November 12, 2009
Introduction: In this podcast episode: hormones and athletes, weightlifting for triathlon, how to pick your pasta, rest day diets, vitamins for kids, and a medical mystery.
Ben: Hey podcast listeners, as seems to be the case, much of the time these past few weeks, I happen to be podcasting from you while on the road and today that on the road is taking me into the Starbucks at the Hilton Hotel in Clearwater, Florida where I am waiting to race in the half Ironman world championships down here. That race is going to take place in a couple of days, but in the meantime I wanted to get a podcast out to you. I wanted to answer your questions and I also wanted to feature an interview today that’s going to cover a lot of the questions and the comments that I’ve gotten about hormones and athletes and testing and finding out what’s going on inside your body. We talk a lot – Dr. Mitchell and I do – about female hormones in particular. That doesn’t mean that you guys shouldn’t listen in, since I know that – or I hope that all of you have mothers and most of you probably have girlfriends, wives or daughters and it will be helpful for you to know what’s going on inside their body when they exercise. So we’re going to have a few special announcements. We’ve got some great Listener Q and As today and then we’re going to listen to that interview with Dr. Mitchell on hormones and athletes.
Eric asks: Ben, I have a question about the miracle noodles. I have read your review and listened to you talk about them on your pod casts, but are they really ideal for an athlete? It seems like with the number of calories that someone training for a big event burns, they would need the calories that come from the pasta. Also, aren’t there other important things that come from whole grain noodles that the miracle noodles don’t have? Can you elaborate a little on your review with the endurance athlete in mind?
Ben answers: Absolutely Eric. First of all, a little background on the miracle noodles. These are something that a physician recommended to me for my clients that wanted weight loss but also wanted kind of a noodle based carb as part of their meals. Miracle noodles also go by the name shirataki noodles and they’re made from a soluble plant fiber called glucomannan and that’s a completely carbohydrate free flour that’s made from a root. So they’re full of water soluble fiber but they have zero net carbohydrates, zero calories. They’re wheat free, they’re gluten free and they work very, very well for everything from stir fries to just serving a bunch of vegetables or nuts over them mixed in with a little olive oil or garlic. Miracle noodles work really well. And actually if you check out my latest healthy holiday shopping list at www.bengreenfieldfitness.com, one of the items on there is the miracle noodles. They have this big ultimate sample pack where you can order a bunch of different types of noodles because they come in different shapes and sizes. But yeah they are calorie free. They’re carbohydrate free and if you’re using them as a post workout meal or a pre-workout meal, they’re not going to give you energy. It would just be like eating a bed of salad essentially, even though they’re chewy and they taste like noodles, they don’t have calories in them. You wouldn’t want to use them to try and replenish and restore energy levels. That being said, there’s a lot of athletes out there that need to improve their power to weight ratio that want to lose fat, and this can be highly effective when you are tapering for a race and you want to get your weight dialed in or when you are going through a period where you’re not training as much on a rest day when you still want to have spaghetti, that type of thing. So they can work but know that pasta and carbohydrates are pretty over emphasized in endurance sports as something I write intensively on in my book Holistic Fueling For Ironman Triathletes, about how a lot of us are bumping up our blood sugar levels too much too often creating inflammation from consuming gluten based foods, wheat based foods and it can be a problem. Yeah, whole grain does contain a lot of good stuff. Unfortunately most wheat that you’re going to get at the grocery store has been processed with what’s called 60% extraction. So what that means is that they extract 60% of that wheat grain or 40% of it, sorry. 60% is left over. But of that 60% of what’s called extraction flour, about half of the vitamin B complex, the E complex, the folic acid, the calcium, phosphorous, the zinc, the copper, the iron and even the fiber are lost. So, you want to select 100% whole wheat if you are going to go with a whole grain pasta. Now some of the benefits – people who eat whole grains compared to refined grains weigh less in studies, can reduce the risk of metabolic syndrome which is the high HDL cholesterol, the high triglycerides, the high blood pressure and the obesity. It can lower your risk for type 2 diabetes. Whole wheat contains something called butane which – it basically helps manage inflammation. It helps fight inflammation whether that be in the joints, whether it be produced from exercise. They have a lot of insoluble fiber, whole grain products do, so that can help prevent things like gall stones. Good gastrointestinal health promoter because they contain a lot of lignins which are phytonutrients. They act almost like these hormone like substances and can actively protect you against different cancers. And so, what else? Fiber is associated with lower risk of breast cancer, both premenopausal and postmenopausal. Whole grains have been associated with protection against child asthma, the phyotchemicals in a lot of the whole grains can be equal to the phytochemicals in vegetables and fruits. The lignins in whole grains can help protect you against heart disease so there are a lot of benefits to whole grains, but yeah from a calorie perspective you do want to be careful if you aren’t using them as a pre-workout or a post-workout based fuel. So even for an active individual, I recommend that you have the miracle noodles around for the times you need to lose weight or lose body fat because even the athlete experiences that sometimes, that need sometimes. So good question. Eric.
Chuck asks: I usually take one day off each week; how much should my diet change on this day? (This might be a related question.) Obviously I would omit my pre and post workout nutrition since there isn’t a workout, but should the rest change? I usually try to keep my calories lower, especially from fat, on these days. Is that right, or since these rest days are usually after an intense day, should I just eat normally so that my body can recover correctly? Also, I was wondering if you could give an example of what a day of eating looks like for you? Thanks Ben, I really appreciate it and I look to your answers.
Ben answers: Rest days, recovery days. Days where you don’t exercise. Absolutely, your diet needs to change. The fancy word for that is periodization or changing your diet as you periodize through your training. Typically you’ll want higher fat intake, higher protein intake on those rest days because when you don’t exercise your body is less insulin sensitive. A workout session makes you more sensitive to insulin. It makes your body less likely to have larger fluctuations in blood sugar levels when you consume carbohydrates so when you’re not exercising, you do want to control your carbohydrate intake. I would not actually necessarily lower your fat intake on a rest day Chuck, I would actually raise it up a little bit. Do more nuts, more seeds, more lean proteins, more protein powders. You can do things like eggs for breakfast instead of oatmeal for breakfast. You can do something like a handful of pumpkin seeds rather than a piece of fruit. So generally about 40% carbohydrate, 30% fat, 30% protein – around in those ranges for a rest day. And as far as what a day of eating looks like for me, and actually before I go into that, you asked should you eat normally because your rest days are after an intense day of working out? No, I prefer for the actual intense day of working out – that to be when the re-feeding occurs and not to say oh I worked out hard yesterday so I’m going to eat a lot today just because the hormone response to eating is typically more dependent on what you did for activity that day and not the previous day. So as far as me, typical day… let’s say it’s a typical day where I’m waking up, I’m going into my office to work with a few clients, to do a few nutritional consultations, going home in the afternoon, maybe working out during lunch, responding to emails from my online nutrition or triathlon or fitness clients and then possibly working out again in the evening, possibly not, but either way a typical day… I’ll have a bowl of oatmeal for breakfast. I usually have some almond butter, some fruit with that. Usually like a banana. I do a little bit of whey protein in that oatmeal and I have that with a glass of EnerPrime which is the concentrated vegetable green powder that I drink in the morning and I will also usually have a cup of coffee with that. Just regular black, typically caffeinated coffee. Midmorning, usually it’s a piece of fruit. For lunch, I will typically have a wrap or a salad and have a lot of vegetables for lunch because those help to keep full… that fiber helps to keep me full. Afternoon, I usually taper off my carbohydrate intake and focus more on a fat based meal, I usually have a handful of TrailMix with a lot of seeds and nuts, sometimes some unsweetened coconut, things like that in the afternoon, for the afternoon based meal. Occasionally I’ll do hummus or guacamole with a rye cracker or with a vegetable like a jicama or a carrot, broccoli, cauliflower. Post-workout nutrition, right now I usually do some fat free yoghurt with a bit of protein mixed in. Occasionally a little bit of almond butter mixed in to that. Sometimes I’ll also do different recovery based supplements. I’m using a new one that hasn’t hit the market yet. I’m just trying it out for a company. It’s called Solar Energy, it’s a bunch of different high antioxidant juices. Look for a review on that in the future. Then dinner, typically a very large salad with a lot of things added like feta or goat cheese. Again, almonds or nuts. Maybe some raisins, some cranberries, about 6 different kinds of vegetables. The other thing that my wife and I do quite a bit of for dinner, is a lot of times we’ll take quinoa and we’ll mix different herbs and cheeses, oils into that. Have a quinoa based meal. That’s especially if the two of us are doing a late afternoon or an evening based workout which is often our habit. I’ll come home from work and do some computer work and then we’ll put the kids in the car and go to the YMCA, drop them off at the kid care at the YMCA, workout for an hour and then come back home and have dinner and if it’s a post-workout dinner, a lot of times we’ll do that quinoa based carbohydrate dinner. If I’m still hungry after dinner, occasionally I’ll take a piece of dark chocolate. Have a piece of dark chocolate. Sometimes I’ll do another one of those coco flavored whey protein mixed with yoghurt treats. Typically that’s kind of a common day for me Chuck. So hopefully that answers your question.
Todd asks: I was most interested to hear Dr. Mitchell’s take on the history of H1N1, and the reasons for the global ‘panic’. As I have 2 young sons, I was especially interested in hearing about naturally protecting kids. I had 2 questions about kids’ supplements — what Vitamin D, Green Food, or Multivitamin do you suggest or use in your family to ensure your kids levels are optimal? Our kids have a pretty clean diet, but we all know that getting kids to eat their vegetables can be a tough endeavor. Any suggestions you have are great, as we are trying to avoid giving H1N1 shots to our kids despite enormous public pressure.
Ben answers: I can tell you exactly what I do Todd. The vitamin D that I use and you can also use this with kids, it’s a nanospray that you spray sublingually on your tongue. One spray and this is sweetened with sweet potato extract so it tastes okay, is about 1000 international units and that’s enough for a kid. I usually do anywhere from 3 to 6 sprays on any given day. I get that from the same company I mentioned earlier, Bioletics. Follow the link in the Shownotes that I put to Bioletics in the special announcement section. Green food or multivitamin, the whole idea behind the green food and the multivitamin is that vegetables are a little bit different than they used to be. Vegetables do contain a lot of phytochemicals but the problem is that our food supply has changed. In the past 50 years, what you could call chemical based agricultural farming depleted about 90% of our soil’s original minerals. So today, the vegetables that you consume are about 11% of what would have been found in produce during World War 2. So to get what you would have gotten from 3 to 5 servings of vegetables 50 years in the US, you would have to consume 40 servings of vegetables per day. That’s about what a horse takes in, which is very different to do and the amount of fiber that you take in when you do that can be pretty tough. So, these vegetables have been exposed to a lot of things in terms of their processing, their refining, the deodorizing, whatever – canning, bottling, packaging – you’re not getting enough nutrients from the vegetables that you eat. So that’s one of the reasons that you want to take in some type of supplements that supply vegetables or the vitamins and nutrients you get in vegetables, to you. Then the other thing is just about everybody just simply based on our lifestyle routine – we fall short of the mark – even at 3 to 5 or 5 to 6 servings of vegetables daily. So to answer your question, what I use and what I mix into either my kids’ bottles or into for example their baby food or their morning oatmeal is something called EnerPrime. You can get EnerPrime by going to Ben Greenfield Fitness and just Googling – entering a Google search for “EnerPrime” at Ben Greenfield Fitness or even typing in www.bengreenfieldfitness.com/supplements. It’s in powder form or it’s in capsule form and it is the equivalent of eating like 10 salads. So I do that, I also give it to my kids. Obviously my kids don’t take as much as I do. They get about half a teaspoon. I take about a tablespoon. But that’s the green supplement that I give to my kids. And as far as the essential fatty acids, I use one called EnerEFA. It’s a flax seed derivative and I break that up and pour it into my kids’ food. I used to rub it into their feet when they were babies just because you get absorption from skin. That’s my recommendation though. That’s what I do. So good questions, Todd.
Kevin asks: Ben I love the show. In fact my whole family listens in to every podcast. My question is actually for my mom she is 62 still very active and actually watches what she eats pretty closely but she gets sores in her mouth and gets pains in her stomach. She thinks it might be a Candida or intestinal yeast infection. Right now she is taking a myriad of things from garlic to acidophilus probiotics, oregano, enzyme supplements, cultured probiotic yogurt and apple cider vinegar. So even with all that she is still having symptoms. Any suggestions?
Ben answers: For those of you who are listening in and you want to know exactly what the yeast infection or what a Candida infection is… we talked about it multiple times in the show but we are exposed to a lot of fungi in our diet and in our bodies. Fungi proliferates if your diet has a high sugar or starch based but it can still be there even if you’re eating a pretty healthy diet. You want to eat lots of vegetables, nuts, seeds and oils – what would be called a high alkalinic based diet and avoid a lot of acid based – sugar, packaged processed foods, yeast based breads and pastries and even things that would be fungal based like mushrooms and truffles, things of that nature. As you mentioned, there’s herbs. Oil of oregano is a fantastic example. Tea tree oil topically can help a little bit with fungal infections but everything from cranberry juice to grapefruit seed extracts, boric acid is something that I’ve heard of being used to soak some of the foods that you eat. But ultimately what it comes down to is you may need to see a health professional and sometimes you do have to take the big guns out. If you look at a great book on yeast called The Yeast Connection, it actually has a website and that website is probably one of the best resources on yeast infections and controlling Candida I have ever seen. It’s called www.yeastconnection.com. Not only does it have a huge packet in there that you can bring to your doctor to kind of control and watch and track your symptoms, but has a ton of proactive steps that you can take to control Candida and yeast. I would visit that website. Now I’m obviously not a physician. I don’t specialize in controlling yeast infections or anything of that nature. This website gives you a lot of information on herbs, nutrients, digestive enzymes, probiotics, vitamins, minerals and even antibiotics that you might have to take into consideration if you’re really trying to control that yeast infection. And it sounds like that could be the case. So it might also be some medical mystery that you have to go see a physician about. If you tell me where you live, Kevin, I might be able to help you find a physician in your area that could really help you out. But also, go to www.yeastconnection.com. A great website and great book as well.
Tom asks: I have visited many triathlon sites for assistance in the how to’s. I am a beginner to triathlon but have worked my way up to a mile swim. I can bike 25-35 miles. I can run 5 miles. My question is an important one and that is the use of weight training during the week alongside the bike, run, and swim. This seems to be a lot to do. I have done 2 a days with combos of bike-swim, run-swim, but can it safely be done doing a body group in weights and also add these other exercises? I think I know the answer but at 43 yrs of age is it necessary to add on weight training to an already 5 day a week program?
Ben answers: Absolutely Tom, and the idea is that especially at 43 years old, you’re only going to experience more of what’s called sarcopenia as you age which is the natural loss of muscle tissue. You’re going to experience a loss in the hormones like testosterone that can actually be increased through weightlifting and resistance training and you’re basically going to experience a lot of the effects of kind of a loss of fast twitch muscle. Maybe a slight gain in slow twitch muscle, but ultimately endurance is going to be easier for you to maintain than strength, power and speed so it’s going to be important for you to be including components in your training that have a strength, power and speed emphasis. All the athletes that I coach and work with, especially the older athletes, they are doing weightlifting and weight training. The nice thing about weightlifting and weight training is there are very effective sessions that you can do that are only 20 up to 40 minutes in length that are just circuit based full body sessions that get you in the weight room, out of the weight room and don’t take a lot of your time because yeah it can be tough to juggle that stuff. But if you can – even after a bike ride get in a 20 or 30 minute based weightlifting routine, that can be incredibly effective in making you a better athlete and really making you stave off some of the things that you may lose as you age. One thing I highly recommend you check out is my book –shameless plug here, I know – but Top 12 Resistance Training Routines For Athletes was written for the busy individual who just needs to get in and out of the gym and doesn’t have time to do the two hour weight lifting routine that you might get out of a football or basketball based traditional weightlifting program. It’s bodyweight, quick circuits, highly effective. Stuff that I personally do. As a matter of fact, if you go to the video section of www.bengreenfieldfitness.com, there are some videos of me doing some of the workouts that are in that book and that series. You can find that at the www.thestrongtriathlete.com. Ultimately what it comes down to is there are ways you can squeeze it in. There are ways you can safely squeeze it in and a lot of times for me, a typical week might look like a swim and a run session on Tuesday, Thursday and Saturday. A bike session on Monday, Wednesday and Sunday and then a couple of 30 minute weight training routines just thrown in any day that I can throw them in. I try and get at least two in during the week. And I don’t have a rule for myself for the days that occur. Sometimes it’ll just be like okay I finished my bike ride, hey I’m riding by the gym on my way home, I’m going to pop in, 20 minutes, pop out. So you can do that type of thing. Anyways, I hope that answers your question. Remember if you have a question, email [email protected]. Be sure to check out all the links in the Shownotes. If you have a follow-up question or follow-up comment, you can comment on the blog at www.bengreenfieldfitness.com. And it is a blog and comments are completely acceptable. There’s even a share button there where you can bookmark the blog post, you can share them, email them to your friends, etc. so check that out and we’re going to move on to this week’s interview with Dr. Roby Mitchell.
Hey podcast listeners, this is Ben Greenfield and I am here once again with one of our nation’s – really probably one of the world’s experts in natural medicine – Dr. Roby Mitchell also known as Dr. Fitt from www.drfitt.com and that’s Dr. Fitt with two Ts. And Dr. Roby Mitchell is really a consultant even to other physicians worldwide who are interested in transitioning their patients under regiments that take them off drugs and into more healthful lifestyle changes like nutrition, exercise, bio-identical hormone replacement, targeted supplements. But he himself and I’ll have him tell us about this in just a second has a very strong athletic background. Knows a lot about what goes on inside your body from a hormonal level when it comes to sports. We have been getting a ton of listener questions about what happens to your hormones when you compete. Not only from female listeners but also from male listeners who are concerned about their testosterone levels as well as the health of their girlfriend, their wife or their daughter. So we’re going to cover all that today and I’m going to warn you the listener that this particular interview happens to be recorded at a Starbucks. So if you happen to hear an espresso machine grinding in the background, that’s why. Dr. Mitchell, thanks for coming on the line.
Dr. Roby Mitchell: You’re welcome. Always glad to be in.
Ben: So you have a background in sports, in athletics. Can you kind of briefly touch on what your experience is as an athlete, as a triathlete in sports? What you’ve done?
Dr. Roby Mitchell: Well I started in athletics at the parochial level, just playing basketball and I ran track in high school. And then once I got to college, I put a lot of that to the side because I knew my academic performance was going to take me a lot further than my athletic skills but I did broaden my horizon at that point and started investigating other activities. So I was a runner and then I hurt my knee and that – I was dating a triathlete at the time and she got me into cycling to rehab my knee and then once I finished the rehab, she said well you’re doing two sports already. Might as well add another one on and get into these triathlons. So I started swimming and I found that type of cross training excited me a lot more. It really added a lot of variability. So of course I continued to do that and by doing that and getting into the gym and so forth, I started to interact with a lot of other very high level athletes and one of the things that you see when people start getting into performance – particularly at a high level – is that people are looking for an edge. Unfortunately sometimes, people’s desire for that edge and performance enhancement goes outside the boundaries of safety and good sense. So me, as I – and this was when I was an undergraduate and not really in medical school – so as I started to get more medical education about the dangers of some of these performance enhancing things, and then also from my own… like any other athlete, I’d like to be the best out there also and so I’m looking myself also for things that are safe and effective. I started to gain a wealth of knowledge about these hormones and other things that supposedly enhance performance. Some things which do and some things that don’t. So that is what brought me here to having a bit of good information about these types of things that enhance performance.
Ben: I think a really good place to start this discussion, since you know a lot about hormones is almost like a hormones 101 for the people who are listening. Especially a hormones 101 for athletes in terms of how hormones actually affects performance and health in both men and women and then which hormones are the important ones that people need to be concerned about.
Dr. Roby Mitchell: So hormones 101. That’s a good title. Because there’s so much misinformation and disinformation about hormones, what they do and what they are. First let’s start with just a simple definition of what a hormone is. So hormones in general are these chemicals that are produced by a gland that then interface with your DNA to make a cell behave in a certain manner. So, chemicals that are produced in a gland and then travel through the bloodstream and have a target in some cell or all cells in the body – those are what hormones are. And they actually manipulate DNA. So they’re kind of the orchestrators or they’re the keyboard operators for DNA. DNA has a big long alphabet, right, that controls how our cells behave. So all the information for everything that your body does, every protein that it manufactures, every immune cell function, your energy, your ability to breathe, everything is written in that DNA code. Now that code is like typewriter keys. It has to be typed on and there’s a particular message that has to be typed and depending on what message is typed, then that cell does a particular thing. Hormones get in there and actually type on the computer keyboard right? Now there are other nutrients and so forth, vitamins and minerals and some of these macromolecules that are building blocks but they don’t actually get in there and type on the DNA. So hormones have a unique position as far as not just our athletic health but our overall health. Now, there’s a bit of confusion when we start to talk particularly about steroid hormones and that of course is when we start talking about athletic performance, steroid hormones always come into the conversation. So we need to understand what a steroid hormone is. Steroids just means that that hormone – its base is cholesterol. Cholesterol is the fundamental building block that our body uses and from that fundamental building block that’s very similar to a car going a conveyer belt, you’ve got a chassis and down the line something else is put on there. the headlights are put on, the steering wheel, the tires and at the end of the conveyer belt you have this car that’s assembled. A similar thing can happen with cholesterol. So the cholesterol starts there on the conveyer belt either in the adrenal hormones or the testes or the ovaries and different molecules are attached further on down the conveyer belt and then that cholesterol an become cortisol, it can become progesterone or testosterone or estrogen or progesterone or DHEA, depending on what molecule is attached. So that’s the medical definition of a steroid hormone. Now we can – a scientist can take that molecule that’s similar to cholesterol and add some things to it or even take some of these hormones that are already made such progesterone or estrogen, add something to it to enhance its ability to do the things that these hormones do. Those are synthetic steroids. Now those are the ones that we have the problems with. Now no question that they do have a greater capacity to do what hormones normally do. That’s why they’re banned substances but they also have the negative effect of causing a lot of negative things. So it’s important that we distinguish between steroid hormones which are natural to the body and or important and then synthetic steroid analogs. These are not hormones. They are chemicals. So they are hormone analogs. They’re not really hormones. So there’s hormone replacement and there’s hormone substitution. When we put something in synthetic that the body has never seen before, that’s a hormone substitution. When we put bio-identical hormones, that’s hormone replacement.
Ben: Okay, so which hormones in terms of the ones that you would really want to monitor or look at in an athlete, whether male or female, would you consider to be the most important to keep your eye on?
Dr. Roby Mitchell: When we talk about athletic performance, there are – the human organism is – in order to propel itself and kind of be on the top of the hill in an environment, you need strength, speed and you need to metabolize oxygen and glucose very efficiently. So that’s basically what an athlete is. And why people got into athletics initially, it was to be a better hunter gatherer, right? So, the hormones that allow us or mainly focus on that are the androgens, so testosterone. Testosterone is a basic anabolic hormone. An anabolic just means that it causes tissues to gain size. So testosterone is a very important – androgens are very important hormones as far as improving structural strength, integrity and size. So, generally men don’t compete against women because we have more testosterone which is an advantage in our strength and speed and ability to metabolize oxygen. Thyroid is another hormone that improves our athletic ability because it improves our ability to metabolize oxygen and glucose, right? So thyroid is another one. Those are the two big hormones that athletes normally or some variation of those. Now the other class of hormones that really help us metabolize glucose and oxygen are the synthetometics – things that are associated with adrenalin. So things like epinephrine, norepinephrine – those are our natural ones, but then when we come to the performance enhancing thing, so things that are as benign as caffeine or as dangerous as cocaine or methamphetamines, those are performance enhancers but then again they have some negative side effects.
Ben: Interesting, and what about the female hormones? The estrogens and the progesterone?
Dr. Roby Mitchell: Okay, that’s a good point that you bring up. This male versus female hormones. There are no male, female hormones. There are hormones that men can produce a little more of or females can produce a little more of, but we all have the exact same hormone production. Females produce a little bit more estrogen and progesterone, males produce more testosterone but we all produce the same hormones. So with that… so testosterone, same function in women as it has in men and it’s improving this muscular strength and the ability to metabolize glucose and oxygen. So that’s when that runner from South Africa, right, when they thought she might be a male, that’s what all the hoopla was about. So that gives her an advantage. It turns out that it was naturally done. Because of a genetic quirk, she had testicles embedded up in her abdomen that were producing testosterone so that gave her a particular physical build and increased muscle and so forth. She wasn’t cheating, trying to cheat but that’s what testosterone does. And so in women, testosterone is as important. Now we don’t want to make an unnatural balance of testosterone but a women, as she reaches age 27 or so, testosterone levels start naturally going down. Testosterone, DHEA, these other androgens. So that puts her out of her normal balance particularly as far as athletic performance. So when we start to monitor these athletes, that’s something we want to particularly, with female athletes… so an athlete is kind of like a formula 1 race car driver. We really have things fine tuned in order for that piece of machinery to be optimized in performance. So women athletes have to be particularly cognizant about the hormones that affect their ability to maintain muscular and bone strength and integrity and to metabolize oxygen and glucose. So the androgens in general… so testosterone, DHEA and thyroid hormone are particularly important for female athletes.
Ben: Now, since a lot of the questions that I get are from female athletes or from male athletes concerned about female athletes, can you explain what happens when a female athlete – let’s take a large number of our athletes – triathletes or endurance athletes, either suppresses her cycle through vigorous training, not necessarily overtraining or just training very consistently with long training hours basically producing amenorrhea or else takes birth control pills during heavy training. There’s kind of two different scenarios there that you see quite typically among female triathletes. But is there a risk with either of those scenarios, and if so, what is it?
Dr. Roby Mitchell: So the suppression of the menstrual cycle through exercise happens because of the amount of fat loss and subsequent decrease in estrogen production and ovulation, so not producing an egg. The human body is designed such that it is very resilient to those types of situations. Again, our body is still genetically a caveman body and that body was designed to resist extremes in environment and temperature and that type of thing. So a woman’s body will shut down when it perceives that there is an environment on the outside that’s not really conducive for the life of a child, for being pregnant and making a child sustain a pregnancy. So when a woman goes through heavy training, she gives the body impression that there is famine on the outside. So it will stop the menstrual cycle. The body is very resilient though. When that amount of fat and estrogen production comes back, boom. Her cycle comes back and things will happen just as normally as they should. So the regular training that happens, not a problem. Now when we go to these birth control pills, here again we’re talking about hormone substitution, not hormone replacement but hormone substitution. The hormones that are in these birth control pills – one of the most dangerous ones is called ethanol estrodial and that is a hormone substitute that is a much more powerful estrogen than the body’s normal estrogen. When you take those over a long period of time, it – one, increases your risk for all types of cancers that come from those types of estrogens. So breast cancer, these other types of cancers. It also increases your risk for blood clot diseases, so strokes, heart attacks, those types of things. The synthetic hormone substitutes… they also increase the amount of yeast that’s produced in the body so long term on the birth control pill is not a good idea. For women athletes, I normally recommend the sponge for actual birth control. If they are looking to minimize their menstrual cycle then I have them take higher dosages of vitamin A and progesterone and make sure that their thyroid is where it should be. But female athletes want to think long term about their health and not make winning the next triathlon their greatest concern. That should be a recreation for women athletes, but you want to think about your long term health more than you want to do about the gold medal.
Ben: Now would there be any risk of say, like, permanent infertility in either of those scenarios?
Dr. Roby Mitchell: No, not in of themselves. Certainly not suppressing the cycle again because the body is very resilient. It’s used to that type of stress that makes women stop their menstrual cycle. The body is prepared for that. The birth control pills also – usually there’s not a problem with fertility after taking the birth control pills unless it leads into some other problem that then indirectly causes infertility.
Ben: Now in terms of what the amenorrheaic female athlete actually lacks, you mentioned that being low in fat can influence the actual production of the estrogens. Can taking in a higher fat diet actually help the female triathlete in a situation like that? Or any female athlete?
Dr. Roby Mitchell: You mean if they’re trying to induce their menstrual cycle back?
Ben: Yeah, basically.
Dr. Roby Mitchell: Yes. So increasing the amount of fat in their diets, slowing down on the training, yes many times that will take care of that. Now amenorrhea which means you’re not having a menstrual cycle can be for other reasons also. So if that happens, the athlete does want to make sure that there’s not a secondary problem, particularly a hormonal imbalance that’s causing that amenorrhea. Again, hypothyroidism is a very common cause of either no flow or even a very heavy flow. So either of those can be caused by hypothyroidism. Imbalances of other hormones can be a problem also. There are some other issues, if a person has amenorrhea, that they want to get checked out also. Just make sure this is a physiologic amenorrhea and not one that is induced by something that is abnormal or some anatomic abnormality.
Ben: Right, now in terms of a postmenopausal woman, is there any increased or decreased risk for her as far as training intensely or vigorously? Is osteoporosis more of a concern with something like that?
Dr. Roby Mitchell: More of a concern with the postmenopausal women?
Ben: Uh huh.
Dr. Roby Mitchell: I wouldn’t necessarily say more of a risk for the postmenopausal women because these women that – particularly these athletes – we see osteoporosis or at least osteotania or reduction in bone mass in women that become amenorrheaic with heavy training also because one of the things they stop producing is progesterone. So normally, with a normal menstrual cycle, there is a roundabout ovulation – the 15th day of the cycle, the woman starts to produce this hormone progesterone from the corpus lidium. Progesterone is a hormone that allows women to produce more bone. So if you’re having anovulatory cycles, then that can cause – even in somebody that’s training, doing resistance exercise, that can cause a reduction in bone mass. So we don’t necessarily want to put women in a class of premenopausal versus menopausal. We want to look at whether there’s hormone imbalance or if there’s not hormone imbalance. Anytime there’s a reduction in these hormones that normally stimulate bone growth, then there can be osteopenia, osteoporosis, but that can happen at any age.
Ben: So for an athlete, a female athlete, especially at any age who’s getting enough calcium, potassium, vitamin D, magnesium in her diet – she could still risk having osteoporosis if hormone levels are suppressed from training?
Dr. Roby Mitchell: Yes. So, again the calcium, magnesium, selenium, these other things – those are the bricks and mortar – those are the building blocks. You have to have the contractor there to make anything happen and the hormones are the contractors. So we can throw all the bricks and mortar and wood on the site that we want and just sit there and look at it and it will just stay bricks and mortar and wood and it won’t turn into a building. You have to have those hormones there in order to again type on the DNA to make things assimilate.
Ben: Now in terms of actually finding out what’s going on at the hormonal level, can somebody actually be tested for hormonal imbalances, and if so, what type of test would you recommend that they get and what type of things should they be looking for on such a test?
Dr. Roby Mitchell: So the most proactive and autonomous thing that a person can do is just to get their own saliva test. So if they go to www.salivatest.com, there’s a company that will test – the company will send them a kit and they will collect their saliva right into a receptacle and send it back into the company and then that company will just from their saliva, measure their hormone levels. Now there are different kits depending on exactly what you want monitored but for say for instance a woman that is still menstruating, she would do a different test than a woman that is done menstruating, but they’ll send you back a profile of what your hormones look like. Then a woman could then take that to a practitioner that is trained at looking at these hormonal levels and that doctor then could guide them as far as balancing their hormones.
Ben: Interesting. I actually have done that test. I went through a company called Bioletics. It was the same thing. They sent me a tube and it was a salivary collection, so it seemed pretty easy to do.
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