On May 15th I shared an instagram post about What it Means to be a Female Athlete in support of National Women’s Health Week. It included a list as silly as de-tangling my hair to as serious as motivating myself to run despite menstrual cramps. Later that week I shared my current nutrition struggle of battling anemia and posted high iron foods for female runners. Both of these posts got me thinking about the nutrition concerns of female runners. Rise Up Nutrition is not exclusive to female runners, however this blog post will highlight the extra challenges female runners face from a nutrition perspective.
All runners should consider nutrition when optimizing health and performance, but there are a few concerns that apply specifically to female runners that should not be overlooked.
1. DIMINISHED MUSCLE RECOVERY:
The first nutrition concern of female runners is optimizing muscle recovery. Muscle recovery is enhanced with protein intake and anabolic (growth) hormones including testosterone and insulin. Muscle recovery is diminished by catabolic (break down) hormones like progesterone, adrenaline, and glucagon.
High progesterone levels in women stimulate the accumulation of body fat and catabolism of protein metabolism. This means that during the recovery period after a run, female runners are more likely to break down muscle, more so then they already did during the run, and more so than their male counterpart. This excess catabolism will result in soreness, weakness, and diminished strength over time.
During this recovery period, women are also more likely to store fat. The combination of storing more fat while breaking down excess muscle can lead to a higher body fat to muscle ratio, and an undesirable weight to power ratio.
In addition to progesterone hindering muscle recovery, women also have the disadvantage of low testosterone. Women have testosterone levels ranging 8-60ng/dL, compared to an adult males 240-950 ng/dL, making it significantly harder to build powerful muscles despite the same training or work effort. Though “building muscle” may not be the goal of a female runner, repairing the muscle after a run is the same physiological mechanism of “building muscle.”
Furthermore, when testosterone is low and estrogen is high, the capacity for muscle glycogen (stored energy) to mobilize is lower. This slows the process of recovery, resulting in less energy available for use during a two-a-day run, or back to back hard training days.
THE FIX: OPTIMIZE PROTEIN & CARBOHYDRATE INTAKE AFTER A RUN.
As altering hormones is out of the question, the fix to diminished muscle recovery is optimizing protein and carbohydrate intake during the recovery period. Female runners need more protein and carbohydrates in the recovery period.
The first 30-minutes is when a woman's insulin is most sensitive, which will allow carbohydrates to be optimally stored in the form of glycogen. After this time, glycogen storage diminishes and fat storage increases. Take advantage of this 30-minute window and aim for starchy vegetables like potatoes, corn, and parsnips, or grains such as pasta, cereals, and breads soon after a run.
While insulin is high and nutrients are being shuttled into the muscle, a boost of protein during this time will start the muscle recovery process as well. Many have heard that 20g of protein is an ideal amount, however many women eat only 10-15g thinking that they "don't need to build muscle." As I previously mentioned, this isn't about "building muscle" but rather repairing the muscle to optimize training response, reduce soreness, prevent injury, support ligaments and tendons, improve power output, and sustain high energy output day after day. Between 20 to 30g is going to help overcome the effects of progesterone and lack of testosterone. For 30g of protein try a sandwich with 3oz deli turkey and 1 oz cheese, or a cup of oatmeal cooked with 1 cup milk, 2 Tbsp almond butter, and 2 oz pumpkin seeds.
2. IRON & FATIGUE
The second nutrition concern for female runners is maintaining high iron levels and preventing anemia.
Iron is a mineral which holds oxygen within our red blood cells. When women have low iron, oxygen can no longer be held within the red blood cells. Without adequate oxygen, our muscles are not able to create energy to sustain endurance exercise.
Just as running in high altitude is harder because the air has less oxygen, running with low iron is harder because the blood has less oxygen. Your body will feel fatigued and deprived of energy during runs. If not addressed, this fatigue will be felt during normal activities of daily life as well.
Due to monthly blood losses of the menstrual cycle, female runners are at higher risk of low iron compared to male runners. Furthermore, a female’s lower calorie intake, and higher rates of vegan or vegetarian diets may contribute to higher risk of iron deficiency. Specific to runners, ground impact or “foot strike”, muscle contraction, and gastrointestinal bleeding from prolonged endurance may all contribute to increased iron breakdown. New research also shows that high training intensity increases hepcidin, an inflammatory hormone, which alters the body’s iron homeostasis. All these factors combined put female runners at risk of iron deficiency and anemia.
THE FIX: EAT HIGH IRON FOODS & CONSIDER SUPPLEMENTATION.
High iron foods should be eaten regularly: red meat at least twice a week, poultry, fish, and shellfish regularly. Non-meat iron foods include the skin of potatoes, oatmeal, quinoa, dried fruit like gogi berries and raisins, nuts and seeds including almond butter, spinach and kale. Female runners should get their iron checked annually at a physical or regular check up with their physician to know if they need supplementation. If iron is below 35ug/dL consider a daily iron supplementation. This supplement should not be taken with calcium (such as in milk and cheese) or with oxalates and phytates (such as in tea and coffee) as these nutrients can inhibit absorption.
3. MENSTRUAL DISCOMFORTS
In addition to losing iron every month, female runners must also cope with the pain and discomfort associated with their menstrual cycle. Every woman's menstrual cycle symptoms differ, from heavy flow to ongoing spotting, lower back pains to ovarian cramps, and severe bloating to feelings of never-ending hunger. Many of these symptoms alter both physical and mental performance. Fortunately, a few of these symptoms can be managed with nutrition.
The bloating is a result of hormones retaining water within cells but dropping blood volume in the blood vessels. Lower blood volume results in more viscous blood which means more effort on the heart to pump and greater difficulty for your body to sweat and cool itself during a run. So while a menstruating woman may be tempted to consume less water and sodium to prevent further bloating, this is actually a very critical time to do the very opposite: Drinking more water will increase blood volume, making it easier on your heart to pump blood, and allowing your body’s cooling system to work properly, avoiding the risk of heat stroke. Having an extra boost of sodium will also help pull water out of the cells and back into blood vessels, contributing to the needed shift in fluid balance.
Other menstrual discomforts include cramping from uterus contraction. Although the contraction cannot be stopped, some anti-inflammatory and muscle-relaxing agents may decrease the pain which will help motivate you to get out there and run. ROAR, a book published in 2016 by Stacy Sims, PhD, notes that magnesium, omega- 3 fatty acids, and a low dose of 80 milligrams of aspirin can reduce the effect of cramp-causing hormones that contract the uterus.
THE FIX: RUN THROUGH MENSTRUAL DISCOMFORT WITH EXTRA HYDRATION AND ANTI-INFLAMMATORY AGENTS.
During the PMS or menstrual phase (whenever you are experiencing the bloating) swap your pre- during- and post-run water with an electrolyte beverage. Despite bloating, continue to drink around 3 liters of fluids daily (varying depending on heat, humidity, and individual variances) and consider adding salty and hydrating foods like soup, pickles, or salted watermelon. Consider the concoction of magnesium, omega-3, and 80mg aspirin for 5-7 days before the period starts to reduce cramping.
Despite the unwanted side effects of a menstrual cycle, having a regular monthly period is a critical component of health and performance for female runners.
Lack of a menstrual cycle for three months in a row, or lack of a period by age 15, is known as amenorrhea. Amenorrhea indicates that the body does not have enough energy to produce adequate female hormones. Without producing estrogen, bones become weaker and the risk of injuries including stress fractures, and the long-term consequence of osteoporosis, drastically increase. Even though osteoporosis sounds like a condition for older women, not active young runners, it is unfortunately very common in runners who continually miss their period, and is cause for an abrupt end to their running career.
Lack of a period also means lack of ovulation and the inability to become pregnant. If left untreated and prolonged, a female’s uterus and hormone profile can irreversibly change to mirror that of a post-menopausal woman. In turn, this can compromise the potential of becoming pregnant in the future.
THE FIX: AVOID AMENORHEA. EAT MORE.
The easiest way to avoid amenorrhea is to maintain positive energy balance. This means you must eat and consume more energy than you expend in activities of daily life, and in exercise. The traditional concepts of "dieting" and "weight maintenance" to burn more than you consume must be completely forgotten. Eat more food! Give your body more energy. For such a complicated process of hormone production, this may seem like too simple of an answer. But it is the answer. You must eat more food. You must eat much more than your burn off in running.
5. DIET CULTURE
Aside from what is occurring in her body, female runners must also be sure to ignore diet culture. Diet culture is western civilization's focus on weight loss and dieting for health. Though less "scientific", the pressures female runners face to look thin, have a "runners’ body" or lose weight to be faster creates a culture that emphasizes thinness and dieting instead of fueling and training. This focus on weight loss results in reduced energy intake, and can lead to physiological consequences, like amenorrhea discussed above. Furthermore, this pressure creates a stressful environment and can take away from a runner’s mental focus on performance and training.
THE FIX: FOCUS ON FUELING. STOP CARING ABOUT LOSING. DITCH DIET CULTURE.
Focus on how foods fuel your body and avoid focusing on appearance and weight as much as humanly possible. Remove the word "calorie" from your vocabulary and replace it with "energy." Do not step on the scale if it negatively affects your mental thoughts about body image and fueling. Remember that “good nutrition” does not have to mean following a specific diet or trying to achieve weight loss. Learn to fuel your body and surround yourself with an environment that does not focus on appearance or thinness, but rather performance and fueling.
READ MORE: What it Means to Fuel
READ MORE: The Ideal Weight for Runners