid tissue, nodes, nodules, bone marrow and organs.

Bone marrow is where millions of new blood cells are produced every day. Bone marrow also serves as the site where cells are stored and matured before they enter the circulatory system.

Our immune system would not be complete without the gut-associated lymphoid tissue (GALT) – and Peyer’s patches in the small intestine. Nearly 80% of our immune system is actually based in the digestive tract.

The thymus gland is a small gland known as the “seat of courage” and is located behind the breastbone. Our thymus helps regulate the immune system and is a storage tank for immune cells such as lymphocytes and monocytes responsible for eradicating viruses.

Our spleen is an oval shaped mass of lymphatic tissue which acts as a large blood filter. It recycles iron, captures and destroys pathogens and initiates the maturation and release of immune system when the body requires it (e.g. to fight infections).

Our lymph nodes act as a filtering system for the clear fluid called lymph which contains waste and immune cells. The lymphatic vessels act as the super highway carrying lymph between the 600 lymph nodes in our body located in our limbs, armpits, abdomen and groin.

Lymphatic nodules also contain lymphatic tissue and are positioned on mucous membranes in our respiratory system and gastrointestinal tract, tonsils and adenoids.

The immune system has many lines of defence.

Our immune system is equipped with a multi-tiered response approach. A healthy immune system is always ready (24-7) to battle with foreign invaders.

The immune system includes our first line of defence which acts like the bouncers of your body deciding what can come in and what can’t such as the skin, mucous membranes, gastrointestinal tract and secretions like mucous, acidic vaginal secretions, bile, gastric acid (HCL), saliva, tears, and sweat.

The next line of defence kicks in when the bouncers have gone on a smoko and a pathogen is detected by the body. This part of our system also houses our infection-fighting cells such as our natural killer cells and phagocytes which act like Pac-men against microbial invaders. Our immune system also releases antimicrobial proteins such as complement and interferon which interfere with virus replication and protein which co-ordinate cell-to-cell communication. This part of the system deals with viruses, fungi, parasites etc.

Our immune system also keeps a record of every germ it has ever defeated so it can recognise and destroy the microbe quickly if it enters the body again.

Maximise what’s needed for robust immunity in athletes

In addition to enjoying a balanced wholefoods diet containing real foods rich in colour and vitality colourful rainbow on your plate, there are key foods to include in your diet you want to enhance your immune system.

The big guns

Vitamin C builds resistance to infection and stimulates immune cells and proteins such as interferon which help eradicate viruses. Vitamin C rich foods include veggies such as red capsicum, spinach, parsley and sweet potato. Fruits such as kiwi, berries, paw paw, pineapple citrus, guava, broccoli, mango, and currants are great sources of vitamin C. Rosehip, Camu Camu, and Kakadu plum provide concentrated forms of vitamin C and can be found in powdered forms such as Wild C.

To optimise absorption vitamin C is best ingested with bioflavonoids. Lots of foods rich in vitamin C also contain bioflavonoids but they can also be found in celery, garlic, red onions, garlic, grapes, apricots and green tea. In some circumstances, it is beneficial to supplement vitamin C. Vitamin may cause gastric upset in large doses. Dividing the doses throughout the day can reduce the side effects.

Zinc is responsible for supporting immune cell production and proliferation which fight off infections such as viruses. Common deficiency signs may include frequent colds, extended recovery periods, poor wound healing, low stomach acid changes in smell or taste and white spots on nails.

Zinc is lost through perspiration and displaced when other nutrients such as iron and copper are high as they share a common carrier in the body. Zinc supplementation should be under the guidance of a qualified practitioner to get the right dose and timing correct because high doses can impact other nutrients ( iron and copper) which may then contribute to immune dysfunction.

Foods rich in zinc include pumpkin seeds, fresh local seafood shellfish and oysters, tahini, peanuts, liver, eggs, nuts and seeds and legumes. Just remember to soak or sprout legumes, nuts and seeds to break down the phytates that may bind to zinc and reduce zinc’s bio-availability.

Obtaining adequate protein will supply the amino acids for antibodies and immune protein production.

Keeping well hydrated is also important for our first line of defence. Ginger and lemon drinks are a great alternative to water.

Immune modulators

Vitamin D, A, E and selenium are important antioxidants, immune modulators and help maintain healthy mucus membranes. Exposing your unprotected skin to direct sunshine for 15-20 minutes daily will help boost vitamin D levels. Vitamin A-rich foods include cod liver oil, orange coloured foods such as carrots, sweet potato and apricots and kohlrabi. Vitamin E is found in nuts and seeds (such as sunflower seeds), eggs, and dark green leafy vegetables. Selenium is rich in Brazil nuts, alfalfa, meat eggs, onion, garlic and broccoli.

Shiitake and reishi mushrooms and green tea are also supportive of the immune system and build robust immunity in athletes.

Look after your gut health with pre and probiotic rich foods (think fibre and fermented foods like kimchi, sauerkraut, kefir, tempeh, kombucha, and quality yogurt). Choline found in lecithin from soy, eggs, beef, pork, olives, and broccoli, assists with the formation of the mucosal layer in the respiratory system and gut.

Include herbs and spices in your cooking that support healthy immune responses. Turmeric, ginger, Ceylon cinnamon (Cinnamomum verum), Cayenne peppers, garlic, horseradish, parsley, garlic, onions, oregano and thyme are all good choices.

What to avoid for robust immunity in athletes

Avoid substances that reduce immune system function.

1. Studies show sugar reduces the capacity of white blood cells within 1 hour of consumption and can last for up to 5 hours afterwards. Sugar can also feed some pathogens. Skip the middle isles of a supermarket where the processed foods are and spend more time selecting fresh foods.

2. Avoid too much caffeine or other stimulants that will stress our nervous system, impact on sleep but also deplete stores of zinc, and magnesium which we need in times of stress.

3. Avoid excessive alcohol and it may also suppress the immune system.

4. Avoid late nights binging on Netflix and obtain adequate sleep. This means at least 8 hours per night ideally hitting the pillow before 10pm. Sleep deprivation can increase your risk of picking up infections and reduce robust immunity in athletes.

5. Avoid or minimise unnecessary stress. Focus on what you can control and let go of the rest. Your mindset matters in times of stress and unpredictability. Be as flexible as you can with everything including your training, work, family and routine. Stress heightens cortisol which in turn smashes your infection-fighting cells. Consider ways of dispelling stress other than more exercise such as meditation, mindfulness, relaxing activities such as reading or creative activities and watching comedies rather than more bad news stories.

6. Avoid over-exercising. Keep your exercise balanced. Robust immunity in athletes requires regular exercise, however moderation is the key. Too much exercise of long duration and intensity can make athletes more susceptible to respiratory infections. For more information on exercise and its impact on the immune system click here

For further information on the suitability of these measures for your particular situation, contact us for an individual assessment.

Many women suffer from period pain and other PMS symptoms. But what most women fail to realise is that it is NOT normal to have severe period pain, heavy bleeding, breast tenderness or discharge, debilitating drops in energy or significant mood swings as part of premenstraul symptoms. A healthy balanced woman can observe her period without experiencing symptoms that impact her quality of life and ability to function. Pain is just one of the many issues women experience around their monthly cycle, however, it tends to be what prevents us from enjoying life the most.

In naturopathic medicine the overuse of NSAIDS (non-steroid anti-inflammatories) for menstrual cramping or period pain (dysmenorrhea) is cautioned as it may contribute to the erosion of the gut lining and contribute to a digestive condition called leaky gut where the tight junctions within the gut lumen come apart.

Commonly used NSAIDS such as Ibuprofen may provide temporary relief, but they may also suppress some of the compounds that look after your gut lining. Once damaged, the tight junctions in your gut start to drift apart creating a “leaky gut”. This then allows toxins and larger particles to enter the bloodstream and trigger an immune response, inflammation and gastrointestinal distress. This may go on to contribute to a whole range of systemic issues such as food intolerances, skin issues and immune dysfunction. The good news is that there are lots of great natural solutions for period pain.

Ultimately getting your hormones balanced will assist with the symptoms, but while you are doing that here are a few options to make you more comfortable:

Athletes who are competing in their premenstrual phase may consider magnesium, zinc and fish oil at therapeutic doses for at least 5 days before their period is anticipated to reduce cramping and lower abdomen and back pain
A hot water bottle or heat pack on your abdomen and/ or lower back
Herbs such as cramp bark, turmeric and Black Cohosh may reduce PMS symptoms due to their anti-inflammatory actions and calming action on the uterus.
Consume more anti-inflammatory foods like cherries, blueberries, avocado and chia seeds. Fish such as salmon, cod, mackerel, sardines, bream, snapper or flathead high in omega-3 fatty acids, are also healthy choices. Consume more calcium-rich beans, almonds, and dark leafy greens. These foods contain compounds that combat inflammation.
Reduce coffee, refined foods and high sugar intake, bread, pasta and anything processed high in trans-fatty acids. These foods may contribute to inflammation and encourage period pain and tender breasts.
Sipping chamomile tea may inhibit the pain-causing prostaglandins associated with PMS without the side effects on your gut.
Seed cycling can help your body maintain a subtle balance and transition throughout your natural cycle.
Ginger and cinnamon are our favourite remedies for period pain. Studies demonstrated these two natural wonders provide the equivalent pain relief as ibuprofen when taken at therapeutic doses.
Fennel- Fennel extract can assist with severe menstrual cramps.
A combination of both 100mg of vitamin B1 and 500mgs of fish oil daily for 2 months has been shown to significantly reduced period pain.
Exercising-Most women find that exercising helps relieve menstrual cramps. Some women find yoga and tai chi are gentler forms of exercise that are more comfortable during the premenstrual phase.

As women, we need to consider our periods as the scorecard for our greater health. If you would like to understand how you can balance your hormones through practical nutrition, and natural medicines we welcome the conversation.

We aim to equip women with a balanced perspective so they can make an informed choice about contraception options and what they put into their bodies. We in no way suggest women should come off their medications without due consideration. We also don’t shy away from the fact that there is a dark side to artificial hormones. It is important to consider all the pros and cons of any medication.

The most widely used contraceptive medications include the combined oral contraceptive pill (OCP) (containing synthetic estrogens and progesterone) such as Yasmin or Estelle, or injections, patch and vaginal ring. Progestin-only contraception includes the mini-pill (e.g. Noriday 28), implanon (progestogen) and hormonal IUDs (Mirena). Intrauterine devices such as the copper IUD are also a preferred option for some women.

Although contraceptive medications have similar names and molecular structures to female hormones, they have very different functions in the body. Artificial hormones mimic our natural hormone responses by “approximately” fitting into our hormone receptors but provide a different response. For example, progestin used in medications prevents pregnancy by inhibiting ovulation, changing cervical mucus making it unfriendly to sperm and by reducing the proliferation of uterine lining to inhibit implantation. Natural progesterone, on the other hand, thickens the uterus lining and helps with the implantation of an embryo. Contraceptives are metabolised differently between individuals due to the type, concentration, duration and timing of medication used. Although generally relied upon as contraceptives, they may also be used to manage issues such as acne, period pain, endometriosis and heavy bleeding.

Albeit highly effective as contraceptives, there is a dark side to long-term use of these pharmaceuticals such as toxicity and nutrient depletion through their impact on gut and vaginal microbiomes, liver function, oxidative stress and chemical accumulation.

Let’s now consider the drawbacks and benefits of contraceptive medication.

Pros

Up to 99.5% effective as a contraceptive (depending on type)
Easy to use (in pill form)
May manage symptoms such as period pain, acne, irregular or heavy bleeding
Improves predictability and regularity of bleeding
May reduce the risk of iron-deficiency anaemia if caused by heavy bleeding, some cancers (colorectal and ovarian) and ectopic pregnancy
Prevent bleeding or symptoms on race day or hard training days (if PMS is an issue)
Lighten bleeding

Cons

They don’t prevent sexually transmitted diseases like other barrier forms of contraception.
Not all women will experience side effects, but some may have weight gain, depression, acne, hair growth, irregular bleeding, nausea, mood swings and headaches. Studies show that women on higher doses of OCP had 50% greater incidence of bloating, breast tenderness and nausea than those on low dose options.
May impact on the immune system and alter immune response, triggering autoimmune disorders. Studies show an increased risk of developing Lupus in women who take OCPs.
OCP use is linked to increased risk of cardiovascular issues, high blood pressure, blood clots, and thromboembolism. OCPs may be potentially contributing to an increased risk of cancer and liver tumours, and reproductive issues including premature menopause and reduced fertility.
May alter the intestinal microbiota and vaginal microbiome composition after just 6 months of use. Both IUDs and OCPs may increase the risk of bacterial vaginosis, trichomonas vaginalis and candida albicans infection in sexually active women. Studies suggest OCPs may also contribute to leaky gut through changing tight junction expression in the gut which can contribute to food intolerances and other immune reactions.
May indirectly contribute to body toxicity by adversely affecting the capacity of the gut to metabolise and excrete other xenobiotics (e.g. polycyclic aromatic hydrocarbons, pesticides, polychlorobiphenyls, heavy metals, benzene derivatives, dyes, artificial sweeteners) and metabolic by-products.
May reduce vital nutrients and contribute to excess accumulation of others. Studies show the OCP reduces zinc, selenium, vitamin E, Co-enzyme Q10 (a cofactor in energy production), B12, phosphorus and magnesium levels but contributes to higher copper and cadmium levels. OCP use may also increase ferritin levels, resulting in enhanced iron absorption, but potentially contributing to iron overload and oxidative damage. The toxic effects of potentially high copper and cadmium in the body deplete antioxidant (glutathione) levels, inhibit antioxidant enzyme activity, and increase the synthesis of harmful free radicals and may damage liver cells.
OCP use is also associated with environmental chemical accumulation in the body. An analysis from the Norwegian study of 1090 women over a 5-year period, found higher levels of the harmful chemical PFAF (Perfluorooctanesulfonate) in women who used the OCP for more than 12 months. Elevated PFAF levels have been associated with infertility, preclampsia, cancer and adverse effects on the liver, thyroid organs and endocrine system.
High environmental impact from oestrogen contraceptives. Over 700kg/year of synthetic oestrogens derived from contraceptives (OCPs, patches and vaginal rings) are released into the environment and contribute to 16% of the oestrogenic load present in waterways worldwide. Oestrogens and progestin are detrimentally impacting the physiology of fish and other aquatic animals. The impact extends to our water and soils.
Although the OCP is widely prescribed to prevent further bone fractures or as a protective measure, however the long-term effect of oral contraceptive use on risk of fracture remains unclear. A 2014 study from the University of Wisconsin School of Medicine and Public Health, involving high school athletes concluded there was no difference in the frequency of musculoskeletal injury between athletes who used the OCP users and non-users. Another 2015 study reported there was no difference in fracture risk for women aged 38-49 years of age between OCP users and non-users. A 2015 study published in the Journal of Women’s Health suggested contraception injections such as DMPA have been shown to be associated with low bone mass and osteoporosis in women.

Minimise the downside to contraception

If you choose to take the OCP or other contraceptive, read up on possible side effects and talk to your prescribing G.P about other options if you experience side effects.
Ensure your diet is high in nutrients that help with drug and hormone metabolism and detoxification such as the cruciferous family of vegetables ( broccoli, cauliflower, kale, cabbage, Brussels sprouts, arugula, daikon, bok choy, horseradish, Chinese cabbage, Romanesco broccoli, kohlrabi, radish, turnip, wasabi, turnips and watercress). These vegetables are rich in indole-3-carbinol and glucaric acid which assists with oestrogen detoxification and healthy hormone metabolism. Glucaric acid is also found in many fruits and vegetables with the highest concentrations also in oranges, apples and grapefruit.
Speak to your naturopath about your current mineral status. Minerals tests can detect issues in nutrients such as copper, zinc, selenium and other nutrients affected by OCP use.
Improve your antioxidant status to counteract any side effects of OCP use by including brightly coloured fruits and vegetables in your diet daily.
Speak to a natural awareness fertility (FABM) educator who can explain other contraception options and methods of predicting or calculating the fertile phase of a woman’s cycle. Natural family planning is estimated to be around 85% effective when performed correctly.
Speak to your partner about other methods of contraception.
Reduce your overall toxin and chemical load by using organic skin and personal hair products and opting for non-toxic household chemicals.
Consider natural options (such as herbal medicines, nutritional medications and dietary intervention) for hormone balancing if you are using the OCP for symptom management. Consider natural options to manage PMS.

For further information on the suitability of these options for your particular situation, contact us for an individual assessment.

In this article, we discuss how to obtain accurate pathology tests. Whilst this article is not meant to serve as a diagnostic tool, it may be helpful to better understand what basic pathology tests are useful and how to prepare yourself so you get the most accurate results.

Pathology test results should always be considered in conjunction with symptoms, a thorough physical examination, and discussed during an appointment so that the context and relevance of your results can be determined. One abnormality in pathology tests does not tell much of your health picture, however, patterns of pathology tests can provide a holistic picture of your overall health, your absorption, and digestion of key nutrients and provide warning signs that require further investigation.

WHAT PATHOLOGY TESTS ARE MOST USEFUL?

Your GP or naturopath can arrange pathology tests for you. Exactly which pathology tests you require, will need to be determined by your healthcare practitioner. As a good starting point, I suggest the following tests for my patients:

*Full blood count and hematology- provides a general picture of your immune system, red blood cells and overall health

*Liver function tests (LFTs)- provide some clues as to how your liver is working and if your liver is under stress.

*Electrolytes– including potassium, sodium, and other key electrolytes required for sports performance and optimal health

*Fasting blood glucose- is a general marker that indicates how well your body is modulating your blood sugar. Issues with blood sugar stabilisation may cause symptoms such as sugar cravings, frequent urination, fatigue, and energy drops after meals.

*C- reactive protein (CRP) is an inflammatory marker that is useful when interpreted in conjunction with iron studies. Iron storage may be impacted by states of high inflammation.

*Iron studies- provides information on your iron storage (ferritin), the protein carriers for iron (transferrin), and how effectively your body is saturating these carriers and transporting iron around your body (transferrin saturation).

*Thyroid hormones- TSH, T3 and T4 provide information on how your thyroid is functioning and can be an early warning sign of autoimmunity and nutrient deficiencies such as iodine, selenium, tyrosine and zinc

*Vitamin B12 ( active and inactive) is also suggested for plant-based patients or athletes who infrequently consume red meat.

*If you are prone to mental health issues (especially seasonal sadness/ low mood), autoimmunity, frequent colds, bone health issues, or hormonal imbalances vitamin D, copper and serum zinc may also be useful markers.

Tests may be repeated every few months to ensure a patient is responding to treatment and improving nutrient absorption through targeted nutrition approaches.

How to get the most accurate pathology tests

To get the most out of your pathology tests, it is recommended your prepare appropriately.

fast for 12-16 hours (have dinner and then postpone breakfast until after your blood draw).

AVOID

strenuous exercise for a minimum of 24 hours. Ideally, at least 48 hours if possible. This includes running, cycling, or strength training. Most patients find it easiest to do a blood test the morning after a rest day.
obtaining the blood draw when feeling unwell such as with a cold or flu when checking iron studies as infection may influence your test results
alcohol or supplements for 24-48 hours prior to your blood tests

We use a number of pathology collection centres across Australia including Clinical Laboratories, Dorevitch, and Nutripath to obtain accurate pathology results. We also refer to functional testing such as mineral testing completed through Interclinical Laboratories.

To keep your energy sustained, it is important to maintain blood sugar control. Natural blood sugar control is possible when done correctly and with professional guidance and supervision. When individuals fail to fuel themselves properly, they may experience reactive hypoglycemia (low blood sugar) or dysglycaemia (abnormal blood sugar levels) with an exaggerated insulin response. As a result, there is a subsequent dramatic drop in blood glucose, causing physical and emotional symptoms (see below). When blood glucose levels become unstable we can feel like we are on an energy roller-coaster throughout the day.

Symptoms can mimic other common issues such as anxiety or even menopause.

Symptoms of blood sugar dysregulation:

Nausea
Seeing flashes of light
Moodiness and “hangry” relief after eating
Negative attitude/ irritability
Exaggeration of relatively minor problems
Feeling emotionally flat or depression
Lightheadedness or dizziness
Sweating and flushes
Sugar cravings
Fatigue
Heart palpitations
Shakiness
Paleness
Cold/clammy skin
Poor concentration and memory

Thyroid issues, hormonal imbalances, or high exercise demands can exaggerate these symptoms, especially with inadequate fueling in between multiple daily training sessions. There are a number of simple steps that may help stabilise blood sugar.

1. Protein is essential to blood sugar stabilisation and should be included in every meal including breakfast. Quality protein can be found in lean animal meats (kangaroo, lamb, beef, chicken) and fish. Vegetarian options include tofu, tempeh, legumes, eggs, dairy, and high-protein grains such as quinoa, buckwheat and amaranth. Vegans and vegetarians must practice protein source combinations to obtain all the essential amino acids.. For example: consume chickpeas with brown rice.

Athletes should ideally consume 1.2-1.6 grams of protein/kilogram of body weight which equates to 60-80 grams of protein for a 50kg female and 90-128 grams for an 80kg male athlete per day. It is beneficial to have 20 grams of protein with carbohydrates within 30- 60 minutes of completing a training session. A good option is a smoothie with a scoop of protein powder (pea, brown rice or whey if tolerated), a small can of tuna or 2-3 eggs.

2. Carbohydrates
Intake of low GI (Glycemic Index) carbohydrates will help keep blood sugar levels more sustained, and energy levels consistent. A high GI carbohydrate will cause a surge in blood glucose, triggering a response from the pancreas. This can contribute to the symptoms described previously.

Good sources of complex carbohydrates include porridge, Bircher muesli, brown, basmati or wild rice, barley, oats, buckwheat, quinoa, amaranth, teff, rye, sweet potato, and root vegetables with skins on. Sourdough bread, corn on the cob, bananas, fruit smoothies with protein powder, and homemade muffins using wholemeal flours such as hemp, chia or buckwheat are all good options. Consuming carbohydrates with quality fats and soluble fibre also reduces the GI of foods.

3. Magnesium
Magnesium assists with blood sugar control by supporting healthy insulin secretion.

Magnesium is abundant in amaranth (a grain), pumpkin seeds, dark chocolate and raw cocoa, wholemeal bread, quinoa, firm tofu and dark leafy vegetables. It is also found in oat bran, brown rice, cooked spinach, avocado, coconut water, kale, legumes, sesame seeds and cashews.

4. Chromium
Chromium deficiency reduces your body’s ability to use carbohydrates for energy and raises your insulin needs. Chromium may enhance the effects of insulin or support the activity of pancreatic cells that produce insulin. Chromium is found in meats, fish, poultry, wholegrains, dairy, broccoli, cheese, mushrooms, asparagus, green beans, apples, bananas, grape juice and potato.

5. Probiotics
Probiotics especially those containing more than one species of beneficial bacteria may help regulate blood sugar by influencing the way the body metabolises carbohydrates by reducing inflammation and preventing the destruction of pancreatic cells that make insulin.

Maintaining energy throughout the day

Have regular meals throughout the day eating every 2 hours
Consume protein at every meal. Aim to make up at least 1/3 of your meal from protein
Stay hydrated by drinking water regularly (2-3 litres per day minimum)
Cinnamon, nutmeg, cloves, vanilla, stevia, and ginger can all be used instead of sugar to add sweetness to food.
Carbohydrates higher in fibre and from unprocessed sources are better
Consume carbohydrates within 30 minutes of completing a session
Fat reduces gastric emptying time and as a result, slows down the absorption of glucose from the meal. Consume beneficial fats with carbohydrates from raw nuts and seeds, fish, avocado and cold-pressed oils.
Increasing the acidity of food or meals will slow gastric emptying time. A simple tip is to add vinegar dressing to salad or vegetables.
Short-term supplementation of magnesium, chromium, probiotics or cinnamon, and other blood sugar-stabilising herbs and nutrients may be beneficial for some individuals.

Always seek help from a healthcare practitioner if your symptoms persist.

The amino acid leucine is of particular importance to female athletes keen to optimise recovery across the menstrual cycle. Leucine is one of the nine essential amino acids the body needs to obtain through the diet. Leucine along with other amino acids, are required for protein synthesis, tissue repair and nutrient absorption.

The demand for protein changes throughout the menstrual cycle. The fluctuations in estrogen and progesterone have a profound effect on muscle turnover and protein synthesis. Amino acids like leucine are harder to access during the high hormonal phase (day 12 to day 23 of a typical 28 day cycle). It is suggested to be harder for females to build and maintain muscle during this hormonal phase making it even more important to ensure adequate intake of essential amino acids during this time.

Strength training including weights or resistance stimulates muscles to take up leucine (and other amino acids) and triggers muscular growth. Leucine can help prevent the deterioration of muscle with age so it is super important for masters athletes to obtain adequate leucine in order to optimise recovery.

The richest sources of bio-available protein including leucine are in eggs, milk, fish, and meats. Milk contains both whey and casein protein. Whey is more easily absorbed and is higher in leucine than casein. Whey is also digested at a much faster rate than casein, ensuring blood leucine levels rise soon after ingestion and triggering protein synthesis responsible for building muscle. Hence why many athletes swear by chocolate milk as their preferred recovery drink. Female athletes need additional leucine to optimise recovery and would benefit from options such as a post-workout smoothie including yogurt, milk, protein powder or almond butter.

Recent research also suggests that the combination of other highly bio-available proteins rich in leucine results in more favourable muscle hypertrophy compared to other proteins such as whole milk protein, casein and soy protein.

Vegans and athletes with dairy intolerance

Athletes who choose to avoid dairy need not feel they are missing out. Interestingly, a recent study found both whey and rice protein isolate administration post-resistance exercise improved body composition and exercise performance with no differences between the two groups when taken in adequate amounts.

Leucine-rich foods

Leucine can also be found in plant-based proteins included including soy, lentils, kidney beans, tofu, quinoa, hummus, rice, and almonds. These plant proteins contain approximately 50% less leucine. Therefore vegan athletes need to pay attention to getting enough high-quality plant proteins that offer the optimal amount of leucine (about 2.5 grams per meal or snack).

Vegans want to consistently enjoy soy, beans, legumes, seeds and/or nuts regularly at every meal and snack. Don’t have just porridge for breakfast; add organic soy milk and walnuts. Don’t snack on just an apple; slather apple slices with peanut butter. A blend of rice and pea protein powders makes a good substitute for whey-based protein powders. Some plant-based protein powders also provide added amino acids, making them a good choice for dairy-intolerant or plant-based athletes.

As a general guide 2 grams of leucine can be found in 120 grams beef, 130 grams almonds, 400 grams tofu, 3 eggs, 600ml cow’s milk or 900ml soy milk, 380 grams lentils, 350 grams kidney beans, 70 grams cheddar cheese, 350 grams yogurt, 27 grams whey protein isolate, 50 grams rice protein powder.

Elite athletes with large volumes of training may struggle to obtain adequate leucine from their diet alone, especially if vegan. These athletes may consider using protein and collagen powders including leucine, isoleucine and valine 30 minutes pre and post-workouts in addition to a diet rich in leucine to optimise recovery.

This table compares the leucine content of plant and animal foods.

Animal food	Plant food (swap)	Leucine (g) approx
Eggs, 1 large	Peanut butter, 2 tablespoons	0.5
Milk, ½ cup	Soy milk, low fat, 1 cup	0.5
Tuna, 25 grams	Black beans, 1/2 cup	0.7
Chicken, 60 grams cooked	Tofu, extra firm, 170 grams	1.4
Cheese, 14 grams	Almonds, 21 grams	0.3
Beef, 40 grams	Lentils, 1 cup	1.3

We recommend including a variety of leucine rich foods in your diet in order to optimise recovery.

Most women’s daily protein intake should account for 30% of their diet to optimise recovery. A gram of protein per kilogram of body weight is adequate for recreational athletes, while elite athletes may require up to 1.8 grams per kilogram of body weight, especially when competing in power and high-end endurance sports. On lighter recovery days protein intake can be reduced slightly keeping in mind other processes in the body require adequate protein intake (hormones and immune cells for example).

Consuming 20-25 grams of protein within 30 minutes of finishing a session is ideal for optimal recovery while having a protein-rich snack such as a high protein, low-fat yogurts such as YoPro or Chibani Fit at bedtime can boost protein synthesis by 22 %.

When you wake in the morning you are in a catabolic state after fasting for 10-12 hours during the night while sleeping. Having a protein-rich breakfast is really important to optimise recovery, restock your glycogen stores, fuel your daily activities and prevent overeating and sugar cravings later in the day. Great breakfast options to optimise recovery include scrambled eggs on toast or an omelette with sweet potato and veggies, a protein-rich smoothie, porridge with added yogurt or protein powder or scrambled tofu.

Vegetarian and vegan athletes are at greater risk of anaemia due to reduced intake of animal products containing iron and B12.

It is important to remember there are two different forms of dietary iron.

Heme iron is found in animal meats such as liver, lamb, beef and kangaroo.
Non-heme iron is derived from plant sources such as legumes, dried fruits, nuts and leafy green vegetables, tofu and eggs.

Heme- iron is the more readily absorbed form of iron. Eggs and many plant foods also contain non-heme iron, but have reduced bio-availability compared to meat sources. Vegetarians and non-meat eaters need to be mindful to consume adequate amounts of non-heme iron along with foods that enhance iron absorption

The key to maintaining iron adequacy is to consume non- heme rich foods at every meal and load your diet with healthy wholefood plant sources that are packed in all the co-factors such as vitamin C, bioflavonoids and folate. These co-factors help extract and absorb iron at every opportunity throughout the day. Avoidance of foods that contain nutrients which inhibit iron absorption is even more important for vegetarians and vegans as they have less room to move.

Iron absorption will be decreased by up to 60% if you have tannin-containing drinks or foods such as teas, coffee, red wine, peppermint tea and chocolate within two hours of an iron-rich meal.

This doesn’t mean you have to go completely without your treats, it just means you are best to have them in moderate amounts and avoid having them at the same time.

Mother nature also provides a reminder of blood-building foods in red-coloured plant foods. Beetroot, rhubarb, berries, dried figs and plums all contain iron.

Vegetarian Meal Plan

Breakfast: scrambled eggs (2), ½ cup spinach (cooked) plus 1 grilled tomato and 2 slices wholemeal toast with butter. Include a large glass of freshly squeezed orange, parsley and kiwi juice.

Morning tea: 50g dried apricots plus 50g activated almonds

Lunch: cooked lentils (1 cup) with 1/2 cup quinoa, ½ cup fresh tomato added at last minute, 1 cup salad greens including capsicum, grated carrot, shredded cabbage and 1 tablespoon of tahini dressing

Afternoon tea: 1 bowl of Beet Berry smoothie bowl with coconut and cereal topping

Dinner: 1 cup grilled tempeh (fermented tofu) with 1/2 cup steamed broccoli, 1/2 cup baked pumpkin and 1 beetroot with lemon, parsley and olive oil dressing

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