#166 – All about women’s health, menstruation, & metabolic health | Doc Talk with Dr. Lauren Kelley-Chew

How do women’s health and the menstrual cycles link to metabolic health? These two things are more connected than you think. This understudied population gets a deep dive in this episode of Doc Talk with Dr. Lauren Kelley-Chew, our Head of Clinical Product. She shared with us the connection between hormones and insulin sensitivity, why women’s hormones constantly fluctuate, and why keto may not be for you.

04:46 – The menstrual cycle goes beyond menstruation

The menstrual cycle is made up of four chapters and is the body’s process for women of reproductive age getting ready to have a pregnancy.

The menstrual cycle, I think as you pointed out, the most famous part of it is actual menstruation, which is when bleeding is occurring. And I think a lot of people think of that as your period or as the entire menstrual cycle, but there’s actually four chapters, and of course you can think of the cycle amongst as many different types of chapters you want, but often there’s four that are talked about. And probably as our audience knows, but the menstrual cycle is the body’s process for women of reproductive age typically to get ready to potentially have a pregnancy. But of course, many women choose not to be pregnant or are not pregnant in their lifetimes, and the menstrual cycle is still occurring. And really it’s just as meaningful. There’s all kinds of hormonal changes happening every month throughout the month.

07:19 – The lack of research on the menstrual cycle

There has been very little research on the menstrual cycle in general, especially in the area of metabolic health.

There really hasn’t been nearly enough research on the menstrual cycle even separately from metabolic health, just the menstrual cycle in general. For example, I think a lot of women talk about having cramps. It’s really the amount of research that has gone into understanding that, how to prevent those or how to modify them really is just barely any research at all within the scope of how many research dollars have gone into other things and other areas. So I think this is something that I hope changes, but that’s just something to point out that a lot of this stuff, we really are scratching the surface when you think about the fact that half of the population at certain chapters in their life, more or less is experiencing this.

12:04 – The connection between hormones and insulin sensitivity

Most people believe that estrogen is connected with higher levels of insulin sensitivity, and that progesterone is the opposite.

In general, it’s believed that estrogen is connected with higher levels of insulin sensitivity, which is to say lower levels of insulin resistance and a better ability to tolerate carbs. And progesterone is the opposite. It’s associated with lower levels of insulin sensitivity, higher levels of insulin resistance and less ability to tolerate carbs. And yet, when progesterone is the primary hormonal signal, there’s also more of a carb craving. And again, this probably links evolutionarily to something connected to what the body is craving in relation to preparing for pregnancy and implantation. But what this means in terms of the cycle is that the first half of the cycle, which is the follicular phase, we said that estrogen peaks, so estrogen we can think of as the kind of primary hormonal signal during that phase. And then in the second half, the follicular phase, progesterone is peaking. And so we can think of progesterone as the primary hormonal signal during that phase. And so what this means broadly speaking is that during the first half of your cycle, you are in a position to tolerate carb loads better and at the same time maybe craving carbs less.

14:50 – Testosterone and the female body

People tend to think of testosterone as a male hormone, but it’s actually the most abundant hormone in the female body.

One that’s kind of important for this conversation is testosterone. And I think people tend to think of that as a male hormone, but it’s actually the most abundant hormone in the female body. And women’s bodies are really, really sensitive to testosterone. Testosterone is also changing throughout the menstrual cycle, and specifically it peaks right around ovulation. And so some women will describe that they actually feel like they have the most energy around ovulation, so say around days 13 to 15. And some experts like our advisor, Sarah Gottfried, talks about timing of stress on the body. So specifically, if you want to do a really high intensity workout or you’re thinking about doing fasting or some other form of stress on the body, that you can take advantage of that period, say day nine through 14, when testosterone is increasing, estrogen is increasing and you’re moving towards ovulation, the thinking is that your body will be best able to adapt to that stress and grow from it. And it might be just easiest psychologically to do it. If you’re craving a ton of carbs at the end of your cycle and you’re trying to carb restrict, that is going to be a very difficult challenge and you might want to time it so that you’re doing that carb restriction at a time when your body’s a little bit less likely for that to feel painful.

17:05 – Listen to your body

Cravings are your body’s way of trying to communicate to you, especially about hormonal changes during your menstrual cycle.

I tend to think that when your body’s telling you something, that’s a signal that I try to respect. Now, to your point, how I respond to that signal, I think there’s healthier ways to respond and less healthy. And really it’s not about judgment that one is good and one is bad. It’s more that if I know I want my body to feel a certain way, what food choices are most likely to lead me to feel that way and to be strong in my body in the way that I would like to. So I try not to put judgment on one choice or the other. I think some of the cravings, and there’s actually a lot of conversation about specifically the craving for chocolate during the menstrual cycle, and we should come back to this once we’ve really checked out what all of that’s about. But I know that there’s theories around specifically that craving in relation to hormonal changes. Separately, even from potentially insulin resistance, but that there’s chemicals in the chocolate that are specifically linked to cravings.

18:05 – How to satisfy cravings in a healthy way

While it’s important to listen to your body’s cravings, try to find a healthier way to satisfy those cravings.

My approach is to what you said, which is I try to satisfy cravings in the healthiest way possible. And I think that that actually starts well before we even talk about food. It starts with good sleep and it starts with low stress and with exercise so that you’re not in a situation where you’re so low sleep and your cortisol levels are so high that you really don’t have, at least for me, I don’t really have the mental functioning to be thinking to myself well, I crave X, so therefore I’m going to make this strategic decision. I’m much more able to do that when I’m well rested. I’m not stressed, I’m moving. And when basically I’ve planned. I don’t know if you experienced this, but planning goes a really long way and it’s easiest to plan when you have all those other pieces put in place. And I think it’s important to talk about the fact that having those things in place does reflect quite a bit of privilege in terms of day to day life. The vast majority of people may not have the option to have all of those pieces in place. If you have kids at home, if you have multiple jobs, if you have all kinds of things, there’s constraints on your ability to control your sleep, to control your stress, to control these other things. So I think that’s something important to note. And I would just say that then it’s trying to get as far along those things as you can realistically, knowing that everything is connected essentially.

23:12 – Hormone fluctuations are normal

Due to hormones, women’s bodies deal with major changes all month long, which influences things like mood.

In society, there’s been so much time where it’s almost expected that a woman should feel the same all month long. And if she’s experiencing anything different, it’s like she’s moody or she’s whatever. And I think what you said is what’s so true, which is actually there’s major changes happening in the body all month long, and those are linked to people’s moods in different ways. And I think we should come back to this because I actually want to refresh on the research related to, for example, estrogen and its connection to mood. And then as we transition into progesterone. But I do think overall it’s what you said, which is knowing that there’s actually things happening. It’s not just that you’re moody. Your body is undergoing changes, this is true in pregnancy, this is true in menopause. This is true even outside of these kind of defined moments that we recognize as a society are hormonal shifts. Even just as you transition from 30 to 40, from 40 to 50 throughout your lifespan, as you change your lifestyle, your diet, the stressors in your life, like you said, your hormonal balance is changing.

28:41 – It’s okay if keto doesn’t work for you

Only about half of women find that keto works for their body. Depending on the state of your hormones, keto may not be the right fit for you.

Sarah Gottfried, again, our advisor who does a lot of work in women’s health. She talks about having worked with of the many kind of tens of thousands of patients she worked with clinically in her practice that I think she says about half of them of the women who try keto experience issues with menstrual irregularity, high cholesterol, levels of stress, sleep issues, and she calls these women keto refugees. And I think she shares also in her personal story that she was one of these keto refugees. I know for me when I did keto, again, I did it for about seven or eight months and it got my fasting insulin really low and achieved some of the things that it’s supposed to. But also for me, it was definitely conducive to weight gain. I did not feel as energetic as I like to. There were things that I just felt weren’t really optimal for me. And I think this is a pretty typical experience. And the theory behind that, and again, this is very much evolving research, but Sarah talks about some of this is that when you restrict carbs in that way for women, it can throw off their hormone balance across a variety of hormones. For example, it can increase cortisol. The stress of not having that carb energy source or such low amounts of carbs that you’re really pushing your body into ketosis, that that can increase cortisol in women, which of course is not conducive to things like weight loss. It can also throw off thyroid function. And when thyroid function is off, again, might not be conducive towards achieving the goals that you were hoping to achieve when you started keto in the first place.

32:43 – Keto wasn’t designed for women

Intermittent fasting and the keto diet were both created for and researched on men, which is why it may not work as well for women.

Most of the research on keto diet has been on men. So that 16 and 8 protocol, for example, where you’re fasting, or sorry, this is intermittent fasting. 16, but the same applies to keto. Both diets have been essentially were formed around research on men. And I think that’s really to say what you said, which is if it’s not working for you, it’s not because somehow there’s something wrong with your body. It’s simply that diet has not been well researched in women and really neither has intermittent fasting. And so we’re dealing with two modalities that many men find a lot of success with. And women, the experience has been more varied. My hope is that whether through levels or other researchers that we start to understand, well, what would keto be for women specifically? And my guess is that whatever that ends up being, if a man followed that, he might say, wow, there’s something wrong with my body because this isn’t working for me. Just switching the framing I think really puts into perspective how difficult it is for women to try to follow male-centric tools.

Dr. Lauren Kelley-Chew (00:06):

I do think overall it’s knowing that there’s actually things happening. It’s not just that you’re moody. Your body is undergoing changes. This is true in pregnancy, this is true in menopause. This is true even outside of these kind of defined moments that we recognize as a society are hormonal shifts. Even just as you transition from 30 to 40, from 40 to 50, throughout your lifespan, as you change your lifestyle, your diet, the stressors in your life, your hormonal balance is changing. And I think if anything, the overall theme of all of this is that hormonal balance is so complex and it’s fragile in some ways. Of course, the body’s amazingly resilient, but there’s so many things that can knock that hormonal balance off. And when one piece goes off, everything starts to get a little bit less smooth.

Ben Grynol (00:58):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health. And this is your front row seat to everything we do. This is a whole new Level.

(01:24):

When learning about health and wellness, well, it is pretty apparent that it’s hard to decipher all this different information. The deeper you go, the more you learn, the more you realize how technical things can be. And sometimes, you need someone to break it down. So we started this series called Doc Talk. Initially it was Dr. Taylor Sittler, Head of Research at Levels. He and I sat down and did an episode around inflammation. Later, he and Tom Griffin, Head of Partnerships did an episode around resilience. The idea was to break down these concepts into simple terms so that we can understand them and other people can understand them too.

(02:03):

And so now we’ve continued to iterate on this, and Dr. Lauren Kelly-chew head of clinical product at Levels, she and Jackie Tsontakis, part of the growth team, they sat down and they discussed this concept around women’s health and they thought, Hey, why don’t we turn this into a series where we can have more episodes around women’s health? And so Jackie and Lauren, they sat down and discussed initially things like hormonal changes, how it plays into fertility, how it plays into women’s menstrual cycles, and how metabolic health changes. Especially when you take into account things like different stages of life when women are going through menopause or when they’re in their earlier years of fertility and they might be thinking about things like starting a family. It’s a great conversation. Here’s where they kick things off.

Jackie Tsontakis (02:55):

Hi everyone, I’m Jackie and I am on our partnerships team at Levels, and I’m here with Dr. Lauren Kelly-Chew. This is the first episode of a Woman’s health Doc Talk series where Lauren and various members of the Levels team will be talking about the intersection between women’s health and metabolic health.

Dr. Lauren Kelley-Chew (03:14):

Yeah, excited to be here and excited to be chatting about this because as you know, Jackie, there hasn’t been nearly enough research or conversation about women’s health, especially when it comes to metabolic health. My background, I’ve been in the healthcare world from lots of different perspectives over the last 10 plus years from being a private equity investor doing healthcare investments to then doing clinical training and getting my MD, co-founding a startup in the digital therapeutic space focused on digestive diseases and went to Google and Verily and worked on health tech there. And now happy to be at Levels and working on metabolic health.

Jackie Tsontakis (03:51):

Such an awesome background. I love reading your bio all the time and just all the different things that you’ve done in the healthcare industry and that brought you to Levels. I was so excited about this series. Just to your point, there’s not enough out there on this topic. And anytime I see a podcast about the different phases of the menstrual cycle, well, what’s happening to our bodies, I always listen because I’m so interested in it personally. So I wanted to focus the conversation on that today, what’s happening to our bodies. I recently learned that your menstrual cycle is not just the week that you’re getting your period. So I’d love to start there. I’m a newbie when it comes to this. So if you don’t mind just going through the different phases of the menstrual cycle for anyone like me who kind of just learned that this is actually a multiple week thing that’s happening in our bodies.

Dr. Lauren Kelley-Chew (04:45):

So the menstrual cycle, I think as you pointed out, the most famous part of it is actual menstruation, which is when bleeding is occurring. And I think a lot of people think of that as your period or as the entire menstrual cycle, but there’s actually four chapters, and of course you can think of the cycle amongst as many different types of chapters you want, but often there’s four that are talked about.

(05:06):

And probably as our audience knows, but the menstrual cycle is the body’s process for women of reproductive age typically to get ready to potentially have a pregnancy. But of course, many women choose not to be pregnant or are not pregnant in their lifetimes, and the menstrual cycle is still occurring. And really it’s just as meaningful. There’s all kinds of hormonal changes happening every month throughout the month.

(05:30):

The first thing I think that’s important for people to know is that what we’re going to talk about is a kind of typical 28 day cycle, but some women have cycles that are less or more days, and of course, there’s a range that’s considered kind of the normal range. And then there’s people of course who have cycles outside of that range too. And those sometimes are linked to different conditions or different imbalances hormonally. And some of those are actually really specifically linked to insulin resistance in metabolic health, which will be the topic of a whole other Doc Talk. But for example, polycystic ovarian syndrome where you can see cycles being shorter than a month or much, much longer than a month. Anyway, so that’s the preface.

(06:10):

The four main phases. The first phase is exactly what you said, which is menstruation itself. This is when you are shedding uterine lining. The body has decided that there is no pregnancy and it is dropping hormone levels down to baseline and really preparing for another cycle of potential pregnancy. So we say that menstruation is the first one to five days or so. And I think as a lot of women have experienced, it’s not exactly five days. It can really vary, but that’s the first chunk of the menstrual cycle is menstruation itself.

Jackie Tsontakis (06:45):

During that phase, I have heard some people say that they feel the worst during that phase, and then some people feel the worst during other phases, worse meaning lower energy levels or just lethargic. And maybe it would make sense to go through each phase first, but that fluctuates just based on person to person or does that have to do kind of with insulin resistance, metabolic health, how you’re feeling, your body?

Dr. Lauren Kelley-Chew (07:14):

Both. And I think this goes back to the way we started this conversation, which is unfortunately there really hasn’t been nearly enough research on the menstrual cycle even separately from metabolic health, just the menstrual cycle in general. For example, I think a lot of women talk about having cramps. It’s really the amount of research that has gone into understanding that, how to prevent those or how to modify them really is just barely any research at all within the scope of how many research dollars have gone into other things and other areas. So I think this is something that I hope changes, but that’s just something to point out that a lot of this stuff, we really are scratching the surface when you think about the fact that half of the population at certain chapters in their life, more or less is experiencing this.

(08:01):

But the short answer to your question, and we can go through each phase, is that hormone levels are at their lowest during menstruation and so many women will feel that drop in hormone level that happens during menstruation. But to your point, I also think it’s a lot of personalization here. And I think even women who have experienced, I know I’ve certainly experienced that sometimes one month will be different than another month. And so there’s even variation within the same person.

Jackie Tsontakis (08:28):

Totally. Okay. On stage two. Sorry I interrupted.

Dr. Lauren Kelley-Chew (08:31):

Okay, stage two or interrupt away. Stage two is the follicular phase. During this phase, the body is basically preparing an egg for ovulation to potentially meet a sperm and be fertilized. But what’s happening hormonally during this phase is that estrogen is beginning to climb and ultimately peaks right around the time of ovulation. So this is a time when the body is really using a lot of energy to prepare for what’s coming, and we’ll come back to what this means for metabolic health. But I’ll kind of finish the phases and then we’ll go into each one more deeply.

Jackie Tsontakis (09:07):

Perfect.

Dr. Lauren Kelley-Chew (09:08):

So from the follicular phase, you can think of that as about day five through day 14. So it’s after bleeding stops until ovulation. Ovulation is phase three. Ovulation is when the egg is actually released from the ovary and becomes available for fertilization.

(09:24):

And I should say, again, I’m describing these phases within the context of pregnancy, but it’s really important to note that this is not just about pregnancy. This is the rhythm that almost all reproductive age women have happening in their bodies every month regardless of pregnancy. So I think actually the fact that we frame as a medical community, often the menstrual cycle in terms of pregnancy, we have some work to do there. And next time I talk about this, I hope that I will phrase it a little bit differently, but this is the standard way of thinking about it.

(09:55):

So ovulation is when the egg is released, it coincides with the spike in several hormones including, like I said, estrogen tends to be at its peak right around ovulation. The final phase is the luteal phase, and this is when the egg is available for fertilization, it’s either fertilized or not. If it’s fertilized, you go into a whole different process of pregnancy or potential pregnancy. If it’s not, which is what we’re talking about, then the body ultimately prepares to shed the lining and to start again. But while it’s kind of preparing potentially for pregnancy and implantation, the hormone levels also change. And specifically progesterone rises and kind of peaks out during the luteal phase. And as you get towards the very late part of the luteal phase, progesterone and estrogen start to drop again. And we start over with menstruation.

Jackie Tsontakis (10:51):

Super interesting. I have personally thought lowest energy levels and just kind of that blah feeling of not wanting to do anything like lack of energy, not feeling as interested in things that I’d normally be interested in like hanging out with friends. I’m just, Oh, I’d rather just have a movie day today right before menstruation. So during that luteal phase. And I’ve heard on some podcasts and other sources say your body is potentially preparing yourself for a pregnancy during that phase. Do you feel like that’s a myth or is that true, maybe why we’re feeling that way? Or is it because of more related to hormones rising during that time?

Dr. Lauren Kelley-Chew (11:40):

It’s true that your body is potentially preparing for a pregnancy, and I think that process can use a lot of energy and it changes the kind of hormonal signaling that’s happening in your body. Maybe this is a good moment actually to talk about metabolic health and how that might be influencing energy and some of the things that you’re describing. So estrogen in general, and these are generalizations, and again, really, really we need more research on this, but in general, it’s believed that estrogen is connected with higher levels of insulin sensitivity, which is to say lower levels of insulin resistance and a better ability to tolerate carbs. And progesterone is the opposite. It’s associated with lower levels of insulin sensitivity, higher levels of insulin resistance and less ability to tolerate carbs. And yet, when progesterone is the primary hormonal signal, there’s also more of a carb craving. And again, this probably links evolutionarily to something connected to what the body is craving in relation to preparing for pregnancy and implantation.

(12:41):

But what this means in terms of the cycle is that the first half of the cycle, which is the follicular phase, we said that estrogen peaks, so estrogen we can think of as the kind of primary hormonal signal during that phase. And then in the second half, the follicular phase, progesterone is peaking. And so we can think of progesterone as the primary hormonal signal during that phase. And so what this means broadly speaking is that during the first half of your cycle, you are in a position to tolerate carb loads better and at the same time maybe craving carbs less.

(13:15):

And yet in the follicular side, there’s been a lot of research… well, by a lot, it’s relative. There’s been some research within the realm of relative to the research in this area, showing that women during the second half of their cycles, when progesterone is the primary signal actually crave carbs more, but can handle them less well. So for example, there was an observational study looking at women, what they called in the wild, which is just to say living their normal lives and the amount of consumption of carbs and processed carbs actually more than doubled during that second half of the cycle. And as we know, from any of the other Doc Talks, when you have insulin resistance, high car loads, glucose instability, you are going to feel fatigue, you are going to feel the brain fog, all these things that are linked to the metabolic dysfunction with or without menstrual cycle.

Jackie Tsontakis (14:04):

It’s interesting. There’s a chance that our hormones are kind of leading us to not take as good care of our bodies like those cravings and maybe being lethargic, you might not be exercising as much anymore during that phase. And then maybe that actually in turn has to do with how we’re feeling. It’s just that cycle that we always see. If you’re not taking care of your body and eating higher carb meals and not moving as much, you’re not going to feel as good. So that could also be just a matter of the way that we’re feeling ourselves during that time.

Dr. Lauren Kelley-Chew (14:38):

Exactly. And the other hormone that we haven’t talked about yet, and probably we could do a whole nother episode on other hormones that are occurring to the menstrual cycle because estrogen and progesterone are just two of them. But one that’s kind of important for this conversation is testosterone. And I think people tend to think of that as a male hormone, but it’s actually the most abundant hormone in the female body. And women’s bodies are really, really sensitive to testosterone.

(15:03):

Testosterone is also changing throughout the menstrual cycle, and specifically it peaks right around ovulation. And so some women will describe that they actually feel like they have the most energy around ovulation, so say around days 13 to 15. And some experts like our advisor, Sarah Gottfried, talks about timing of stress on the body. So specifically, if you want to do a really high intensity workout or you’re thinking about doing fasting or some other form of stress on the body, that you can take advantage of that period, say day nine through 14, when testosterone is increasing, estrogen is increasing and you’re moving towards ovulation, the thinking is that your body will be best able to adapt to that stress and grow from it.

(15:50):

And it might be just easiest psychologically to do it. If you’re craving a ton of carbs at the end of your cycle and you’re trying to carb restrict, that is going to be a very difficult challenge and you might want to time it so that you’re doing that carb restriction at a time when your body’s a little bit less likely for that to feel painful.

Jackie Tsontakis (16:08):

Definitely. And I love to hear your opinion. So if we’re craving carbs or I’ve craved chocolate, something sweet typically in different phases in my menstrual cycle, what is your thought on giving into cravings? How do you balance that? I mean, I have a really hard time fighting cravings, and sometimes I’ll just have a piece of dark chocolate and that’ll help. And maybe it’s around feeding into those cravings in the most healthy way that you can. But what is your experience, even if there’s no research, what do you do personally, even if you ever experience cravings? And how do you kind of manage that yourself?

Dr. Lauren Kelley-Chew (16:50):

I’ll give you my personal experience because again, I think there certainly are probably people researching this, but it’s not super well established, at least not research that I’ve seen. So there’s a few things here. One is that in general, I tend to think that when your body’s telling you something, that’s a signal that I try to respect. Now, to your point, how I respond to that signal, I think there’s healthier ways to respond and less healthy. And really it’s not about judgment that one is good and one is bad. It’s more that if I know I want my body to feel a certain way, what food choices are most likely to lead me to feel that way and to be strong in my body in the way that I would like to. So I try not to put judgment on one choice or the other.

(17:34):

I think some of the cravings, and there’s actually a lot of conversation about specifically the craving for chocolate during the menstrual cycle, and we should come back to this once we’ve really checked out what all of that’s about. But I know that there’s theories around specifically that craving in relation to hormonal changes. Separately, even from potentially insulin resistance, but that there’s chemicals in the chocolate that are specifically linked to cravings. And I personally love dark chocolate, [inaudible 00:18:02] everything in that family. So my approach is to what you said, which is I try to satisfy cravings in the healthiest way possible.

(18:11):

And I think that that actually starts well before we even talk about food. It starts with good sleep and it starts with low stress and with exercise so that you’re not in a situation where you’re so low sleep and your cortisol levels are so high that you really don’t have, at least for me, I don’t really have the mental functioning to be thinking to myself well, I crave X, so therefore I’m going to make this strategic decision. I’m much more able to do that when I’m well rested. I’m not stressed, I’m moving. And when basically I’ve planned. I don’t know if you experienced this, but planning goes a really long way and it’s easiest to plan when you have all those other pieces put in place.

(18:51):

And I think it’s important to talk about the fact that having those things in place does reflect quite a bit of privilege in terms of day to day life. The vast majority of people may not have the option to have all of those pieces in place. If you have kids at home, if you have multiple jobs, if you have all kinds of things, there’s constraints on your ability to control your sleep, to control your stress, to control these other things. So I think that’s something important to note. And I would just say that then it’s trying to get as far along those things as you can realistically, knowing that everything is connected essentially.

(19:25):

And I think within that, that’s something that I really want to help women and men for things that impact men more specifically, but women feel like is that they have tools to make small changes, even if they can’t become the most optimized person for a variety of reasons. And I think there’s so much that we can do that are little things that would still make a difference in terms of how we feel for example, right before menstruation. These things, we can make tweaks that I think can help.

Jackie Tsontakis (19:51):

Definitely. And sometimes I feel like even having an explanation for how I’m feeling just helps me understand what’s happening inside my body. If I were able to be like, I’m feeling a little bit tired, but I got a good night’s sleep, I’m having these weird cravings, I’m cramping, and I am able to kind of associate that with a certain hormone that’s rising in my body, I just feel better knowing what’s going on in my body. Just having that information, I feel like helps you feel more in tune with your body and understand what’s going on and then kind of think about how to react rather than if we can prepare for that and kind of know, okay, I’ll be ovulating at this time, I’ll be in my menstruation phase at this time, that can help us prepare too. Just having this information, I feel so much more educated on how I can kind of prep for each phase already.

(20:46):

When you brought up stress, that’s another big piece of how we’re feeling during different phases of our ovulation, or sorry, of our menstrual cycle. And I just wanted to ask about that and how that plays into how are hormones are affecting our mood stress levels. I know different people will face different feelings, emotions, I guess I should say, during different phases of their menstrual cycle. What are the most, people talk about PMSing, and I feel like PMSing is not just the way you’re acting or the way you’re feeling emotionally, but people kind of talk about it in that way. Where does that come from and how do hormones play into just the way you’re feeling, acting, thinking, that kind of stuff?

Dr. Lauren Kelley-Chew (21:41):

I think there’s a lot to talk about here, and we should probably do an entire episode on PMS. I think that would be interesting.

Jackie Tsontakis (21:47):

Totally.

Dr. Lauren Kelley-Chew (21:48):

I’ll just say some things that come to mind. I think that one of the things that people talk about the most is what you mentioned, which is basically PMS. And if we think about that phase, and that’s specifically essentially say the five to 10 days before menstruation. So the official term for it would probably be the late luteal phase, call it days 20 through 28 of your cycle. And during that time, progesterone, as we know, is starting to peak. Progesterone is associated with all kinds of things in addition to lower levels of insulin sensitivity. It’s also connected with, for example, water retention. And I think as many women have experienced, and I’ve certainly experienced, you begin to feel that water retention growing. And-

Jackie Tsontakis (22:31):

Is that bloating?

Dr. Lauren Kelley-Chew (22:33):

Bloating or feeling fat, I think which is a term-

Jackie Tsontakis (22:36):

Yeah.

Dr. Lauren Kelley-Chew (22:36):

A phrase that we probably don’t want to continue to kind of use, but this feeling that your body’s changing and that it doesn’t feel as good as it normally would potentially. And I think there’s so much psychology linked to that as well. Then, as you get closer to menstruation, both estrogen and progesterone start to drop off. So then you start to feel this real let down in hormones. And that also has ties to the psychology and mood and how it feels to just drop off those hormones. And I think these changes, in society, there’s been so much time where it’s almost expected that a woman should feel the same all month long. And if she’s experiencing anything different, it’s like she’s moody or she’s whatever. And I think what you said is what’s so true, which is actually there’s major changes happening in the body all month long, and those are linked to people’s moods in different ways. And I think we should come back to this because I actually want to refresh on the research related to, for example, estrogen and its connection to mood. And then as we transition into progesterone.

(23:41):

But I do think overall it’s what you said, which is knowing that there’s actually things happening. It’s not just that you’re moody. Your body is undergoing changes, this is true in pregnancy, this is true in menopause. This is true even outside of these kind of defined moments that we recognize as a society are hormonal shifts. Even just as you transition from 30 to 40, from 40 to 50 throughout your lifespan, as you change your lifestyle, your diet, the stressors in your life, like you said, your hormonal balance is changing. And I think if anything, the overall theme of all of this is that hormonal balance is so complex and it’s fragile in some ways.

(24:20):

Of course, the body is amazingly resilient, but there’s so many things that can knock that hormonal balance off. And when one piece goes off, everything starts to get a little bit less smooth. And so I think it’s incredible. But thyroid function is related to this. Sex drive is related to this. Mood is related to this. Feelings of confidence even have been shown to have connections to the different phases of the menstrual cycle and in relation to testosterone and also in relation to testosterone as it may get lowered from life stressors. So that’s a whining answer to your question, but I think there’s so many things happening at once that certainly there is actual physiologic change happening and there is actual psychologic change happening. And those are essentially one and the same in my mind.

Jackie Tsontakis (25:07):

Totally. I mean, it’s just funny to think about at the time when we’re feeling most, I guess, vulnerable, we’re feeling maybe we’re retaining more water, we’re not feeling great from an emotional perspective, we’re craving carbs. That’s actually the time when we should be paying most attention to our bodies. And actually, from what I understand, maybe even avoiding high carb foods during this time, and all these things are so hard to do, just taking care of your body is so much easier said than done. And when our bodies are feeling kind of the worst overall I’ll say is when we should be paying the most attention to it. And I guess that’s kind of a theme, that’s a theme across metabolic health. Even when you’re feeling bad, I think it’s really important to take care of your body. But it’s just so interesting, the advice that you mentioned that Sarah Gottfried kind of has as well, just that that’s actually the most important time to pay attention to how we’re feeling our bodies just to in turn feel better.

Dr. Lauren Kelley-Chew (26:10):

And I think one way of thinking about that kind of in an optimistic sense is that it’s a time when small decisions and changes can have a huge impact. So you can almost view it as a high impact time. So every little thing you do is in some ways really valuable. And I think because to the extent, like you said, we know we’re in a situation where our insulin resistance is probably higher, so that doesn’t mean that we eat no carbs, right? We don’t want to make our lives as absolutely difficult as possible, but it’s what you said, which is using the strategies that we know work to just try to make life as easy on our bodies as possible in terms of not loading it with huge carb loads or having a small amount of high fiber carb, like a small amount of berries, let’s say. And then going for a walk. And hopefully you’re pairing those berries with fat and protein and all the strategies that we talked about in our other talks. But just really putting those into place. And I think just celebrating the fact that you’re helping your body.

Jackie Tsontakis (27:07):

Totally. And then just to kind of close out with a few last questions around keto, we had talked about this a little bit before when we were going back and forth, and I was wondering how all this advice coincides with a keto diet. So during times where we can process higher carb foods a little bit better or can’t, are there recommendations around should we be matching our diet if we’re trying to be as keto as possible? Or in other words, as low carb as possible, should we be matching that to different phases of the menstrual cycle and what’s best in terms of how we should be fueling our bodies during different phases if we’re trying to be keto? I’ve experimented with keto before, so that’s kind of where the question comes from. And I’ve gone off and during certain period times of the month, I’ll say it feels really hard. So is there advice around that, around what makes the most sense?

Dr. Lauren Kelley-Chew (28:07):

I’ve also experimented with keto. I was keto for about eight months. It can be very challenging. I think, so we’re waiting into territory here of very much evolving science and evolving research. I think the thing to start with is that kind of going back to the idea that women’s hormones and the balance are very complex, and this is not just reproductive age women. This is also women who are at other phases of their lives, such as going through menopause or post menopause. Still, the hormonal balance is really intricate and diets like keto can stress that balance. So Sarah Gottfried, again, our advisor who does a lot of work in women’s health. She talks about having worked with of the many kind of tens of thousands of patients she worked with clinically in her practice that I think she says about half of them of the women who try keto experience issues with menstrual irregularity, high cholesterol, levels of stress, sleep issues, and she calls these women keto refugees. And I think she shares also in her personal story that she was one of these keto refugees.

(29:14):

I know for me when I did keto, again, I did it for about seven or eight months and it got my fasting insulin really low and achieved some of the things that it’s supposed to. But also for me, it was definitely conducive to weight gain. I did not feel as energetic as I like to. There were things that I just felt weren’t really optimal for me. And I think this is a pretty typical experience. And the theory behind that, and again, this is very much evolving research, but Sarah talks about some of this is that when you restrict carbs in that way for women, it can throw off their hormone balance across a variety of hormones. For example, it can increase cortisol. The stress of not having that carb energy source or such low amounts of carbs that you’re really pushing your body into ketosis, that that can increase cortisol in women, which of course is not conducive to things like weight loss.

(30:03):

It can also throw off thyroid function. And when thyroid function is off, again, might not be conducive towards achieving the goals that you were hoping to achieve when you started keto in the first place. In terms of pairing to the cycle, I’m not sure if there’s been specific work done on exactly kind of titrating how keto you are to different phases of cycle. But I do think knowing that you are most likely to be able to pull back on carbs during the first half of the cycle. And of course the irony there again is that’s the cycle where you’re most insulin sensitive. So you’re actually most able to tolerate carb loads, but you’re also probably most able to get yourself not to be too carby. The second half of the cycle, again, I think would be much more challenging to do, and yet also that’s the time when your body is less able to tolerate carbs. So there’s a little bit of an inverse relationship there that I think is interesting.

(30:53):

But in terms of timing, what Sarah I think has suggested is when you’re doing intermittent fasting, actually hers is a specific to intermittent fasting to do it in the days nine through 14. But I would think that probably that’s a reasonable time to try keto as well. And then Sarah has, of course, an entire methodology that she uses, which is a modified keto diet that she believes in her patients has really helped to maintain hormonal balance amidst reducing carbs. But just to say it kind of cycles and it introduces small amounts of nutrient dense carbs at certain times in order to avoid that full on keto syndrome.

Jackie Tsontakis (31:33):

Super interesting. I mean, most people will, I mean, that I know anyway, that have tried a keto diet, have done it to manage their weight or maybe even lose weight. And to think that a lot of the advice out there that might be targeted towards men is that keto can be really effective way to manage your weight. And for some women it might be, but to think that this actually might cause us to gain weight, I think is not something that’s talked about enough. So someone might think, what’s wrong with me? Why isn’t this working? But it’s totally normal and actually really common for a strict keto diet to maybe not have the effects that you want as a woman. So it’s so interesting for me to hear this.

(32:15):

Yeah, I have not had major success with the strict keto diet, but kind of listening to my body and doing keto some days and then doing heavier carbs, not super heavy carbs, but avoiding carbs less, I’ll say, on other days has worked better for me just listening to my body. And it also kind of feels good to listen to your body and feel like you’re in tune with your body rather than fighting it so much.

Dr. Lauren Kelley-Chew (32:41):

And most of the research on keto diet has been on men. So that 16 and 8 protocol, for example, where you’re fasting, or sorry, this is intermittent fasting. 16, but the same applies to keto. Both diets have been essentially were formed around research on men. And I think that’s really to say what you said, which is if it’s not working for you, it’s not because somehow there’s something wrong with your body. It’s simply that diet has not been well researched in women and really neither has intermittent fasting. And so we’re dealing with two modalities that many men find a lot of success with. And women, the experience has been more varied. My hope is that whether through levels or other researchers that we start to understand, well, what would keto be for women specifically? And my guess is that whatever that ends up being, if a man followed that, he might say, wow, there’s something wrong with my body because this isn’t working for me. Just switching the framing I think really puts into perspective how difficult it is for women to try to follow male-centric tools.

Jackie Tsontakis (33:45):

Totally. Well, here some more research around all of this, but I’m so excited that we are able to have this conversation and kind of just start the conversation around women’s health and metabolic health and how they intersect. I mean, even just the relationship between food and our hormones. I feel like there’s a whole nother topic that we could get into, but I am so interested to hear about that just from little, that we’ve talked about that food does impact our hormones and the way that we’re treating our body does impact our hormones. It’s not completely out of our control, I’ll say. So what’s really encouraging is that these are things that we can control. We can make ourselves feel better by fueling our bodies correctly throughout the menstrual cycle. So this is really helpful for me. I’m going to take some of these tips and use them to just react to my body and listen to my body more effectively.

Dr. Lauren Kelley-Chew (34:36):

And I’ll do the same. And I’m looking forward to more conversations on these topics, including some of the ones we touched on today and just really opening up the conversation around women’s health, metabolic health, and all of the evolving research that we can implement into our lives.