Thursday, April 18, 2019

The Friday 5

Hi, friends! Happy Friday to you!

So, we’ve had quite the fun April vacation week. We got back from New York City on Monday morning, which, of course, was a great way to kick off the week. On Wednesday, I filmed a donut review with Jack from The Donut Digest at my beloved Coffee Shack.

The location closer to our home went out of business, but the original Coffee Shack is alive and well (in Marshfield). It’s about 30 minutes away, so I don’t often visit. But when I do, it’s a special occasion! 🙂

Jack gave the honey dip a B- grade, but the coconut donut is a solid A for me! 🙂

And the iced coffee is THE BEST around. Check out all of the fun flavors, which are brewed from flavored beans, not sugary syrup. Coffee Shack even has flavored decaf iced coffee! 🙂

Yesterday, Mal and I went to the driving range and then enjoyed a little happy hour action before picking up Quinn from school. My new fitness endeavor is learning how to play golf this summer, so it was a great start to this new project. I actually hit some decent balls!

All in all, it was a fun vacation week. And now that it’s Friday, it’s time for another edition of The Friday 5 where I recap my 5 favorites from the week. Enjoy!

1. Jeni’s Ice Cream– Omgggggg. Our NYC friends bought this ice cream for us to try one night (well, ok, both nights we visited because we loved it so much), and it’s absolutely incredible. The Gooey Butter Cake was out of this world! OMG. And if you go onto the website you’ll see that the Jeni’s flavors are truly something else. We found Jeni’s pints at Murray’s Cheese, but it looks like they’re in some Whole Foods locations and available online. I’m definitely planning a trip to our local Whole Foods this weekend! 🙂

2. Beautycounter Brilliant Brow Gel – Gals, full brows are in, which is why I love the new brow gel from Beautycounter. I don’t have very full brows, so I love that this fills them in while still looking natural. It’s like a mini mascara wand that colors the brow hairs, not the skin. I went with soft black, but it comes in 5 shades including clear. Photo: before on the left/after on the right. It’s subtle and natural-looking, but makes a difference!

3. Almond Joy Chia Pudding – I dug out this oldie but goodie recipe (if you haven’t tried chia pudding, you’ve gotta try this recipe with almonds, coconut, and chocolate!). This recipe is perfect to make a double batch of at the start of the week (add collagen for added protein) to have on hand for the easiest grab-n-go breakfast, snack, or dessert! Plus, it’s packed with protein and healthy fats!

4. Butcher Box Breakfast Bundle – It’s no surprise that we love Butcher Box in our house, so I was really excited to hear that when you sign up this month you get a free Breakfast Bundle that includes 2lbs of pork breakfast sausage and 2 packs of bacon (yes, you get all of that for FREE!). The uncured bacon (free of sugar, nitrates, and hormones is made from pasture raised heritage breed pigs) pairs perfectly with our favorite paleo pancakes. And the sausage can be used in a bunch of meal prep recipes. We’re eating less meat nowadays, but when we do, we make sure it comes from high-quality sources. The bacon actually comes from Niman Ranch!

5. Clean-Crafted Wine from Scout & Cellar – This Sauvignon Blanc is light, crisp, and perfect for Spring! The amazing thing about Scout & Cellars Wine is that it is clean-crafted, which means it just includes grapes and less than 50ppm of sulfites.

Some mass-produced wines on the market have as much as 350ppm of sulfites. No wonder I feel like crap in the morning after only drinking a glass or two! Mass-produced wines can also have added sugar or sweetener concentrate, ferrocyanide, ammonium phosphate, copper sulfate, mega-purple, GMO ingredients, and synthetic pesticides. Yikes! This isn’t to say that I’ll never drink mass-produced wine again. I love to have wine out and have drinks with friends, but I will definitely do my best to control the wines that I drink at home!

Sales of the Week

Question of the Day

Do you have a favorite bacon or breakfast sausage recipe?

P.S. Local peeps: There’s a CrossFit throwdown at Salt Shack in Hanover, Massachusetts in June! I’ll be there spectating and chatting about macros, so if you’re into the competition thing, please check it out. This one will be FUN! 

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Keto and the Menstrual Cycle: Is There Reason To Worry?

It seems every “keto for women” forum abounds with stories about menstrual cycles gone wild in the first few months of keto. Irregular cycles, breakthrough bleeding, and periods lasting much longer than normal are common complaints. Sometimes these stories are cited as evidence that keto isn’t good for women, at least not premenopausal women, and that we need carbs for healthy hormones. Yet, many women don’t notice any changes in their menstrual cycles at all, while others report improvement in PMS symptoms and cycle regularity from the get-go.

What gives? Why do some women’s cycles apparently become wacky when they start keto, while others feel like keto is the key to period bliss? Can keto “mess up” the menstrual cycle?

We know that diet—what and how much we eat—can profoundly affect our hormones. This is true for both women and men. One of the reasons people are so excited about ketogenic diets is specifically because keto shows promise for helping to regulate hormones and improve cellular sensitivity to hormones such as insulin and leptin.

At the same time, women’s hormones are especially sensitive not only to dietary changes but also to downstream effects such as body fat loss. Furthermore, one of the ways women’s bodies respond to stressors is by turning down the dial on our reproductive systems. It’s reasonable to hypothesize, then, that women might have a tougher time adapting to or sustaining a ketogenic diet. Keto can be stressful depending on one’s approach, and that might negatively impact women’s reproductive health. But do the data actually bear that out, or is so-called “keto period” more misplaced hype than genuine fact?

Note that throughout this post, I’m going to use the term “reproductive health” to refer to all aspects of women’s menstrual cycle, reproductive hormones, and fertility. Even if you aren’t interested in reproducing right now, your body’s willingness to reproduce is an important indicator of overall health. When your reproductive health goes awry—irregular or absent periods (amenorrhea) or hormone imbalances—that’s a big red flag. Of course, post-menopausal women can also experience hormone imbalances that affect their health and quality of life (and low-carb and keto diets can be a great option for them).

Menstrual Cycle 101

Let’s briefly review what constitutes a normal, healthy menstrual cycle, understanding that everybody’s “normal” will be a little different. A typical cycle lasts from 21 to 24 days on the short end to 31 to 35 days on the long end, with 28 days being the median. Day 1 is the first day of your period and begins the follicular phase, which lasts until ovulation. Just before ovulation, levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (a form of estrogen) spike. Next comes the luteal phase covering the approximately 14 days from ovulation to menses. LH, FSH, and estradiol drop, while progesterone rises. Estradiol bumps up again in the middle of the luteal phase. If a fertilized egg is not implanted, menstruation commences, and the whole cycles starts over again. All this is regulated by a complex communication network under the hypothalamic–pituitary–gonadal (HPG) axis, which is closely tied to the actions of the adrenal (the A in HPA axis) and thyroid glands.

Across the cycle, fluctuations in body weight are common as fluid is retained and then released along with shifts in estrogen and progesterone. Changes in blood glucose are also normal, and insulin-dependent diabetics often find that they need to adjust their dose at different times of their cycles to keep their blood sugar in check. The most common pattern is higher blood glucose readings in the pre-menstrual period (the second half of the luteal phase), and lower readings after starting your period and before ovulation. This is generally attributed to the fact that progesterone, which is highest during the luteal phase, is known to reduce insulin sensitivity. However, different women experience different patterns, which can also be affected by other factors such as oral contraceptive use.

Normal fluctuations in insulin resistance and blood glucose can mean that women get lower ketone readings at certain times of the month than others. When these occur premenstrually—and so they tend to coincide with a period of (transient) weight gain and food/carbohydrate cravings—women often feel as though they are doing something wrong. Rest assured that these variations reflect normal physiology.

The many factors that affect your cycle and the levels of your sex hormones include: other hormones, gut health and microbiome, metabolic health (e.g., insulin sensitivity), environmental toxins, stress, sleep, immune health, nutrient deficiencies, activity level and energy expenditure, and age. Each affects the others, and all (except age of course) can be affected by diet. It’s no surprise, then, that it can be extremely difficult to pin down a root cause of menstrual changes or reproductive issues.

What the Research Tells Us About Keto and Menstruation

As I said at the outset, there are lots of anecdotes, both positive and negative. In my experience, most women whose cycles seem to go crazy when they start keto find that things get back to normal—and often a better version of normal—after a few months.

First, it’s tricky to determine the effects of keto per se, since many people combine a ketogenic diet with calorie restriction (intentionally to lose weight or unintentionally due to the appetite suppressing effects of keto) and with fasting (intermittent and/or extended). Each of these can independently impact the factors listed above, lead to weight loss, and affect the menstrual cycle and reproductive health.

So, is there any evidence that keto itself causes changes to menstruation?

The scientific evidence is scant….

The one statistic you’ll see floating around the interwebs is “45% of (adolescent) females experience irregular menstrual cycles on keto.” This statistic comes from one small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls reported amenorrhea (loss of period) and three were diagnosed with delayed puberty. However, the ketogenic diet used for epilepsy is different and usually much stricter than an “everyday” keto diet needs to be, and epilepsy is frequently associated with menstrual dysfunction regardless of diet.

To extrapolate the findings of this study and argue that nearly half of teenage girls (or women generally) are likely to experience menstrual problems from going keto is a huge leap.

The fact is, I’m unable to find any studies done in healthy human females (or mice for that matter) demonstrating that otherwise normal menstrual cycles are disturbed by going keto.

5 Ways Keto-Related Factors *Might* Affect Your Menstrual Cycle

With the limited amount of research looking directly at keto and menstruation, let’s look first at whether there are direct effects of carbohydrate restriction or elevated ketone production on the menstrual cycle. Those are the defining characteristics of keto and what differentiates keto from other ways of eating. Then we can examine indirect effects that occur due to factors such as weight loss. These are not unique to keto, though they might be more likely on a ketogenic diet compared to other ways of eating.

Carbohydrate Restriction

There is no real body of evidence that looks at ketogenic levels of carb restriction and menstruation, but there are some clues. In this small study, functional hypothalamic amenorrhea (FHA) was associated with dietary fat restriction; women with FHA actually ate non-significantly more carbs than matched controls and nearly identical total calories. Likewise, in this small study, FHA was associated with lower fat intake but no significant difference in carb intake.

This meta-analysis looked at the effect of low-carb (not keto) diets on markers of reproductive health among overweight women. The researchers found four studies that examined effects on menstruation; all showed improved menstrual regularity and/or ovulation rates. Of six studies that looked at levels of reproductive hormones, five reported significant improvements.

Carb restriction also results in decreased insulin production. Hyperinsulinemia and insulin resistance are frequently associated with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility and a frequent cause of menstrual irregularity. There is currently a lot of interest in using keto to treat PCOS, but only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, with positive results.

Ketones

No studies have looked at the direct effects of ketones on menstruation.

Weight Loss

Of course weight loss is not unique to keto, but keto can be very effective for weight loss. Some women experience rapid weight loss when first starting a keto diet. Weight loss in and of itself can impact menstruation through a variety of pathways (and, of course, keto isn’t the only way people lose weight). A key way is by reducing the hormone leptin. Leptin’s main job is to communicate energy availability to the hypothalamus—high levels of leptin tell the hypothalamus that we have enough energy on board, which also means we can reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.

Body fat loss can also affect estrogen levels since estrogen is both stored and produced in adipocytes (fat cells). While fat loss in the long term will decrease estrogen production, it is possible that rapid fat loss might temporarily raise estrogen levels and can also affect estrogen-progesterone balance. These transient changes in estrogen levels might underlie some of the menstrual irregularities women report.

Stress

Stress can impact the menstrual cycle in myriad ways. Cortisol acts on the hypothalamus and pituitary glands, affecting hormone levels, sleep, immune function, and gut health, to name a few. Diets can be a source of stress, both at the physiological and psychological levels. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but this can be mitigated by following the Keto Reset tips for women.

Thyroid Function

Thyroid dysregulation is another common cause of menstrual irregularities, and there remains a pervasive belief that keto is bad for thyroid health. Indeed, the thyroid is sensitive to nutrient deficiencies and caloric restriction, and thyroid hormones, especially T3, do frequently decline on keto. However, as Mark has discussed in a previous post, changes in T3 levels might not be a problem, especially in the absence of other problematic symptoms. Moreover, many practitioners now use keto as a cornerstone in their treatment of thyroid disorders.

What Should I Take From These Findings?

The first takeaway: there just isn’t much direct evidence about how keto might affect your menstrual cycle, positively or negatively. We have some studies suggesting that low-carb diets improve some aspects of menstruation and reproductive health, but keto is more than just another low-carb diet. Ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.

Second, the ways that keto is likely to (negatively) affect menstruation aren’t unique to keto, they’re common to any diet: hormone shifts mediated by energy balance, stress, and weight loss.

Furthermore, since keto is so often combined with caloric restriction, time-restricted eating, and fasting, even the anecdotal evidence might not be able to tell us all that much. If a woman is eating ketogenically, in a big caloric deficit, and doing OMAD (one meal a day), and her leptin plummets, how are we to know what really caused it? We don’t have good evidence that otherwise healthy women start a well-executed ketogenic diet and end up messing up their menstrual cycles.

That said, women do need to be cognizant of the sum total of the signals they are sending their bodies when it comes to energy availability and stress. A lot of women come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues. It’s important that they’re extra careful about how they approach keto. Done correctly, it might be just what the doctor ordered. I encourage any woman who’s dealing with other hormonal issues to work with a medical practitioner to tailor a keto diet to her unique needs.

But I’m Telling You, Keto Made My Period Go Haywire!

Ok, I believe you, really! But changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but important—shift in your nutrition. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week before you planned while you’re on vacation. However, that doesn’t make them bad from a health perspective. We need to respect that our bodies are dynamic systems. Changing the input will invariably change the output, and the system might need a few months to adapt to a new normal.

If your cycle goes wonky but you’re otherwise feeling good, give it a few months to sort itself out. If after a few months it’s still all over the place (or definitely if you’re having other disruptive symptoms), enlist help. In the meantime, check to make sure you’re not short-changing yourself nutritionally or calorically. Scale back on fasting efforts, and consider shifting more toward a traditional Primal way of eating.

At the end of the day, if you go keto and experience negative effects, stop. Keto is super hyped right now, but if your body is sending you clear signals that keto is not a good approach for you at this time, don’t do it. You can always try again later. It might be that your first attempt at keto didn’t work, but with a few adjustments and some experimentation over time you can find a version of keto that works for you.

Thanks for reading, everyone. Do you have comments, questions, or feedback? Let me know below.

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References:

Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Human Reproduction Update 2014; 20(2): 153–174.

Fontana R, Della Torre S. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016;8(2):87.

Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obesity Reviews 2007;8(1):21-34.

Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014;37(11):1049–1056.  

Tena-Sempere M. Roles of Ghrelin and Leptin in the Control of Reproductive Function. Neuroendocrinology 2007;86:229-241.

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Nutrition: Keep It Simple

I recently started to dip my toes back into one-on-one nutrition coaching! When I set out to become a Registered Dietitian, my goal was to help people feel their best with healthy eating, fitness, and lifestyle changes. I imagined myself meeting clients at grocery stores to talk about which products are my favorites, meeting clients for walks on a trail and talking through their nutrition questions, and sharing some of my favorite tips and recipes along the way. That dream turned into KERF. While I do hear from you guys in the comments and on social media, it’s mostly a one-way street.

So when I had a mutual friend reach out to me about in-person nutrition coaching, I started to say my usual “Thank you for asking, but I’m not set up for that right now.” Until I realized that this was actually the perfect opportunity for me to see if one-on-one coaching was still something I wanted to do!

I updated some of my materials from years ago when I did Real Food Consultations under another RD, and spent some time polishing up a Nutrition Bootcamp document that I will send to all clients. We met in the Whole Foods cafe (naturally!) and talked and talked and talked. Luckily healthy lifestyle is my favorite topic! I left the session feeling really energized, which is a good sign to me that it’s something I should be doing more of.

All this to say: I think coaching is something I’d like to get back into! I’d like to keep it lifestyle, cooking, habits based, as I don’t feel qualified at this time to take on clients with medically necessary diets. At least not in the short term. And I think sticking with local clients might be the best way to get started.

But I am curious if any of you would be interested in online coaching?

I have thought about doing online coaching for years, and many of you have emailed me asking about it. It’s a bit intimidating to get set up for something like that. However, the more I think about it, I don’t think I’d complicate things by making a bunch of different packages, promising detailed meal plans, or delivering lots of math heavy calculations. I think I’d just charge a flat rate per session and have each session be open for any and all topics based on the client’s interests. (I would do an intake form and ask for a food dairy so we’d have a foundation to jump off from.) This is all just swirling in my head for now and might never come to fruition, but I thought I’d at least mention the idea here.

Nutrition: Keep It Simple

I stumbled upon this little graphic somewhere on the internet and had to laugh out loud (especially the part about intermittent fasting.) I sent it to my client who has tried all of the diets in the world.

Nutrition can be SO confusing. But you know what my response is: keep it simple. Real food. Eating mindfully to hunger cues. A well-stocked fridge. Emphasis on VARIETY and COLORFUL foods. Adding over subtracting. And remembering that the Squiggly Line is more important than obsessing about a number on a scale.

More posts on real food nutrition:

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Clean Eating German Lentil Soup Recipe

This German lentil soup recipe is absolute comfort food on a chilly day or evening.

This amazing recipe is one I grew up with. My grandmother always made lentils for me, so I eventually began to… Read more →



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