January 14, 2020
Today's article is a guest post by Dr. Jolene Brighten (pictured above), an expert in non-hormonal birth control, post-birth control syndrome, and the long-term side effects associated with hormonal contraceptives.
You can catch her on last week's podcast, “The Pill – Everything You Need To Know About The Dangers Of The Pill, How To Get Off It Safely & Safer, More Natural Birth Control Alternatives,” where we discuss how common forms of birth control can result in serious and dangerous health consequences like depression and an increased risk for autoimmune disease, heart attack, thyroid and adrenal disorders, and even breast and cervical cancer.
Dr. Brighten specializes in treating women’s hormone imbalances caused by the pill and has created a proven 30-day program in her new book “Beyond the Pill: A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill” designed to reverse the myriad of symptoms women experience while on the pill. Featuring simple diet and lifestyle interventions, her program is a crucial step to reversing the risky side effects of the pill, finally finding hormonal health, and getting your badass self back.
In today's article, you'll discover the truth about whether or not birth control contributes to weight gain, why women should care about testosterone, tips for supporting your hormones and leveraging them for increased athletic performance, what your options are for non-hormonal birth control, and much more!
Do Birth Control Pills Cause Weight Gain?
How and whether hormonal birth control contributes to weight gain has been a debate since the introduction of the pill. In fact, it is cited as one of the major barriers to women beginning hormonal birth control.
Studies suggest that the weight gain caused by the pill is most likely due to water retention or is minimal. However, in a 2014 Cochrane Review regarding birth control and weight gain, it was concluded that the “available evidence was insufficient to determine the effect of combination contraceptives (ethinyl estradiol and progestin) on weight, but no large effect was evident.”
In other words, it doesn’t appear that hormonal birth control directly causes weight gain, but we do need more evidence to understand where women’s concerns arise from.
While birth control may not be the cause of weight gain, there are other studies pointing toward a negative effect of the pill on body composition. In short, it may contribute to decreased muscle mass, strength gains, and thereby, reduced metabolism.
As it turns out, the connection between the pill and our health is more complicated than we imagined with many studies concluding that results are only true for some women. It's important to understand how the pill may work against your gym goals—and why we need to be looking at more than just weight loss, starting with its effect on one specific hormone, testosterone.
Testosterone And Your Metabolism
Testosterone is often thought of as the “male sex hormone,” but it's an important hormone in women’s health too. Testosterone plays a role in our mood, heart health, bone strength, libido, and muscle mass.
And while it can cause acne, oily skin, and hair loss when in excess, it is still an essential part of your health.
The pill is effective at lowering total and free testosterone. In 2014, The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis, concluded that the pill is effective at lower testosterone levels while increasing levels of sex-hormone-binding globulin (SHBG), a protein that binds free testosterone. So in addition to reducing testosterone production, it also binds to free testosterone available in the body via SHBG.
Acne and PCOS are some of the primary reasons women are prescribed the pill for non-contraceptive reasons because it is so effective at lowering testosterone.
As I explain in my book, Beyond the Pill, testosterone is rising in your cycle leading up to ovulation, during the follicular phase. Your follicular phase, following menstruation, is a great time to lift weights and build muscle. Testosterone has been shown in studies to increase muscle mass through protein synthesis.
In addition to lowering testosterone production, some birth control pills also block androgen receptors. Unfortunately, that means that androgens like testosterone and DHEA can't aid in muscle growth or stimulate positive changes to muscle tissue. And while blocking these receptors works wonderfully for decreasing acne, it could sabotage your long-term metabolic health.
In a natural menstrual cycle, you will also experience a rise in your metabolic activity and will burn more calories during certain times in your cycle. Most notably, women’s basal metabolic rate increases in the luteal phase. Unfortunately, while on the pill, you aren't ovulating and therefore won't enjoy the bump to your metabolism.
Does Suppressing Your Cycle Give You a Competitive Advantage?
For decades women have been told that suppressing their cycle could provide a competitive advantage. You might have heard recommendations that athletes begin or remain on the pill to overcome the decrease in exercise tolerance during the luteal phase.
Some studies have shown a decrease in time to exhaustion during the luteal phase, while other studies have noted that in temperate climates, there is no decrease in female athletic performance during the luteal phase.
In fact, a 2003 study published in the Medicine & Science in Sports & Exercise concluded that “regularly menstruating female athletes, competing in strength-specific sports and intense anaerobic/aerobic sports, do not need to adjust for menstrual cycle phase to maximize performance.”
All this biology can get complicated, so the point I want you to walk away with is this: You don't need to suppress your cycle with the pill to excel as an athlete.
In a randomized, double-blind, placebo-controlled trial in highly trained athletic women it was found that the use of “moderate dose triphasic oral contraceptives resulted in a mean decrease in VO2MAX of 4.7% compared to a 1.5% improvement in placebo.” (this is actually similar to what happens to VO2MAX in response to metformin, which Ben and I discuss in this podcast episode).
This decrease in VO2MAX, a test to evaluate cardiovascular fitness, was not associated with significant changes in weight or strength or endurance performance, but was accompanied by an increase in skin-fold measurements. The researchers concluded “the decrease in VO2MAX that occurs when oral contraceptive is taken may influence elite sporting performance in some women.” However, this study was only after using birth control for a couple of months and long term studies are needed to determine if there is a potential impact on athletic performance and if the decrease in VO2MAX persists after discontinuing.
Insulin Resistance and Hormonal Birth Control
Insulin is a key hormone in regulating blood glucose and is involved in strengthening the body of athletes. Studies have shown that hormonal birth control is associated with insulin resistance in some women. If you’re unfamiliar with the utilization of glucose by muscle and the role of insulin, I invite you to review this article for a deeper understanding.
In the “Metabolic Mayhem” chapter of Beyond the Pill, I provide in-depth information on how hormonal birth control affects our metabolism and insulin resistance and may even put us at risk for diabetes.
Supporting Your Hormones and Leveraging Them For Athletic Performance
Recently, the United States Women’s National Team (USWNT) soccer team attributed their win, in part, to tracking their menstrual cycle and implementing specific practices to leverage where they were in their cycle.
That’s right, working with your cyclical self has that level of potential.
Here’s how to support your hormones for athletic performance.
1) Track your cycle.
Record the first day you start your period, how long it lasts, and how many days until your next period as a starting place. If you have symptoms, record those. Once you get the pattern down of tracking your cycle, begin recording your exercise routines, including your max output, time to fatigue, and the time it takes to recover.
2) Work with a coach who understands your cycle.
Many women in my practice have found that by tailoring their exercise to their hormonal shifts they’ve been able to make tremendous gains. Find a coach who understands how to work with your cycle and support your cyclical nature. Kion has a number of coaches that specialize in women's health; browse them here. Both your physical activity and caloric intake will vary throughout a monthly cycle, which means extreme over-training or under-eating will not help you reach your goals.
3) Banish sugar and refined carbs
If you're on a medication like the pill that causes insulin resistance, blood sugar dysregulation, and potentially decreased metabolism, then eliminating offending foods is a must. This includes processed foods, desserts, white bread, and pastries. Does this mean you'll never get to have a slice of pie? Not at all. But it does mean you'll need to rein in those foods that spike blood sugar at least for a period of time in order to recover your metabolism. Read Ben's article, “The Ultimate Guide To Biohacking Your Blood Sugar Levels (And Why Sugar Sometimes Isn’t Bad).” for more on blood sugar.
4) Eat a nutrient-dense diet
My philosophy on food is to fill your plate with so much nutrient-dense goodness that you just run out of room for anything that doesn't serve your hormones and metabolic health. A bonus to eating protein, fat, and vegetables at every meal is that in addition to balancing blood sugar, it will also support your liver and gut in their ability to detoxify hormones.
5) Use smart supplements
If you’re using a medication like hormonal birth control that is known to deplete magnesium, zinc, CoQ10, B vitamins, and antioxidants then it is a good idea to not only build a diet that supports your body, but also bring on a quality multivitamin or prenatal.
6) Support your gut health
Your gut is one way you eliminate hormones you no longer need. Research shows oral contraceptives impact gut flora, adversely affecting estrogen metabolism with all its detrimental consequences including weight loss resistance. The pill also increases your risk for inflammatory bowel diseases like Crohn’s disease. Leaky gut and other gut issues also frequently trigger or exacerbate inflammation, and chronic inflammation paves the path for nearly every disease on the planet including obesity, and it certainly takes a toll on your gut. Ben has no shortage of resources for learning about and optimizing gut health. Here are a few to check out if you want to take a deeper dive:
- Dangerous Probiotic Myths, The Probiotic Ben Greenfield Uses, Anti-Aging Effects Of Probiotics, Should Males Vs. Females Take Different Probiotics & Much More.
- How To Fix Your Gut: 9 Bad Things That Happen When Your Digestion Goes Wrong, How To Hit The Reboot Button & The Best Way To Detox Your Body.
- Why Healthy People Get Broken Guts, And What You Can Do About It.
- What Your Gut Can Tell You About Exercise, Diet & Longevity (& The Best Way To Test).
- How To Beat Bloating & Customize Your Diet: An Overview Of Ben Greenfield’s Gut Results From Viome (& How To Know Which Foods Are Right For You).
- The Gut Super-Special: Eating Camel Poop, Weird Constipation Causes, Pig Whipworms & More: How To Banish Bloat, Fix Your Microbiome & Reboot Your Gut.
7) Time your meals
If you feel like your adrenals are shot and you're having episodes of hypoglycemia, then it may be necessary for you to eat regular meals. Otherwise, I encourage patients in my practice to engage in intermittent fasting with a simple practice of shutting down the kitchen at a certain hour in the evening and then not eating again until 12 or more hours the next day. Intermittent fasting has been shown to be effective for weight loss but, more importantly, helps maintain your lean body mass (aka muscle).
We're learning more and more that maintaining a healthy weight and body composition is about way more than just calories and time spent in the gym. So whether you're an athlete or just a frequently gym-goer, it's important to know how your homeyness and the birth control pill can potentially affect your energy levels and ability to achieve your goals.
Non-Hormonal Birth Control Alternatives
What are the options for preventing pregnancy other than hormonal birth control? Birth control has been instrumental in helping women to take control of their reproductive health. The ability to prevent an unplanned or unwanted pregnancy is important for all women.
Here is a brief list of non-hormonal birth control options:
Condoms are an effective means of preventing pregnancy when used correctly. When used properly, 0.02% of women will get pregnant. Condoms have the added benefit of helping protect against sexually transmitted infections (STIs). Ben recommends using a more natural condom, such as the Trojan Lambskin condoms or Sustain Natural Latex Condoms.
2) Fertility Awareness Method
This involves learning and interpreting the signs of ovulation. Fertility Awareness requires diligence because otherwise, the pregnancy rate is between 13% and 20%. Ben's wife, for example, currently uses a new fertility tracking system called “Oova” for this.
Diaphragms are reusable silicone domes that fit over the cervix. When used perfectly, women have a 6% chance of becoming pregnant. It’s important to note that diaphragms have been linked to UTIs, yeast infections, and discomfort.
4) Copper IUD
The copper IUD is a non-hormonal IUD placed in the uterus by a practitioner. Women using the copper IUD have a 0.5%–0.8% chance of becoming pregnant. Like all methods of birth control, there are risks involved (such as Pelvic Inflammatory Disease).
Using hormonal birth control is a personal decision, but the idea that it is necessary for athletic performance is antiquated. If you choose hormonal birth control for pregnancy prevention then be sure to track your symptoms and support your body. At this time, there is not sufficient evidence to support the notion that using hormonal birth control will improve athletic performance. In fact, there is research to suggest it may do quite the opposite.
Ben here again. Remember, while Dr. Brighten is a doctor, she's not your doctor. Please consult your doctor before beginning or stopping any medication and to determine the best birth control for you.
But if you're currently on or have been on the pill, I highly recommend checking out her new book Beyond the Pill: A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill a d/or listening to my podcast with her here.
It is an actionable plan containing everything you need to know for taking control and will help you:
- Locate the root cause of your hormonal issues—like estrogen dominance, low testosterone, and low progesterone.
- Discover a pain-free, manageable period free of cramps, acne, stress, or PMS without the harmful side effects that come with the pill.
- Detox your liver, support your adrenals and thyroid, heal your gut, reverse metabolic mayhem, boost fertility, and enhance mood.
- Transition into a nutrition and supplement program, with more than 30 hormone-balancing recipes.
Featuring simple diet and lifestyle interventions, Beyond The Pill is the first step to reversing the risky side effects of the pill, finally finding hormonal health, and getting your badass self back.
Leave any comments, questions, or concerns you have for Dr. Brighten below!