Women's Health Archives - Page 2 of 2

Have you ever heard of hepcidin? It’s worth understanding mainly if you are a female athlete or someone who suffers from iron deficiency anaemia.

Iron is an essential element for many biological processes. Too little iron can have many detrimental effects on your health and sports performance. We have previously discussed the impact iron deficiency and anaemia has on thyroid health and poor immunity. Excess iron can be toxic, so regulating iron levels are vital to a healthy, balanced body.

Hepcidin is an iron-regulating peptide hormone that’s produced in your liver. It works to control the delivery of iron to your blood from food through the lining of the intestines. It is the master regulator in iron metabolism and the balance between iron storage and the absorption better known as iron homeostasis. Hepcidin also tightly influences red blood cell production.

When hepcidin levels are unusually high, it reduces intestinal iron absorption and red blood cell production. Low hepcidin levels stimulate iron absorption, and iron supply to bone marrow and promote hemoglobin and red blood cell production. Iron deficiency is common among female athletes, and is much higher than their male counterparts. It is often cited as being a result of the menstrual cycle during premenopausal years. Depleted iron stores can have many adverse effects, including poor performance, low energy levels, and general well-being.

Some research has shown that active females with compromised iron possess an inherent protective mechanism once iron deficient. This adaptation allows the body to adjust to a reduced iron supply. It is proposed iron depletion may be a combination of exercise-induced losses and hepcidin accumulation.

Running is known to acutely increase hepcidin levels (peaking three hours post-exercise), therefore reducing iron absorption and recycling.

Timing iron supplementation to correlate with low hepcidin levels may enhance absorption and positively impact iron levels in the blood. In practical terms, if you exercise in the morning, you might consider taking your iron supplement straight after you exercise, before hepcidin rises.

Hundreds of athletes have used our handy anaemia quiz to help determine the likely risk of having low iron or anaemia. we encourage you to use this free tool if you have a history of iron deficiency or you are unsure if your iron stores may be declining.

Want to know more? Contact the Athlete Sanctuary to learn how we can support you further. Book an appointment here.

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

References

Ganz, T. (2016). Hepcidin. Rinsho Ketsueki, 57(10), 1913-1917. DOI: 10.11406/rinketsu.57.1913.

Sim, M., Dawson, B., Landers, G., Trinder, D., & Peeling, P. (2014). Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. International journal of sport nutrition and exercise metabolism, 24(2), 177-187.https://pubmed.ncbi.nlm.nih.gov/24225901/

Alfaro-Magallanes, V. M., Benito, P. J., Rael, B., Barba-Moreno, L., Romero-Parra, N., Cupeiro, R. FEMME Study Group. (2020). Menopause Delays the Typical Recovery of Pre-Exercise Hepcidin Levels after High-Intensity Interval Running Exercise in Endurance-Trained Women. Nutrients, 12(12), 3866. https://pubmed.ncbi.nlm.nih.gov/33348847/

Nirengi, S., Taniguchi, H., Ishibashi, A., Fujibayashi, M., Akiyama, N., Kotani, K., & Sakane, N. (2021). Comparisons between serum levels of hepcidin and leptin in male college-level endurance runners and sprinters. Frontiers in Nutrition, 8. https://pubmed.ncbi.nlm.nih.gov/34136516/

Pagani, A., Nai, A., Silvestri, L., & Camaschella, C. (2019). Hepcidin and anemia: a tight relationship. Frontiers in physiology, 1294. https://www.frontiersin.org/articles/10.3389/fphys.2019.01294/full

Sim, M., Dawson, B., Landers, G., Trinder, D., & Peeling, P. (2014). Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. International journal of sports nutrition and exercise metabolism, 24(2), 177-187. https://pubmed.ncbi.nlm.nih.gov/24225901/[/vc_column_text][/vc_column][/vc_row]

Anaemia caused by iron deficiency is a condition in which there is not enough iron to form enough healthy red blood cells of sufficient size to carry oxygen to the tissues of the body.

Iron plays a crucial physiological role in your body. But despite its importance, iron deficiency anaemia is still a common problem among female athletes. Iron deficiency can have major adverse effects on your well-being and your athletic capacity.

It’s not uncommon for iron deficiency anaemia to be quite mild and go unnoticed. But women – and especially active, athletic women – are very prone to this condition. If gone untreated, the anaemia will worsen, and the signs and symptoms will intensify.

Without enough iron, your body can’t produce enough hemoglobin – the substance in red blood cells that enables them to carry oxygen – and as a result iron deficiency anaemia can leave you short of breath, headachy, tired, and unable to complete a training session or event with your usual enthusiasm. Iron deficiency is missed in 47-82% of females and 95-100% of male adolescents and young adult patients.

10 signs of iron deficiency

*Fatigue that starts even after a good night’s sleep

*Restless legs

*Nausea

*Bruising

*Pale or itchy skin

*Hair loss

*Shortness of breath

*Poor concentration and decision-making, “foggy brain”

*Rapid heartbeat or “fluttering feeling”

*Headache, dizziness or light-headedness

Keep in mind this is just a small number of the 75 known symptoms of iron deficiency. Unusual cravings for non-nutritive substances, such as ice and dirt

CAUSES OF IRON DEFICIENCY

Low or little dietary intake of iron-rich foods is often blamed as the key factor contributing to iron deficiency. With plant-based eating increasing in popularity amongst the athlete community, this is a key factor for many athletes. Lack of awareness of how to consume foods that enhance iron absorption or knowledge on sources of plant-based iron-rich foods can render an athlete with symptoms in a matter of months. Poor intake however is not the only cause of iron deficiency anaemia.

*Blood loss. Blood contains iron within red blood cells. If you lose blood, you lose some iron. Women with heavy periods are at risk of iron deficiency anaemia because they lose blood during menstruation. Athletes who are frequent blood donors are at increased risk for iron deficiency.¹ Athletes who regularly use nonsteroidal anti-inflammatories are likely to have increased gastrointestinal blood losses increasing their risk of iron deficiency³.

*An inability to absorb iron. Dietary iron is absorbed into the bloodstream through the small intestine. An intestinal disorder, such as celiac disease, stomach ulcers, ulcerative colitis or Crohn’s disease, which affects the intestine’s ability to absorb nutrients from digested food, can lead to iron-deficiency anaemia. If part of the small intestine has been bypassed or removed surgically, the ability to absorb iron and other nutrients will be reduced. Inflammation in the digestive tract is aligned with symptoms such as bloating, gas, diarrhoea or constipation, food intolerances, or loud gurgling, and may signal the integrity of the gut lining may be compromised. Without good integrity, absorption of nutrients is also reduced.

*Low stomach acid. Adequate stomach acid (hydrochloric acid- HCL) is required to break down minerals such as iron and extract them from the food we eat. Low stomach acid is a common issue following times of prolonged physical or emotional stress and can be found alongside iron deficiency.

*Iron stealers. Bacteria overgrowth, Helicobacter pylori, and parasites within the digestive tract can impact the way iron is absorbed and may contribute to blood loss, therefore, contributing to iron deficiency over time.

*Post natal– Without iron supplementation, iron deficiency anaemia occurs in many pregnant women due to the iron requirements of the mother and baby. Post-natal iron deficiency can occur as many women are naturally preoccupied with their new arrival and forget to have adequate medical checkups for themselves. Fatigue is often experienced by mother’s and therefore iron deficiency can go undetected for many months. This depletes not only the mother but also the baby’s supply of iron who depends on the mother for iron for the first 6 months of life until solids are introduced.

Hundreds of athletes have used our handy anaemia quiz to help determine the likely risk of having low iron or anaemia. Find out if you are getting low on iron here.

Want to know more? Contact the Athlete Sanctuary to learn how we can support you further.

References

Choe, Y. H., Kwon, Y. S., Jung, M. K., Kang, S. K., Hwang, T. S., & Hong, Y. C. (2001). Helicobacter pylori-associated iron-deficiency anemia in adolescent female athletes. The journal of Pediatrics, 139(1), 100-104.
Eiduson, R., Heeney, M. M., Kao, P.-C., London, W. B., Fleming, M. D., & Shrier, L. A. (2022). Prevalence and Predictors of Iron Deficiency in Adolescent and Young Adult Outpatients: Implications for Screening. Clinical Pediatrics, 61(1), 66–75. https://doi.org/10.1177/00099228211059647
Safarova, K. N., Dorogoykina, K. D., & Rebrov, A. P. (2019). Is anemia a clinical marker of NSAID-induced upper gastrointestinal lesions in patients with spondyloarthritis?. Almanac of Clinical Medicine, 47(5), 410-418. https://doi.org/10.18786/2072-0505-2019-47-037
Hinton P. S. (2014). Iron and the endurance athlete. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolism, 39(9), 1012–1018. https://doi.org/10.1139/apnm-2014-0147
Mayo Clinic (2022). Iron Deficiency anemia. https://www.mayoclinic.org
Sim, M., Dawson, B., Landers, G., Trinder, D., & Peeling, P. (2014). Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. International journal of sports nutrition and exercise metabolism, 24(2), 177–187. https://doi.org/10.1123/ijsnem.2013-0067

Relative Energy Deficiency in Sport – or RED-S as it is known – is caused when there’s a negative balance between dietary energy intake and the energy output needed to promote optimal health, performance, growth and daily life.

Up until 2014 RED-S was referred to as the female athlete triad – disordered eating, menstrual disturbances and low bone density. At this time the International Olympic Committee updated their position statement with the new term (RED-S) to be far more reflective of the wider-spread effects in both female and male athletes – on performance and throughout the body.

In 2018 the IOC published the RED-S Consensus Statement Update.

More than 10% of athletes experience RED-S throughout their career, yet despite its potential to have such adverse effects, RED-S is still only just becoming widely recognised and discussed within a majority of sports.

Symptoms of RED-S

There are many physical symptoms of RED-S, including:

Fatigue
Recurring illness
Difficulties staying warm in the winter and cool in summer months
Poor sleep quality
Stress fractures and low bone mineral density, and impaired accumulation of peak bone mass (PBM)
Weight loss, or below healthy weight
Growth restriction in junior and teenage athletes
Disordered eating or eating disorders such as bulimia or anorexia, orthorexia, restrictive disorders or recurrent dieting/fasting
Digestion issues
Vitamin and mineral deficiencies
Metabolic disturbance
Menstrual disfunction

But REDS can also have far-reaching behavioural and psychological effects as well, including:

Pre-occupation and constant discussion around food
Poor sleep patterns
Restricting or strict control over food intake
Overtraining or struggling to take rest days
Impaired judgement, coordination and concentration
Recurrent soft tissue injury
Irrational behaviour
Fear of food and weight gain
Severe anxiety
Withdrawing or becoming reclusive
Reduction in motivation
Depression

REDS can have an incredibly adverse long-term effect on athletic performance, including an increased risk of injury and decreased training and performance responses. These effects can include:

Decreased muscle strength
Decreased endurance performance
Impaired judgement
Decrease in coordination
Decrease in concentration
Decrease in glycogen stores
Negative impacts on muscle recovery
Poor muscle growth
Increased risk of injury

WHAT ARE THE LONG-TERM EFFECTS OF REDS?

The majority of our bone density is formed during our teenage years. If our bone density formation is impacted during our adolescence or early in our adult years, it can lead to issues with bone weakness and osteoporosis later on in life.

Longer-term, REDS can also have a negative impact on fertility, thyroid function, cardiovascular function, and mental health.

The good news is that most of the negative consequences of RED-S can be reversed if picked up early.

WHAT ARE THE COMMON MYTHS SURROUNDING REDS?

The common perception that athletes with RED-S have an eating disorder is false. Although eating disorders are associated with RED-S not all athletes with eating disorders have RED-S and not all athletes with RED-S have an eating disorder.

It’s true to say that athletes with RED-S can present as underweight- but this is not true in all situations. RED-S can exist without the athlete appearing to be underweight.

RED-S is also not something that just female athletes suffer from. All athletes competing in sports with higher training volumes or weight category restrictions are at a higher risk of developing RED-S. This can include athletes competing in sports that can be judged by aesthetics including figure skating, gymnastics and synchronised swimming, and body weight-dependent sports including long-distance running, mountain biking, and cycling, and weight classed sports such as lightweight rowing and marshall arts.

In one study 44% of ultra-endurance runners were identified as being at risk of developing RED-S while 39% of elite female sprinters should signs of RED-S.

“RED-S can occur in athletes of any competitive status. Among world-class endurance athletes, 37% of females presented with amenorrhea and 40% of males with testosterone in the lowest quartile range indicative of RED-S, which is similar to the reported 40% of Australian female athletes competing at the 2016 Rio Olympic games who were identified as at risk of RED-S. Similarly, among recreational female exercisers, 45% had risk factors associated with RED-S.” (Sports Information Resource Centre).

WHAT SHOULD I LOOK OUT FOR?

The most important piece of advice when it comes to RED-S is – listen to your body. Don’t ignore niggles and definitely don’t skimp on sleep and recovery. You should also:

Monitor menstrual cycles
Think about your relationship with food and/or exercise
Be mindful of your eating patterns: disordered eating to eating disorder.
Notice your exercise dependence
Monitor your behaviour, mood and sleep patterns
Notice change in clothing fit
Be aware of growth and development
Note injuries, illness and gastrointestinal issues
Athletic performance (stagnation-deterioration)
Try to be flexible in your approach

WHERE TO GET HELP

We appreciate that talking about many of the symptoms associated with RED-S can be difficult. Our Sports Naturopath and Holistic Coach Kate Smyth has extensive lived experience with REDS in elite sport and provides a discreet and confidential platform to share your concerns.

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

Resources

The Sport Information Resource Centre: SIRC,

Berg, S. E. (2021). The Relationship between Eating Disorders, Weight Control Methods, and Body Satisfaction in Elite Female Runners Competing at the 2020 US Olympic Marathon Trials.

Sygo, J., Coates, A. M., Sesbreno, E., Mountjoy, M. L., & Burr, J. F. (2018). Prevalence of indicators of low energy availability in elite female sprinters. International Journal of Sport nutrition and exercise metabolism, 28(5), 490-496.

The high demands of sports make athletes more vulnerable to illness, with 65% of athletes experiencing regular colds and infections. Zinc is a key nutrient required for immunity and keeping an eye out for low zinc symptoms, may just make the difference between being sick or great performances.

It can be so frustrating to put in many months of hard training only to be sidelined during a taper or on race day by heaving lungs, debilitating fatigue, and a pounding headache. Sports performance is materialised through consistency, akin to writing a book, one page at a time. Forced breaks from training due to illness detract from progress and drains confidence. Not all athletes rest when unwell and opt to “push through” the illness only to experience prolonged symptoms and more disruption to competition.

Building a robust immunity is all part of a holistic approach to coaching and training. So how do you minimise your risk of getting sick?

There are many nutrients that contribute to a healthy immune system as discussed previously.

Athletes may be more susceptible to being deficient in zinc because exercise, particularly strenuous and endurance exercise, increases zinc requirements, encourages zinc loss through sweating, and changes zinc transportation and metabolism.

In our opinion, zinc plays the most critical role in supporting athletes and immunity.

Zinc’s role in hormone control and immunity

Zinc regulates several crucial processes in both your innate and adaptive immune system. Being deficient in zinc can lead to athletes becoming more susceptible to respiratory illness, particularly in the colder months.

Apart from zinc’s well-established role in immunity, this mineral, contributes to protein structure, regulates gene expression, metabolism and is the second most abundant trace element in the body after iron. Zinc deficiency can impact an athlete through hormone dysregulation (testosterone, thyroid, and growth hormones to name a few) and may affect erectile function and fertility.

Zinc is essential to maintaining optimum performance due to its function in metabolism and healthy cell division – essential in repairing damaged tissues after you exercise.

Studies show being deficient in zinc can lead to a reduction in the number of fast-twitch muscle fibres and muscle mass and performance decline. For Masters Athletes this is of particular relevance as aging is also associated with sarcopenia, the age-related loss of muscle mass, muscle strength, and physical performance.

Zinc also helps maintain blood sugar control and assists with muscle contraction during exercise, glucose metabolism, and glycogen storage.

Zinc also plays an essential role in antioxidant production by increasing antioxidant activity and inhibiting free radical production that may damage tissues, impact liver function, and prevent muscle exhaustion.

Low zinc symptoms

Apart from recurrent colds and other infections, there are many low zinc symptoms.

*Anxiety and depression

*Hormone imbalances

*Poor concentration

*Stomach pain and gas

*Slow healing

*White spots on nails

*Skin issues and acne

*Loss of appetite

*Loss or change of smell

*Changes in taste

Zinc rich foods

The most concentrated sources of zinc are contained in animal products, particularly meat, seafood and dairy. Vegan and plant-based athletes may be more susceptible to zinc deficiency due to reduced dietary intake, lowered gastric acid (which is zinc-dependent) and higher phytate consumption. Phytates found in plant-based zinc-rich foods such as legumes can inhibit zinc absorption.

Soaking nuts and seeds and legumes prior to cooking is a great way to minimise this issue and allow for greater micronutrient absorption.

Iron absorption

The gastrointestinal tract plays an important role in maintaining total body zinc homeostasis by regulating zinc absorption and excretion. In order to boost your absorption, the addition of a probiotic may be beneficial.

In certain situations, zinc supplementation may be recommended. The amount ingested, supplement form, and the timing of zinc matters. Speak to a naturopath or nutritionist with an interest in sport before self-prescribing. You’ll definitely want to avoid zinc toxicity. High zinc levels can have a detrimental impact on your performance through anaemia, copper and iron deficiency and unpleasant gastrointestinal side effects.

Zinc testing

Serum blood testing is used by some conventional practitioners to determine zinc levels in the body. Keep in mind 60% of zinc is stored in muscle and 30% in bone therefore serum may not be the best measure of zinc homeostasis. A mineral test can be another alternative method of assessing zinc levels and is available through our clinic as explained here.

If you need help building a robust immune system, book an appointment with our naturopath.

References

N. Walsh. Nutrition and Athlete Immune Health: New Perspectives on an Old Paradigm.
2019 Nov 6. doi: 10.1007/s40279-019-01160-3.
A. Venderley, W.Campbell. Vegetarian diets : nutritional considerations for athletes.
2006;36(4):293-305. doi: 10.2165/00007256-200636040-00002.
J.Hernández-Camacho, C. Vicente-García, D. Parsons, I. Navas-Enamorado. Zinc at the crossroads of exercise and proteostasis.
2020, 101529, ISSN 2213-2317. doi.org/10.1016/j.redox.2020.101529.
P. Trumbo, A. Yates, S. Schlicker, M. Poos. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.
2010 March.101(3):294-301. doi: 10.1016/S0002-8223(01)00078-5.
A. Baltaci, R. Mogulkoc, S. Baltaci. Review: The role of zinc in the endocrine system.
2019 Jan;32(1):231-239. PMID: 30772815.
P.Ranasinghe, S. Pigera, P. Galappatthy, G. Katulanda, & R. Constantine. Zinc and diabetes mellitus: understanding molecular mechanisms and clinical implications.
23(1), 44. doi.org/10.1186/s40199-015-0127-4
M. Hambidge, N. Krebs. Zinc metabolism and requirements.
2001;22(2):126-132 doi: 10.1177/156482650102200202

Iron deficiency is one of the most common issues athletes face. Iron and thyroid health go hand in hand and the effects of exercise on the thyroid gland and hormones are not well understood.

Iron and thyroid function
Undiagnosed iron deficiency presents an increased risk of impaired thyroid function. Active women have high-energy lives, managing work, family and training, and many will accept low energy and brain fog as simply a result of being overworked or as an inevitable part of hormonal changes.

However, low thyroid function, iron deficiency, overtraining and hormonal changes also present with many of the same symptoms.

Signs that your thyroid function may be underactive (hypothyroid) include fatigue, unexplained weight gain, headaches, low blood pressure, dry skin, constipation and cold intolerance. These early signs of cellular hypothyroidism can appear when blood pathology remains within standard ranges.

As with most chronic issues, there are multiple factors that may contribute to dysfunction.

The Link between Exercise and Thyroid Function

In athletes, endurance and high-volume training promotes thyroid function. During exercise, your hypothalamus stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which in turn signals your thyroid to synthesise and release the thyroid storage hormone T4 and active thyroid hormone T3.

These hormones influence your body’s metabolism and allow it to increase exercise intensity. Over time, this repeated, high demand of your thyroid during prolonged intense exercise may impact your thyroid function, causing it to slow down and consequently lose the ability to produce sufficient hormones.

Iron and Thyroid Function

Normal thyroid function is dependent on several nutrients to regulate the synthesis of thyroid hormones. Iodine, iron, tyrosine, selenium, and zinc are needed to facilitate the conversion of T4 to T3 . A deficiency of any one of these nutrients would result in reduced T3 production, causing you to experience hypothyroid symptoms. Vitamins A and D also play important roles in cell receptor behaviour to regulate thyroid hormone metabolism.

While iodine is the key mineral for healthy thyroid function (read more…here) it is not uncommon to find iron deficiency in hypothyroidism. Although widely recognised for its influence on red blood cell production, iron is also an important component of thyroid peroxidase, an enzyme essential for thyroid hormone biosynthesis.

Iron deficiency interferes with the normal functioning of the thyroid, contributing significantly to fatigue, exercise intolerance and lightheadedness.

Increased menstrual bleeding can lead to iron deficiency. Many of us dismiss low energy as a symptom of a busy, active lifestyle and so iron deficiency frequently goes undiagnosed in perimenopausal women. For athletes, iron plays a critical role in exercise performance as outlined in our blog “Increase your iron absorption and rebound from anaemia” here

The most common causes of iron deficiency include inadequate dietary iron intake, inflammation, poor iron absorption in the gut, parasites, iron loss through sweat, urination and faeces, blood loss through menstruation. Pregnancy, breastfeeding or high-volume exercise will also significantly increase iron demands. Take our free anaemia quiz to see if you may be iron deficient here

Thyroid Function and Sex Hormones in Women

Your thyroid function is sensitive to fluctuations in sex hormone levels, particularly oestrogen. Oestrogen stimulates the production of the thyroid hormone precursor, thyroglobulin, and increases the protein that carries thyroid hormones in your blood.

As oestrogen changes (such as during peri-menopause) so too does thyroid hormones, which play an important role in metabolism, muscle strength, energy production and expenditure, heart function, and temperature regulation.

As oestrogen levels rise and fall later in life, menstruation may become irregular and heavier. Peri-menopausal women may experience symptoms for over ten years as described in our blog on “Natural solutions for menopause” here .

During peri-menopause declining oestrogen may impact thyroid function and can lead to inadequate production and circulation of thyroid hormones.

Exercise During Hormonal Changes

Despite common misconceptions, women can train and perform well throughout peri-menopause, and beyond, if they listen to their bodies and be mindful of maintaining adequate dietary intake of key nutrients. It is important to recognise that both iron deficiency, thyroid function and hormonal changes can impact your ability to exercise.

Years of consistent exercise accumulate like pages in a book. As a mature you know your body very well. The pathway to success utilises your book of wisdom and skills. Mature athletes can benefit from greater recovery, individualized strength and conditioning and modified programs. Focussing on the balance between training intensity and volume will help you to achieve your desired goals.

If you suspect your symptoms are impacting on your quality of life and sport, it’s time to seek support to help you navigate the journey.

Blood serum pathology and functional tissue mineral testing can be a good starting point due to the critical role nutrients play in hormonal and thyroid function.

With the right self-care and a holistic approach to health, you can continue to achieve your life goals and physical challenges irrespective of hormonal changes.

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

References

Kawicka, A., & Regulska-Ilow, B. (2015). Metabolic disorders and nutritional status in autoimmune thyroid diseases. Postepy Higieny i Medycyny Doswiadczalnej, 69, 80–90.
Luksch, J. R., & Collins, P. B. (2018). Thyroid Disorders in Athletes. Current Sports Medicine Reports, 17(2), 59–64.
Santin, A. P., & Furlanetto, T. W. (2011). Role of estrogen in thyroid function and growth regulation. Journal of Thyroid Research, 2011.
Soliman, A. T., De Sanctis, V., Yassin, M., Wagdy, M., & Soliman, N. (2017). Chronic anemia and thyroid function. Acta Biomedica, 88(1), 119–127.
Wouthuyzen-Bakker, M., & Van Assen, S. (2015). Exercise-induced anaemia: A forgotten cause of iron deficiency anaemia in young adults. British Journal of General Practice, 65(634), 268–269.

Some women experience absolutely no symptoms during their transition through menopause but if you are like 80% of women who do, it’s reassuring to know there are treatment options available. Help for menopause is here.

Perimenopause is the stage where most of the symptoms begin and these can persist for over a decade. Menopause officially commences 12 months after your last period. Women can go through menopause anywhere between the ages of 40 and 58 years but the average age is 52 years. Symptoms can occur due to the falling levels of estrogen and progesterone, which has a multifaceted impact on organs and tissues throughout the body.

Most women identify menopause with hot flushes, night sweats, vaginal dryness, mood swings, poor libido and fatigue. Symptoms usually occur in the perimenopausal phase due to declining progesterone. Oestrogen actually increases to levels 30% higher than before but can go through periods of variations similar to a roller coaster leading to insomnia, depression, poor concentration, irritability, anxiety and poor stress tolerance and lethargy. In the later stages of perimenopause, oestrogen declines which may contribute to other symptoms such as heart palpitations, joint pain, osteoporosis and mental health issues.

One of the associated effects of estrogen decline is an increased risk of osteoporosis. This is due primarily to the 1-2% loss of bone density per year of menopause, as well as 10 years post-menopause. Estrogen decline is also associated with elevated cholesterol, cardiovascular disease, hypothyroidism, urinary tract infections and thrush.

Some women have concerns about the use of hormone replacement therapy (HRT) or are unable to use this option due to breast or ovarian cancer risk. Fortunately, there is now a large body of evidence that supports the use of herbal and nutritional medicines during the menopausal transition.

DIETARY INTERVENTIONS

Phytoestrogens are naturally occurring estrogen-like compounds found in plants, fruits, or vegetables and are commonly divided into three main classes: isoflavones, lignans, and coumestans.

Isoflavones are found in the legume family, with high amounts in soybeans and soy products.

Lignans are found in high-fibre foods such as unrefined grains, cereal brans, and beans, with flaxseed being a particularly good dietary source of lignans. A recent systematic review found that women who consumed protein bars containing flaxseed (410 mg of lignan) for 6 weeks reported a 50% decrease in hot flushes. Seed cycling can be helpful for women who want to boost their intake of fatty acids and lignans.

Coumestan-rich foods include alfalfa and clover sprouts, peas, pinto beans, and lima beans.

Herbs

Hops (Humulus lupulus) dampens tension and anxiety. The active ingredient in hops, 8-prenylnaringenin, is a potent phytoestrogen and has been demonstrated to reduce vasomotor symptoms by improving the ability of the blood vessels to expand and contract. Numerous clinical trials have also documented significant reductions in the frequency of hot flushes, sweating, insomnia, heart palpitations and irritability in women who used a hops extract for 6 weeks.

In clinical practice, a combination of herbs is often used to support women during the transition through menopause. Korean ginseng (Panax ginseng), which is considered to be a “buried treasure medicine”, is another popular herb for active women suffering from fatigue. Ginseng’s active constituents include saponins, amino acids, vitamins (particularly folic acid and niacin), alkaloids, phenolic compounds, and flavonoids. Ginseng has been widely used in traditional medicine to assist with building resilience to stress and used as an energizer, to increase libido, and testosterone and alleviate menopausal symptoms. Clinical trials have shown ginseng significantly reduced depression and improve perceived well-being, exercise performance and energy in perimenopause.

Another popular herb is chasteberry, or vitex. This herb has shown positive results in reducing PMS, anxiety, hot flushes and breast tenderness in perimenopausal women. Vitex is used to support the transition from perimenopause to menopause due to its ability to increase progesterone levels and help maintain a healthy balance between progesterone and estrogen.

For women experiencing persistent hot flushes or night sweats as a result of menopause, Red Clover (Trifolium Pratense) may often be prescribed. This herb contains high levels of phytoestrogens for improving hormonal balance, as well as helping improve bone density in those at risk of osteoporosis. Several clinical trials demon straight the isoflavones present in red clover inhibit bone resorption and therefore reduce bone turnover associated with osteoporosis.

Ginkgo Biloba is similar to red clover because of the phytoestrogens it contains and its ability to naturally elevate estrogen levels. Studies show that Ginkgo Biloba can reduce mood fluctuations associated with both PMS and menopause, as well as improving libido in 84% of trial participants after 4 weeks.

Sage, most commonly prescribed as a tea, has long been used in the management of fevers. However, there is also evidence to support the use of sage for menopausal hot flushes and night sweats. A study that assessed the use of fresh sage leaves in food or as tea demonstrated that the intensity and frequency of hot flushes were significantly reduced over a period of 8 weeks with consistent use.

Hormones play an integral role in your health, and changes in hormone balances can be challenging. There are many different ways that nutrition can be used to navigate menopause, without having to experience the numerous, negative side effects of HRT.

As with any element of health, there is never a one-size-fits-all approach and therefore we recommend individualised treatments for menopausal symptoms.

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.

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.

Women’s Health

Zinc testing

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