273: Healing Hypothalamic Amenorrhea and Eating For Fertility with Dr. Nicola Sykes, PhD

Introduction 

You're listening to Biceps After Babies Radio Episode 273. 

Hello and welcome to Biceps After Babies Radio. A podcast for ladies who know that fitness is about so much more than pounds lost or PR's. It's about feeling confident in your skin and empowered in your life. I'm your host Amber Brueseke, a registered nurse, personal trainer, wife and mom of four. Each week my guests and I will excite and motivate you to take action in your own personal fitness as we talk about nutrition, exercise, mindset, personal development and executing life with conscious intention. If your goal is to look, feel and be strong and experience transformation from the inside out, you my friend are in the right place. Thank you for tuning in. Now, let's jump into today's episode.

Amber B 00:46 

Hey, hey hey! Welcome back to another episode of Biceps After Babies Radio. I'm your host, Amber Brueseke, and today I am interviewing Dr. Nicola Sykes, PhD. She wrote a phenomenal book called No Period. Now What? A guide to regaining your cycles and improving your fertility. And so today I'm having her on the podcast to talk about hypothalamic amenorrhea. It's a mouthful, we'll she'll discuss what that is and and we will refer to it most of the time as HA. But this is a really important concept and topic to talk about in this space because HA is often caused by over-exercising and under-fueling your body. And so I will let Dr. Nicola talk about all the specifics, all the science related to it. But this is a topic that needs to be discussed more in this industry. I am all for changing your body. I am all for understanding macros and being able to, you know, have your nutrition be able to support whatever goals that you, that you want to have. But there is a limit to where a lot of people take exercising too far and a lot of women take under eating too far and it actually, your body can start to shut down because of it and, and that's we're going to talk about on this episode. So I think this is a really important topic. I think it's one that's not talked about nearly enough. A lot of us tend to think more exercise is better, but there's actually a point that exercise becomes unhealthy. It becomes damaging to you, you know, I'm all again about using your nutrition to be able to support your goals, whether that's fat loss or gaining muscle or performance in the gym. But a lot of times we get too extreme with that and we cut calories too low and we under fuel our body and that's not a good place to be in either, it's well all preached all the time, most of your life should be lived at maintenance. We can go into deficits at, you know, points of time, but it should be for a short period of time. We really want to make sure that, sure that our body is really well fueled. So I'm really happy to have Dr. Sykes on the podcast to be able to talk about this topic because I think it needs to have more conversation in the fitness space. Exercise is great, but not when it's actually starting to damage your body. Again, like, you know, fueling your body is, is good, but under fueling your body for a long period of time can cause a lot of problems and that's what we're gonna talk about on the podcast today so I am really excited to introduce Dr. Nicola Sykes.  

Amber B 03:22 

I am so thrilled to have Dr. Sykes on the podcast to talk about incredibly important, important topic. So Dr. Sykes, thank you for being here. I, welcome, I am so excited to introduce you to my audience. 

Dr. Nicola Sykes 03:34  

Oh, thank you so much for having me. I was so excited when I saw your Instagram message from a while ago. I've been sort of off social media and it's just nice to get back into chatting with people. And, you know, teaching people more about HA through, through podcasts, which is been the main way that I've contact, you know, I've gotten in touch with people. So I really appreciate it. 

Amber B 03:52  

It's, this is gonna be such an important conversation, and one that whether or not you feel like you have Hypothalamic Amenorrhea or not, I think everybody should listen to this because it's an important topic of conversation, it’s an important thing to understand, and we're going to talk about how you may, this may be impacting you more than you even think. 

Dr. Nicola Sykes 04:11 

Absolutely. 

Amber B 04:12 

And so don't just toss this way of like, oh, that doesn't apply to me. I really highly recommend you listen to what Dr. Sykes has to say. So let's start with an introduction.  

Dr. Nicola Sykes 04:22 

OK.

Amber B 04:23 

Let's start with who are you? Why should people listen to you? Why do you know what you're talking about and just give us a little bit about the background on you. 

Dr. Nicola Sykes 04:30  

Sounds good. So I have a Ph.D. in Computational Biology, so I'm a scientist by training. I lost my period myself at the end of my Graduate School career, I decided to go on a diet with, along with a whole bunch of people in my lab. I was like, you know, I've got some love handles to lose. I always wanted to have, you know, that they're running down my bicep, I thought that looked so cool, you know, the six-pack all of that and I was like, you know, my friends are going on a diet I’m going to do that too, and I was also interested in getting pregnant. And so I was starting to read about that and I read in so many places like lose weight, to have an easier time getting pregnant, lose weight to have a healthier pregnancy. So it's like. I was like, oh, this is great. All my, like, everything's lining up. It's all you know, it's all gonna work out awesome. So I did, I was, and I was exercising a lot at the time. I was weight training, I was playing ice hockey, volleyball, squash, you know, I just, I was super active. So I cut my calories significantly and I lost a bunch of weight really quickly and I was like, this is amazing. Know I did get that you know it totally worked. And then like six weeks later, I went off the pill to start the process of trying to get pregnant and I did not have a period. I was like what's going on? I was like, oh, you know, maybe I'm, you know, maybe I've taken this whole thing a little too far. I didn't, you know, I didn't really know at the time. So I went to see my doctor and she said, oh, you know, it can sometimes take up to three months after you come off the pill to get your period. So, you know, come back and see me in three months, if you still don’t have it, which little side notes, there are studies that have looked at period recovery after going off the pill. And basically, if you haven't ovulated by within a month after going off the pill, there's probably something else going on. So it's, you know, there's no reason to wait three months or six months or a year or whatever people say, like if you don't have your period by six weeks after going off the pill, something else might be going on. 

Amber B 06:25 

Investigate. 

Dr. Nicola Sykes 06:26  

So yes, investigate. So I ended up being diagnosed with Hypothalamic Amenorrhea about eight months later, you know all sorts of diagnostic, whatever. And the doctors are basically like, well, you know, maybe you could eat a little bit more and maybe you could exercise a little bit less and Oh yeah, fertility treatments. And so, you know, I kind of went down the path of fertility treatments. I ended up having four failed injectable cycles, but then did end up getting pregnant naturally while we were waiting to do IVF. It took me about 18 months from the time they went off the pill to actually getting pregnant. Then I ended up on bed rest while I was pregnant and I found a message board online about hypothermic amenorrhea, and I started posting. And you know, I I shared my own story because I, you know, I learned a lot through that. And I also started kind of gathering other people's stories and people would ask questions that I would go like, look at, look, stuff up in medical journals because I'm a scientist. That's what I do. 

Amber B 07:27  

Because you can read the medical journals and understand it. 

Dr. Nicola Sykes 07:29  

Yeah, yes, yeah. And so after a while, you know I I I sort of became the mother hen of this group. And you know, there were a couple 100 people on the board at any one time. And after a while they were saying, you know, you know so much about this. You should write a book. And I was like, Yeah, I should because I mean it's, you know, I looked around and there still wasn't at the time. There was really very little on the Internet about it. And you know, so I was like, there's totally this is this is a place where people need more information. They need more guidance and I have the knowledge so yeah, so I it it ended up taking me 3 1/2 years to write the book which was well longer than I expected. But you know, things happen is about a year of editing, which also was well, you know, not not not in my expectation but I spent the first year doing a survey of all the people that had been on the board. So the book contains a lot of information about sort of other people's stories and journeys and answering questions that nobody really could give you an answer to before like how long might it take to recover? You know, what kinds of things do people need to do in order to recover? So I've been doing this for, like 15 years now, and I would say that I'm probably the world expert in HA, because it's the only thing I do, you know, a lot, I think medical doctors, you know, they might know a little bit about HA. They might know about relative energy deficiency in sport, but they often have, like it's their, their focus is much more broad, but for me this is like this is what I do. So I've recently updated the book, it's been translated into French. We're working on translations into German, in Spanish and so I've, you know, learning more, updating the research, all all of that kind of stuff. So yeah, that's sort of my, who I am and why I'm doing this.  

Amber B 09:16 

That's fabulous.  And the, the book is “No Period, Now What?” And we'll link it in the show notes, but I highly recommend it. It is kind of a Bible, like, I, I look at it as like a Bible. It's like you put everything in here to really understand this and when, when, she says she's the world renowned expert on this like it's very evident in this book that you have spent your life figuring this out and learning about it and researching it. And combining the research that is available to us and it's it's just, it's fantastic. I'm a nurse by trade, my husband's a medical doctor so like the science in here just makes my little nursing heart happy.  

Dr. Nicola Sykes 09:52 

I love it. 

Amber B 09:53 

Have it all in one in one book and yet make it easy and understandable for the lay person as well, you know, it sounds like that's what you do on the on the board is like you could go with the medical journals and then translate it in for a lay person to be able to understand it as well. And that's, that's a gift as well, not a lot of scientists do that, so that's awesome. 

Dr. Nicola Sykes 10:10  

Thank you. 

Amber B 10:12 

So for people who are hearing us talk about hypothalamic amenorrhea and they're saying, and HA is what we kind of go short. That's a mouthful. 

Dr. Nicola Sykes 10:19  

Yes. Yep it is. 

Amber B 10:20  

Can you just kind of give us a little quick rundown of what that is? 

Dr. Nicola Sykes 10:26  

So, it's all kind of in the name, so the hypothalamus is the part of your brain that controls most of your other hormonal system. So it controls your reproductive system through the territory gland. It controls your thyroid also via the pituitary. It controls your stress hormones through the the adrenal glands in your kidneys. And it also controls your water balance and growth hormones. So it's sort of master regulator and it takes an input from your body hormonal input in terms of how much you're eating, what kind of stress are you under. So basically as a like it synthesizes the input from your body and then sends out signals to control all of those other systems. The amenorrhea part is lack of a period. So it’s lack of a period because of suppression of your hypothalamus is basically the the easy way to understand it. There are a few major factors that can suppress your hypothalamus, biggest one is nutrition intake. So if you're under consistently under fueling, if you're cutting out food groups, if you are doing some kind of intermittent fasting, those are all things that can quite easily suppress your hypothalamus. The stress from exercise can also play a role in that because when you do it particularly high intensity exercise that elevates your cortisol levels. Cortisol suppresses the hypothalamus and so psychological stress as well can also suppress the hypothalamus. So sort of a combination of those factors for most people that ends up leading to depression of the hypothalamus and one of the most obvious the ways that that is manifested is through a missing period. So as you're saying, as you're saying at the beginning, this can be quite relevant for people, even if they're not missing their period, because depending on your genetic, you know your genetic makeup, you might be more or less sensitive to those sorts of those sorts of stressors on your body. For some, some, some person might sort of be under fueling by, say, 100 calories a day and lose their period. Another person might be significantly under fueling during a lot of exercise and not lose their period, but they might still experience a lot of the other symptoms that go along with the suppression of the hypothalamus and just the general under fueling I mean, there's so many things that our body needs energy for and when we are consistently under fueling, our body has to shut things down. It has to conserve energy so that it can keep us breathing, heartbeating, you know, sending energy to the brain like those are the most important things. And so if we're under fueling, then that other things that are not quite as important get shut down, one of which can be the menstrual cycle, but also, you know, things like you can experience brittle hair and nails, bone density loss, you know, there's there can be changes to the elasticity of arteries and I think it's arteries, I'm not a cardiologist, so that's you know, so just lots of lots of symptoms increase need to pee, you know lots of anxiety, lots of sort of emotional symptoms, you know, you've probably heard the term hangry, absolutely our body needs energy to keep our brain well balanced and when we're not getting enough energy then it's, you know, it's much easier to spiral into anxiety and you know, being impatient and all sorts of things. So that's what's important for everybody to be fueling well as opposed, you know, and whether you're missing your period or not and it's also, it's true for people who have penises as well, so you know there's much less obvious symptoms and I think the best, the best name for this condition is probably relative energy deficiency in sport. That sort of comprises the entire constellation of all the different symptoms that one can experience missing period being one of them, and sort of the most obvious but yeah. 

Amber B 14:38  

So before we were, before we hit record, we were talking a little bit about the misdiagnosis of HA, and that oftentimes when you know when women miss their period and that's concerning and they go in, a provider will sometimes misdiagnose and miss HA and misdiagnose it as polycystic ovarian syndrome or PCOS. So can you talk to us a little bit about the overlap of those two with the symptoms, but the the divergences of the two with the treatment? 

Dr. Nicola Sykes 15:06  

Yeah, yeah, absolutely. And I think that's such an important point. It's much more common for people to have polycystic ovarian syndrome than it is to have HA. So it's probably about 10 to 1 in terms of the ratio. So doctors are much more likely to see PCOS than they are to see HA, and so it's not, it's understandable that somebody would go in with the missing period and I would just say, oh, it's PCOS, not necessarily knowing that there are multiple other conditions that can cause missing periods. So there's a chapter in the book on diagnosis that sort of talks you through what blood work should be done, what things to look for, stuff like that, because there are other things besides. So there's PCOS, there's hypothalamic amenorrhea, there's premature ovarian insufficiency, which is basically like another term for premature menopause. There can be physical issues that cause a missing period. There can be thyroid issues that cause the missing period, so it's really important to get to the bottom of what's going on. So both PCOS & HA are called diagnosis of exclusion. That basically means you rule out anything else that could be going on and then you know you end up with that as your, as your reason. So some things that are in common between PCOS and HA are obviously the missing periods or very infrequent periods. If one does an ultrasound, there are often lots of small follicles on the ovaries. There are some technical criteria for calling an ovary polycystic, which is 25 or more follicles on one on either ovary or an ovarian volume that's more than 10 cubic centimeters. I prefer the volume criterion because it's a little bit less subjective. But a lot of times, a medical professional will look at the ovaries and say, oh, there's lots of follicles. You have polycystic ovarian syndrome. It's like not necessarily the case. You can have a lot of follicles on your ovary without having PCOS, so I really, especially in somebody who is exercising a lot watching what you know, “watching what they eat”. It's much more likely that HA is the correct diagnosis, and so then you would look at then you would look at blood work and that's where you can really distinguish between the two. So with with PCOS, you often have elevated androgens, so well above the normal limits. The androgens are the hormones that are sort of “typically male-like testosterone”. And then some of the precursors of testosterone. With HA, you will likely have a low level of luteinizing hormone LH, and that's often elevated in PCOS so that that can be a a nice place to tell the difference between the two. You can have HA with normal LH. It's just very typically then a very mild case. You can certainly have PCOS without elevated LH, so it's really looking at the conglomeration of all of those hormones to kind of make a distinction between the two. And then looking at, you know, really thinking about somebody's history, you know, have you had an eating disorder? Have you lost a lot of weight recently and very recently it's, you know, within the last few years, I mean, it doesn't have to be like really recently, have you been on the birth control pill? I mean that there's nothing wrong with being on the pill, but it does mask missing periods.  

Amber B 18:28 

Sure. 

Dr. Nicola Sykes 18:29 

And sometimes it can be given as a as a Band-Aid like oh, you don't have your period. Take the birth control pill, which I really, really hate. I really think it's important to get to the bottom of why your period is missing before you go start thinking about OK, what do I do to get it back and recognizing that the bleed that you get from birth control is not a natural menstrual cycle. You're not ovulating and when you're taking a birth control pill, that's how it works. So just, you know, just really understanding that understanding that birth control is not a solution to this, it's just masking the problem. 

Amber B 19:01  

Yeah, it makes you bleed every month, but it doesn't fix the actual problem. You're still not ovulating. That is the problem. 

Dr. Nicola Sykes 19:05  

Yes, exactly, yes. 

Amber B 19:07  

So, so fascinating. One of the things that you wrote in your book was you said, no matter what our conscious minds think, if the hypothalamus sentences an unfavorable nutrient balance or stress environment, it will shut down the ability to cycle and procreate. And I loved this sentence because we I think so many of us are so good of, like, like we and we have in our mind the sense of like, oh, that's not me. Oh, this isn't a problem for me. Oh, I feel my body well, Oh that I’m really good at stress management. 

Dr. Nicola Sykes 19:38  

Or I'm doing all the things I'm doing all the things I'm supposed to be doing. I'm exercising. I'm eating well, you know, so. 

Amber B 19:44  

Right. So how do we often like, can you talk a little bit more about how we often trick ourselves into thinking things are fine when really our body is giving us these signals that like, hey, listen like things aren't actually fine. 

Dr. Nicola Sykes 19:54  

Yeah, I think it's, I think it's just really important to recognize the, that so much of the messaging that we get around nutrition and exercise is actually detrimental. So this idea that less food is always better and more exercise is always better. It's like no, you know absolutely exercise is healthy. It's good for your heart. It's good for your bones, it's, but it needs to be properly fueled. And if you're not fueling your exercise, then it's actually not doing a lot of those things, you know, a lot of those beneficial things. So I think just really recognizing that, especially on the food side of things like there's so many ways in which we are made to feel guilty about nourishing our bodies well, you know, like there are all these rules that come out about like, you know, don't eat too close to bedtime. Don't do this. Don't have dairy. Don't have gluten. Don't have sugar. You know it's bad, bad, bad, bad like there's so much fear mongering around food and so then when we do all those things, we cut out all of those items, you know, maybe, then we think, oh, I'm doing a really good thing for myself. 

Amber B 21:03  

Doing the right thing for my body. 

Dr. Nicola Sykes 21:04  

Yeah. And so it's just really hard to push through that messaging and recognize that you know, there's like all of those little pieces are taken sort of out of context. And you know, this idea that we should be consistently under fueling to be healthy, you know, it's just not evidence supported and you know, people often feel crappy when they're under fueling like they're a lot Uh, lots of people have GI issues and that's that's when the drives you nuts because you know you start under fueling and then your body needs to, like, slow down your digestion in order to extract more energy. It might not make the hormones or the enzymes that are needed because that costs energy like you know your digestion takes about 10% of what you eat like your calorie wise, nobody ever talks about that. So then you maybe you're constipated. Maybe you're bloated and then you're like, oh well, maybe it's the dairy. Maybe it's the gluten. So then you cut out more stuff, and then you actually feel worse. So then you then you start see doing more things, maybe you go see an allergist. Maybe you're told like you're allergic to all these things you cut out even more. And really what you just need is to give your body the energy that it needs. So I think it's just there's so much, there's so much information in the popular media that's sort of taken out of context, like studies about keto, for example, we’re specific. The keto is initially designed to help people with seizure disorders,  

Amber B 22:38 

Epilepsy. 

Dr. Nicola Sykes 22:39  

Yes, and now, suddenly, something we all are supposed to do and it's like, well if you cut out carbs like that's a quick source of energy for your body. If you're exercising without that quick source of energy like that can actually do more damage, and you know your body just can't get the, you know, can't get what it needs. So it's yeah. 

Amber B 22:57  

Yeah, it's really fascinating and it seems like this is a common thing that happens with HA. It's like if you don't actually get to the root of what the problem is, then any solutions that you're throwing at it are actually making it worse. And so we, like you said, we go to the allergist and we say you have a sensitivity to gluten. And so then we cut out gluten, which now makes us more nutrient deficient, which now exacerbates the HA and continues that cycle. And it's like if we can actually figure out and diagnose what actually is going on and what the problem is, the solution to it is very different than cutting out more things. It's actually what you call. 

Dr. Nicola Sykes 23:31  

Or taking a bucket of supplements. 

Amber B 23:32  

Or or right all the supplements to reduce your bloating and all of the things it's like, let's just fix what's actually causing which is under fueling your body. So and you call this going all in. So can you kind of explain that term, what does that mean? 

Dr. Nicola Sykes 23:48  

So I kind of think of the hypothalamus as following Newton's first law. So an objective motion stays in motion an object at rest stays at rest. So when you have your ongoing normal menstrual cycles, you can do for example a lot of high intensity exercise. You can do a little bit of under fueling and things will be fine. Once you get to the point where you are under fueling enough or you're doing too much exercise in your hypothalamus is shut down, then it's at rest and then you really kind of have to baby it to get it started again. So all in kind of addresses all of the factors that can be suppressing your hypothalamus all at once. And when you do it, when you do everything all at once, it's just that much easier for your hypothalamus to restart for your body to take the energy that it's consuming and put it towards the things that it needs to and, you know, you can get back to your normal life more, you know, more quickly. So all in is really the the number one thing is fueling your body well. So I have evidence in the book it's Chapter 8 for 2500 calories per day as sort of a general guideline for what people should be eating. You know, that sounds like a lot the the sort of guideline that you will read most places is 2000. That's based off of self-reported surveys where people will tend to underreport what they're eating, so the the 2500 calories comes from some much more rigorous studies using something called doubly labeled water, which is basically they have participants drink water that has this radioactive but like lightly radioactive so they can measure how much you know how much energy your body is using or they have you live in what's called a room calorimeter. So it's you, you're in a contained room and that that also measures like all of the carbon dioxide that's coming off you, all the water and everything and so based on those mechanisms we we can assess that for somebody who's active, which people with HA tend to be about 2500 calories is where you should be eating, what you should be eating in a day. So many of us are eating well below that and exercising. And so, you know, it's no wonder that our bodies are shutting down because they're just not getting anywhere near the energy that they need. So 2500 calories a day is a basis. You know, it's not. It doesn't have to be perfection. It's a guideline. It's basically just to give people an idea of like, if you're eating significantly less than that, this is about where you need to be. I don't think that counting calories is beneficial overall, you know, I generally tell people like count for a day or two, so you can see what 2500 looks like and then just like, let go, eat what you want you know, all of, all of that stuff because counting and tracking is stressful. It's just an added layer of stress, you know, permeates our day. So that's the first thing.  

Cutting out high intensity exercise is the second part of going all in, this I find is actually often harder for people because a lot of us really enjoy the high intensity exercise that we're doing. It feels fantastic. I mean I, you know, I play ice hockey still, I love it. It's like I'm sprinting. I'm getting a great workout. It's so much fun, you know, I know a lot of people feel the same way about running. I will never be a runner, but you know, people love it and you know, so it's it's hard to give that up, but the stress from the exercise as well as the energy that it's burning can be enough in and of itself to prevent your hypothalamus from starting up again, so it may not like, as I was saying before, it's if somebody has a normal menstrual cycle, they can do a lot of high intensity exercise and it's fine. It's just something that suppresses your hypothalamus and enough that you can't get, you can't get it started again while you're doing high intensity exercise. So my general recommendation is if you're doing some kind of planned movement to keep your heart rate at about 100 beats per minute, and that's based on the cortisol that's generated as you go, you know, as you challenge your body more than that. So then there, you know, there are few other components. You know, making sure that you're eating regularly through the day eating some carbs, some fats and protein, you know those are, those are sort of the general goals of all in, but it's really just about feeding your body well and cutting out the high intensity exercise for the time being. And that just gives your body the energy to repair everything that it needs to repair and to, you know, sort of get things started again. 

Amber B 28:21  

Yeah, so good and I and I know a lot of people freaked out when they heard that. So we're gonna talk about firstly on this topic like I I know you know that because your book like addresses all of those fears that people when they hear 2500 calories and they hear cutting out actually it's like if if you just told me to eat 2500 and I can keep my exercise, I might be OK, because I can counteract it. But then the cutting that exercise like you said is like, oh gosh, now I you know, I'm really, all of my babies are taken away from me. 

Dr. Nicola Sykes 28:47  

But even what you just said about you can counteract that, that's exactly it. That's the problem is if. 

Amber B 28:52  

That's the problem. 

Dr. Nicola Sykes 28:53  

You you know you, you can't counteract it because your body needs that energy to, you know, to rebuild and restore and repair and get back to a place of being truly healthy, I mean, I think that's, you know, I think that's something that's really important is, you know, we're often so worried about, like ohh, I can't eat too much sugar because it's “unhealthy”. I might gain weight and get diabetes and be unhealthy. But when you don't have a menstrual cycle, you're not actually healthy, and when you're consistently under fueling, you're not actually, you're not actually healthy. So it's like we just have to kind of like reorganize our thoughts in a way like stop being afraid of those things that might happen down the line. Probably not, and think about where you are right now and what your body is dealing with right now and like like let's figure out how to address that instead of doing things now for fear of something that's probably not going to happen and is not a reality at the moment. 

Amber B 29:49  

Right. Diabetes is not happening right now. Your unhealthy behaviors and your body is unhealthy right now, so let's yes prioritize fixing that and and we can deal with the other stuff down the road, which is probably not gonna happen yet. 

Dr. Nicola Sykes 30:00  

Yes, yes. 

Amber B 30:02  

It's really it's really, really good. And so for this period of time of all in, I know you talk about in the book that you recommend at least six months we talk to more of us about that recommendation cuz I think some people are like I can do this for a couple of weeks and then I'm good. And I can add my exercise back in. It's kind of like, whoa, step back a little bit. So talk to us a little bit about that recommendation. 

Dr. Nicola Sykes 30:20  

So it's really it, I mean it comes from so many places. One is just allowing your body time to as a as I've, as I've been saying, restore and repair and regenerate and kind of get everything working again and sort of resettle in a place of being more balanced and the other really important part is the mental side of things, you know, it's it is easy to do this for a week or two weeks. I mean, for some people it's not even easy to do that, like some people it's, you know, even adding a few 100 calories is a big challenge, you know, something to work work through work towards but just kind of redoing your understanding of how your body works. I mean so much of again so much of the messaging that we get is fear based. It's like if you eat a cookie, you know you're gonna double in size overnight if you don't workout one day, you're going to turn into a puddle of Jelly and you know, lose all of your fitness. And it's like none of that is real. None of that is based in biology, like, our bodies don't actually work like that, so taking a bit of time away from the high intensity exercise just gives you a chance to recognize that your body doesn't need it in the way that your brain has been told it does. You know, like I said, I think exercise is fantastic. It's it really is super healthy when it's well fueled and when it's not obsessive, you know, it's like you can take a day off weightlifting and it's actually probably better for you. You know you can take a day off running. It's probably better for you because then your body can rest and repair. You know, if you're exercising every single day, think about why you're doing that, like, what are you getting out of it? What are you giving up to be doing that exercise every day? And so that, you know, the three to six months whatever it is, of being all in really gives you a chance to kind of reevaluate your priorities, see things that you've been missing because you've been so focused on your food and your exercise, you know, it really gives you a chance to rebuild some relationships that are outside of exercise, you know, plus you probably feel like I was saying more patient and more balanced and less anxious and that also helps in building relationships and you know it's it can be a very lonely existence when you're just going to the gym every single day and you know you're not going out to eat with friends because, Oh my gosh, they, you know, the menu is there's too much on the menu and I can't deal with that and so I think the mental side of recovery is also really, really important. And that takes that, takes well more time than the the physical side of recovery. 

Amber B 32:56  

Yeah, makes a ton of sense. So I know one of the big fears that women likely have in their heads as they start this process is fear of weight gain and, and that can be a hard pill to swallow, that, you know, this may lead to some degree of weight gain and that actually may be part of the point that, may be part of the recovery process. So what suggestions do you have and you've already mentioned some of them, I love this idea of refocusing on like I'm not healthy right now instead of weight gain will cause me to be unhealthy in the future, it's like, yeah, but you're not, you're not healthy right now. So I love that one. Any other suggestions that you have of working through that, that mindset struggle that so many women have when it comes to weight gain. 

Dr. Nicola Sykes 33:33  

Yeah, I think, it is really, really hard again, because our society puts so much fear on us around the idea of being big or getting bigger. 

Amber B 33:40  

So much. 

Dr. Nicola Sykes 33:44  

You know, it's like in some place it you just kind of get this messaging since you're very, very young, that like being big is sort of the worst thing that can happen, like, please come on, I mean, there are plenty of people in this world, in big bodies who have lovely lives and you know, the idea that that's the worst thing that can happen to you is just ridiculous. But it sells, it sells so many things, so you know it's all over the media. So there are a few books on this topic that I really, really love, there's More Than A Body by Lindsey and Lexi Kite, the tagline on that is “Your Body Is An Instrument, Not An Ornament”. 

Amber B 34:16 

I love that one. 

Dr. Nicola Sykes 34:21  

And there's Sonia Renee Taylor's book, “Your Body Is Not An Apology”. There's “You Have The Right To Remain Fat” by Oh, shoot, I'm forgetting the author, my apologies. I'll come back to that at the end. 

Amber B 34:34  

Yeah, we'll link them in the Show Notes. 

Dr. Nicola Sykes 34:36  

Oh, Virgie Tovar, I think.  

Amber B 34:38 

OK.

Dr. Nicola Sykes 34:39 

So all of those are fabulous and I think it's just it's it's a really good way of shifting your mind to focusing on the things that you do as being the most important things about you as opposed to what you look like and and it's just so helpful in our entire lives, like when you don't worry as much about your appearance, you can get out the door twice as fast in the morning, you know, as you age, you don't worry so much about like the Gray hair or the wrinkles. It's, you know, it's like, you still spend well, less money on products that you don't actually need, you know, it's just, so I think that that's something that I've really come to appreciate through my journey in this in, in this arena is I've just come to a much healthier relationship with my body. Like I appreciate my body for what it does for me, not for what it looks like. I mean, you know, I go out in sweatpants and whatever I you T-shirt, I just I I'm just me. I'm just me out in the world. And you know, if someone else wants to judge me, that is their problem, not my problem. You know, I I just move in the world the way that I feel comfortable, you know, I gave up wearing high heels long ago, because why would anyone do that? You know, just the little stuff, like that, but all of it kind of plays the It's all just about building this self-validation and self-worth that's based on who you are and not what you look like and it just it, it just makes moving through the world so much easier in on a myriad of levels. 

Amber B 36:13  

It's really, really good for podcast listeners. I'm going to direct you back to episode 87 cause I actually interviewed Lexi kite. She's a phenomenal and the title is Struggling With Body Image, Listen To This, and I highly recommend their book. We'll link up all those books that you just recommended in the show notes, but I think there is a lot of work that a lot of women can do to really separate who we are from what we look like. And the more that you're able to do that and recognize that you aren't your body, it's you are completely separate from that. It's such an empowering place to get to and this this process of like maybe having some weight gain and and focusing on your health and holistically, maybe that push that you need to really do that inner work to break free from that, I am my body or I I deserve to, I need to look a certain way for other people or or whatever. Yeah, I love the chapter that you have on expanding mentally and physically and in it you talk about how to deal with comments from other people because I think that's another fear that a lot of women have is. Yes, I don't wanna gain the weight, but then what are other people gonna think about me if I do gain weight? And you know, we we live in a world where we unfortunately often have to navigate comments about our body, unwanted comments from other people about our body. So, you know, do you have any suggestions of how we can handle this if if that is something that occurs, we can't control other people. So how do we, how do we handle other people’s judgments of us? 

Dr. Nicola Sykes 37:36  

I think that's probably one of the most challenging things about this. So first of all, you know what, what I was saying before is that, you know, you are not anybody else's opinion of you. You are your own self and that's the most important thing. Unfortunately, our society feels very free to comment on other people's bodies, especially women's bodies. And especially if you're, you know, pregnant, or if you, you know you have a change in what your body looks like, I, you know, I think that sometimes just calling people's attention to that, like you know, I I don't feel comfortable with you commenting on my body, you know, that's and you can change the, you change the conversation immediately or you can just leave it there and, like, let them marinate in. 

Amber B 38:20  

Marinate on it. 

Dr. Nicola Sykes 38:25  

Yes, yes, yeah. You know, it's, I mean and a lot of times those comments are well-intentioned as well, and so also I think recognizing that, you know, people aren't generally trying to be nasty to you, you know, they're, you know, people might say, oh you look, you look really healthy. You look so much healthier, you know. If you're focused on, I'm feeling bigger in my body, they're commenting on my, you know, they're commenting on me looking healthier, that means I've changed. That means I. That means I'm “fat”, you know, it's that's a lot of internal, what's the word I'm looking for? Twisting of what the person has actually said, so I think really, really being careful about that sort of just taking comments for what they're worth, letting them drop if they're, you know, if they make you upset, just like I don't need that person's opinion. That's not. That's not who I am, but also not twisting what they've said to be a negative comment when you know, maybe it's not a negative comment, maybe it's just meant as a, you know, maybe it's meant as a compliment. Again, I don't think people should be commenting on others bodies. I think you know the more that we can work ourselves not to comment on other other people's bodies, certainly with their children not commenting on people's body size, you know, like compliment people for their smile or, you know, for the great work they've done, you know, there's so many things that we can compliment others on that are not what they what they look like. So. And I think we, you know, training our children from a young age that, you know, we don't need to talk about other people's bodies. We don't need to judge other people's bodies. I think can be really helpful and I think a lot of times it's the self judgment that's the hardest.  

Amber B 40:08 

Yeah, I agree. 

Dr. Nicola Sykes 40:10  

You know, I, so I, one of the things that we say in the book is, you know, think about what you're saying to yourself, would you say that to your best friend? Would you say that to somebody walking down the street? Most of the times, it's no. And so we're, we are often our own worst critic and so really trying to get away from that, you know that's where sort of getting away from the focus on your body helps but also, you know if there's a part of your body that you just, you know, you're really unhappy with, think about why, think about how you would talk to a friend about that part of their body, you know, for me I for a long time I hated my thighs. I hated the fact that when I would sit down, they would spread out and I would tell myself they look like tree trunks and I'm like, you know, these thighs are fantastic, like they're so strong, they like, let me play ice hockey like you know, the fact that they spread out when I sit down like that's what thighs do. That's just normal. 

Amber B 41:04  

Where did, where did we get the idea that that was abnormal? Why is that a problem? 

Dr. Nicola Sykes 41:09  

Right. Yes, yes. I mean really like, thinking, thinking about how you would, you know how you're talking to yourself and the negativity that you're putting on yourself and trying to transition that, you know, it doesn't have to be loving yourself. It doesn't have to be loving your body. I mean, you should always love yourself. I take that back, love yourself for sure. You don't have to, you don't have to necessarily love every part of your body, but just think about it, like, that's the way my body is, and I'm OK with that, you know, nobody's body is perfect. I mean, I think this there's some people on Instagram, like Danae Mercer is the one who comes to mind. She's often showing, like her, her stories and whatever, like how people on Instagram pose themselves and, like, pull their clothing and like, really weird ways in order to look at a certain way, but it's not reality. And so I think just kind of getting away from the idea that we need to be perfect. It's, you know, our bodies are, every body's a different size, shape, color, you know and it's all good. 

Amber B 42:07  

It's really good. It's really good. So let's talk a little bit about the the timing of recovery and what that that process looks like. So how long does it typically take for a woman to be able to get her period back after she's going all in? What does that transition look like and and is this like the new normal where we're not doing exercise or eating, you know, 2500 calories or what does that, that next step look like for someone who's in recovery? 

Dr. Nicola Sykes 42:29  

Hmm. OK, so when I read the book, one of the questions that I asked of the survey was how long did it take you to recover? So from when you decided I need to get my period back to when you actually got your period back. So the average time at that time was five months and the, sorry the average time was eight months. The meeting was five months. The median is lower than the average because there were some people for whom it was two or three years, yeah. 

Amber B 42:56  

All right, yeah. 

Dr. Nicola Sykes 42:58  

I noticed in my support group not too long after that that there were many more people getting their periods back sooner than I would expect based on that being the median or the average or whatever. So I did a much less scientific survey in my Facebook group, and I found that the median time was more like 3 months. And I think it's because after my book was published, people know what all in means. They know what they need to do. And so well more people are actually, just biting the bullet like saying, OK, I'm just going to do this so that I get it, you know, get it over with basically so the median is more like 3 months these days for for somebody to get their period back. Obviously it's dependent on so many factors. I mean it depends on where you're starting from, how long you've been sort of under fueling, you know all sorts of things. Brief side note, the amount of time that you've not had your period doesn't correlate very much with how long it takes for recovery. So there were some people who've been missing their period for 20 years, and it was still sort of in that, you know, 5 to 8 month kind of time frame. So you know it's it's, it's more when I say that is where you're coming from, like how underweight are you for where your body wants to be, for example, you know that that, that kind of thing and obviously our genetics like some people are more sensitive, some people are less sensitive that's just the way it is, so I really encourage people not to compare with others around them because that's just again that just leads to negativity and self doubts and everything. And I can promise you that this works. I mean, thousands of women have used this to recover missing periods and, you know, feel better and all you know, it's just it's it's well proven at this point. So yeah, so somewhere around 3 to 6 months is sort of a general guideline for how long it might take. Some people take longer. There's a chapter in the book called still no period that offers some guidance and suggestions for, you know if it is taking longer than that for you and and then, yeah, once you do get your period back, this is actually a time that we still need to sort of maintain what you've been doing for all in.  I found well too many people who get their first period. They're like, yay, I'm recovered. Let's get back to all my exercise, let's get back to under, so “intuitive eating” and and you know, then their second period is nowhere to be seen. So I recommend waiting until you've had three periods before you start adding exercise back, before you start thinking about changing food. And then once you get to that 3-month mark, you're still, like it's you still can't just immediately go back to sort of your previous level of training. It needs to be a slower ramp up. So another reason that I suggest waiting for three cycles is that gives you the opportunity to learn about tracking your ovulation, figuring out what your personal signs are, ovulation or tracking, you know, tracking temperatures, using one of the ovulation monitors.  Also, all sorts of ways you can do it that's also chapter in the book. But I think it's really really, really important, like I cannot stress enough the importance of tracking your ovulation. It's so helpful as you're sort of working to make changes like adding back exercise or making changes in your food because you can you can just like you make a small change you see, is your ovulation affected? If it's not great, you can add some more exercise or you know, do something with your food, if it is, then you wait a little bit longer. You give your body a chance to equilibrate, and then you know as your ovulation comes back to normal, then you, you know, then you can add a bit more. So the other, the other really important thing about sort of life after those 3 periods is not changing food and exercise at the same time, like if you want to add exercise you should actually add a bit of food to kind of make sure that your body is still feeling well nourished and, you know, getting the energy that it needs and a lot of people you know overtime the goal is sort of intuitive exercise and eating. And for many of us that have had HA, intuitive eating means eating a bit less than we have been. So that's why I sort of said “intuitive eating”, you know, so it's just something to be careful about, you know just making sure that you really are consistently fueling your body well, you know, over time like, yeah, I I don't count calories. I haven't counted calories in 16 or 17 years now, and I just, you know, but I know that on the days when I'm playing ice hockey, I need to eat a little bit more, you know and so it's just really like listening to your body also understanding that there is a discrepancy when we do high-intensity exercise between the amount of food that our body asks us for and what it actually needs. It makes no sense to me. It does not make biological sense to me, but that is the reality so for someone who's you know, if someone wants to get into back into marathon training, for example, after having had HA really being diligent about nutrition and fueling well and not even necessarily focusing on hunger because the the the high-intensity exercise can dampen our hunger signals and mean that we're not feeling as well as we need to. 

Amber B 48:12  

Yeah, that makes a lot of sense. I know I'm gonna ask this question because I know people are thinking this question and that is the question of if we gain weight during the recovery process, can we expect to lose that weight or is that now our new normal? 

Dr. Nicola Sykes 48:28  

I really, really, really don't like to focus on weight because I think that. 

Amber B 48:32  

I know I have asked the question because everybody’s thinking it. 

Dr. Nicola Sykes 48:33  

Yeah, I know, I know, I know. That totally, totally. You know, but again, think to yourself like, why is this a problem for me to be in a bigger body? Like really, really dig into that question. Really think about why this is something that you're asking yourself or asking me, you know, for many people, there is a a change over time in weight distribution. What have you, you know, as you add more exercise, you might lose some weight. You might not lose some weight, and I think I think really being OK with that being OK with your body at the size that it wants to be is so important, you know, I really discourage any kind of deliberate under fueling, you know, so maybe you maybe you might lose some weight and that's fine. But if you're saying to yourself I don't like how my body is, I'm not going to eat that cookie or I'm not going to, you know, I'm going to skip breakfast or whatever. Then that's really just going right back down that slippery slope to HA and all of the associated symptoms. Again, you know another one that I just want to point out that people might notice is feeling cold all the time, like, that's a, that's a big one. 

Amber B 49:43  

Yeah. 

Dr. Nicola Sykes 49:44  

That's a big sign of, you know, your body not getting the nutrition that it needs, you know, I just, I think that as I said, I think I think exercise is fantastic. It's super healthy. I you know, I I think people should be people should exercise as much as they want to as long as it's not sort of for these obsessive reasons like changing your body, fueling that exercise well is really important and you know just kind of let your body do what it does, I mean, it's interesting there was one person that I worked with, she noted after recovery that she was 20lbs heavier, but her marathon PR went from 330 down to three hours. So it's like often people are like I need to be small to be a good runner, it's like you know, you need to be well fueled to be a good runner, yes. 

Amber B 50:30  

Well fueled to be a good runner. Yeah, that's that's so good. Well, this has been fantastic. Thank you so much for coming on and giving up of your wisdom and your expertise, I I highly, highly recommend your book, No Period, Now what? Like I said, we'll link those all up in the show notes. So if you wanna check out those books that she recommended, I will link them up for you. This has been fantastic. Thank you so much for taking the time and coming onto the podcast, sharing your knowledge and expertise. This has just been a fantastic conversation. 

Dr. Nicola Sykes 50:59  

Thank you so much for having me. Can I put in a little plug for my podcast? 

Amber B 51:02 

Yes, please do. 

Dr. Nicola Sykes 51:03  

OK, so I've I've done two seasons. I'm on hiatus right now because like I said, I'm working on the translations and everything, but people can find my podcast at noperiod.info/allin and that's just all of the episodes. So we also we and we actually interviewed Lindsey Kite, the twin sister. 

Amber B 51:19  

Ohh, but, you listen to the other half on her podcast and then do you have any, I know you had mentioned like a Facebook group, is that a paid Facebook group for clients or do you have any like resources, if somebody is wanting to have a community who's kind of going through similar things, they're going through? 

Dr. Nicola Sykes 51:35  

So I moved off of Facebook for a number of reasons, but so I do have a support group. It's at noperiod.info/support or if you're trying to get pregnant noperiod.info/ttc so you know I I think that the, you know, it's a really nice group of people in there and it's it's really helpful to have other people to talk to who understand what you're going through because many of us don't know anybody else in real life. If and so you know some of the concerns that come up, I mean some people, you know, some people you might tell, like, I have to eat so much more than I'm used to and other people like, Oh my God, that's amazing. It's like, well, yes and no, and just having somebody that understands why that's a challenge and it helps you work through it can be can be really useful, yeah. 

Amber B 52:19  

Yeah, I can just see how having a community of people who get it in this situation is so valuable and so important. So, we will link all of those things up in the show notes, we'll link up the podcast. We'll link up everything you just shared right now, so people can remind you. 

Dr. Nicola Sykes 52:32  

And one last thing is I do I do work with people one-on-one. So everything from like a small like a blood work consult just to look at your blood work and you know, let you know what I think about your diagnosis to, like longer sessions or working with me on an ongoing basis. So that's all. 

Amber B 52:48  

Sweet. Awesome. Yeah, that's fantastic. Amazing resource, if this is something that you're really wanting to tackle and and heal and get, you know, heal your body and get a little bit healthier. 

Dr. Nicola Sykes 52:57  

And your mind, and your mind. 

Amber B 52:59  

So good. Well, thank you so much Dr. Sykes for being here. I really appreciate your time. 

Dr. Nicola Sykes 53:03  

Thank you so much for having me. I really appreciate you too. 

Amber B 53:07  

I thought that was such an important topic to bring on to the podcast again, one that I feel like is not talked about enough in this space. I'm all for exercise. I'm all for macro counting, but it doesn't mean that it is for everyone and it does not mean it is for every stage of life or every season. And I think that is really, really important to acknowledge. Not everybody is going to be helped by being in a clerk deficit and in fact a lot of women need to spend more time out of a clerk deficit, fueling their body well. And I think if you are somebody who has struggled with HA or is struggling with over exercising or continually under eating. I really highly recommend Dr Sykes' book No Period. Now what? I've linked it all up in the show notes, so if you go to bicepsafterbabies.com/273, just the number of this episode. I've linked her book up. I've linked the three books that she mentioned, as well as all the information of where you, you can find Dr Sykes and all the the things that she referenced her podcast, her Instagram account, and the different communities that she hosts. I highly recommend checking those out if this episode spoke to you. That wraps up this episode of Biceps After Babies Radio. I'm Amber, now go out and be strong because remember, my friend, you can do anything. 

Outro

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