Why Calorie Deficit Diets Disrupt Menstrual Health (Episode 458)

Full Transcript: Episode 458

Lisa: Today I’m sharing a brand new interview in my FAMM Practitioner Series. I’m sharing a conversation with one of the FAMM graduates, Rose Constantine Smith, and we are getting into the interesting and controversial topic of dieting and weight loss, and we touch on the role that many dietitians play in supporting their clients to lose weight. And I find this to be a really interesting topic because in my world, when I’m working with clients, I have never specifically worked with clients for the purpose of weight loss. In my work, I’m supporting my clients to chart their cycles for birth control, for conception. I have programs where I’m working with clients who are trying to conceive and we’re working to optimize the cycle, balance hormones, prepare for pregnancy, identify underlying fertility challenges, all of those types of things. And so it is really interesting to have this conversation about how the perspective shifts when the goal is weight loss toward a different type of goal, when the goal shifts to preserving fertility and or preparing for pregnancy.

All right, so I will take a moment to tell you a little bit about Rose. Rose Constantine Smith is a registered nutritionist specializing in women’s health. Using nutrition, lifestyle, and now menstrual cycle charting, Rose supports women to meet their health goals while helping them to understand and appreciate their bodies beyond their physical appearance. She works with women of all ages with issues including menstrual cycle health, digestion, preparing for pregnancy, supporting energy, postnatal recovery, and health post menopause. Now with her knowledge of fertility awareness which helped her through her own journey where she was left with very little support after the birth of her daughter, she is on a mission to provide women with the information and support they deserve to navigate their health and hormones smoothly throughout their life. And to hear more about Rose’s personal story, you can have a listen to episode 439. So without further ado, let’s go ahead and jump into today’s episode.

Lisa: And I’m excited to be here today with Rose. Welcome to the show, welcome back.

Rose: Thank you, good to be back.

Lisa: Yes, yeah. We were just chatting in the pre-chat when we did our episode for the FAMM Practitioner Series. I feel like there were so many different topics we could go into and I remember we had a conversation about weight, weight loss, and I thought it would be really fun and informative to have a conversation about that. If the listeners want to hear a little bit more about your story, I can direct them to our previous episode so I’ll put that in the show notes. And I think yeah, we can jump in. I would love just to kind of maybe just give us the overview of what inspired you to jump into nutrition and focus on women’s health and then we can kind of dive into weight loss afterwards.

Rose: Yeah, absolutely. So it’s sort of, obviously my interest in nutrition always just started with food. I just love food. I want to know more about it. I did loads of cooking and so that’s when I went to university and kind of hadn’t thought about where I was going to go long term with it. Originally, yeah, and I say it was all about the food. So, but I noticed while I was doing my degree, I found myself being a lot more restrictive and being really aware of like the calorie in, calorie out. That was very much what we were taught as a way for managing weight within the public. It wasn’t like we got loads of information about women’s health or anything like that specifically. So when I came out with my degree, I was working in a public health setting. And again, because you’re working in public health, it’s so general that you can’t give any kind of specific advice to anybody, whether that’s a man or a woman or a child, it has to be so broad. And I think after I had my little girl and went through all of these issues with my own hormones and various other health issues, which again, I mentioned in the previous podcast, I think I was just thinking this general health stuff like it doesn’t work actually for the majority of the public because there’s such a broad spectrum of different things going on for everybody. And that was kind of when I thought I just really want to start specializing and work with people on a one-to-one basis. And that’s when I found you. And it just completely blew my mind how much there was to learn about women and hormones and the impact that diet has on our hormones and how empowering it can be actually to move away from calorie in, calorie out, actually thinking, well, what is my body telling me? Because regardless of whether my calorie sum adds up correctly, if my body’s telling me something else is wrong, then you can’t ignore it. It’s like a warning sign, isn’t it? So I feel like I’ve done a complete sort of turn in what I’m doing now, but it just all makes sense in a way that before it didn’t. And it just, I felt like I was always kind of locking horns with the situation because it was like, I just, it doesn’t fit right, this doesn’t seem right to be giving such general advice to everybody, if that makes sense. So that’s kind of how I got to where I am today, whistle-stop tour.

Lisa: Yeah, for sure. Well, so I think one of the things that really interests me is the weight loss conversation because I don’t get women who come specifically for weight loss. Weight loss could be a side issue, but it’s not the main issue. So maybe just share with us a little bit about your training so we get a sense of that. How much of your training was around weight loss and how were you trained to help people lose weight? And I suppose I can add another question there, which is, and I think we know the answer, was there a difference presented for how men versus women would lose weight or was it kind of the same idea for both parties?

Rose: So it was pretty much the same in terms of that second question, so other than the fact that obviously the calculation would be different because men have a bigger body mass and that sort of thing. But otherwise there wasn’t any allowance other than when you were pregnant and the extra 200 calories you can have in the last trimester. There wasn’t really any other information around what do women need for their hormones and do they potentially need different things at different times of the month, or if there’s a certain symptom they’re experiencing, whether that’s to do with a nutrient deficiency, that was never kind of looked at. It was always again just really generic. And in terms of kind of the education around it, it was, as I said to you earlier, it’s very black and white. It’s very much like, this is the nutrient, this is what it does in the body, rather than it being, this is how it interacts in the male body, this is how it interacts in the female body. And there was nothing kind of around different approaches that you need to consider. I think again, this was kind of a post-university thing, but there’s obviously loads of talk about fasting and the benefits of fasting. Actually, now I think about it, within the degree they do talk about fasting and how it can be beneficial. And again, no mention on how that could actually interfere with your menstrual cycle. So that was something that I did in the past. I did fasting as a way to — I think I just kind of went off breakfast and I was like, I just don’t think I’m having it. And it sort of suited me and I’d heard about all the benefits, so it was really good, so, oh great, I’ll give it a go. And it was, yeah, it was only later on that I thought, actually, I think this is actually contributing to my changing moods.

Lisa: And in terms of the kind of strategy, so maybe share with us, when you graduated, you know, from nutrition school, like when you come out ready to help everybody with their weight loss goals, what is the main strategy that you’re focusing on?

Rose: Basically, calorie deficit is the key thing that you would be asked to be looking at. And obviously there was always the balanced plate, which is another thing that I just don’t understand because in England it’s very much like lots of the refined carbohydrates. Have wheat biscuits for breakfast and then two slices of bread at lunch, and it’s not actually talking about, actually, proteins and healthy fats are really important. Like it’s almost — I don’t know, I think I read something earlier just saying that it takes something crazy like over 10 years for some new evidence to actually get to mainstream information. And I think that sort of delay is really showing in what the education is when you’re at university. So yeah, when I left university, it was very much you take the calorie deficit approach and this is how weight loss happens. And then you start working with clients and you realize this is not as straightforward as that. And actually there’s so many different things that come into play when you’re dealing with somebody and their health and their weight. And it’s actually the two things, like weight loss and health, are not actually the same. If that makes sense. I’ve heard myself say to so many women that a size six body is not necessarily healthier than a size 12 body. It’s just different sizes and different set points. And it’s kind of actually coming to terms with that as a different way of looking at it.

Lisa: Well, weight loss is certainly not a black and white topic. I mean, I think today we’re coming at it from a certain perspective, but there are obviously situations where weight loss is very beneficial within a person’s overall health goal. There’s certain comorbidities and issues with weight depending on how far that goes. Maybe share with us some of those differences because I think that you’re right that weight isn’t necessarily correlated with health. And I also often talk about the competing goals. So if you have a client who needs to lose weight to reach a certain health goal, I think that that could be completely fine. However, at the same time as that client is losing that weight, they may not be able to also try to do two separate goals at a time. So maybe you can share a little bit about why we’re not throwing it out and saying no one ever loses weight, but maybe just share a little bit about the complexity of that topic.

Rose: You know, absolutely. It is. And I think that’s where one of the clients I’m working with at the moment, she is in a position where she would like to lose some weight. So the first thing we were doing was actually, okay, well, before we talk about taking anything out, let’s get the balance of your meals right. Because she was getting too much carbohydrate, not enough protein, not enough healthy fats. And so I think from her perspective, she was thinking like, hang on a minute, where’s all the cutting out and removing the bad stuff or whatever you want to call it bad stuff? And it’s only now, we’re like a few weeks down the line and we’ve got her food nutrient levels where they need to be, that we can then talk about, okay, well, what are the things that you can remove that is not going to damage your nutrient intake? So for example, it’s looking at, is it the refined carbohydrates, actually, is that the thing that’s upping your calorie intake to a level which isn’t healthy? Because there is obviously a point where we do need to think about having too much or too little, but not removing those things that are actually providing a huge amount of nutritional density. And as we were saying earlier, it’s just this approach that, oh well, you just stop eating or you just half what you eat. And it’s not actually thinking about, well, actually, you need to think about the macronutrients that you’re reducing. So is it the proteins? Is it the fat? Is it the carbohydrates? Are you still getting sufficient vegetables into your diet? And that’s why I feel that that kind of disjoint is just that you can’t just cut it all out. It has to be a bit more targeted, if that makes sense.

Lisa: Well, and from your perspective and experience, I’m not sure how to ask this question, but a couple of things come to mind. I feel like if your goal is weight loss, then there should be a period of time potentially where you’re utilizing these strategies. Maybe talk a little bit about that. I’ve worked with a number of clients who have either specifically because they were working with a nutritionist, or indirectly because they were trying to lose weight on their own, developed a strategy of eating which is basically sustained under-eating with no end date in mind. So maybe you could talk a little bit about kind of in those situations where it would make sense, and maybe you could share from your experience, what are situations that it does make sense to focus on weight loss for a period of time? And when you’re recommending, like, what is, is it just forever that we’re doing this? Or what are the kind of expected timeframes? Like give us a little gate around how long we should be doing this for.

Rose: I think, to be honest, my approach when it comes to helping people with weight loss, and for the majority, is that you’re trying to find a way of eating that you can sustain forever. Because you could go on this low calorie diet and yes, you might lose weight for however long you’re doing it and you might get to the weight you want to be. But that doesn’t necessarily mean that the rest of your physical health is as good or where it needs to be. But also, as soon as you try to find some normality within your eating again, the weight is going to come back on again because by going into this huge calorie deficit, you’re putting yourself into starvation mode. Your body is trying to hold on to everything you’re eating because it doesn’t know when you’re going to start eating normally again. And then when you do start eating more again, it sort of leads to this greater weight gain. And often people find that they gain more than they were to start with. And it’s all about what they call your set point. And we all have a sort of set point where our body is comfortable and it will try and keep you within this point. It doesn’t like you going out of it. So when you’re trying to force yourself out of this set point and into a lower energy intake, your body is going to do things like turn down your energy burn to try and keep you within the set point. So it is, you’re really forcing your body out of its comfort zone to try and lose weight. And so if you’re going to do it, it’s actually about finding a sustainable way of eating. It’s going to be a way that you actually are eating for the rest of your life because you can’t come in and come out of diets and expect the weight to stay the same. It sort of has to be a continuation. So quite often, again, going back to this client I’ve been working with, it was more about, okay, we need to reframe where you’re eating, let’s make tiny adjustments of what you’re doing now. And then we need to think, okay, well, we need to reduce your total calorie intake. So how can we do that in a way that’s sustainable for you? And there’s obviously tools like MyFitnessPal and other tracking devices that you can use to check in, although I don’t really like to push them on to people because I think they can lead to disordered eating and a little bit too much of an obsession around calories and proteins and fats and that sort of thing. But actually using it, I think sometimes you suggest it when you’re trying to look at protein intake and saying, just do it for a few days, see where you fall, check in with yourselves, and then you can use that as a tool to move forward. I hope that answers your question. But I just feel like the misconception is that you can do a short-term diet and then the weight will stay off, but actually it does need to be a long-term change.

Lisa: Yeah, no, that’s interesting. And I’m finding this conversation really fascinating because like I said, I don’t do that. So I don’t have clients come to me specifically for the goal of losing weight. So what I often see are women who have different goals but they’re inadvertently under-eating. So they’re kind of doing these behaviors, whether it’s consciously or unconsciously, to either maintain or lose weight. Whereas in this scenario with you, it’s a different kind of thing because they’re being prescribed a certain level. I’ve also worked with clients who have been prescribed a sustained low-calorie diet for the purpose of weight loss. What I observe and what we talk about a lot in the FAMM program is how this affects the menstrual cycle. Because if I’m working with a client who’s on a sustained under-eating plan where they’re running a calorie deficit every single day, we see signs of that in the menstrual cycle chart. So maybe share with us then your own kind of personal experience of this and how it can affect the cycle, as well as with clients, and how that’s changed your perspective on this approach to weight loss.

Rose: Okay, so I think for myself, as I said earlier, I’ve done fasting in the past and I was doing a lot more exercise. And it was only when I came off the pill that I actually could see the impact of all these things I was doing, which I thought were really good, on my menstrual cycle health. In that I had 50-day-long cycles. I didn’t have a period for a year. And then after having my little girl, I then obviously had the really low mood in the middle of my cycle. So I was like, clearly I’m doing things that aren’t actually supporting my menstrual cycle. I might be a smaller size, but that doesn’t necessarily mean that my cycle is healthy. And so for me, it was a real, personally, it was a shift in thinking. Okay, I need to step back and move away from thinking about the physical benefits, the way you look, whatever that might be, and look at what is my chart telling me. And that’s when I tapered down the exercise a bit. I still exercise. I love it, purely because it sort of brings me happiness. It’s not that I do it out of any kind of obsession. I still do it, but I eat more, I eat more protein, and I’m more focused on, am I getting weird symptoms during my cycle and is it a normal length? And those sorts of markers, instead of, well actually, is my weight changing or anything like that.

And I actually had an email inquiry today from a woman who’s going through this whole issue of body image and also thinking that she’d like to have children at some point. And she says, I’ve done all these diets and I’m doing all this exercise, and but also I’m thinking that I’d like to have a baby. And it’s, I think for women it’s such an emotionally driven thing, looking a certain way but then also trying to bear children at some point in your life. And we spend so much time thinking about the way we look, that it’s only when we then try and have a child that you suddenly think, oh, actually, has everything that I’ve been doing actually been the opposite of what my body needs? And that’s kind of the way that for me, the focus has really changed, and it’s been so refreshing. I think that’s what I really try to encourage women to see it as now. And I think that when I’m working with women now, I love being able to use their chart because I’m no longer having to think — well, it still is a consideration that, are they within a healthy weight range for them? But there’s also all this other information which is actually potentially more important when looking at what’s going on with their health and well-being. Of course, being obese is not necessarily a good health marker, but there are all these other health markers out there that we can use. Does that make sense?

Lisa: Oh yeah. Yeah, it definitely does. And it made me think of what you had said before about coming up with a sustainable way to eat to avoid kind of going back and forth. And what I think is interesting is that, so one of the challenges potentially with the approach that you’re talking about and the approach that I’m talking about also, which would be to find a more balanced way of eating to really optimize the hormones, while also addressing your energy needs — if you’re working out all the time, it’s important to consume enough to account for that so that you can have healthy hormones and all of that. But if the goal is weight loss, I would imagine that you would see slower results in this kind of sustainable way versus the clients who I’ve worked with who under the supervision of a nutritionist have been eating in a calorie deficit and were able to lose a lot of weight in a short period of time. Yeah, I’m not sure if you want to comment on that, but it takes longer. But also, one of the things that I’ve seen, I’m not sure if you’ve seen this, is I’ve worked with clients who did have kind of massive weight loss in a short period of time, and the results in terms of their cycles were often negative, were often lasting. So even once they’ve kind of stopped this habit, some of those negative kind of menstrual cycle hormonal disruption type things persist for a while afterwards. So it draws into question the sustainability of the whole thing.

Rose: Yeah, absolutely. And it is interesting just thinking about what you were saying there about the fact it’s a longer process to lose the weight and get to where you want to be. Because I remember I was talking to somebody about my approach to nutrition and somebody said, yes, but that’s boring. And people want quick results. They want to be told they’re going to lose the weight in six weeks. And I wish for those people that do want to try and lose that much, if they do need to lose it and they want to lose it quickly, I wish it was that easy to do it in a really healthy fashion. But the reality is that, as you’ve just shown with the information about actually how long it takes for their cycle to get back to normal again, it just shows how much of an impact it’s having on your internal health. And I think back, before you said about, if you’re having a stressful month or something, your body will delay ovulation because it doesn’t feel it’s safe to ovulate. And similarly, it’s as though when you put yourself into the starvation mode, your body is thinking, well, there’s not enough food around, so we shouldn’t be trying to conceive a baby right now. And I’m sure that there are studies that have shown this relationship with the body responding to what you’re putting into its environment. But yes, it is a much longer process, but it’s one diet, one change that you sustain and is sustainable. And I think that’s the key.

And so many people that I’ve worked with, it’s like this light bulb moment of, oh, so I can actually go and — I always remember this one person I worked with and they were saying, I said, how did your week go, how’s it been with your food? And they said, well, yeah, it’s been a really good week, but it was my partner’s birthday at the weekend and so I had cake. And I’m just like, it’s your partner’s birthday, this is about a way of eating forever. Like, you can still have cake at these occasions. It’s not about saying you can never do it. You haven’t now fallen off the bandwagon and you’ve ruined it. It’s actually, this is just part of normal life and it’s trying to find a balance that works for you and gets you to a healthy weight. That is completely — and people might think it’s boring or it’s not giving the results as quickly as they want, but it is maintainable. And that’s the secret. You’re not going to have to go back to another nutritionist at another time or have this yo-yo, because actually the changes you’re making are doable and don’t leave you feeling completely starving at the end of the day.

Lisa: Well, one of the things that you’ve been mentioning is how adding the menstrual cycle as an additional vital sign has been helping you in this process. Whenever I’ve spoken to a number of nutritionists who at some point maybe want to move a little bit away from the weight loss focus and move more toward the hormonal health focus, so maybe you can share a little bit about how incorporating the menstrual cycle is allowing you to kind of move out of that. Because what you said is like, oh, it’s not sexy, it’s not fun or whatever, but I have found that when you are able to re-shift that focus from pure weight loss or pure body image to health — like, look what’s happening in your cycle, look at what’s going on in your luteal phase — maybe you can kind of share with us how that’s been helping, and also some of the specific things that you see in the menstrual cycle when your clients are not eating enough.

Rose: Yeah, definitely. So it has been a complete game changer in the way that I work with people. And the fact that I can now — it’s like evidence in front of them. It’s not just me saying it, it’s like, look, your chart is saying these things and we can see the improvement. And I think that’s like — I think you always say it’s like having a monthly scorecard, and it’s exactly that. Because you can actually see from one month to the next, I made these changes and look how it’s affecting my cycle this month. And so yeah, some of the things that I would see would be like a short luteal phase, low body temperatures. And I think that also when you’re looking at their food diaries, you can sort of be like, if you’re saying that you’re eating all of these things but your chart is saying this, then potentially something else might be going on, or you need to review it again. And so it’s also a really good sign just to see, does what they’re saying they’re eating match up with what their chart is saying?

And then obviously another thing that I notice symptom-wise, when we’re charting and talking about mood, and there’s obviously that low mood after ovulation, which is quite common, and more issues around those cycle symptoms, sometimes the spotting before your period, kind of all like flags to say that potentially there’s nutrient deficiencies and or they might not be eating enough. And that’s when we start to talk about how much they’re exercising and are they actually eating more on the days they exercise. I think that’s another thing a lot of women don’t think about, is that actually that’s something to consider — they do need to eat more. And so it has really added so much more context to what you’re talking about, rather than before it was, oh, well, we’ll just track your weight and how much energy do you feel you have. Now we’ve actually got all this wealth of information that comes from charting that allows you to dig so much deeper into what’s going on with their health and well-being. And I think for them, the value that comes from that is so much greater, to be able to see the benefits. And I think especially if you’re thinking in the future about having a baby, knowing that you’re doing these things that’s setting your body up — that is such a powerful tool. And I think as a woman, again, moving away from that focus of, I want to lose a couple of pounds to fit into these jeans I wore when I was 18, to actually, I’m a woman now, and in a few years or in a year I’d like to have a baby. And so I probably need to be thinking, not about those kind of jeans from when I was 18, but instead about what does my body need? What does the health state need to be? And that’s, I just love it.

Lisa: Well, and now I’m curious. So when you were in nutrition school and you were learning about weight loss, did the topic of fertility come up? And women trying to conceive, like, was that something that was part of the conversation?

Rose: No, we talked about like prenatal — these are the vitamins and minerals you need to be thinking about having, and the prenatal supplement and that sort of side of stuff. And then also obviously when you’re pregnant, things that you shouldn’t be eating and the fact that you might need those extra calories once you’re in the final trimester, that sort of stuff, postnatal things they might be deficient in. But there really wasn’t much focused on it. It just didn’t go into the detail that actually women need to know about. And I’m experiencing with each client I see that everyone’s just like, I just can’t believe I wasn’t told this before. How did I not know that? These seem like the sort of information that should be public knowledge. And that’s kind of where we are with it, sadly. They have to search for the information rather than being provided it when they should be.

Lisa: Well, and I think you had alluded to this a little bit as well in terms of your experience with fasting and how we weren’t necessarily taught to look at the male and female body differently. I suppose now that you have the menstrual cycle as a tool and you’re kind of seeing how this all plays out, what are your comments on that? I think this is something I’ve talked about on the podcast a few times. I think I did do an episode that was kind of addressing the male influencer issue, which is that a lot of women are following these male fitness influencers who are telling them to fast, skip a day of eating, and all that kind of stuff. And the reality is that there is a lot of research on fasting and the importance of it on health, but a lot of it’s done on men. But maybe you could talk a little bit about that, you know, some of the gaps in research and how you’ve kind of found some of those trends to affect your clients.

Rose: Yeah, and it’s exactly that. The majority of the studies are done on men because the scientists don’t want to be thinking about fluctuating hormones and how that might impact the way that they respond to a certain diet. And so yes, there are proven benefits to fasting and they can’t be denied. But whether there is enough evidence to show that they’re actually beneficial for women is incomplete. And I think the fact that, as we’ve been saying, fasting does impact your cycle and not for the better — you can’t ignore that fact. And I think that is the sort of overriding message, is that there is not enough information available to say if it is good for a menstruating woman or not. But from what we can see from charts is that it doesn’t have a beneficial effect. And I can say from personal experience that when I was experiencing the PMDD, I was fasting, and so potentially that was a big trigger. And it was when I stopped fasting and I started making changes that those mood symptoms went away. So yes, I might have felt better in different ways, but the PMDD was just completely unlivable. I think that’s a big sign from the body saying, yeah, this isn’t working, you’ve got to make some changes. And that’s again what I see with clients. And unfortunately you are having to undo some damage when they have read different things or heard different things or seen something on social media. And I think that’s actually something I see with a lot of people that come to me, is that they are just confused. What should I be eating? What shouldn’t I be eating? How much should I be eating? Should I be training this much or not this much? And it’s having to unpick all of that. And I think again, that coming back to the charting is a really nice way to say, well, what’s your chart saying, and let’s use that as a guide to see if the things you’re doing are supporting your health or not.

Lisa: This conversation is so complex because, I mean, after being in the field for so long, I feel like it’s never just black and white. So listening to this episode, it’s not like, and you should never ever fast, or oh, you should never ever try to lose weight, or anything like that. But what I’ve found too, and I think you’ve had the opportunity to see this as well because you’ve been charting now over a good span of time, so you’ve had the opportunity to see how different things can affect you and how you can make certain changes and see certain improvements, but how different strategies can affect you. And I’ve had clients who have short-term goals, like who say, okay, this is my goal right now, I’m going to join this gym challenge and I’m going to do this thing for the next six weeks, then once I’m finished that, I’m going to move on to my next goal, which is whatever it is. And so maybe you could share a little bit about that and how we can use the cycle to inform our choices. Like you said, you had PMDD symptoms crop up when you were fasting. And maybe for some of your clients, it would make sense for them to do a certain stint of something for a period of time. I don’t know if you want to share a little bit about how that could work.

Rose: Yeah, I’d say first of all, of course, I definitely think there is a place for fasting, particularly if you’re not menstruating or you’re post menopause. There are benefits to be seen there. And if you are in an unhealthy body weight and you want to lose weight, then again, not saying that that’s something that you shouldn’t do. But it’s, as you say, using the chart as a sign for what’s going on. And if you do have these goals, whether it’s that you’re training for a marathon or whatever it might be, and that is going to put additional stress on your body, again, it’s using the chart. So you might see these changes and you can respond to it. So it might be, for example, taking the idea of going and training for a marathon, it might be you think, oh, I’ll actually, maybe I need to increase my energy intake more because my chart’s showing signs that I’m not getting enough. But also potentially you need to keep working. This is a period of time and I’m training for this and my focus is on the marathon and potentially it’s not on having a baby in the next year. So I can do that, but I need to be aware of how the way my body’s going to respond. And again, just using your chart as like a nudge to kind of see where you are and checking in.

Lisa: This is like advanced cycle hacking. I mean, I have seen the same kinds of things in the charts and with clients where even if you’re choosing to run a marathon right now and you know that could have a temporarily negative effect on the cycle, you can use that information to kind of optimize what’s going on. You can see if you’re showing signs of low progesterone and maybe optimize that protein intake or optimize your sleep. So one of the things I’ve supported clients to do with this knowledge is to then optimize it. So we know it’s not going to be perfect right now because you’ve got all these things happening, but we can still focus on nutrients, we can still focus on incorporating as much high-density micronutrients as possible and optimizing that protein intake. So I feel like it really shifts it from pure weight loss or pure fitness or whatever the goal is, to at least we’re incorporating that conversation around our bodies, our health, balancing hormones, potential future fertility, whatever the case is.

Rose: Yeah, exactly. It’s easy, again, just using the chart as a way to say, okay, what I’d like to do is train for this marathon, how can I do it, and what do I need to do to support my cycle as I do it? And as you say, if you’re seeing changes in the luteal phase and thinking, okay, well, this is a sign that maybe I need to work on my progesterone and therefore need to look at the strategies for that. And so at least you’re not ignorant to it. You’re being clued in on what’s going on.

Lisa: It’s such an interesting shift in the way that we are looking at the menstrual cycle. I think that’s why — I mean, I’m clearly obsessed and this is my wheelhouse here — but I feel like it’s such an important piece to potentially add to that conversation, especially for your clients who are coming primarily for weight loss. What I found interesting also is that when you just see the cycle, like you said, and it’s not me saying stuff, it’s you doing stuff and us just seeing what happens. How long is your cycle, when are you ovulating, what’s your luteal phase like, all that kind of stuff. And when your clients start to see that, oh my goodness, my activities, my diet, my sleep patterns are directly affecting my hormones and my moods, I feel like it’s really empowering. So I mean yeah, as you think about then, maybe you could share a little bit. I’m not sure if your practice has kind of changed in terms of what type of work you’re doing with clients, but knowing all of that, maybe share with us then how your approach has changed, and also how it’s affected you personally in terms of how you approach weight loss or just in general achieving some of those other health-related goals.

Rose: Yeah, I think, well, as much as possible when I’m working with clients, I would encourage them to chart, but obviously some of them do, some of them don’t. But still, as you said, you can still ask them questions about how is your cycle, how long is it, how’s your bleed, how’s the pain, and so forth. So I’ll use all of those tools when I’m assessing them initially. And that will then actually come into play with the nutritional recommendations I’m making, whether their goal is for fertility or PCOS or weight management. Regardless of the topic, it’s just a way of getting that additional bit of information and actually not ignoring it. It’s kind of like, actually, that’s a really big piece in the puzzle of your health and we need to consider it as a woman. So yes, my practice is very much focused on the female, and using information from the cycle, whether we chart or not, to kind of lead what we’re doing in terms of nutritional interventions and any changes we make. And as I said earlier, it’s first of all looking at those foundational factors before you start thinking about, oh, we need to cut calories. It’s actually, what are you eating and what’s the quality of what you’re eating? And are you getting all the nutrients you need to support a healthy menstrual cycle?

So I think I kind of feel like, whereas before it was based very much on how’s your sleep, how’s your energy, how’s your gut health, how do you feel about your weight, are you in a healthy range — the leading thing in my mind now is always, how’s your menstrual health? And actually, that’s linking to so many other things going on with your body, and a lot of those other points I just mentioned are linked with your menstrual cycle. So it’s just very much the focus of what I’m looking at now. And I think clients feel like they’re actually getting a lot more detailed, individualized support, which is really nice for them. And it’s incredibly rewarding for me to see that they’re getting results, not only in what they might have come in for, but also in their menstrual health too.

Lisa: Well, for someone who tuned into this episode because they saw weight loss and they’re thinking about, well, wow, I haven’t seen Lisa talk about weight loss, I wonder what this episode is about. Or maybe they tuned in because they themselves are on that journey and looking to kind of optimize their body size, whatever that looks like. What would you want her to know, just in a general sense?

Rose: So if somebody needed to lose weight for health, then yes, it’s possible, but it’s not a short-term fix. It takes a lot of time and consideration, but it’s something you’re only going to do once, and it’s changes you make once and you make them right in a way that’s going to support your body. So it is possible, but it just needs to be done in a really careful way. As women, we have a lot of different things going on and it’s not just a matter of cut the calories. But also, I think, and again thinking back to this email I had this morning and the emotions that come behind a woman and their weight and trying to shift that focus away from body size to actually menstrual health or trying to conceive. It’s a really tough shift. We’ve gone through probably two decades, depending on how old we are at the time, where all we were thinking about and all we were made to think about was the way you look, the way you look, the way you look. And suddenly you’re thinking, actually, perhaps that’s not the answer to everything. And especially when you’re trying for a baby, there’s other things to consider. And it’s a really difficult thing to get your head around. And I think, don’t underestimate that, and be kind to yourself at times like that, because it can be really difficult.

Lisa: Yeah, I mean, I couldn’t agree more. And I feel like it represents such an interesting opportunity for women. As a mother now of three, I often think about that — when you are in that stage of trying to conceive, it’s that beginning of your entrance to motherhood. And often motherhood is an opportunity for you to kind of realize that it’s not about you as much anymore, and you can’t control what kind of personality your kids are going to have. So what I always find is that this whole process of fertility, pregnancy, birth — this is just my opinion — seems to be like your initiation into, this isn’t about you anymore. And so often what you think you need to do, or your ideas of how this is going to look and this is going to be perfect and I’m just going to do this and whatever — it just doesn’t always work out that way. So this could be a really interesting introduction into looking at your body differently and moving away from, like you said, some of those ideals we had about body size, into kind of how being healthy is often different to those ideals in terms of menstrual cycle health.

Weight loss is obviously a super controversial topic as we have discussed. But also, a lot of women fall into that spectrum of wanting to lose weight and wanting to be really small, when they themselves may actually be below what we would consider a healthy weight. So I’m not sure if you want to comment on that.

Rose: Yeah. I mean, I can speak from personal experience that probably going back about five years, I was probably about a stone lighter than I am now, but I also didn’t have a menstrual cycle. And I was trying to get pregnant and I was trying to work out why my cycle wasn’t coming. And it was only through charting and actually looking at my energy intake that I realized that actually maybe I need to be a little bit heavier than I am. And I think that’s a really hard conversation for women to have together and with themselves and to come to terms with. And that is, yeah, like when I talk about unnecessary weight loss, it’s more around the fact of women who come to me and potentially to you, who are putting themselves in these calorie deficits because they feel they need to be in a smaller body than actually potentially their body is meant to be. And that’s when you can sort of see that actually they’re not eating enough, and or they’re not getting enough protein, or they’re training too much. And that’s when it’s kind of having to think, well, actually, let’s move away from weight for a minute and let’s just look specifically at what your chart is telling us. And I think that’s — hopefully, I’ve found it personally a really useful way to move away from the focus of weight.

Lisa: I couldn’t agree more. But Rose, I just want to thank you so much for being here. I’m really happy that we were able to have this conversation about weight loss. And like I said, I’m really fascinated just in terms of how many nutritionists I’ve talked to over the years, for whom this was a really big focus of their education and their client work. So it’s really interesting to gain some insight into how you’re trained, what the training focuses on, and also how you’ve managed to kind of modify that to really suit your female clients.

Rose: Yeah, it’s been a journey, but I think that’s kind of — there’s been so much learning along the way. And I think that all of that and everything I’ve learned over the years actually really shapes the way that I can work with women now, perhaps with a bit more of an angle of understanding. I find, you know, it’s a benefit in a way, but it’s just a shame that that information is not available at the beginning. It’s a standard, consistent problem, I think, across all institutions it would seem.

Lisa: Yes. So before we go today, can you share with us where we can find you, where you are on the socials, website, where you are in the world?

Rose: Yes. So on Instagram, I am @b.womensnutritionist. My website is www.roseconstantinesmith.co.uk. I’m based in the UK, but I also see clients online so you can see me from anywhere. But more specifically, where I am is in Suffolk in the UK. I have a clinic in Southwold and also in Melton near Woodbridge, so you can see me face-to-face there.

Lisa: Awesome. Well, thank you for being here and yeah, I’ll talk to you again soon.