Episode 50: Amenorrhea And Infertility in Female Athletes

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Thanks for joining us for episode 50 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show!

Today we are answering the following question from a listener:

“Hi Laura and Kelsey. I’m a 26 year old female struggling with infertility as I’ve been amenorrheic since 2011. My cycle was always irregular in college while playing volleyball. But recently I’ve gained a little more weight and stopped running distance, but I still haven’t started my cycle. My thyroid test came back normal but my vitamin D is low at 35. I’m in the full sun at least 20 minutes nearly every day and eat a fairly strict Primal diet. Do you have any supplemental suggestions to increase my vitamin D and possibly help my cycle return? Thanks! Love the show!”

Struggling with amenorrhea is troublesome on its own, but it’s a double whammy when becoming pregnant is the goal. Whether you are trying to conceive or just regain a regular cycle, a re-evaluation of your diet can shed light on the mystery.

You may follow a Paleo, Primal, or other type of strict diet. But that doesn’t always mean it’s the healthiest approach to achieving a balanced way eating for your body and activity level. What you’re not eating is just as important as what you are eating, especially when taking your activity level into consideration.

Listen today as we discuss the major dietary factors that contribute to hormonal health. A few tweaks to your diet may be what you need to regain balance!

Here’s what Laura and Kelsey will be discussing in this episode:

  • How following a strict Paleo or Primal diet can contribute to macronutrient imbalances
  • The importance of eating according to activity level to maintain coloric balance
  • How appropriate carbohydrate and caloric intake are synergistically crucial for hormone health and fertility
  • The link between thyroid health, diet, and fertility
  • Insulin’s involvment in repairing hypothalamic amenorrhea
  • Adjusting the ratio of protein, fat, and carbohydrates in your diet
  • Balancing the ratio of vitamin A, D, and K2 for hormonal health
  • Additional nutrients for hormonal health
  • Recommended supplements
  • How to approach making changes to your diet

Links Discussed:


Kelsey: Hi, everyone. Welcome to episode 50 of The Ancestral RDs. I’m Kelsey Marksteiner and with me as always is Laura Schoenfeld.

Today we are going to skip our little update. Our lives are a little boring this week. We’ll just jump into the question for this week so that we can get right into the meat of the content. But before we do that, here’s a word from our sponsor.

Alright. So today our question is from Sarah and she says, “Hi Laura and Kelsey. I’m a 26 year old female struggling with infertility as I’ve been amenorrheic since 2011. My cycle was always irregular in college while playing volleyball. But recently I’ve gained a little more weight and stopped running distance, but I still haven’t started my cycle. My thyroid test came back normal, but my vitamin D is low at 35. I’m in the full sun at least 20 minutes nearly every day and eat a fairly strict Primal diet. Do you have any supplemental suggestions to increase my vitamin D and possibly help my cycle return? Thanks! Love the show!”

Laura: Alright. Well, there’s a couple of things that if Sarah was one of our patients that we would defiantly would want to know more about. When she tells us that she has a strict Primal diet, I think we know what that means from a food selection perspective. Generally Paleo plus probably dairy I think is more of the Primal approach. But just because you’re following a specific type of diet as far as the food selection is concerned, that doesn’t really tell us a lot about exactly what she’s eating, how much she’s eating, the types of macronutrients that she’s getting in each meal, the micronutrients that she’s getting. So those would be things that I would love to hear more about from Sarah if we were working together.

But generally if this person is experiencing either amenorrhea or irregular cycles from her athletic endeavors, so volleyball or if she’s doing distance running, my experience from the research that I’ve read, that tends to come down to a calories in/calories out imbalance. So she mentions that she had gained some weight, which is fine. That’s not uncommon. Sometimes that can be helpful depending how low the woman’s body fat percentage was. But from the research that I’ve done, the weight itself is not actually the indicator of whether or not the period is going to come back. Gaining can be helpful I think because it generally means that you’re exercising less and eating more, which corrects that calories in/calories out imbalance. But the weight itself is not actually going to fix the problem for most people.

When I talk about calories in/calories out imbalance, essentially all that means is that she may have inadequate food intake for the amount of exercise that she’s doing plus whatever her basal metabolic needs are. In the research that I’ve done on mostly amenorrhea in women with eating disorders, but also just the female athlete triad which is very common in women who are athletic maybe doing competitive sports, the biggest factor that they find to be related to whether or not the cycle is happening is the calories in/calories out balance. If somebody’s chronically under eating, even if they’re gaining weight or reducing their exercise, if they’re still not getting the balance of intake that they need, then that can actually cause irregular cycles or amenorrhea.

Kelsey: With a strict any sort of diet, I mean that can be really, really common. Like you were saying before, we really need to kind of know exactly what that looks like. Anytime I have somebody who says they eat a strict diet, I mean that’s one of the first things I think about is caloric intake.

Laura: Right.

Kelsey: Because more often than not, anytime you’re being very, very strict about something and you’re not also being concerned about caloric intake, chances you’re under eating. And especially since she is, it sounds like she’s active though she’s dialed back on the running distance, but I’m sure if she’s still doing any sort of other activity. That’s a little unclear from what she’s saying here.

Laura: Yeah. I feel like it sounds like she’s still athletic. But stopping running distance, does that mean that she’s gone from thirty miles a week to ten miles a week? Or does she do other types of activities? That’s definitely things that we would want to know more about.

Now with the Primal diet, I know that typically…and this is I’m assuming Mark Sission’s recommendations. Mark tends to be a little bit of a lower carb recommender, I guess. He’s got that, what is it? The insidious weight gain carb graph, which I’ll admit, I used to have that on my website as an example. So I’m not necessarily saying Mark is a jerk for saying this stuff. But I don’t agree that 150 grams of carbs a day is going to lead to weight gain in everybody.

She may be on a very low carb Primal diet. And in that situation, this is someone that I would definitely want to see eating more carbohydrates. Carbohydrates are I think, and we’ve talked about them so much that I hope people are not just sick of hearing about carbs. But I feel like this drum needs to be beat pretty frequently because of the things that I see in my social media, and in my clients, people that just don’t understand the volume of starches and fruit and that kind of stuff that they need to eat if they want to be eating a more moderate to higher carb Paleo or Primal diet.

Kelsey: It’s a lot. You’d be surprised.

Laura: I know. It is, and it’s something I’ve struggled with trying to purposefully eat more. It’s like my default mode is low carb if I just stop paying attention, which is really, I don’t know. I mean, I think it’s common with a lot of women, a lot of people who are kind on board with the whole Paleo, Primal approach. And If you’re not actively including carbs at every meal, and honestly for a lot of people if they’re not actively measuring, and tracking, and being very conscious about the amount of the carbs they’re eating, it’s really, really easy to be under eating carbs on a Paleo or Primal. I’ve gotten some backlash on Facebook and stuff like that when I’ve put articles out about, oh how does Paleo kind of harm somebody’s health, or fertility, or whatever. And people get really annoyed and they say Paleo isn’t low carb, that’s BS that that person thinks that the Paleo diet caused that. And on one hand I agree with the sentiment that Paleo is not “low carb” by definition.

Kelsey: Right.

Laura: However, and Kelsey I know you’ve experienced this with your patients as well, it almost always defaults to low carb. If somebody’s eating the typical Paleo diet, if they’re following the typical recipes, or if they’re looking on some Paleo blogger’s Instagram and saying oh I’m going to eat like she eats. I’ve not seen a lot of high carb Paleo recommendations out there.

Kelsey: Yeah, not at all. I mean, it’s unfortunate. And I think it’s changing and hopefully we’re part of that change.

Laura: Trying to be.

Kelsey: Yeah. It just is one of those things that almost all the literature out there, whether that’s books, blogs, podcasts, whatever, the stuff that people are exposed to from the beginning if they’re just getting into Paleo is pretty much all recommending at least a somewhat low carb, which in our eyes would be pretty darn low carb kind of diet. So then people get used to eating that way. Maybe they do it from a month or two and that sort of becomes the new normal. Then when they’re sort of more into the Paleo world, they’re hearing maybe that carbs are not bad inherently, that maybe they should be eating more carbs, especially if they’re doing more activity. Then they start to think about eating more carbohydrates.

But you’re right in that once you kind of started that Paleo, Primal sort of diet and you’ve done it for a while and your new normal is a low carb diet, its actually really hard to get to a more moderate carbohydrate intake because like you said, it’s that default that everybody falls back to. You just know how to put meat and vegetables together and like that’s easy. For whatever reason, adding the carbohydrate is like this extra piece that when you’re paying attention it can happen and it works. But when you’re not, it’s really easy to fall back to a low carb diet.

Laura: I think with women because we tend to have this message of how much food volume is normal for a woman to eat, when I’ve done tracking of my carb intake, it even shocks me sometimes when I’m doing a Paleo carb source for my meal how much food I have to eat to get that carb intake where I want it to be.  I think this weekend actually for one of my dinners, I had actually had a little bit of a hectic day and I didn’t get the meals in in the morning and the lunch time that I had really wanted. I still ate, but it wasn’t what I would have wanted to be getting in and I knew I was going to be training the next day. So I’ve noticed that if I don’t eat enough the day before I do a heavy lifting session, I don’t do as well. I was like, alright I got to make up the carbs. I’ve got to get them in. I ended up eating two sweet potatoes with dinner. I just kind of used that as an example because I’ve had some clients that they’ll say, oh well I’m not low carb, I have like a sweet potato every day. Or, I had a banana at lunch, or something. And I’m like, that’s still low carb.

Kelsey: Right.

Laura: They’ll say, I eat 120 grams of carbs a day. That’s not low carb. No, it actually is still low carb. Getting to a moderate to high carb diet on Paleo is very, very challenging. And that’s actually something that I know I’ve wanted to see more resources on and maybe that just means we have to create the resources or something. Because even in our Paleo Rehab group that’s going on right now, I see like we have some students that will post photos of their food and I’m just like, where’s the carbs?

Kelsey: Yeah.

Laura:  I’m like, I don’t understand. And they’re like, oh I have some strawberries on my salad.

Kelsey: No!

Laura: I’m like, no! That’s not enough! Or they’ll say, oh well I had like half a sweet potato at lunch.

Kelsey: Mm hmm.

Laura: It’s frustrating because I feel like there is just such a misunderstanding about carbohydrates. We were there too. When I say we, I know I was…

Kelsey: I was too. No, totally.

Laura: …back when we first started learning about all this stuff because you just get all this information about why carbs are bad. Even my mom and I were talking about a patient that was being discussed in the ADAPT program that Chris Kresser is running about how he was having blood sugar issues, and he’s diabetic, and what causes these blood sugar issues in people. And we were doing some research about this product that could potentially be helpful for someone to use pre-workout to keep them from having a blood sugar spike. On the website it said something about oh the product doesn’t raise insulin, which is the fat storage hormone. And I was just like, you know insulin is not just a fat storage hormone, right? I mean it also is a nutrient shuttler. So it literally allows your cells to take up all nutrients including proteins.

Kelsey: Yeah.

Laura: It’s an anabolic hormone. So if you’re doing a lot of exercise, or weight lifting, or any sort athletics and you want to put some muscle on, you kind of need insulin to do that.

Kelsey: Mm hmm.

Laura: I think there’s this really serious aversion to anything that raises insulin or anything that raises blood sugar. Even in our program we have some people who are talking about, oh well I was really worried because my blood sugar spiked to 120 after I ate.

Kelsey: Right. That’s normal.

Laura: I know, that’s totally normal! So it’s just amazing to me how much confusion there is about carbohydrates. I’m definitely going down a rabbit trail right now, so I’ll bring it back to the question at hand.

But that’s honestly, without knowing what this girl’s diet is, that is my assumption that she’s probably not eating very many carbs. She may be under eating calories in general. But even if she’s not super low in calorie, the question is whether or not a low carb diet can induce hypothalamic amenorrhea on its own. I question whether or not that’s possible. When I say I question it, I don’t have any research. But I do think from what I’ve seen in my clients who are following a strict low carb, Primal, or Paleo diet that weren’t menstruating, that increasing their carbs up to more of a moderate to higher carb intake a lot of times fixed the problem.

Kelsey: Yeah. Now do you know with your clients like that, do you know if originally they were under eating calories as well?

Laura: Yeah, so that’s the tough part because some people will argue that a low carb diet inherently won’t cause those problems and that it’s just the under eating side of things that’s causing that, which I think is a valid critique. That’s definitely possible. But that doesn’t mean that a low carb diet is then appropriate and you just need to then add like tons of coconut oil to get your period back. I do think that there is importance to carbohydrate consumption with fertility. My biggest concern about low carb, or I guess the low carb diet is the way that it affects thyroid function.

Kelsey: Mm hmm.

Laura: The thyroid function is really important for fertility as well. Now she says, “My thyroid tests came back normal.” The question is what does that mean, thyroid test? Is it her TSH? Because if you’re having hypothalamic amenorrhea, then your TSH is probably going to be normal or possibly even a little bit low.

Kelsey: Right.

Laura: Because TSH is the hypothalamus stimulating the release of thyroid hormone. Right? So if your hypothalamus is basically telling all your hormones to slow down because you’re not getting the food that you need, then actually your thyroid test for the TSH should come back normal. But that doesn’t mean that your thyroid hormone is working well. That doesn’t mean that your T4 is converting to T3 very well. That doesn’t mean that T3 is being very active.

Kelsey: Right. And usually when someone if they’re going to like a conventional type of doctor, more often than not they’re just running TSH. They’re not doing a full thyroid panel a lot of times. If this woman hasn’t had a full thyroid panel done, and that includes TSH, T3, T4, reverse T4, and antibodies, that would probably be a good idea just to kind of make sure that everything is converting correctly like you’re talking about here.

Laura: Yeah. That can be a little tricky even with hypothalamic amenorrhea because again it’s really the brain telling the ovaries and also potentially the thyroid to stop producing hormones as much, which is a safety mechanism for the body if you are in a chronically underfed state. There’s really no reason that the body should be reproducing if you are in a famine.

Kelsey: Right.

Laura: If you think about the way that would be working in nature, it shuts down those unessential processes. And getting back to full function really does require lots of inputs that tell your body we’re not in a famine situation anymore, we have plenty of food around. Honestly I think that could be a big reason why the increase in carbs can be helpful because if you’re eating carbs and your insulin is up, those hormones are going to be signaling to your body that food is available.

Kelsey: Right.

Laura: Even if you’re eating a ton of coconut oil on top of your diet trying to get those calories in, if you’re insulin is not going up, that’s not really telling your body you’re being fed enough. Eating pure fat like that is not physiologically normal for your body. Most people out in the…we say the wild, but the ancestral approach to food or for thinking about traditional diets, most traditional diets are not people like literary eating pure fat.

Kelsey: Right.

Laura: There’s usually protein and carbs in that food, or at least one of the two. Usually protein, but sometimes carbs as well. Usually carbs is what I should say. And even protein raises your insulin.

Kelsey: Mm hmm.

Laura:  I think that the insulin involvement in the fed versus fasted state is really important in repairing any sort of hypothalamic amenorrhea caused by a calorie deficit for a long period of time.

Kelsey: Yeah and carbs are a great way to get that up again.

Laura: Right.

Kelsey: I mean, I agree. I think that the low carb piece is really, really important here and I do definitely think that the calorie part is important as well.

Laura: Right. If she adds carbs and she’s still 1,000 calories under her needs for the day, that’s not going to fix it.

Kelsey: Yeah, that’s not going to make a difference. Yeah.

Laura: Yeah.

Kelsey: Exactly. But like you were saying before, if she’s pretty close or even if she’s a few hundred calories off, I would say if anything add those extra calories back as carbohydrates. Don’t try to add that as fat like you’re talking about here. It’s not as likely to help. Maybe it would help, but I think generally adding carbohydrates is if nothing else going to kind of make you get your period faster and just work a little better than if you’re simply adding calories as things like fat.

Laura: Right. And if she’s already at her calorie needs and she’s low carb, then I would actually suggest reducing the fat intake and replacing that with the carbs. So say she’s on, I don’t know, a 2,400 calorie per day diet. I’m just using that as a general number for someone who is athletic, and young, and a woman. And maybe she’s getting that much from a diet that has 100 grams of carbs in it and most of her calories are coming from fat. And then with protein, it’s hard to over eat protein unless you’re doing like tons of protein of shakes during the day. But if you’re just eating meat, it’s very difficult to over eat on protein because our bodies have pretty fine-tuned protein appetites.

So if she’s eating 100 grams of protein, and 100 grams of carbs, so she’s getting 200 grams from protein and carbs. That would be 800 calories. So then maybe she’s getting the other, what is that? That would be like 1,600 calories from fat if she is getting 2,400. You can see how getting that much fat, 1,600 calories, that’s almost 200 grams. It’s probably closer to 180, but that’s a lot. That’s like 10 plus tablespoons of fat for the day. Again, seeing where it can get really easy to under-eat on a low carb diet. But let’s just say for argument sake that she is eating that much calories. Then I would actually take out a significant amount of that fat and replace it with good 100 – 150 grams of carbs.

Kelsey: Yeah.

Laura: To get her up into that 200 to even like 250-300 grams of carbs range, which to a lot of people that do Paleo and Primal, they’d probably hear the word 250 grams of carbs and they’re like, insidious fat gain, I’m going to get obese if I eat that many carbs!

But that’s not true at all. What will happen is if you don’t reduce your fat and you go up to 250 grams of carbs per day, yeah, you probably will put weight on. But that weight is probably actually going to come from eating excess fat that you don’t need because your body can easily store fat that you eat as fat, whereas if you’re eating a lot of carbs to turn carbs into fat it takes a little bit of metabolic activity and you’re not going to get an exact 1 to 1 conversion of the calories you eat from carbs into stored calories as fat. And I’m not saying people should be worried about gaining weight necessarily, but I could understand somebody doesn’t want to put on 20 pounds from eating 300 grams of carbs and 200 grams of fat per day. That I think would probably cause weight gain in a lot of people.

Kelsey: Right, right.

Laura: But we’re assuming that this girl is on a low carb diet. Of course we may be wrong, but that would be where I would start with this person.

She had mentioned her vitamin D as being a possible concern. However, vitamin D of 35 is actually perfect. I would say that’s a really good number. Anywhere between like 30 and 45 would be optimal in my book.

Kelsey: Mm hmm.

Laura: I don’t even know if high 20s is something to be that concerned about.

Kelsey: Personally I like to see it around 35 as the lower end, but like a perfectly normal lower end.

Laura: Right.

Kelsey: If someone is like 29 – 30, I do want to see them get it up a little bit to around 35 where this woman’s at. But yeah, I mean you certainly don’t need to feel like you need push your vitamin D up super high. There are people out there that recommend trying to aim for like a level of 100, which is ridiculous to me.

Laura: Yeah. I guess my point is that I’m not seeing a vitamin D at 29 or 32 or something as being the cause of a health issue.

Kelsey: Oh, yeah. For sure, for sure.

Laura: I feel like with this question, she really seemed to think that the vitamin D was the problem.

Kelsey: Yeah.

Laura: It’s very unlikely to be the problem here.

Kelsey: Yeah, absolutely.

Laura: Now, if she was lower like in the high 20s or something and she wanted to do some supplementation, that’s not dangerous. But I don’t think it’s going to solve the problem. What I would say is more important to fertility and good hormone function as far as fat soluble vitamins is concerned is vitamin A.

Kelsey: Mm hmm.

Laura: So if she is getting sun and maybe she’s supplementing with vitamin D, it doesn’t seem like she is, but she could be. I would want to make sure that she’s getting that balanced with vitamin A. So 35 for D is perfect and she doesn’t need to add a vitamin D supplement if she’s getting pretty good sun exposure during the day.

Kelsey: Yeah. If that’s what she’s at normally and with her current sun exposure, no need to add a supplement I don’t think.

Laura: Right.

Kelsey: If she starts to go down over time and she’s noticing it trending downwards, maybe she needs a little bit of a supplement to just maintain that level. But it sounds like she’s getting a good amount of sun pretty much every day. So unless that changes, yeah, she probably doesn’t necessarily need a supplement.

Laura: Yeah. Of course with vitamin D the other two fat soluble vitamins that we always talk about are A and K2, which help vitamin D work optimally. Even if your vitamin D levels are on the lower end of normal, if you’re getting lots of K2 and vitamin A in your diet, then you’re going to have better vitamin D function that someone who’s got higher vitamin D but is basically not getting any K2 in their diet.

Kelsey: Right.

Laura: I would say maybe this girl wants to supplement with K2 if she’s not getting it in her meals, which a lot of us don’t unfortunately. Unless she’s eating like goose liver pate, and grass fed Gouda, and that kind of thing.

And then with the vitamin A, that’s something that again there’s evidence that it helps produce sex hormones. So if you’re vitamin A deficient, that can cause your sex hormones to be low. And that can also cause your thyroid to not function as well even if your thyroid test comes back normal. So you need vitamin A to use thyroid hormone appropriately. If this girl’s not eating liver pretty regularly, I would say that would be the first thing I’d want her to do if that’s possible.

Kelsey: Mm hmm.

Laura: If she absolutely refused to eat liver, which is totally understandable, liver is not exactly my favorite either, then I would put on a vitamin A supplement in that case, or maybe do desiccated liver as a supplement. And that’s just because of what I know of the involvement of vitamin A in both fertility and thyroid function and the fact that a lot people if they’re not eating liver, they’re really not getting enough preformed vitamin A. So supplementation in that situation is potentially appropriate.

Kelsey: Yeah. Absolutely. Do we have any good…I know you use a combo vitamin A, K2 mix.

Laura: Actually A, D, and K2

Kelsey: Oh ok, perfect. Yeah.

Laura: It’s a little frustrating. They don’t’ have an A and K2 combo.

Kelsey: Yeah.

Laura: I wish they did. It would make my life a little easier. As far as products are concerned, if you are taking D, there is a vitamin D3 that also contains A and K2 in a pretty good ratio. That one is called D3 Complete. It think it’s by Allergy Research Group or something.

Kelsey: Yeah, I think it is.

Laura: Also, there are options for individual supplements that if you wanted to be a little more specific about the dosages. For example, I have by a company called Seeking Health, I have their D, A, and K2 individual…well actually no, they don’t have K. Well, they may have K2. I have Thorne K2 drops, which those are pretty expensive. But luckily the dose is pretty low so they last a long time.

Kelsey: Yeah. They last forever.

Laura: But the vitamin A drops are I think 5,000 IU per drop. The vitamin D drops are, I want to say either 1 or 2,000 IU per drop. And then the K2, a full dropper, which is I think like a milliliter or something is 15 milligrams, which is pretty high because you only need a milligram maybe if you’re supplementing with K2 as the MK4 version. So those are what I personally use because I like that I can pick and choose what I’m doing.

Kelsey: Yeah.

Laura: So for example, if it’s winter and I haven’t had a lot of sun exposure, then maybe I’ll take a little bit of vitamin D a couple times a week. If it’s in the middle of the summer and I’m tan and I don’t think need vitamin D, I’ll skip it.  As far as the vitamin A is concerned, if I’m eating liver, I don’t take vitamin A supplementation. But if I know I haven’t had liver in a while, then I’ll just do a little bit of the drops for vitamin A. Or if I’m having symptoms that my vitamin A is potentially not ideal, like if I start to have breakouts, or I have this thing called keratosis pilaris which is pretty much under control at this point. But if that starts to come back, I know that my vitamin A needs to get attended to.

Kelsey: Yeah.

Laura: And then with K2, there’s really no established reason not to supplement with K2 for most people and there’s no established toxicity level. So I’m not too worried about getting more K2 than I need. And the reason for that as far what I’ve been explained to by…well I’ll say that this is what I remember Chris Masterjohn saying. I feel like I’m probably going to butcher it and I don’t want to put words in his mouth. But I think what he was saying is that K2, the function of K2 is that it carboxylates proteins so that they function differently. Like osteocalcin is a protein that puts calcium into the bones and teeth. So when K2 is activating that protein, it just carboxylates it, which is…I think it’s adding, is it a CH3?

Kelsey: Oh gosh. Bringing back the biochemistry.

Laura: No CH3 is the methylation. I don’t remember what carboxylation is, not important. But anyway, so when it carboxylates the protein and activates it, the theory is that if you run out of proteins to carboxylate, there’s nothing else that K2 ends up doing and it’s just inert. So that’s the theory and again, please don’t quote Chris Masterjohn on that. This is what I feel like I remember him saying, which I think makes sense if that’s the function of the protein.Or I’m sorry, the function of the vitamin.

So that’s why I don’t think that there has been an upper limit established, whereas vitamin D is actually a hormone more than a vitamin. And vitamin A is something that we know can become toxic if taken in excess. Of course if vitamin A and vitamin D are balanced, the risk of toxicity is extremely low. You have to take a very high dose of both to get toxic in either. But I tend to be a little bit more cautious with over-supplementation of D and K2 than I would…or I’m sorry D and A than I would with K2.

Kelsey: Yeah. I totally agree. And I personally like to take them separately, and I usually recommend that my clients take them all separately too for the exact reasons that you just explained. Especially for Sarah here, her vitamin D is normal right now and she’s getting a lot of sun. To me, she doesn’t really need that vitamin D supplement. So taking the A and K2 separately probably makes the most sense for her because I don’t think I’ve ever seen an A and K2 supplement combination. Yeah. Probably it just makes sense to do the two separately.

Laura: Yeah. Now if somebody wants to use a D, K2 combo, there’s no reason to not take K2 if you’re taking D.

Kelsey: Mm hmm.

Laura: So I know Thorne Research has a D and K2 dropper that a lot of my client like to use.

Kelsey: Yeah.

Laura: But that said, if you’re not taking vitamin D, then you need to be taking K2 on its own.

Kelsey: Right.

Laura: So in that situation, especially with the droppers, I find the droppers very easy to use. It’s like literally you just have them where is convenient and you take a drop, like however many drops of each one that you’re supposed to. So for me, that might be one drop of vitamin D, and 2 drops of A, and with K2 honestly I’m just like whatever comes out of the bottle I’m taking. It doesn’t matter. But I’ll do a couple drops of that. And it takes like 10 seconds to do that, and it’ll allows you to have a lot of control, and it prevents the possibility of overdosing on something that you don’t really need. Because in this person’s situation, if she’s taking that D3 Complete that we were talking about because she wants to get A and K2, she’s possibly going to be pushing her vitamin D higher than it really needs to be.

Kelsey: Mm hmm.

Laura: Which again because it’s combined with the A and K2, I’m not as worried about because it’s not just vitamin D on its own. But it’s still not necessary and it’s questionable whether it would be healthy.

Kelsey: Yeah.

Laura: Not something that’s necessary.

Kelsey: Right. For those of you who… because I’m the kind of person that any sort of liquid supplement, like I’m always wary of it because I really hate some tastes. I have a very particular palate and if something tastes disgusting, I will not take it. So just know that like the K2 from Thorne, those drops I mean it literally tastes like nothing. It’s mixed with MCT oil I think, right? And so it’s just like taking a drop of oil. It doesn’t taste like anything. If you’re someone like me who knows that you won’t take a supplement if it tastes bad, know that these do not taste bad. They’re very, very mild.

Laura: I’ve had one person say that they didn’t like the taste of the vitamin A.

Kelsey: Oh, yeah?

Laura: And in that situation, I’d suggest mixing it into some kind of fat containing food. It’s like literally if you’re taking 2 drops, it’s so miniscule the amount. I honestly think it’s not that big of a deal and people should just like get over it because it doesn’t taste that bad.

Kelsey: Yeah.

Laura: But some people do have very sensitive tastes and in that situation mixing it into some food is fine. The vitamin D drops that I use from Seeking Health are actually blended with olive oil.

Kelsey: Oh, hmm.

Laura: They actually have this like olive oil flavor, which is a little bit odd. But again, totally benign flavors, like they’re really easy to take. All you have to do is just put some drops on your tongue and then swallow with some water afterwards if you don’t want to have the flavor lingering.

Kelsey: Yeah. I actually put them under my tongue.

Laura: Oh, ok.

Kelsey: Just because of my weirdness because I don’t like to taste things if they potentially taste bad. Yeah, I put it under my tongue and then I just like swish back some water. And that seems to be perfectly fine. I don’t even notice it at all, even if I’m taking a lot of K2 at once for whatever reason like forgot to take it the whole week or something and I just take like a pretty full dropper, or something like that. Yeah, no big deal.

Laura: Yeah. So as far this question is concerned, again we would be really focusing on her calorie intake, her carb intake, making sure that her vitamin A and K2 is being balanced with the vitamin D, which again is not really needing to be supplemented. After that with this person, it would really come down to any specific holes in her diet for example. So if I was noticing that for example her zinc intake didn’t look so high, zinc is a good example of a nutrient that’s very important for fertility. So maybe we would look at adding some shellfish into her diet, or possibly a supplement if she wasn’t able to eat shellfish.

Or like the B vitamins, again if she’s eating liver she should be good. But if she can’t eat liver then we’d want to look at making sure that her B vitamin status is appropriate and making sure her B12 and her folate especially.

I’m trying to think of some other basic nutritional approaches that would be important here. Because again, for the women that I’ve worked with, honestly I feel like the calorie and the carb thing works so well that we don’t really have to go super deep into this like functional medicine approach.

Kelsey: Yeah. I mean, I would add to the diet recommendations here just that for people…if you are severely under eating, we’ve talked about this before, but take it really slow in increasing your caloric intake over time. Don’t feel like you need to get to your goal level of calories tomorrow because that’s going to be a really big change for your body to deal with and sometimes people will just feel overly full. Food will kind of make them sick because they’re just like stuffing themselves. So don’t feel like you need to stuff yourself right off the bat. Maybe increase your calories by 100 or so calories like every few days or even every week depending on what you feel like is appropriate for you and how many calories you need to add to diet currently.

Then sort of the same thing with the carb, fat trade off here. If this person is eating a lot of fat right now, which is certainly possible, and we kind of want to swap that with carbohydrates if she’s eating a relatively appropriate calorie intake. That’s another thing that I’ve found can be really tough for people when they’ve been on sort of a strict Paleo or Primal diet in the past because they’re just so used to eating all that fat and it’s like a whole new world to try to like not eat fat. And not take it out completely obviously, but to them even a normal amount of fat intake feels really low and it feels like they’re not eating fat. So again, don’t make that swap immediately and fully. You can really take your time to do that if it feels like a huge change for you right now.

Laura: I will say that I don’t want people to be scared off from the full on approach where you just start doing it. I think what Kelsey is trying to say is that if you’re feeling uncomfortable or if it’s hard to digest the food that you’re eating because you’ve changed too fast, then go slower. That doesn’t mean everyone’s going to have a problem.

Kelsey: Right.

Laura: I know for me, switching to a high carb diet really didn’t affect my digestion whatsoever, and in fact it probably made it better. I don’t want people to expect indigestion from eating the appropriate amount of food and increasing their carbs. But it does happen. So if is happening to you, don’t give up and say oh well this just means I can’t tolerate carbs and I might as well stay on low carb.

Kelsey: Right.

Laura: Just go a little slower and make the transition a little bit more I guess….

Kelsey: Gradual.

Laura: …step wise and not just doing it all at once because it can potentially cause some indigestion, or over fullness, or maybe some blood sugar issues if somebody’s going from a ketogenic or a very low carb diet to one that is high carb because your body is not ready to be insulin sensitive right away.

Kelsey: Right.

Laura: Now I will say one issue that I see in a lot people who switch from low carb to lower fat, higher carb is that they still end up not getting enough carbs in, which that can definitely cause symptoms of hypoglycemia and blood sugar dysregulation. Because I’ve had some people who said, when I eat higher carb my blood sugar tends to be all over the place. And then we look at what they consider higher carb and it’s like 150 grams or 160 grams.

Kelsey: Right.

Laura: So if you’re trying to go higher carb and you don’t go high enough, that can cause your body to start making that switch the more the glucose heavy metabolism, but then you’re not giving it enough glucose to run appropriately. So then that’s when you experience that hypoglycemic situation. That is a possible issue that you can run into when you’re making that slow change. And that’s why I say if you don’t have any issue with digestion, and you can handle eating that much food at once, or if you have to split it up into more than 3 meals, that’s fine. But I find that going in that kind of like no man’s zone of not really low carb, but not high enough carb to get the benefits of eating a high carb diet, that’s where some problems can happen too.

I think this is a good example of why working with someone is really important because they can help you to figure out what the appropriate approach is. Because like I said, for some people going like full on, just go for it high carb kind of thing, that works great, and it’s fine, and you don’t’ have to worry about it. And then other people that type of approach physically is uncomfortable, and their digestion is not ready for it, and it just won’t work for them.

Kelsey: I feel like I get all those people.

Laura: You get all those…..

Kelsey: Yeah, that it’s hard for. I had very few people who have been able to do it right off the bat. Though there have been some. But, yeah, for a lot of people there’s some problems.

Laura: I get all the people that are like, I can’t eat that many carbs because that’s not good for you.

Kelsey: Right. So it’s a little a easier.

Laura: It’s a lot of re-education about why that’s not true.

Kelsey: Right.

Laura: which, I mean to be fair, the mental aversion to carbs is just as much of a problem as a digestive aversion.

Kelsey: Oh, totally.

Laura: If anything, at least the digestive symptoms can kind of go away on their own, whereas as the mental issues…I say mental issues like if you’re literally afraid of carbs, or if you’re thinking these carbs are going to make me fat, or if you’re just like mentally opposed to the thought of eating carbs, that’s not just going to necessarily go away on its own. You really have to kind of combat that mentality and work on it because that in itself as we have experienced in a lot of our clients causes problems in its own both with under-eating, and too low carb, and over exercising, and all that stuff that causes a lot of these health problems in the first place.

Kelsey: Absolutely.

Laura: I feel like, Sarah, we’re making a lot of assumptions about you. We could be totally wrong. But this is our experience with a lot of people that we’ve worked with. Hopefully this is applicable to your situation. If not, feel free to come share in the comments if we like totally misinterpreted what your diet looks like.

But if it was accurate, then again really what we really want you to focus on is making sure you’re getting the calories that you need. You can go onto some online calculators and figure out with your amount of activity what’s an appropriate calorie intake for you. And then work on increasing your carbs. Again I hesitate to have anyone get stuck in that 150-180 grams per day zone where it’s like not high carb and it’s not low carb either. Consider going into that 200 plus range. And then look at your vitamin A intake and if you’re not eating liver once a week, then maybe you want to start doing that. Anything else to add, Kelsey?

Kelsey: I think that’s great. And like you said, I hope we are making the right assumptions here. It’s hard with all these podcast questions. You kind of get like bits and pieces of information. But even if it doesn’t apply to you, Sarah, and you have to kind of write back to us and we can help you a little further, hopefully this applies to anybody else dealing with some of the issues that we talked about today and you can really take this to heart and start to work on those issues. Because like Laura was saying before, I mean almost all of this stuff can be resolved simply by eating more calories and more carbs and paying attention to some of those important nutrients. But beyond that, I mean usually people do not have to go beyond that.

Laura: Right.

Kelsey: So it’s a pretty, I mean I say easy fix, and I mean that just in the sense that it’s not really, really complicated to figure out a lot of times. It can certainly be hard mentally to kind of make these big changes to your diet, especially if you’re someone who has been scared of carbs or calories for a long time. It certainly may not be an easy change. But it’s definitely worthwhile change. At least you don’t have to kind of go down to that functional medicine rabbit hole where you can’t figure out what’s going on. A lot of the times it’s pretty straight forward. So as long as you put in the effort and the work to raise your calories, and carbs, and maybe some of these new nutrients we’ve talked about, chances are you will get your period back and you will hopefully stop struggling with infertility.

Laura: Perfect. Well that was a great way to end that question. Anyway, thanks for joining us everyone for our 50th episode. It’s a little crazy to say the number 50.

Kelsey: I know.

Laura: Next stop is 100, right?

Kelsey: Yes!

Laura: That’ll be in a year from now if we’re doing it weekly.

Kelsey: Right.

Laura: So stay tuned. But anyway, thank you again for joining us. Feel free to share your questions or responses to this question in the comment area of the blog post for this episode. And certainly if you have any additional questions you’d like follow up answers to on another podcast episode, then submit those through the contact form on our website. But enjoy the rest of your day everybody and we’ll see you here next week.

Kelsey: Alright. Take care, Laura.

Laura: You too, Kelsey.



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I'm a women's health expert and a registered dietitian (RD) with a passion for helping goal-oriented people fuel their purpose.

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