Ep.44 The Truth About Menstrual Cycle-Syncing: Working Out And Your Period With Dr Frankie Jackson-Spence

0:00For women that are on it for contraceptive purposes, being aware of what it is doing. so that when you come off, if you don't think, what has the pill done to me? What is cycle syncing? Cycle syncing. Cycle syncing. Cycle syncing has been truly like junior year. Young girls hit puberty. Your bodies are going through this huge metabolic change and most likely some weight gain. Rather than having the support they need, notice that they're putting on weight and then start to calorie restrict, which is gonna also negatively impact that. You can do a workout and you feel like superwoman. And then you can have days where you feel flat.

0:31That's not down to differences in motivation. And I think we need to understand why our bodies are behaving the way they are. During a menstrual bleed, you can also become a bit iron deficient. And it's important that we do replace this. And everyone thinks, oh, I've just got to eat some red meat. But actually, you can get iron from lots of food sources. Actually, there's some interesting evidence that can help with the symptoms of both PMS or actual menstrual cramps.

1:04what's up guys welcome back to the podcast this episode actually came about because we did a talk at a shreddy event we commissioned Dr. Frankie to do this talk around the menstrual cycle and training and nutrition and how to train alongside your menstrual cycle in order to I guess use it to your strengths because a lot of the fitness industry talks about how best to train what best to eat etc etc and only sees females in terms of like the recommendations I guess as just mini males like males that just need to consume less which as Dr Frankie explains kind of could not be further from the truth and I put snippets of this on my Instagram story and I got an overwhelming amount of people requesting for Dr Frankie to come on the podcast talking about this so I'm really excited for you to hear everything in this episode I found it incredibly interesting and I can't quite believe that I didn't know a lot of this.

2:01It seems insane that as someone with a period I would not. But then again that's a result of there literally being no studies that are on females rather than just males. Especially she talks about within this podcast how actually before 1993 there was no need for females to be in studies as much as males and therefore so much of the information that we know about human health and physiology actually is just based on males even before the human stage of experimentation so even at the stage of rats for example which is just absolutely unbelievable I think you'll find this episode incredibly interesting I certainly did and I am off to find out everything else that I need to know

2:47Dr Frankie is an NHS doctor a media and content creator who offers factual and relatable health advice in preventative medicine. A qualified doctor working on the front line, Dr. Frankie graduated with a degree in medicine and surgery in 2018. Since this, Dr. Frankie has set out to better understand the risk factors for cancer, becoming heavily involved in clinical trials at Barts Cancer Institute for Renal and Bladder Cancer. Alongside this, Dr. Frankie started an educational social media page to provide expertise on a range of health and well-being topics. In her well-known Medical Monday, Frankie posts a weekly poll on her Instagram to allow people to ask health-related questions, each time focusing on a different topic.

3:25Frankie's profile began to grow and as a result Frankie now also makes regular appearances to share her knowledge, becoming an enthusiastic public speaker for general preventative health. Although there are many things I'd love to discuss with Dr. Frankie, today we share a conversation about training, nutrition and the female menstrual cycle. This episode covers the entire cycle story, exploring what a normal cycle looks like, when ovulation occurs and how to identify important changes that sometimes signify significant health problems. Dr. Frankie also discusses how a female's strength may be affected by constantly changing hormone levels and how we can adjust our training and nutrition to reach our full potential at any point in our cycle.

4:00Thanks so much for joining me. Thank you for having me on. I'm very, very, very, very, very excited. I would like to go kind of back to the beginning of your career and your work choices, your uni choices, all of that. I'd love to hear like a whistle-stop tour of your background and your career up to now? Yeah so I went to medical school many moons ago now, longer than I'd like to admit and yeah I did a generic medicine degree and I started to get interested in research during that time so I'm currently practicing as an academic oncologist but I got interested in research and that meant that I applied for something called the Academic Foundation Programme which is basically where you have protected time to do research projects.

4:46So I think that stems from me just generally being quite an inquisitive person. And whilst I was at uni, we all tend to have a side hustle, don't we? I trained to be a personal trainer and started posting fitness content on Instagram to basically get PT clients. But also because I was just super interested. So if someone told me you need to work out in this specific way, then I would want to read up on why I was doing that, which kind of links with like my research interests in medicine. Of course. So I'd read the papers about why we train a certain way or why we eat a certain way. So that's kind of how the Instagram aspect of my career started, mainly fitness focused.

5:26And then when I graduated as a doctor, which was five years ago, I kind of had a complete shift in mindset towards where fitness fit in my life. I was working on a hospital ward as a junior doctor weekends nights all that kind of thing and I just didn't have the same time to dedicate to the gym um so I realized that that's what the majority of people feel yeah like we're all so busy and actually we don't have time to go and lift for two hours a day when we're at uni you have that privilege just on that note it's so interesting because I've seen so many fitness influencers say that recently and kind of almost like apologize in hindsight and be like Because you look at fitness influencers and so many of them are in their early 20s or even late teens.

6:11I started as a late teen and kind of being like, no excuses. If it was a priority, you'd make time for it, all of this. And of course, prioritisation is a thing. Something can not be a priority, but it can also not be a priority because you can only choose one priority in your life. And actually being like, you know, following these people where it's like working out is literally their job. like it's actually quite weird when you think of the precedent that's then set for the rest of the I guess people who are following them who have I guess quote-unquote regular jobs I'm quite glad that I never did the fitness influencing full-time because it was also just like I would have never really had that insight whereas it was always kind of alongside a full-time job or yeah absolutely so when I started work and I was like I can only train three times a week that is probably what's the normal population who train is and it's actually enough so then my content kind of shifted towards general health and more of like a holistic health view and lifestyle medicine and kind of behavioral things we can do to prevent disease and kind of then I became a Instagram doctor and this is happening in parallel with my research career so I did the foundation training through medicine which is basically two years of doing a little bit of everything.

7:26And then I've specialized now in oncology. But I actually am doing a research fellowship. So my real job, I guess, or my kind of job behind the scenes of Instagram is working on kidney and bladder cancer clinical trials. And then I have this media platform where I share educational content, which is much more generic. and I'm kind of like so interested in research that I have this kind of oncology research focus but also general medical things that I post about. Yeah and I think that's really interesting because I think the way we view things is that like it has to always be very specialist and I guess the way you approach something is like you have all of the equipment to be able to analyse things in the way you need to analyse them and you have the medical backing and you have all of this.

8:11That doesn't necessarily mean that you're going to at the top of your head have all of the information you need to talk about something but when you're presented with the information you can consume it in the right way and apply it to say something like diet and nutrition or diet and nutrition like nutrition and training obviously there are very much specialists in subjects and it's really important to you know look at their research and all of these things but you can learn from that as well you can be able to I guess translate that into a way where people who are following you for fitness are able to you know find that really interesting get a little bit more insight and actually action that in a way that is useful in their lives yeah and I've taken a stance on social media as being like an advocate for women's health so I talk a lot about general women's health issues like um you know menstrual cycle or breast cancer or ovarian cancer or smear tests and actually whilst I'm not a gynecologist so an expert specialist in that area I am someone who can analyze the evidence present it in a way that is relatable to young women so I think there is a real space in the media for doctors like that because actually whilst there's someone who may have spent 30 years researching these things and are certainly more of an expert than I am and whilst they don't have the knowledge in you know kidney and bladder cancer like I might it has to be on social media in a digestible way that people can relate to and I think like as doctors we many people turn to social media for health advice and it's a really dangerous space You get a lot of unqualified advice.

9:42And actually, I think as doctors, we have a duty to present that in a digestible way. And it helps for me the fact that I'm relatable to other 20 something. Yeah, for sure. We talked earlier this week about the idea of training and nutrition and how that relates to women and how within, I guess, the fitness industry and nutrition industry, we literally are taught that we're essentially little men rather than being taught that, you know we're actually very different in a lot of ways I found your talk incredibly interesting for people listening Frankie came to do a talk at a Shreddy event where she was talking about all of these things and I wanted to be able to talk through it on the podcast so many people responded to my story saying I'd love to hear kind of a breakdown of this so I'm really excited to kind of go into this today I'd like to firstly ask you why you wanted to talk about this specifically so what you just mentioned about females being underrepresented in the fitness and nutrition space actually in health care women have been really underrepresented so when you look back at historical medical trials a lot of them are largely focused on male subjects up until I think 1993 the FDA put in legislation basically saying that women need to be better represented in medical trials so if you look at anything that was done before that they're mainly focused on men and that's the same with pre-clinical studies like rats they're usually male rats and things that is insane yeah so our entire health care system is based on this male-centric model and I think it does women a real injustice women are hugely you know underrepresented in medical trials this can lead to delays to diagnosis misdiagnosis and under treatment and I've just been personally interested in reading about that and I think particularly when it comes to training there's lots of things people just do which I see people doing like facet training which we can get on to that are based on male models yeah and I just wanted to question that and I thought if that's something that has been kind of new to me it's definitely going to be new to a lot of people on that in terms of a kind of wider topic I remember hearing about the book Invisible Women and how females kind of, I guess, hadn't been analysed in any way enough for society to, I guess, be built for us.

12:01And I just think it's so insane that I assume anyone within a scientific field would want their research to be as accurate as possible and want it to be as representative as possible because it's just correct. Like, it's not even about awaiting in a certain direction. It's actually about creating conclusions that are correct. and it seems so insane that there are whole areas of science and healthcare that have just been never looked into on kind of a female basis yeah I think it's getting better now like trials have to have kind of equal number of men and women now but a lot of the healthcare that we do or a lot of you know things in the fitness space we do are based on historical data that's just kind of well established it's in the textbooks we don't challenge it and I think women have been kind of the only difference that people say is like the reproductive organs when actually I think the differences in physiology go way beyond that it isn't just that you know women have a uterus and men don't it's there's lots of differences and we really haven't looked into that and actually when I was preparing for this talk and looking for kind of scientific backing to the things I'm saying the lack of research was highlighted you know there really isn't that much on the differences between male and women and I think it's something that we need to start conversations about And why is it important then, I mean, beyond the obvious, I'd say moral implications, but why is it important for everyone, both male and female, men and women to learn about these differences?

13:28I think it's just really important in general to know why your body's working the way it is like when it comes to the fitness industry we've all experienced that some days you can do a workout or you can go for a run and you feel like superwoman like you are just flying the weights feel good you're recovering quickly you're running faster than normal and then you can have days where you are in five minutes into that workout and you feel flat everything feels heavier you feel more tired you're just mentally not in it and that's not down to differences in motivation it's a little bit down to how well fueled you are or how well you slept but actually some of that is hormonal and some of that is due to being different parts of the menstrual cycle and things like that and I think we need to understand why our bodies are you know behaving the way they are to kind of cut ourselves some slack yeah I completely understand that and I guess on top of that you know the huge lack of diagnosis in areas like PCOS and endometriosis etc like I would assume based on the hormonal differences due to those things I would assume that there is also further differences with that in mind like understanding that there are hormonal balances especially involved in kind of PCOS kind of the effect of that on you know on all of it as well I think I as someone who has you know had those I found it really really hard to find further information on kind of what I should and shouldn't be doing and certain things saying you know you shouldn't actually be doing super high intensity exercise and other things saying you know like it's fine like but there's just so little research so it's so hard to know what's right and wrong yeah well when it comes to endometriosis I think the average time to diagnosis for a woman is eight to ten years imagine having this completely potentially disabling condition and it takes ten years to get to a diagnosis yeah like that's completely unacceptable yeah and actually we definitely need to be focusing more as women as you know equals in the healthcare setting and not just kind of like baby making machines yes yes would love that we're going to go through this in a very um i guess systematic way and talking about the menstrual cycle in particular especially when as it relates to training and a bit of nutrition as well could you talk me through the different phases of the menstrual cycle and what happens essentially at each stage yeah so anyone that's listening to this I would love for them to just quickly Google a diagram of the menstrual cycle and study it because it's amazing how many people think they know about the menstrual cycle, but really all they're comfortable with is the menstruating part of it, the period, which lasts a few days.

16:08And actually for me, that's the least interesting part of the menstrual cycle. So if you look in a textbook, the menstrual cycle lasts 28 days. This is very much a textbook length. It can actually be anything from 21 days to 40 days and be considered normal. It starts at day zero with a menstrual bleed, which can last for a few days. Everyone's different. Five days is the average. And this is when the endometrial line is shed and you have a bleed. During this time, the levels of estrogen and progesterone are female sex hormones are low. and this basically stimulates something in the pituitary gland to release a hormone called follicular stimulating hormone or FSH and this basically sends a signal to the ovaries to start developing and maturing eggs that are already in the ovaries and they develop in a follicle and as throughout the follicular phase the levels of estrogen rise and this causes a rise in another hormone called luteinizing hormone or LH and that triggers ovulation.

17:15So at this point an egg is released into the fallopian tube and sets out on its journey to potentially be fertilized. And that's when basically the follicle that the egg developed in becomes this kind of hormone production machine and it starts to secrete progesterone. So in the second phase which is called the luteal phase after ovulation progesterone is the dominant hormone and this basically shifts your entire energy system into potentially preparing for fertilization and implantation of a baby or a fetus and or a fertilized egg and that basically triggers the endometrial lining to thicken, store carbohydrates, store protein and then if the egg doesn't get fertilized then the endometrial lining will degenerate and the whole process starts again.

18:02So I think a few people listening probably could describe that but I think there's a lack of translating that into what it actually means for the way you feel you know when we are menstruating for women who are having periods you know that you can feel a little bit crappy yeah and you cut yourself some slack you might think oh I'm craving certain food groups or I need to rest or you know I can have a day off from training on this day but actually those other phases of the menstrual cycle have their own implications for the way you feel as well. Yeah that's so interesting as someone who's had to spend a lot of time I guess thinking about these things just because of I guess I can only speak from my perspective but having had issues with that it's you know it's something I've spent a lot of time being able to know when my symptoms are going to be far worse for example I know I'm a few days away from my period now and that means I get really bad flare-ups so literally yesterday I was walking around looking like I was about six months pregnant and was you know in a lot of pain And I assume that will be because of the endometrial lining, not only, you know, growing inside my uterus, but also other places.

19:07And being able to, I guess, identify the effects of that at different stages, because you're so right in saying that I will only, you know, we usually only think about things in the way of whether we're bleeding or not. Whereas, you know, it's a cycle and each of the different stages has as many symptoms as the bleeding. It's just one of them, I guess, is really visible. Yeah. And I don't want it to be that women only kind of look to learning about their body and their hormones when they unfortunately get a condition like your experience. Like we need to be taking ownership and have the empowerment to be educating ourselves, even if that doesn't happen.

19:40Yeah, no, for sure. And so what would a quote unquote regular cycle look like? So a regular cycle doesn't really exist. The textbook cycle would be, as I described, with each phase, the follicular phase and the luteal phase lasting 14 days each, having a bleed for around five days and the whole process taking 28 days in total. like I mentioned a cycle length can vary and it can still be regular if it's between 21 and 40 days the luteal phase is pretty fixed at 14 days so once you've ovulated you have about 14 days in the luteal phase but actually the follicular phase so the first half can vary in length up to kind of 26 27 days so that's very different from the you know textbook 14 days and if you're someone that experiences particular symptoms during your follicular phase it's quite relevant to know that yours is lasting potentially 50 % longer than the textbook average.

20:36Interesting and so how does someone then know if something is abnormal or out of the ordinary I guess if there's such a range of ordinary or regular? Yeah so irregular periods would be anything less than six to nine periods a year or no periods so if someone is experiencing less than six to nine periods a year then they should see their doctor because that's um that's technically irregular and what can we do if we are particularly prone to experiencing irregular or missed periods so it would be important to go and get a diagnosis for the reason that's happening sometimes people are irregular but that's actually normal for them and there's no kind of organic cause found for that but things like PCOS are very common and if someone is having less than 12 periods a year maybe less than six to nine a year it might be that they have a condition such as pcos where their hormones are a little bit different um and it's important to get a diagnosis for that yeah what's so difficult though i guess is that when diagnoses are so hard to come by because of the lack of research in areas and i guess in some places the lack of being taken seriously because we're i've talked about this before on this podcast because females are meant to bleed you know and meant to have this menstrual cycle it's I guess meant to be painful to some extent and so this there's this assumption that that pain is normal I guess no matter to what extent that is and then looking at the extent to some people have that I just remember my first ever experience of you know I was 12 when I realized that there was definitely something wrong like I was in I'd get migraines every day of my period I could they were with aura so I couldn't see I would have a super high fever like 39 around so literally couldn't even write my own name and all of that and I you know waited about nine months from the you know getting a referral getting an ultrasound going to a doctor and the doctor literally looked at me as I walked in and said well you're not fat and you're not hairy so you don't have PCOS it then took me literally about 12 years from then to just knowing I knew I knew I had it like I knew I had it and they'd you know and kind of but it actually took me that long to be able to get a diagnosis so actually how would you recommend that people can I guess deal with those things when also diagnoses are so hard to come by yeah I think it's interesting what you say there because even if there's no organic cause like even if you didn't have PCOS that doesn't mean that your symptoms aren't real right so we have lots of conditions that get a little bit of scrutiny in the health care setting because there isn't an organic cause or a malfunction but that doesn't mean that a patient isn't experiencing those symptoms so first of all I would relay that to the doctor you know even if you don't know what it is yet I need to be investigated because these symptoms are real for me and when you were talking before you mentioned about we're expected to have a bit of pain that is true like if you think about what's happening in your period your uterus is contracting to expel the menstrual blood but if it is causing a dysfunction to your daily life if it's stopping you doing things that you want to do that is a problem like we shouldn't have to tolerate kind of being disabled for five days every month um to you know to be taken seriously so um I think we just need to really advocate for you for ourselves and I think that's unfortunate that I have to say that yeah but it is the case and I hope that kind of with new generations of doctors and more education and more conversations like this we see a shift and I think we are seeing a shift yeah but that is going to be a slow change unfortunately and of course if anyone like sat there and told me that now I'd be like absolutely not but obviously you know it's I guess a shame that that would happen to people so young as well I want to move on to talking about um training in accordance with your menstrual cycle so you talked a lot at the shreddy talk about cycle syncing could you tell me could you talk a little bit about what that means yeah so it's this quite new concept um there isn't much high level evidence to necessarily that you need to stick to what I'm about to say you know like gospel um but it's an interesting theory.

24:51Essentially, due to the differences in hormonal profiles in the follicular phase, so the first half and the luteal phase, the second half, there is some theory that you can kind of adapt your training to be more efficient during this time. So in the follicular phase, which is the first couple of weeks of your cycle before ovulation, that's when your estrogen hormone is predominant. So that's the main hormone. And estrogen is an anabolic hormone. so during this time you might notice that your training feels great this is when you feel strong you feel fit you can lift a little bit heavier you can run a bit faster you can go for longer and your motivation's high your energy's high and your recovery's better and that is largely because of the hormone estrogen there's been some actual studies done that have shown that estrogen has a positive effect on strength training so particularly on the number and diameter of type to muscle fibers which are basically the muscle fibers that are predominant in things like high intensity exercises or Olympic lifts so if you are someone who is focusing on strength training or in general getting fissure there is the idea that you could focus your training to be in the follicular phase during the follicular phase we have kind of a shift to using carbohydrates as our predominant fuel source and increased ability to storing glycogen.

26:16So it's really important that we are fueling ourselves correctly during the follicular phase. Particularly for women, diet culture has kind of made women in general a bit scared of carbohydrates. And actually, there's evidence to suggest that we would respond really well as women to eating a bit more carbohydrate during the follicular phase to fuel our workouts. Moving on to the luteal phase, this is where progesterone is the dominant hormone. And this is where I think people need to learn a bit more about the menstrual cycle because during our actual bleed, we really cut ourselves some slack.

26:53But during the luteal phase, when progesterone hormone is dominant, it can make you feel really sluggish and really flat. You will retain fluid, energy levels will be lower, it'll take longer to recover. You might not feel as strong or as fit or as fast. and I think we can get really frustrated and it might be because of the hormone progesterone and how our body responds to higher levels of that there has been some studies that I've shown that our exercise capacity is reduced so our body temperature tends to get a bit higher during the luteal phase and that can affect our ability to sustain endurance exercises it can affect our heart rates, our VO2 values, our rate of perceived exertion.

27:38So exercise feels harder. And also our recovery will take longer. Interestingly, even though we might not feel as active and as kind of motivated to move in the luteal phase, our energy expenditure is actually higher. And that's because our body is kind of preparing for potentially fertilization. So a lot of our stores like our protein stores our muscle mass may begin to break down into amino acids our glycogen stores get used up and that's because progesterone is a catabolic hormone and it kind of shifts that energy into preparing the uterus lining so we actually can burn about two to 11 percent more energy a day which is about 300 calories so even though you might feel a bit sluggish in the luteal phase actually again there's a real prioritization to fuel ourselves correctly which is really interesting I think because for people who take their fitness really seriously and might be for example counting their macros or whatever it might be it's almost permission to get not that you need that permission but it's almost permission to cut yourself a bit of extra slack because it's like your body's working harder anyway so you can take a bit of a step back um which obviously you'd hope that people would be able to do regardless but I know that you know for people who take their fitness goals very seriously that might come into their mindset of saying oh no but I need to be working just as hard within that time so just to summarize does that follicular phase is that the first quote-unquote 14 days including your period yes interesting so within your period you're actually more likely to be able to train heavier obviously give or take pain yeah but you've also got to remember that during um the period you're going to have things like cramps that might affect your sleep quality yeah you can get things like breast tenderness and fluid retention so whilst technically your hormonal profile is becoming in favour of better training actually during the bleed the levels of both progesterone and estrogen are low and estrogen rises throughout the follicular phase so probably in those first few days when you're bleeding it's probably not the best time to be pushing yourself So what you're telling me is we have about 10 days, or give or take, where we're at our, I guess, able to push ourselves the most following the period.

29:55You could be one of the lucky people that has a prolonged follicular phase that goes up to 20 seconds. I mean, knowing my uterus, it's very unlikely that my uterus and lucky will come into the same sentence. Just on that note, though, actually, there's some interesting evidence that says actually training on your period can help with the symptoms of both PMS and premenstrual syndrome or actual menstrual cramps. Yeah. So not necessarily like killing yourself in the gym, but some movement, maybe like a walk or yoga. For sure. And also the I guess there's just the endorphin boosting and all of those types of things that I'm sure can very much help in terms of the low mood, etc.

30:33that kind of comes with that PMS. That's so interesting. I find all of this so interesting because obviously it should be talked about regardless. And like, obviously, given this is such a key part of our physiology, we should know about this and it should be really taught and we, you know, it should be talked about, especially in something like the fitness industry that we're talking about now. It is so insane to me that it's not, both from a moral point of view in terms of, you know, actually being able to help people and help people understanding their bodies etc etc but also from like a marketing point of view it seems insane in terms of all of the ways that like we've been able we as women and females have been able to be exploited by like marketing in favor of these things I mean knowing that like the biggest period app is owned by men and like all of these various different things it's insane to me that literally nothing exists that tells us this and I guess it's because you know I mean it's just insane to me that something that happens in most females bodies is not the mainstream yeah and I think that's really interesting when you're saying about we're not taught this I think it's really interesting when you look at what happens to young female athletes so when you you know that start at a young age if you look at like gymnastics things like that and then young girls hit puberty and then go through all these changes make you know most likely some weight gain changes to mood changes to body shape um changes to literally the entire physiology and i think a lot of girls will drop out of sport rather than having the support they need to be like this is what's happening to your body this is why you're feeling that way and these are the adaptations we need to make because i've seen it loads where you know girls going through puberty notice that they're putting on weight and then start to calorie restrict whereas actually you know your bodies are going through this huge metabolic change and actually fueling it correctly is probably the safest and kind of best thing you can do for your performance and actually opposite often the opposite happens yeah that is really really interesting and I guess a big old task to be changing that landscape but definitely talking about it is you know gets part of the way there and so with the cycle in mind then how do we account for different fitness goals whilst being able to work in line with that cycle yeah so I just want to kind of reiterate that this is all kind of exploratory we don't have anything proven um if you are someone who is taking your training very seriously it might be something to consider it's not going to be applicable to everyone but if you are for example trying to get stronger you might want to do the majority of your strength block during your follicular phase and then in your luteal phase maybe focus on technique or mobility or all those things that we neglect a little bit and just kind of take that into account interestingly there's limited evidence but performance doesn't seem to be affected so if you were like running a marathon for example I ran the London marathon a few weeks ago there's no evidence to suggest that someone who runs in their follicular phase is going to perform better than the luteal right Because we know that like high pressured performance moments take into account many more things than just physiology.

33:54It's like mindset, how much training you've done. So interestingly, performance doesn't seem to be affected by this. But when we're talking about training, reading up about how and tracking your own cycle and getting more in tune with your hormones might just help you tailor your training program a little bit. so for someone now who goes to their period app for example and looks at where they are within their cycle what should they be looking at so is it kind of that first half from the bleed so the first couple of weeks before ovulation this could be the time where you push yourself a bit more in the workouts you go for you know increasing your weights in the gym or running a little bit faster if you're trying something new it might be this time in the second half you might want to cut yourself a little bit more slack giving yourself a bit more time to recover we know recovery is affected in the luteal phase and just kind of prioritizing training in the first couple of weeks um what's really interesting about the tracking apps is that they actually track your body temperature and it's quite interesting to look at how body temperature can affect our physiology particularly when it comes to sleep quality so we know that our body likes to drop its temperature a couple of degrees to initiate and maintain good quality sleep.

35:11So sleep might be affected in the luteal phase when your body temperature is a bit higher because of the hormone progesterone. So that might have an effect on your training. So not only is progesterone catabolic and kind of counteracting your hard efforts to build muscle, your sleep is also going to be affected, which is going to also negatively impact that. I think for me, knowing that my body is affected at literally every different stage of my cycle and it like vastly affects not just my training but I know my sleep like how I feel all of these different things I've always been very interested from a point of like I guess need like you kind of got to a point where I was like this is actually ridiculous like there are so many different symptoms at different times and as you say not just at the bleed point and I think like there's a really I know that there's a date that's kind of pretty much like bang in the middle of my in the middle of my cycle which must be kind of ovulation or something but some weird shit happens then too so I'm like I just need to like map this out I've started using like the different symptoms on my tracker to mark completely different things too like I've got my own little key and I'm like you put this into your algorithm and you tell me when I'm next expecting that yeah I would encourage everyone to track their cycle not necessarily as a fertility prevention method but actually just to get in tune with their own bodies something that I think is really interesting is lots of women go on the contraceptive pill or other methods of contraception at a young age and then maybe come off it at a point in their life when they want to conceive and think oh I haven't got my period back or the pills made me infertile or something and actually often what happens is that they may not have had regular periods from the get-go but never had time to realize that because they went on the contraceptive pill at 15 and didn't get in tune with their body so I think it's interesting that you know how little awareness we have on what's normal for us yeah I was put on contraception when I was like 12 13 because of the issues with my period which is insane and I cannot imagine I haven't been off it since and I cannot imagine being off it because I don't know the only you know for example in terms of the operation for endometriosis it's been the pain has been mitigated enough for it not to be worth me having an operation the majority of the time sometimes it's obviously particularly bad but I'm lucky enough that it's been mitigated enough but it does kind of terrify me at the point that I did want to conceive I literally can't imagine yeah coming off it I think um hormonal contraception gets hugely criticized particularly on social media I always say it's a bit like a restaurant review right if you've had an all right time you're probably not going to go on TripAdvisor but if you've had a rubbish time on it you're gonna bad mouth yeah um and hormonal contraception has really great roles in certain gynecological conditions such as treating the pain of endometriosis or treating heavy menstrual bleeding but i think it's useful for women that are on it for contraceptive purposes to be aware that they may not know what their natural cycle is like i think it's hugely important to not slander hormonal contraception oh yeah but it's just being aware of you know what it is doing and even if that means having a short period off it yeah whilst using other forms of contraception um to get in tune with your cycle just so you know what's going on so that when you come off and want to conceive you don't think what has the pill done to me yeah i personally won't be seeing what my period is like without it but that's that's a personal choice based on or wanting to survive so i know that you mentioned that there is also evidence that syncing your diet to shifting hormone levels can also optimize the way you function the way you feel what what does this mean can you tell me a little bit about this so it's just thinking logically about what we've said if in the first couple of weeks your training is going really well you're pushing yourself I think we really need to focus on fueling ourselves correctly I think the diet culture and industries have really just kind of ingrained it in women that they need to like watch what they're eating for a fat loss and weight loss purpose.

39:13I would encourage people to watch what they're eating in the form of being aware of how they're fueling their body. So thinking about the nutrients they're putting into their body and trying to match that with kind of the activity you're doing. So if you are pushing yourself and you're feeling really energetic in your follicular phase, making sure you're fueling yourself adequately for that. Similarly, in the luteal phase, even though your training might drop or shift to more low intensity exercise we know our energy expenditure is increased in that so increasing your calorie intake maybe up to 300 calories a day obviously dependent on body size just like cutting yourself some slack for that there's some very limited evidence that um in the luteal phase we can predominantly burn fat women are really good at oxidizing fatty acids and using like fat oxidation as a form of energy if you increase your you know healthy fat intake in the luteal phase that could help close that kind of calorie gap and meet the extra 300 calories.

40:12Interesting. I personally wouldn't find it hard to eat 300 more calories a day. No, no, I take that on. I am here today to say that I will do this for the people. We'll have an extra shredder bar. Yeah, exactly. Well done for getting that in there. We absolutely love that. That second half of your menstrual cycle when you're likely finding, you know, potentially finding things a little bit harder, you might be taking things a bit softer actually not taking down your calorie not starving yourself because someone's told you once that on your rest days you should be reducing your calories yeah and just like challenging these things that seem to be ingrained in us and that kind of takes me on to this um challenging the point of you know men should consume 2 ,500 calories a day and women should consume 2 ,000 calories a day that isn't necessarily true you know our body mass percentage is to do with our height, how much lean muscle mass we have and how active we are.

41:08And I could really guarantee that some of the females listening to this podcast are probably burning more calories at rest than some of their male counterparts. My like first ever memory of realising calories was I remember that me, myself and my friend had like bought a magazine and it was back in the day where magazines were just trash and they absolutely didn't like could just own being trash. It came with this like little book like the little like handbook of like how to lose weight and we like read the book and it was like drink so much water that you literally need to pee all the time and we like were bringing these like huge bottles of water to school being like oh my god and just like downing it and being like I need to pee again then the teacher would be like no you can't pee I remember at this stage it was like oh make sure you're eating whatever stupid number of calories um there you know it was recommending probably like 1200 or something ridiculous I honestly not tried the 1200 calories exactly I was like oh before I take this on this was probably when I was about like 15 and I was like before I take this on I want to just measure how many calories I do eat a day just to be able to kind of like see whereabouts I fit sit and I ate over 3000 calories on like quite a normal day that I was doing and instantly I freaked out like completely freaked out completely changing obviously I mean I'm five at three so there's arguments but I also you know I'd originally been a competitive gymnast so like I have a huge amount of muscle mass no matter whether I'm sitting a bit you know heavier than I usually do or whatever it's like I very much carry a lot of muscle mass and clearly that was like appropriate for me at the time because I was you know that's absolutely fine like it's not going to change based on me knowing that it's that many calories and I instantly just like cut that in half like oh my god how did you even do that and it's so interesting because that was probably exactly what I needed at the time and now that I don't count calories at all and I have a good I guess I know what's in most things because I used to count macros etc but I'm far enough away from that in terms of you know it's probably about five years since I've since I lasted that I guess I have some sort of awareness but also not a burning awareness I don't kind of like need to know and I don't kind of calculate it in any way even in my head I know that I've gone back up to around well maybe not 3 ,000 but like definitely well above what it would recommend me to do based on my like height and weight etc I mean if you you know if your dog started to put on weight yeah you would what would you start doing walking him a bit more yeah and feeding him a little bit less yeah we've over complicated this whole thing it's so interesting because we see I think we see puberty as the only real time when we're going to like put on a bit more weight and actually I'd say with like the majority of people going into like regular life follow it of course we're going to put on weight in puberty but like going into regular life following university and just becoming adults it's a very natural thing for you to settle into like not being a stick figure yeah like which is you know like very natural especially as a female when you need to be I guess carrying a little bit especially you know we talk about this like pooch or like whatever where you're carrying weight in your lower stomach and it's like that's literally to protect your reproductive organs yeah and they actually do you know adipose cells so fat cells in women have different receptors and respond differently to you know different hormones because that fat is there designed to protect your organs and also carry a bit more fat so you have an energy reserve so that if you were to get pregnant you could support new life so you know there is scientific reasons for all of this and we're constantly trying to defy that based on male models it's so interesting and it's so ridiculous when you really think about it it's so ridiculous that all of this nutrition if any if any nutrition training we've had on these recommended daily amounts or whatever it might be it's literally all based on a male model I think gram for gram of like body mass women need the same amount of carbohydrates as men like per gram of their body mass so we really need to just like accept that and stop trying to be just little versions of men that need less food yeah that's really interesting and can you tell me on the nutrition side what about iron when it comes to your periods and your menstrual cycle so during a menstrual bleed um you will lose some blood it's usually on average around 80 milliliters of blood and that means that you can also become a bit iron deficient or not necessarily kind of biochemically iron deficient but lower levels than what's normal for you so we can we lose iron in the red blood cells during our bleed and it's important that we do replace this so in the follicular phase you might you know have energy because of the estrogen but you might also you know counteracting that feel more fatigued because you might be a bit anemic or approaching that level um so making sure you get enough iron in your diet is something that females that have a menstrual bleed need to also consider yeah and you know when we talk about iron everyone thinks oh i've just got to eat some red meat but actually you can get iron from lots of food sources like green leafy vegetables spinach is a really rich source of iron or tofu or seeds and nuts so just yeah again thinking about what you're putting in your body to fuel what it's going through rather than what you're taking out of your diet yeah I think what you say that's really interesting there is that idea of like we see ourselves as either deficient or not deficient and there's actually first of all that's usually taken from like a standardized I guess amount and for you if you're actually towards the higher end of that and then come down to even a mid-range you're I assume probably going to feel the difference absolutely I mean when I'm working in hospital lots of my cancer patients will become anemic I would offer a blood transfusion not because their level of hemoglobin which is in your red blood cells and drops below a certain level but if they're feeling the effects of that so if they're symptomatic I would think should we transfuse this patient if it's low and they're not feeling any different we don't necessarily need to replace it and similarly you know just because we have these predefined guidelines someone with might be within their normal range but they normally sit at the higher end of that normal range and they're just at the lower end of still normal but they notice that shift and that drop and they might want to supplement yeah that's really interesting and what you said earlier about um faster training i'm really interested in hearing more about that yeah this is really interesting it's something that i've been reading more about in advance of these conversations we've been having so lots of people decide to train fasted for whatever reason I think some of those reasons are that it's been kind of published that fasted training promotes fat loss and also that it can in certain endurance sports like marathon training or long distance cycling um increase your endurance capabilities so basically when I say fasted training I mean exercising maybe first thing in the morning before eating.

47:58And what that means is there's a lower level of glucose, so carbohydrates in your blood. That means you use up your glycogen, which is the stored carbohydrates in your liver and muscles. And you can get through that quite quickly, sort of in the first hour of exercise, maybe even half an hour in some people. And then you start metabolizing fat through fat oxidation as your primary source of energy. This is all kind of in the aerobic energy system so some people choose to exercise in a fasted state to try and speed up their fat oxidation capabilities and for some people they'll swear by this because they find that they lean out they burn more fat and they find themselves getting fitter because they increase their aerobic threshold so the time spent exercising before lactate builds up and you start becoming anaerobic and feeling fatigued but those people are usually men right so men respond differently to facet training than women females are already better than males at fat oxidation and comparably they don't respond the same to facet training first thing in the morning our cortisol levels tend to be higher so that's our stress hormone and for females training in the facet state increases your physiological stress and can increase those cortisol hormone levels even higher and over a prolonged period prolonged and sustained high levels of cortisol can lead to things like amenorrhea so losing periods or becoming irregular even if over the day you're eating enough calories or even if you're a healthy body weight that's so interesting because i train fasted not through a goals basis but just based on like I'm not super hungry in the morning I get up quite early if I'm especially if I'm training and so I just go to the straight to the gym and do that however I also know that I'm very sensitive to cortisol because of PCOS and because of and so essentially probably shouldn't be doing that yeah I think everyone's different and you know sometimes I train fasted as well I do a mixture of f45 and running I tend to wake up and go to an f45 class and i don't really want to eat before because it's so early and i'm not hungry but if you look at the science that raising cortisol from first of all getting up early training on an empty stomach or you know glycogen deplete state and then doing high intensity exercise is going to raise my cortisol and that can long term have negative impacts on your health in terms of fatigue recovery injury predisposition and kind of paradoxically it can actually lead to weight gain but what's interesting about this is I just mentioned that I was doing marathon training I would make a conscious effort to get up earlier to fuel before a run because I knew the science that fueling before my run would mean I have a better run and it's interesting how when I was working out for performance rather than just enjoyment and to stay fit I actually listened to what my body needed yeah so the science is there I'm not saying how to follow this advice is gospel but if you're having you know some workouts that are a little bit crappy you're taking longer to recover you're feeling like you're doing all this exercise and not losing weight it might be worth thinking about am I fueling for the stress I'm putting my body through correctly that's so interesting I need to do some re-evaluation um you talked there about amenorrhea yes can we talk a little bit about overtraining and the potential link to that so this is an interesting one I'm not sure the concept of overtraining actually exists right if you are preparing your body correctly you're fueling your body correctly of course athletes exist exactly athletes exist where they're training pretty much every day but they will be doing the appropriate prehab and rehab they'll be doing the appropriate mobility and physiotherapy they'll be fueling themselves correctly sleeping the right amount focusing on that so actually they've trained themselves so that the amount of the activity they're doing isn't necessarily overtraining the concept of overtraining is when you're pushing your body to a level of stress that it's not adequately prepared for right whether that be you're not actually you know physiologically adapted to pushing yourself that hard you know you can't just suddenly run a marathon one day you've got to train your energy systems to account for that and you see them adapt you can't just suddenly like lift 100 kilos but you can build your body to do that.

52:46So when you get exercise-induced amenorrhea, it is often because you're putting your body under a level of stress that it's not adapted for. And so the levels of cortisol are higher and it sends feedback to the pituitary gland in your brain that says, this isn't probably the appropriate time to get pregnant right now because I'm in a state of stress yeah you know if you're living in the middle of like africa and you're being chased by a lion you know thousands of years ago you might be in a stress state which is not the best time to bring offspring into the world and that is basically what put very simply that exercise induced amenorrhea is telling your body interestingly you can get exercise induced amenorrhea even if during the day you're eating enough calories and even if you're a normal body weight or a healthy body weight so it's all to do with the amount of stress you're putting your body under that's really really interesting I'd love to know from your point of view what I guess three things you would recommend that people either look at or act on when it comes to working out in your period the first thing is everyone go and study what's actually happening in your menstrual cycle and not just learning estrogen rises actually think about what that has on your body I'd recommend everyone tracks their cycle if they can do just to get in tune with what's happening with your body and the third thing is to remember that you are entirely physiologically different to a male and fueling yourself appropriately you know you can be way more active than the generic male you might have much more body mass you might be just built in the way that needs more fuel and And I'd encourage everyone to focus on what they're putting into their body in terms of energy and nutrients to fuel your day to day life in a way that makes you feel good.

54:43Not because we've been conditioned to just have a bit less than men. Yeah. Great. Well, that's so interesting. Thank you so much for coming on. Thank you so much for having me. This has been great.

55:02Thank you.