How to Get Your Period Back | Part 2

– So basically like the
twelve hundred calories is pretty much just diet
industry just wanting us to. – Yeah, yeah and so the
standard recommendation is two thousand calories a day for a woman. And that comes from studies that were done where they looked at people
who were weight-stable and asked them what kind
of things you’re eating, when you’re eating. They had them do food logs for a few days and they came up with
two thousand calories. But the problem with
food logs is that because there already is this stigma
about being in a larger body, people often under-report or under-measure or what have you. So the two thousand is, from the studies that I
talk about in the book, which are much more accurate
than self-reported data, that’s where we get the 2500 calories. So that seems to be a
more realistic number for what a woman actually needs. – Yeah. – And then so obviously we
have this 2000 as the baseline number that’s out there
as to what a woman needs. And then messaging about
oh, you should lose weight, you should be smaller, all of that and so then
you’re told 1500 or 1200. I mean 1200 is all over
the place as a number to eat to lose weight. For most women that’s
their basal metabolic rate. That’s the number of
calories that they expend in a day if they’re just
lying in bed, doing nothing. – Like in a coma, right. I think that’s what I’ve been told. Like in a coma that’s like your calories. – What’s that? – If you’re like in a coma,
that’s like your calories. – Yeah, yeah. Exactly because that’s
the energy your body needs to pump your, you know to
get your heart pumping, for you to breathe. For all the cells inside
you to do their work making protein and DNA. So then there’s nothing left over for all of that extra
movement you’re doing. And about 10 percent of what we eat is burned in the digestive process. So, you know, 1200 is
ridiculously low amount and then that’s definitely
not gonna support somebody for the long term for sure. – For sure, yeah. That’s super important. So let’s go back to
like food a little bit. So you talked about people
are restricting women they’re usually
restricting carbs and fats. So I was one of those people. And I get a lot of people
especially with keto. Like carbs are so bad and I love my carbs, but can you talk about
the importance of carbs and fat in recovery and
just for women in general. – So, our bodies need all
different kinds of macronutrients. Just to not only for fuel,
but also for building blocks. So our bodies are
constantly making protein which is built up from amino acids. So the protein that you eat is digested into it’s components, the amino acids that can then be used to make other proteins within your body. Carbohydrates are a great
source of quick energy which we often need. Especially as you’re moving your body. So sort of any movements
that you are doing are most easily fueled by carbohydrates. Your hypothalamus senses glucose
levels and insulin levels and so if those are consistently low that can be a form of
suppression on your hypothalamus. And so that, sometimes eating keto alone
can just cause a woman to lose her period. Perhaps even if she is
getting enough fuel, but just having the constantly low glucose and insulin can be a suppressive signal. So we need fats because that’s broken down into it’s component fatty acids. And then used to make
some of our hormones, you know used as other building
blocks within the cell. So all of the macronutrients
are, our body uses them. It’s not just for fuel it’s
also for building blocks. And each of the components
also send signals to our hypothalamus. So there are different
hormones that are activated when you eat fat or when you eat carbs or when you eat protein. And then that information is transmitted to your hypothalamus and so that can help it
to then send signals, like oh you know, we
haven’t had a lot of carbs so now I’m gonna crave some carbs because that’s what my body needs. So when we feel cravings like that, that’s actually a sign from our body that it needs that kind of nutrients. When you’re pregnant this can
be particularly surprising because often, especially
in the first trimester, you might find yourself craving carbs and like a lot of them,
from me it was potato chips. Like all I wanted to eat was potato chips. (laughing) – Love it. – Potato chips and fried eggs. And it’s just listening
to those cravings is just. We don’t think of, we think of our cravings
as coming from our mind, like our conscious mind. But really it’s much more like it be coming from
our unconscious mind because it’s hormonal signals
that our brain is sending out like I need carbs. So often when women are restricting, like when you are doing keto or something, you find that if you eat one cookie, then all of a sudden you’re like, oh my god, I have to eat all the cookies. And it’s because your brain is like yes, I need this, and
sooner I need more, more, more because you’ve been
restricting for so long and not giving me what I need. And so now I’m gonna
make you eat all of it. – Yep, the binge cycle,
interstrict cycle is a real thing. That’s crazy. Okay, so you talked earlier about cortisol especially from exercise and stress and you know managing your stress. So how important is that in a recovery, the stress management piece. – So the mental stress management I think is almost the hardest piece in this. – Agreed. – Because we live in a society where we are in stressful situations a lot. So I often encourage women
to look into meditation or you know there’s an app
called Headspace or journaling. That kind of thing. It has to be something that works for you. Like for meditation, uh-uh,
no, not gonna happen. (laughing) – Yeah. – Other people it works really well. Yoga is great. – Love it. Because you’re getting
a little bit of movement and you’re also getting, you know, you’re doing some calming and
introspection and thinking. You know, feeling your body. So that kind of thing
can be really helpful. So I mean the stress, also I think, we often put a lot of
pressure on ourselves that is simply because
we’re perfectionists and we feel like we have to do everything the best that we absolutely can. So letting go of some of
that self imposed stress can also be really helpful. You know you look around
and you look at other people and you’re like they
only half-assed that job and they’re still doing just fine. So maybe I can start
half-assing some things too and be okay with it. You know, I learned a big lesson about this from my friend, my boss. I work very part time as
a project manager at MIT. And there are deadlines for
submission of various things. And especially, when I
work for him a lot more. Previously I was at 30 charge
before, now I’m down to four. But I was getting so stressed
about these deadlines and I would be like staying all night. Trying to get other people to do things. And it was, you know, it was probably the most stressed I’ve ever been in my entire life. I had one time when I
was at the grocery store and I usually remember my
frequent shopper card number and I couldn’t remember
it for the life of me. I had to call my kid and be
like, kids what’s our number? – That’s so funny. – And that was such a wake up call to me. Like I am so stressed in this
job that I’m not even able, my memory is going. I mean that’s awful. But he would, my boss was like, oh you know, it will be fine. And I was like, wow, but
I just can’t do that. But then I learned from him
and he’s always been right, he’s always, like he’s never suffered any consequences from
missing these deadlines. – That’s so funny. – So I’m like if he’s okay with it. So now I’m way more and if we miss a deadline it’s okay. And I’m so much less stressed. And so just kind of figuring out what things are truly important and what things you can let go of. – Yep. I think is a good lesson to learn from that kind of example. – Yeah, I think it’s almost
hard to ’cause like for me I almost felt like the
recovery itself was stressful because it’s like you’re
doing all these things that are scary to you. You’re not going to gym,
you’re eating so much food. Do you have any advice for
women going through it. Like how to manage the stress of recovery and keep your stress down. – Well I think again
there’s a lot of sense of you have to do this perfectly. – Yeah. – You have to eat 2500 calories everyday and you have to not exercise everyday. And if you have to run
for the bus one day, oh my god is it the end of my, no. I mean I think that’s another
really important lesson to learn is that you do
not have to be perfect. – Right. You do the best you can. If you’re good enough most days,
is it gonna be good enough. So run for that bus, go get on that bus and if you slip up one day and you’re like oh my god,
I really wanna go for a run. It’s not gonna be the
end of your recovery. It’s not like you’ve done all this work, you go for one run and you’re
back at square one again. It’s like, maybe it’s
a half step backwards and then you eat a little bit more food and you rest the next day
and you know it’s fine. So I think sort of, if you,
letting go of the perfectionism and being okay with just
doing the best you can. – But it’s so hard. – ‘Cause I see so many people
stressing about recovery and it’s not helping to stress. – I was one of those people. I am so full but I haven’t
eaten 2500 calories. I need 2400 or whatever and it’s like, why am I stressing about this. – Yeah exactly. 2400, 2500, it’s so much better than 1200 that it doesn’t have
to be exactly 2500 calories exactly every day. Some days it might be more. If you’re hungry, eat more. If you’re super full, maybe
you don’t eat as much. – Exactly. – Like somebody who’s recovering from say, an eating disorder. You know a, I strongly recommend
getting a team of people around you to help because I know that my
book has been helpful for some people with eating disorders. But certainly, I’m not an eating disorder
recovery specialist and I really encourage people
to find a team of people who are gonna support your recovery making sure that they’re not, not gonna tell you, oh you
should only get to x weight or you should only eat x
number of calories a day. You know really supporting you
in a way that is not focused on weight and sort of out of
the whole diet culture idea. – Yep. – That this healthy weight
and if you go beyond that then oh my god, things are gonna. – Agree. – So, I think for somebody
that’s in that situation that has been severely under
fueling for a very long time. They probably should have
some medical supervision in sort of trying to eat more. Because there is something
re-feeding syndrome. Where electrolytes can
get all out of balance and that can be really dangerous. And also in recovering from anorexia, you probably do have
to push your body more. You have to push passed the fullness because your signals have gotten
so messed up over the years of under fueling. So when I’m talking about, you can sort of be a
little bit loosey goosey with you know, are you eating 2400, are you eating 2600 or whatever. And you know if you feel full don’t, maybe don’t you don’t
push yourself that day. Sometimes you do have to push yourself. So like again, as with everything else
in this recovery process it has to be very individualized and you need to do what’s right for you. And work with a team,
work with other people. Find a dietician who can help you. All of that can be really beneficial. – Totally, that’s really
helpful, love that. So what should women
look for on their labs to really diagnose HA and can
you talk about the difference between an HA diagnosis and maybe a PCOS. If there’s a difference in that. – Sure, so there’s a chapter in the book. Chapter four on diagnosis
that has a lot of information about all of this stuff. So the blood work that should be done should be looking again in
all of those different causes of amenorrhea that we
talked about earlier. So looking at prolactin, thyroid. So hormones you would
test for PCOS would be free testosterone, androstenedione, DHEAS. Hormones that are sort
of most relevant for any shay diagnosis are FSH
(Follicle Stimulating Hormone) and LH (Luteinizing Hormone). It can be useful to have estradiol and progesterone tested as well. Not really for diagnostic
purposes but more because that can help you assess where you are in a menstrual cycle. So not necessarily good
at the time of diagnosis but maybe down the road a little bit. – Yeah. – So yes. So then if you have HA, most like theta HA will be
on the low side of normal. It can be normal but for most women. I think about 80 percent LH was. I’m trying to remember
the graph from the book. I have a figure where I
show the distribution of LH in the survey respondents. I think something like 80
percent had an LH of two or less. – Yeah I think so. – But there is a range. FSH can also be suppressed
in women with HA. That tends to indicate sort
of more severe suppression. So for both FSH and LH, normal is sort of around six to eight, nine, something like that. – Yep. – So lower than six is what
I typically would look at as being suppressed to some degree. LH in PCOS is often on the higher side. Up to three times what FSH is. It can be a little bit higher in women that are recovering from HA so like that is not a diagnostic
criterion for PCOS it’s just something that’s correlated. For PCOS you would be looking
for elevated androgen. So high free testosterone,
high androstenedione, DHEAS, 17 hydroxy progesterone
can be useful to test since someone is sort of
manifesting PCOS like symptoms. Blood tests for a disorder called congenital adrenal hyperplasia which manifests with PCOS like symptoms but it’s actually a totally
different condition. So a couple other things often women with HA free testosterone
tends to be quite low because we have high
hormone binding globulin which binds up our hormones. And so you can have an
elevated level of testosterone but if you have high SHPG then the level of free testosterone
is actually quite low. So those are some of the
things that are good to test and to look at. And obviously high prolactin can suppress your reproductive hormones. So if you have high prolactin
then you would go down a different pathway. Same thing if your
thyroid is out of balance, if your TSH is very high or very low then that can also have implications for your reproductive system. So those kinds of things you
would want to address first. And then kind of give your
body some time to reaclimate from getting those under control before you then look at it. Is my amenorrhea continuing or has it been fixed by this point. – Would you say that, ’cause for me for example my LH was lower, but it was like three so it’s not as low, FSH was normal, estrogen
was low but normal. But I still had HA so I was
trying to talk myself of like I don’t have HA because it’s normal. But my gut knew. – Yeah. – Would you say that there is an element of gut instinct too sometimes. – Yeah definitely. And you know you also have
to take your lifestyle and your history into account. If you don’t have a
period, your LH is low. I mean I’ve seen people
with perfectly normal LH that there’s no other explanation
for their missing period. They eat more, exercise less
and get their period back. So you can have HA without
any overt weight diagnosis. But if you’ve lost a bunch
of weight in the past. If you’re exercising on a daily basis. If you’re doing a lot of
high intensity exercise. If you’re restricting
your food deliberately. Sometimes women with HA do
not even restrict deliberately but they’re just not eating enough to support the exercise
that they’re doing. So another study found that,
they lifted a group of men. Most studies are done on men. And they had them just go to a buffet, eat what they wanted and
measured how much they ate. And they had them do 800
calories worth of exercise on a bicycle and then send
them back to the same buffet. They ate more than when
they had not exercised. But they did not eat 800
calories worth of more. So it’s more like 400 calories. So if you’re not, sometimes if you’re not
consciously making sure that you’re making up for the
exercise that you’ve done. You can be under fueling. So that can even be harder
for people to accept that it’s HA because
they’re like but I eat. – Yep. – I eat all the time. If you’re running for four hours a day then you have to eat a crap
load to make up for that. – Yes. – Are you really eating
enough to make up for that or are you finding it hard to eat because your digestive
system’s kind of slowed down after you’re running
and so you’re not eating for a couple of hours and either you’re going for your run without having eaten before hand and so your body’s getting
into this huge energy deficit and this can suppress your hypothalamus. – Totally. So we talk about this
concept of being all in. I think a lot of people probably know it because it’s definitely better more, having that earlier famous
and all of these things. But what is considered all in. I know it’s in your book, but what do you consider being all in. – So in my mind all in is eating
a minimum of 2500 calories on a daily basis and cutting
out high intensity exercise. And that’s basically it. It’s easy to say and often way
harder to put into practice. – Yep. – Both just from a physical stand point and even more so from a mental
and emotional stand point. – Totally. – So some women can go all in right away. They read my book, they’re
like oh my god I had no idea. And I’m gonna do this right now. Maybe they’ve been
diagnosed with osteoporosis, maybe they’re like wanting
to get pregnant a year ago. So it’s like a wake up call,
I’m gonna do this right now. For others, especially people who
experience a lot of anxiety and use exercise and
controlling their food to kind of help with that. It can be really challenging
to go all in, cold turkey. So sometimes it’s more of I’m gonna increase my calories by x and I’m gonna cut out one
day a week of exercise. Do that for a little
bit, see what happens. And then often when
you’ve taken those steps, you see that I’m actually okay on the day that I don’t exercise. Or yeah I do feel better eating this food. So now I can take the next
step and increase more, add back the carbs, cut out two more days of
high intensity exercise. So it’s really again, this is something that’s very individual. So I do actually work
with women one on one and this part of the
process that we go through is figuring out what steps
to recovery are gonna work for that one individual
person, her situation, what her goals are, kind of
taking that all into account. – Love that. – So I guess, being all in. How long is the recovery period? How do people know they’re recovered or when they can go back to exercising or eating intuitively. What is your thoughts on
that and how does that work. – So generally I say wait
until you’ve had three periods before you think about
changing either your eating or your exercise levels. This comes from a couple
of different places. One is that our menstrual
cycles tend to be sort of self perpetuating. So the hormones kind of follow on, one after the other. So your estradiol decreases at
the beginning of your cycle. That gets your hypothalamus to make more in releasing hormone which then increases follicle stimulating hormone, the egg grows mature as
it releases estradiol that leads to the, estradiol
gets to a threshold level that leads to LH surge
which causes ovulation. That leads to increased progesterone. And then if you’re not pregnant,
progesterone decreases, estradiol also decreases and there you are back at the
beginning of the cycle again. So if you’ve only had one cycle, you know you’ve only had one period. Your body’s only done this once and it’s very easy for any change to, for your hypothalamus to be
simply like, nah-uh, I’m done. – Yep. – That’s it. So you also have no idea
what your cycle is like. So I really really encourage women as they’re working on recovery to get in tune with your body, to learn about the signs of
ovulation and what that means. Because really ovulation is
the driver for all of this, it’s not your period. The ovulation is the most
important part of this cycle. So learning when you
ovulate, what your signs are. And then once you have that first period you can start to crack
and figure out, okay. What cycle day am I ovulating on, how long is my livial phase
which is the time between when you get you ovulate and
when you get your period. It’s often short in women
that have recovered from HA or recovering. So that can be another really good marker of how your body is handling
any increase in exercise or changes in food habits. So having three cycles
kind of gives you a chance to learn what your body is like, what your ovulation is like, what your normal period is like. To then have that as a gauge for okay I’m gonna start running two
days a week for ten minutes. Then that might be a good place to start. How is that affecting my cycle. If it does nothing for one cycle then the next cycle you can
add back a little bit more. I also don’t recommend changing food and exercise at the same time because then you don’t know what variable is causing any issues. So either start incorporating
a little bit more movement. You know, again, the slowly
is really the best way to go. You can absolutely get back into all forms of exercise down the line. I’ve worked with women
who’ve then gone on to do iron man triathlons or run marathons. And maintain their periods
because they’re eating enough. But it’s not like you go
from after you third period, now I’m gonna train for a marathon. – For sure. – That’s probably gonna
be a little bit too fast. So just kind of taking things
a little bit more slowly. In terms of recovery time. When I did the survey for my book. I asked this question, I have a blog post. It’s no period.info/time. And it talked about not only. So the median time to
recovery was about five months in that group with women. And what’s really interesting
is that there didn’t seem to be any correlation
between the length of time that somebody did not have a period and how long it took her
to get her period back. So for somebody that’s had a
missing period for 20 years that can be really encouraging. Because it’s like you don’t have to take 20 years to get your period back. (laughing) Your time frame is gonna be quite similar to somebody who’s only been
missing their period for a year. So that data was out there. And then I found more recently
in my Facebook support groups that there seem to be a lot
more women who are recovering a lot more quickly than that. Like six weeks, eight weeks, three months. So I did a sort of very
non-scientific survey in that calculation. And it seemed that the
median time to recovery from going all in was
more like three months. So I think one of the reasons it was longer in my initial population is that these were women who came to the fertile thoughts message board maybe already having tried some things. Like you know what we call going half in. Which is maybe you’re not eating as much, maybe you’re still doing some kinds of high intensity exercise. So that is what sort of
counted towards that median. So I think now that my book is out there and there’s much more clear idea of what all in really means. People are getting their
appearance back faster because they’re doing
what they’re body needs and what’s making your body happy. – Yeah I mean I can attest to that because I know I was five months but two of those months were half in. So as soon as I was well in,
it came out a lot faster. And I was a 10 year no period person. So like you said it’s
very encouraging to hear. Like when I was hearing
that I’m like oh gosh, I don’t need to wait two
years, you know what I mean. – Yeah. – So that’s awesome. So where can people find out
more information about you. I know you have a book. Where can they find out
about working with you, your social media, where can they find ya? – So my website is www.nopreiodno .com. – I’ll put it at the end
of the video description. – My Facebook group is
at noperiod.info/support. If anybody that’s watching
this that has amenorrhoea, I highly encourage you to join. It’s a place where you
can vent about stuff. But it’s also a place where
you see just about everyday the positive stories, not only of women getting
their periods back but also of positive
impact that doing this has had on their lives. It’s not just about the period, it’s about learning that you
do not have to absolutely control everything that goes
into your mouth all day. And you don’t have to spend
the mental energy into that. – Yes. – You don’t have to exercise
every single damn day in order to be fit and healthy. You can do other things with your life. You can spend time with
friends and family. And you know that helps
relieve stress as well for the most part, I mean you know, there are obviously
some family members who. (laughing) Meet people and surrounding
yourself with people that. You know social interactions
can be really helpful with reducing stress. So support group is
really, I think it’s great and I’ve gotten so much positive feedback. – I love the group. It helped me so much. – And then working with me
noperiod.info/appointments. I have a whole range of
different amounts of time that people can work with me. It can be a single question ten minute or it can be a half hour, it can be working with me for
six weeks or six sessions. There are lots of different
options because I, you know, for me this is not about making money it’s about helping people recover. Like I cannot tell you how fulfilling doing this work is for me, like so much more than anything
I’ve done in my entire life. And obviously the money is nice but it’s not my driver
for why I’m doing this. I’m doing this because reading about people getting their periods back and that the bone density increases and getting pregnant when they were told oh you’re going to have to use IVF, that warms my heart and my soul everyday. And that’s why I do this. – Love that. I will put all those links
in the video description so people can get to those. Well that’s all the questions I have so thank you so much
for taking this hour to. I know this is gonna be super, super impactful for so many women and it’s gonna be so helpful
so thank you so much. – Thank you so much for having me. I so appreciate your time and the ability to share
this with more people ’cause like I said that’s what really, that’s what this is all about for me. – Amazing, well I will put those links in and the people will find
ya, so thanks again. Wasn’t that so amazing. Nicola has so much information about really healing your relationship
with food in your body and restoring your period. And I can tell you that it
works because I’ve done it. So I’d love to know what you
thought of this interview, if you have any questions or
comments for me or Nicola, you can leave a comment
below and let me know. Also love to hear if you have any one else you’d love me to interview. So I really hope that you
really learn from this interview that our weight does not equal our worth. So we can cross that off, we can drop it off and I’ll
see you in the next video.