Latest / LUZ musings / Introducing Maeve, Ultramarathons, Hypothalamic Amenorrhea, and Nutrition
Transcript
- riverside maeve danielle j. miller' (1): Part of what I'm passionate in health is providing a safe atmosphere to help folks move forward in often the darkest part of their health journey. Hello and welcome to Lose Musings. I'm your host, Dr. Danielle Miller. We are focusing on the people and ideas that make Lancaster County, Pennsylvania, a healthier place to live. Now back to the episode. Hello everyone. Welcome. I'm so excited to be here today with Maeve. Maeve actually works at Louise Medicine and has been here since the springtime, March maybe of 2026. And we're excited to have her on today. We're going to talk about a wide variety of topics and maybe share some information that might be useful to you guys and someone you know. I guess firstly, Maeve, tell us a little bit about how you got to Lancaster and Lou's. Maybe we could start there. That's okay. Absolutely. I moved to Lancaster last August and I moved here initially because I actually ran a hundred miles around the Franklin and Marshall track. And during that experience I met a community of people and I was like, I found my people. I need to move to this place where my people live. I grew up in Baltimore City with a beautiful family and there was not much that was holding me there anymore. It was really, it was part of my my experience of kind of moving on, moving forward. and so I came to Pennsylvania and I really actually struggled in Pennsylvania to find an employment position that I was passionate about. And then I stumbled upon lose medicine, which was a incredible experience. And so I'm very, very lucky to work here with Several amazing women and meet other powerful women in Lancaster County. Awesome. Very cool. you mentioned running a hundred miles at FM, which I don't think many people have done that. So I'd love to talk. You have incredible experience as an athlete. I think you've been an athlete for a number of years now. Can you talk to us about athletics generally? What it is exactly that you do. I think you race competition. Competitively some and maybe just give us an overview of that part of your life because it's a really cool part of your life. It is a very fun part of my life. It takes up a lot of morning hours. There are a lot of early, early runs I do. So I'm a competitive ultra marathoner. I run for the 2026 ASICs team Sound Mind, Sound Body, and I'm a semi-professional athlete. So if you're a professional athlete, typically you have a contract where you do have a salary. that is not me. I am very blessed to be provided shoes, a lot of free race entry, a lot of support from ASICs. but I'm also pretty new. I only started Ultra Marathon running maybe about a year ago, and then I've been training somewhat seriously over the past six months. I now have a coach. I run approximately 100 miles a week, mostly around Lancaster. For anyone who does live in the city, you have probably seen me running my loops. my first a hundred miler was around the track. And prior to that experience, I had never run more than 30 miles. So that was a big test. But it's amazing what you can do if you're committed and if you have a really solid community of people behind you. I love that. And for those of us who are not in the know, what how does one define an ultra marathoner? An ultra marathoner is anyone who is running above the traditional marathon distance. Okay. Typically the shortest ultra marathon is the 50k, so it's about 31 miles. Most folks are specializing in the 50 to 100 mile distance. We do have some ultra marathoners out there who are running 200 plus miles. Wow. My goal, yeah. My goal is to be an a hundred mile specialist. So that is my that's my part of my five year plan. Wow, amazing. And I hear sometimes as a family docs, you know, working with wide variety of people, sometimes certain athletic routes you can burn out or have like a limit to. I'm just curious, is there a lifetime of how long someone could run, say, ultra marathons? Ultra marathons, interestingly, have a very high success rate with folks who are running at an older age. So with the ultramarathon, you are running a lot slower typically. You're often trail running. So the terrain is much softer. It's not nearly as hard on your body. And it encourages proper fueling. So in ultramarathons, the person who wins is the person who can eat the most food. In tradition maybe in traditional marathon running, half marathons, 5k, there is a pattern of underfueling. There's a false sense that being thinner is faster, which is not necessarily true at all and can be really harmful in the long term. With ultra marathons, there's an emphasis on fuel as much as you can. Take in as many carbohydrates as you can. We actually calculate per hour the amount of carbs we take in and what our goal is. For a lot of ultimarathoners, that might be 90 grams per hour, up to 150 for some of the really, really advanced athletes. So the emphasis is on having an abundance mindset instead of a restrictive mindset. This flies in the face of a lot of athletics, right? Yeah, that's really interesting. I'm learning a lot. You did mention food and fuel. well, I guess just a quick question. How long does it take someone to run a hundred miles? I guess I don't even have a concept of how that even goes. That's a great question. It really depends. So if you look at some of our biggest races, the ones that are most well known, Western states is a great example. We will have athletes finishing in 14, 15 hours. There are other races like Eastern states 100, much more technical. when I say technical trail, I mean lots of rocks, routes, high elevation. Okay. Difficult rain to traverse. Often you will have the top finishers maybe twenty-four hours, but sometimes thirty hours. So it's just so different. For perspective, with a marathon, a road marathon, typically people might have At most ten minutes, I would say, between if if they're tr well trained between their slowest and their fastest marathons within a a set period of time. if they're training regularly, versus with trails, I might run a half marathon on road and run that thirty or forty minutes faster than I might run a hard trail half marathon. Wow. And if you're running say twenty-four hours plus. Is that straight? I guess I'm I'm even confused as a non-athlete. Is someone resting at all or are they just rest? So resting for twenty-four hours, there's usually not that much resting. Sometimes we will take dirt naps. So we'll lay down on the trail, have a snooze. But most of the time you don't. You just you just power through. You will stop at aid stations to refuel. So you'll get more food. We usually use gels, we use carbohydrate mixes. for most races there's required gear. So you have to have a check in with the staff there that you have your required gear. Often, not always, your crew is often at those aid stations too. So they will help you with any supplies you might need. But that's happening within minutes, you know, that's not you're not hanging out typically for an hour. But every once a while. Something can happen and your body does shut down and you have to sit down for an hour and and recenter yourself and that's very normal. The best ultra marathoners in the world will go run a race and they'll be number one and then they will run another one and not finish. And it's not a reflection of their athleticism. It's just a reflection of how challenging the sport is. And your body sometimes makes decisions that are out of your control. Really interesting. we've talked about food a little bit in and around how it plays into the race itself. And I would love for you to talk us through the idea of it not being restriction-based. Very exciting to me, because sometimes restriction and athletics go together, which I'm not sure is the wisest thing. So talk to us a little bit about impact on the body, sort of pitfalls, things that we need to keep in mind if we're exercising and of course, trying to stay well. At any quantity of exercise, you're going to need more energy, not less energy. I like to think of calories purely as a s in an energy. And that's how they're defined. And that is how they're defined. instead of just, I'm having a hundred calories of this, I think of, okay, this is this is carbs, fat, protein, maybe some fiber, micronutrients. These are Are chemicals actually that I need to have in my body to fuel my cells. When you exercise, whether or not you are running three miles in your neighborhood or a hundred miles around a track, you have oxidative stress happening in your body. This is natural. Your muscles are breaking down. All of that is natural. We need the process of hypertrophy so that muscle breakdown, then building it back up and strength training. We need that to get stronger. But that healing can't happen. Your body can't come out of fight or flight if it doesn't have the resources to know it's safe. And that's what food is. It's a resource to know that you're safe. And so when people are under fueling, they are taking away from their body's ability to recover. And you want to maximize your recovery. I try to recover harder than I train. So I sleep really well. I eat when I'm Hungry physically, but also if I'm mentally craving something, there are nine different types of hunger, and we actually need to honor all of them. So there are many different ways our body communicates to us. But if we are a car and we're not putting fuel in the car, the car will not drive. And so our bodies need that input. And with athletes, typically, overconsumption is not the problem. Usually it's under consumption. Usually it's restriction and there are sneaky ways that it happens. But the more that you eat, especially in terms of like full fat dairy, the restriction also has different forms. Maybe you're getting in enough calories, but you're restricting your carbohydrates because someone somewhere told you that you should have fewer carbs, which is not true. or we need to have non fat dairy when actually fat is increased. Incredible, it's an incredible nutrient source, and it actually is easier for our bodies to digest. Are you interested in learning more about the approach at Lose Medicine and how we help our patients? Lose Medicine is a medical office here in Lancaster, Pennsylvania with locations both in Africa and Manheim Township. Patients can choose which location they want to join when they become a patient at Lose Medicine. Our office has two main focuses. Firstly, we provide primary care for men, women, and children in all ages and stages of life. And secondly, we offer additional services for hormone health for those who are interested. Whether patients come to LOES for their primary care or a specific hormone focus, the tie that binds Is the same. We listen to our patients and provide exceptional medical care. Our holistic approach puts you at the center of your journey, where we are here to support you in your best health. To join our practice, check out losemedicine.com, that's luzmedicine.com, where you can learn more about our practice and sign up directly online. If you have any questions, we're here to help as well. We would love for you to be our very next patient at Lou's. Yeah, absolutely. I hear you. I think a couple of things you're mentioning we've talked maybe you've hinted at it's different for women too. I think women especially, we have this thing drilled into us about low-fat dairy and about restricting. Can you talk a little bit? And and we see too as in medical field you know, not taking enough fuel having a huge impact on the body. Can you talk a little bit about the specific impact of not fueling enough as a female athlete? Absolutely. So underfueling in nutrition and athletics, it's low energy availability. So this is when our bodies do not have enough nutrients, calories on board, which includes macronutrients. So again, Maybe you're eating enough protein and fat, but you're not getting enough carbs. You can be in a low energy availability state, even if you're getting your maintenance calories, whatever that might be for you. When we're in a low energy availability state as women, our body downregulates systems that it does not deem absolutely necessary. Our reproductive system is one of those. So is our GI. So our digestion typically suffers. Maybe start to have irregular cycles. maybe we lose our cycle altogether. That's called hypothalamic amenorrhea. When your hippothalamus down regulates, because it has these glucose receptors that it needs to in order in order for your hippothalamus to tell the pituitary gland, we can do this, you know, we can have a period. You need carbs because those receptors need glucose. So if we don't have enough carbs, then that entire system is downregulated. And then we aren't getting a period which can affect our bone density, affect our sleep. maybe you feel constipated all the time and you're bloated. All those things are connected and they typically come back to we're not eating enough food. Yeah. we see it commonly at lose medicine. That's I wanted to spend a minute here. absolutely patients under eating all the things, sometimes a specific group of macro, but sometimes everything. hypothalamic gamorrhea is really common. I think people don't know how common it is. we just see a lot of patients struggling with that. So hypothalamic gamoria is a huge, huge issue. common in athletics or under eating or a combination of the two. What does someone do? Because I know you have some experience in this realm. What would you tell someone who is struggling with hypothetic aimarrhea? The first thing that I ask someone when they are struggling with HA is have you actually looked at what you're eating? Because most of the time what we eat is a routine and there should be no shame in it. When people cut out food groups, there's a reason. When someone is overeating, there's a reason. When someone's under eating, there's a reason. And shame is never the answer. So I like to take an objective look first. Like if you take your plate and you actually look at your plate, what's on it? If it is just high fiber carbohydrates, which is what is very common, we pack as much fiber in as possible, which is great for satiety. But then if you're too full to actually finish your meal, you're not eating enough, then that could be part of the problem. So the first thing is I as I ask someone about what are you eating, and then what are you eating between meals? What are some things that you think are healthy? I often love that. Like what do you think is health? And every single time it's a different answer. Because health is different for everyone and what they have seen on social media is different. All of our algorithms are different. But if you can examine your diet as an athlete and you realize, well, I'm only eating carbohydrates that have a lot of fiber in them. So those are our fruits and vegetables, our seeded breads, things with added psyllium husk and other high fiber nutrients. Okay, well, you're probably not getting in enough carbohydrates. that are more simple. pasta, rice, potatoes, those serve a purpose. They're easy to digest, they're easy for our bodies to use for fuel. It's good for our brain. It's good for our reproductive health. it doesn't have to be a twinkie. But also, if you've told yourself at some point that you can't have a cookie, that's also something to examine. In in H recovery, it's always about an abundance mindset. What can I fit in? Not what can I take away. And so carbs are the first thing. Are you eating enough carbs? And are you eating enough dietary fat? Fat helps us produce hormones that we need for our reproductive health. If you aren't eating enough of those things, then you're very unlikely to gain your cycle back. I do not think that you always have to eliminate exercise. I think pulling back exercise can be really helpful. If you are underweight, talk to your primary care provider about what you need to do. Because that can be a very different situation. But some folks, maybe they're a college athlete. They don't just have the option to quit sports. so that means you just need to be very intentional about how you're fueling around practice and during practice, which includes like running nutrition is great, tends to be higher carbohydrate, you can get things in between your meals. If you're just focused on the meals alone, it's unlikely you're gonna get enough. To dig yourself out of HA recovery. And it also takes your body time to settle the nervous system. If your body is in a high stress state, if you have a history of trauma, that can also contribute. So I often, you know, I think it's never it's never simple, but you can always start with nutrition. And the basic things would be am I getting enough fats and carbs and enough calories? And then what are the things in my life that are making me stressed? Awesome. That is a great overview. I find it can be a really frustrating diagnosis for patients. They can feel stuck, the things that they love the most, which are moving. it's hard to sort of put that under the microscope and pull back on that. It's also frustrating for HA patients who try to eat more, start to eat more, but it sometimes feels like they're never eating enough. So what you're saying about the abundance mindset, can you talk just a minute longer about that? For someone who is afraid to eat more and already feels like they're pushing themselves so hard it can be really hard for these patients. Yeah. For the person who is afraid to eat more, I think it's really important to examine why that is. What about food gives you anxiety? Is it that you don't feel well when you eat it? Because for some people they can have disordered eating patterns and it's not a it's not related. To the way their body looks. It's related to how their body feels. Or is it something about, you know, the the lifestyle that you have? Maybe you're extremely busy and it will require some forward thinking about snacks and meal prepping to get you there. But also find your accountability partner. That could be a parent, it could be a friend, it could be a spouse, a partner. someone in your life, not there to tell you what to do, but to be aware that you have a goal you're trying to meet and it's helpful to have someone check in. And you can express to them, here are the ways that I would like you to check in with me. Here are the ways I really don't want you to check in with me. Yeah. 'cause it's good for them too to I encourage folks not to track their food. Especially if you are afraid or have any type of food fear, I would not recommend tracking your food. I think that it's instead good to focus on thinking about how you build your plate. I like to go back to the performance plate, which is approximately half of it is is dedicated to carbohydrates. Also, you have about a quarter for protein and then something colorful. When I say carbohydrates, I'm really talking about like rice, pasta, you know, some potatoes, a bit more simple. And then have that color, those are your fruits and vegetables, and then have two identifiable fat sources. Typically, people will start to increase their overall intake because instead of focusing on calories, they're focusing on meeting meeting the metrics of that plate. So what does that plate look like for them? The other thing is that instead of focusing on I need to eat as much as possible, you know, think about, well, what would I like to add in? Like are there cool foods I want to try that I have not tried? You don't have to start with your fear food list and try and knock them all out. That's really hard. You could give yourself a goal, like a small achievable goal. I would like to go get ice cream with a friend today because I haven't gotten ice cream in a long time because I'm turns out I'm I'm a little uncomfortable with that. That's a great place to begin. that is a that even if that means you're just having a small bowl, that's something you might not have done at all six months ago. And so you don't want to go all in per se. Like you give yourself a few goals each week and you try to chip them off and you have Grace for yourself when inevitably you don't meet one of them, or maybe you have a hard week and you don't meet every expectation you set for yourself. Typically folks who are struggling with underfueling are very high attribuing, they have high they have high drive personalities. So you have to be forgiving. Yes, I would agree. That is really hard when you're in that place. Yeah. Seems like the way we're wired can interfere with this recovery process sometimes. I appreciate you spending time on that topic. and I should make mention and maybe you can talk briefly. One of the reasons Maeve is interested in this topic and has a lot to say about it is because Maeve finished her nutrition degree recently. So can you tell us a little bit about that? Because that's another fun. Yes. So I have a master's in human clinical nutrition. I'm extremely passionate about nutrition. I'm very passionate about nutrition education. I do work particularly with people who are looking to recover their period. So my my two passions are period recovery and then actually mast cell activation syndrome, which is something that not many people are familiar with, but also I think there is a growing conversation around it. And A lot of folks will have these symptoms that they can't figure out. It's like they don't make sense. and it turns out some people have a very overreactive immune system. We have these things called mast cells, which are in every tissue of the body. So you can have you can have symptoms in in every system of the body. And so I work a lot with those folks alongside their providers to help provide nutrition strategies. Because with mast cell, you have a lot of nutrition related triggers. But with hypotalamic amenorrhea, that is where I began my passion with nutrition because I myself I did go through that process and I did not have anyone. So at the time where I was trying to recover my period, I didn't even know not having a period was bad. I just had a sense that I probably should have one. And I was recommended to go on birth control. and something about that just didn't sit right with me because it it is in it felt like a band-aid and I took time to think about how I was eating and what I was doing. I did I did have a fairly significant eating disorder. I was in treatment. it is something that almost took my life. And so I'm very passionate about working with other folks. Men and women, because it does not just affect women to help prevent those same things from happening. and HI was the end of that process for me. And I and I at that point had no idea how to fix it. But my gut told me I probably should be eating more. And so I just slowly over time expanded my diet and I did a lot of experimentation and I I did get my period back after about a year. of work. And I don't want other people to go through that same process. It can take a while. It's different for everyone. But it doesn't have to be a multi-year struggle. Yeah. and often, you know, folks are stuck in quasi-recovery. So that's a big part of why I got my degree. And even while getting my degree, I was struck with the lack of information on it. There is still such this emphasis on nutrition strategies that work for Many populations like intermittent fasting, low carbohydrate diets, keto, but that are just not applicable for female menstruating athletes. Yes. And postpartum and pregnant and lactating. Yeah, a lot of a lot of women don't fit into a lot of those buckets. I agree. Thank you so much for sharing all that. it's incredible. It's so hard to be in that difficult place and For it to be dark for a long time, but to decide to use that power intention and you described it as work, which I think is the best word because it is a lot of work to recover. But to use that work and pay it forward is amazing. because I do think a lot of a lot of folks have suffering are suffering with that. amazing, incredible. If you are a business owner, leader, or HR teammate at your organization, we should talk. Lose Medicine partners with several businesses of all sizes to serve your employees in their health. For a reasonable monthly fee per patient, your teammates have access to the full array of services at Lose Medicine, where we provide primary care, urgent care, and low cost ancillary services such as lab testing. Small businesses, mid sized businesses, self funded businesses, and those offering commercial insurance are all benefiting from direct primary care to their employees in Lancaster County and beyond. Direct primary care as a Benefit to your team helps create stickiness with your employees, keeps them healthy with less time out of work sick, and may help save your organization money. If you've been trying to figure out how to improve benefits for your team, offer something at all in the healthcare space, or show your teammates you truly care for their well-being, direct primary care may be the solution. Contact us today to learn more. Go to losemedicine, that's luzmedicine.com and reach out to us directly. We look forward to learning about your organization and seeing if we can be the partner to serve your teammates in their best health. The theme of our podcast is helping to make Lancaster County healthier. Is there any other tidbits, sort of other words, things we haven't covered as far as you see either your personal work, professional development, or lose medicine, or something about what you think about the idea that we have about keeping and making Lancaster County a healthier place to be? There are so many different people in this county working to make Lancaster a better place to live and to provide better health care. Lose Medicine's a great example. Before I worked here, I did not even know Louise existed. and now I don't know how that's possible because I hear people talk about lose. I'm talking about lose. I it's it's a it's a very special place. It's also really exciting through working here. meeting other people in other industries and professions that are similarly passionate about improving the health of everyone who lives here. We see that in regenerative agriculture. Lancaster is a major farming hub and we have a lot of farms here that are working to provide very nutrient dense, high quality options to folks in the area. We also have markets like Lemon Street Market, we have this you know Central Market. There are so many different places that are actually providing locally sourced foods, which is such a big deal. that's amazing. And then I also see a growing number of health professionals in various areas, such as PT, particularly pelvic PT, nutrition as well, therapy, including like EMDR and all these different. facets of care that help people break out of the unhealthy cycles they might be stuck in or answer questions that they have not been able to answer. So it's exciting for me to feel like maybe I'm doing my part or I'm I'm able to contribute in some way. It's also exciting to see the mosaic that is being constructed here in Lancaster. That I'm not sure maybe that is also happening in other places. But I think something very special is happening here and it's very exciting. Yeah. I I completely agree. I feel very privileged at Louise that we get to interact with so many different professionals beyond our walls. people coming to us, treat us reaching out to others, all the areas that you mentioned. I think there's so much happening. Lancaster being a longtime farming place is unique. You know, I'm from the city too. I'm from right near Boston and Farming was not part of my growing up environment. So it is really neat what is happening here. and I am realizing that we have not yet described, maybe even briefly, your role at Lou's is as community liaison, which can mean a lot of different things and a lot of different hats, but talk to us a little bit about who you're interacting with, maybe the two umbrellas of patients coming to interested in the office, potential patients we call them, and those in the community. I have the privilege of talking to a lot of potential patients every day, people who are interested in joining LUS, who are not as familiar with direct primary care, who have been struggling with various aspects of their health of their health, including cycle irregularity, whether that's due to perimenopause, menopause, hypothalamic amenorrhea, PMOS, you name it, or struggling to conceive. And I have learned so much through speaking to those folks and learning about their experiences. And so that's one my favorite parts of my job is getting to talk to people and hear about where they're coming from and what they're hoping to achieve in this next step in their health journey. I also get to connect with other community members. So I meet with folks who are professionals in the area, in other realms of health that we would love to grow a relationship with. you know, whether that might be a referral pathway so that we can strengthen our connections and provide the best care to our patients. also employers. Insurance is a very expensive way to provide health care. And we have been working on growing some employer connections and partnerships to provide health care at affordable cost to those employees, which is also very exciting. and then I also just get to go to lots of events. So for some of you who may be listening, maybe you've seen me in events, maybe you've talked to me, maybe you will talk to me. I have the privilege of being active in the chambers. It's exciting to go meet all of these folks, learn. There are so many events these days that are centered around different topics that really strengthen my understanding of this community. and aspects of this community that I have no no idea about so those are just some of the things that I do and then I have a lot of fun little admin stuff. But but it is it is a very patient facing position in certain ways and then also I I get to have all these exciting projects as we work on developing the future of lose. Exciting. Very great. Maeve what have we missed today? What have we not talked about? I feel like we covered a lot of ground. I think we did between Luz and Mave and just being a semi-professional athlete, nutritionist, and someone who's recovered from HA and has a lot of passion for helping others recover, which is so awesome. and yes, your role as community liaison for Lou's, which exactly as you said, you get to meet a lot of people. us who are taking care of patients at Lou's and doing that patient-facing work, a lot of what we're doing is meeting patients one at a time. Family medicine, women's health, adults, children, men, women, but maybe get to interact with those interested in joining Lou's and also so many in the public as well, professional and outside the walls of the office, which is super fun. Any anything else? Last words? I think the last thing that I would say is that Part of what I'm passionate in health, it's providing a safe atmosphere to help folks move forward in often the darkest part of their health journey. For me, that's gonna be the nutrition space. But I feel very it it feels very special to witness at Louise a a space that provides that same security and safety to folks who may have medical trauma, a lot of anxiety, maybe they've had really adverse experiences in medicine. They have fear around asking for help. and I know that our goal is to provide that shame-free, safe space. And I I feel very excited to be a part of that and to watch that happen day in and day out. Thank you. Yes, I I could not agree. Awesome words to end on. Lose Medicine exists to provide an excellent medical experience for every patient who comes through our doors. sometimes patients have experienced a lot of negativity in healthcare, which is not surprisingly healthcare is hot mess right now. But also just we're not being helped at all. Just not being helped. Maybe it wasn't especially difficult, it just wasn't helpful. being ignored, you know, and also just lots of runaround, lots of red tape, lots of things not happening just because. So yes, having the experience be easy. helpful and we put a lot of value and effort into making the space safe, comfortable, welcoming, not a sterile, uncomfortable environment. So yes. I love everything you should. Share Thurm, thank you so much. We appreciate you joining us today and listening and learning along with me and Dave. And thank you so much for joining us. We look forward to seeing you again in Lou's Musings. Thank you so much for spending time with us today. We are grateful for you and hope this episode got you thinking. It's important to remember that the content provided in Lou's Musings is not considered medical advice and no doctor-patient relationship is ever formed by listening. Additionally, the ideas and opinions represented on the show and its guests are not endorsed by Lose Medicine exclusively, and we welcome thinkers of all kinds to engage with us and our audience so that we can all learn together. Once more, thank you so much for joining Lou's Musings. Feel free to share with a friend, and until next time, we are wishing you the best in health, always.