Latest / Eat More Carbs | A Period Recovery Podcast / 154. The Best Way to Get Your Period Back: Advice from a Physician

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154. The Best Way to Get Your Period Back: Advice from a Physician · Eat More Carbs | A Period Recovery Podcast

• 0:00
  Hey girlies, just a quick reminder before we dive into
• 0:02
  today's episode. The information shared on this
• 0:04
  podcast is intended to be general sports nutrition advice
• 0:07
  and education related to period recovery for female athletes.
• 0:10
  This is not specific to anyone individual and it may or may not
• 0:13
  apply to your situation. If you are looking for
• 0:15
  personalized guidance, be sure to apply to our period recovery
• 0:18
  nutrition coaching program. Our four month period recovery
• 0:20
  program is designed to help you sustainably get your period back
• 0:23
  and keep it. You can apply now to get started
• 0:25
  in our program and we'll leave the link for the program below.
• 0:27
  This is the Eat more Carbs podcast.
• 0:34
  Hello and welcome back. This is the more Carbs podcast.
• 0:37
  We are a team of dietitians and we talk every Thursday about
• 0:40
  sports nutrition for the girlies.
• 0:42
  My name is Jenna and I host this podcast and my name is Riley.
• 0:45
  You'll also see me on this podcast.
• 0:46
  I am the owner and founder of Steady State Performance
• 0:49
  Nutrition. We specialize in helping female
• 0:51
  athletes recover from low energy availability and together along
• 0:54
  with Lily Rhymer, we are team Steady state.
• 0:56
  Before we get into today's episode, we are going to share a
• 0:59
  high and low. So sharing just a little bit
• 1:00
  about our week, the good, and the parts.
• 1:01
  We wish it on a little bit differently.
• 1:03
  Riley, I don't know about you, but I am so excited for today's
• 1:06
  episode that I almost want to skip over our high and low.
• 1:09
  We won't, but I'm just so excited for today's episode.
• 1:12
  I'm so excited too. This is something that we've
• 1:14
  been talking about for a really long time and I'm so excited
• 1:17
  that we have Doctor Hill on today to answer a lot of
• 1:19
  questions because you all are asking us a lot of these
• 1:22
  questions and I love that, but we're not physicians.
• 1:25
  So I'm so excited that Doctor Hill is going to be on to answer
• 1:28
  those questions that you all have.
• 1:29
  Me too. Before we do though, high and
• 1:31
  low, where are you at this week first?
• 1:33
  Off. I can't believe that like it's
• 1:35
  March next week. That is crazy to me.
• 1:38
  I feel like January was three years and February was 3 hours.
• 1:42
  I don't know what happened. Time is flying and that's not a
• 1:45
  high or low. That's just a statement because
• 1:47
  I just feel like time is flying. My high though, is not related
• 1:50
  to time at all. But I have been sharing a little
• 1:53
  bit about like my running journey on the podcast.
• 1:56
  Also, if you just meet me in person, I'm probably going to
• 1:58
  talk to you about running. I'm going to figure it out
• 2:00
  somehow, but I got a treadmill a couple of weeks ago and I've
• 2:03
  been really liking it. Like it's not the fanciest
• 2:06
  treadmill ever, but I have really been enjoying my
• 2:09
  treadmill. I had to share because I just
• 2:11
  reminded me of like when you got your teacup and it was like,
• 2:13
  it's like the little thing. Sometimes you're like, I just
• 2:15
  need a little like dose of like serotonin or dopamine or
• 2:18
  whatever. But like, I need, I need
• 2:20
  something just to go right in my life and that's.
• 2:23
  My treadmill, I love that. I'm so glad that it's working
• 2:25
  out. I know that we had talked about
• 2:27
  it and originally you were like, I'll probably hate it in a week,
• 2:29
  so I'm really happy, like you're still liking it and enjoying it
• 2:31
  and it's been a useful thing to. Have and it's so funny because I
• 2:34
  can barely get on it because Rob's is on it all the time.
• 2:37
  I'm like, I got it so I could like run in the morning.
• 2:40
  Can't run in the morning. He's running in the morning.
• 2:42
  So I'm like, OK, I'll run it in the evening now.
• 2:44
  You're going to end up with two of them.
• 2:46
  Yep, I am enjoying my treadmill. We will report back in a month
• 2:50
  to see if I still like the treadmill but it's it's good for
• 2:54
  what I needed to do. What about your low?
• 2:56
  My low is I'm bummed that the Olympics are over and and I feel
• 3:00
  like it just really ended on a bad note.
• 3:02
  Like there was so much excitement for the US and we had
• 3:06
  such amazing stories. And then I'm just so bummed out
• 3:11
  about what happened with the men's hockey team.
• 3:12
  I mean, I'm not like I'm bummed, but I'm not surprised.
• 3:16
  Like, I'm not like I'm not outraged because I'm not
• 3:18
  surprised. If you've grown up around
• 3:20
  sports, you know, that these conversations like happen all of
• 3:23
  the time. And like I'm almost like numb to
• 3:25
  it. But like, it's 2026, can we do
• 3:28
  better, please? I think what happens is like,
• 3:30
  there was such an opportunity. There's so such like a divide in
• 3:35
  sports between men and women. And like, it's so frustrating
• 3:39
  because like these conversations are happening in like every
• 3:43
  single locker room. Like the amount of times that I
• 3:46
  have been around a group of male athletes and like that
• 3:49
  conversation is happening and I'm the only female athlete or
• 3:51
  like the only female in that space.
• 3:53
  So like I could speak up, but like, I'm going to be considered
• 3:56
  annoying or like, she's a girl. There was such a opportunity to
• 4:00
  like, change the tone and now. And we're still having there's a
• 4:03
  conversation. It basically was showing that,
• 4:06
  like, OK, like the woman just won a gold medal.
• 4:09
  And like, we just made a joke. Like we're not inviting them
• 4:12
  because they literally won a gold medal and have been like,
• 4:15
  the most dominant program in that sport.
• 4:18
  We have to invite them because we have to invite the girls.
• 4:20
  Women's sports shouldn't be an afterthought.
• 4:23
  I kind of have, like, I kind of got mad about this the other day
• 4:26
  too, about something where someone messaged me.
• 4:28
  It was a guy and he was like, I love what you're doing in
• 4:30
  women's sports and I'm like, you love what I'm doing in sports.
• 4:33
  I mean, you know, yeah, you love what I'm doing in sports.
• 4:35
  I think that's what's like so hard is like there's still this
• 4:38
  conversation where there's like sports and there's women's
• 4:40
  sports and like sports are the default and that means men.
• 4:43
  And then like there's women's sports when like, that's not
• 4:46
  true. It's literally just sports.
• 4:48
  But here we are in 2026, still having this conversation still.
• 4:51
  Having this conversation and I think what's hard is like
• 4:54
  everybody who's like better around sports is not surprised.
• 4:58
  Like no one's surprised because we've had people around us have
• 5:01
  this conversation like all the time.
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  The good news is, though, there's always a good news is
• 5:06
  like the people are not having it.
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  And so I just feel like people are consistently like forgetting
• 5:10
  the power of women, Like, and now like everybody like men and
• 5:13
  women are like coming after these guys.
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  And I'm like, I'm here for the positive response.
• 5:17
  You just for sure. We're not ready for that.
• 5:19
  You did not think that was going to be my low this week.
• 5:21
  I'm so sorry. Sometimes it's just it is what
• 5:23
  it is and we have to talk about these things.
• 5:26
  What's your high and your low? Mine sounds so like trivial in
• 5:29
  comparison. My high is the time of year.
• 5:32
  We have a lemon tree and I have about like, I'm not kidding,
• 5:35
  upwards of 300 lemons in my house.
• 5:38
  And that's less than half of the lemons that I have pulled off my
• 5:41
  lemon tree, which is great because I have so much lemon
• 5:44
  water. I could make all of the lemon
• 5:46
  bars, lemon pies, anything lemon related.
• 5:48
  If you have a lemon recipe that you're like, this is the best
• 5:51
  lemon recipe, please send it my way because I'm trying to use
• 5:53
  all of them because fortunately, unfortunately, I guess you could
• 5:56
  say everybody has a lemon tree in Arizona.
• 5:58
  So I try to gift them and people are like, no, I'm trying to get
• 6:01
  rid of mine. Do you want my lemons for my
• 6:04
  lemon tree? And I will gladly take all the
• 6:05
  oranges, grapefruits and tangelos and all the other
• 6:08
  citrus that we don't have in our yard.
• 6:10
  I'm trying to get rid of all these lemons and nobody wants
• 6:12
  them. You.
• 6:13
  Want to make lemonade? I feel like that's the that's
• 6:15
  the easiest way, yeah. Last time I tried to do like I
• 6:18
  have a creamy like a ninja creamy and I tried to do like a
• 6:20
  frozen lemon type of like ninja creamy but it like it didn't
• 6:24
  turn out that great. So maybe I could perfect my
• 6:26
  recipe and do that instead, Especially this time of year
• 6:29
  when it's hot already. I love this for you because
• 6:31
  Arizona is going to be like 120° in like 2 months so I love your
• 6:36
  mild weather and your lemons. What a great.
• 6:37
  Way to start March. Just such beautiful weather and
• 6:41
  a ton of lemons. I think my low kind of going off
• 6:43
  of what you said with the Olympics is just that the
• 6:45
  Olympics is over. So I kind of am sad this time of
• 6:48
  year when there's not a sport on TV that like I can just watch
• 6:51
  and enjoy and, you know, I feel like.
• 6:53
  Soccer. That's true.
• 6:54
  That's true. OK, I stand corrected.
• 6:56
  Everybody knows that I'm a huge fan of the Olympics and I'm just
• 6:59
  kind of sad that I have to wait another two years.
• 7:01
  But the good news is that the next Olympics is the Summer
• 7:04
  Olympics, and it's in LA, which is really exciting, so I love
• 7:08
  the Summer Olympics. We entered the lottery, so did
• 7:10
  we. What sports do you want to see?
• 7:12
  Track and field. Oh yeah?
• 7:13
  Well, yeah, I figured you would try to go for swimming too.
• 7:15
  Or no I. Think we'll probably, what we'll
• 7:17
  probably end up doing is like we live close enough that you know,
• 7:21
  the marathon is a spectator friendly sport.
• 7:23
  You don't necessarily need tickets like I would go and if I
• 7:26
  don't end up with tickets and just cheer the marathon on.
• 7:29
  I was laughing because actually I was talking about this with
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  somebody like earlier today about what sports like she was
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  talking about how she entered the lottery.
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  And we were like, if we do the marathon, you're going to
• 7:39
  literally see them for 30 seconds, if that.
• 7:42
  But it's not like a huge marathon.
• 7:43
  Like they're all going to be in a pack and they're all going to
• 7:45
  be running 4 minutes per mile and then they're going to zoom
• 7:47
  by. Just whoop and done.
• 7:49
  Yeah, same thing with the big cycling races too.
• 7:52
  It's like the skeleton, like you don't realize how fast they're
• 7:54
  going until they show it and you're like.
• 7:57
  I loved the videos of the like the cameraman who was like
• 8:00
  trying to film it and it was like the fastest like movement
• 8:02
  ever. And I was like that poor
• 8:03
  individual's neck. And I hope they're doing OK.
• 8:05
  That's an Olympic sport in itself.
• 8:07
  No kidding. OK, well, like we kind of teased
• 8:10
  at the beginning of this high and low, we do have a guest on
• 8:12
  today's episode, which we are incredibly excited about.
• 8:15
  I know both of us are just really excited to share this
• 8:17
  episode with all of you, so we hope you enjoy.
• 8:19
  Our guest today brings a unique dual perspective to the critical
• 8:22
  area of sports nutrition. She spent years navigating the
• 8:25
  high pressure world of elite athletics and she has chosen to
• 8:27
  stay within that world throughout her professional
• 8:29
  career working directly with athletes as a board certified
• 8:32
  physician. Before her medical career, she
• 8:34
  was a two time Georgia High School Swimmer of the Year and
• 8:36
  an Olympic Trials qualifier who went on to compete for Stanford
• 8:39
  University. That first hand experience with
• 8:41
  the demands of sport eventually LED her to continue at Stanford
• 8:44
  for both medical school and her pediatric residency.
• 8:46
  After serving as Clinical Assistant Professor in
• 8:49
  Adolescent Medicine at Stanford and as the lead physician at
• 8:51
  Equip Health, she Co founded Athlete MD in 2025, a virtual
• 8:55
  medical practice. Her work focuses on helping
• 8:57
  athletes navigate rides and disordered eating with a
• 9:00
  clinical approach that honors the athletes Dr. while
• 9:02
  prioritizing their long term well-being.
• 9:04
  Now living in Georgia with her husband and three children, she
• 9:06
  supports athletes all over the US.
• 9:08
  We are honored to have her on the podcast.
• 9:09
  Speaking with us today, please welcome Doctor Catherine Hill.
• 9:12
  Thank you for having me. I've been such a fan of your
• 9:14
  work in your podcast, so this is an honor to be able to chat with
• 9:17
  you today. Well, we're so excited to have
• 9:19
  you here. I think it's going to be really
• 9:21
  useful to have conversations from like the physician side of
• 9:24
  things because we get a lot of questions from athletes that we
• 9:27
  can't necessarily answer. So we're hoping that you can
• 9:29
  help clear up some of those things from like the medical
• 9:31
  side of things and Reds recovery.
• 9:33
  One of the first things we want to talk a little bit about is
• 9:36
  going to the doctor and the importance of meeting with your
• 9:38
  physician before undergoing any type of treatment for Reds or HA
• 9:42
  recovery. What should athletes do if their
• 9:44
  current doctor tells them that it's normal for them to lose
• 9:47
  their period because they're active?
• 9:48
  I love this question so much and unfortunately we are still here.
• 9:52
  I first got into this work sort of by accident because of my
• 9:55
  experience as an athlete when I was told this very thing that,
• 9:58
  oh, it just means you're working hard.
• 9:59
  It just means you're an athlete. It's totally normal for a young
• 10:02
  woman to not have a period. And, and of course, now we know
• 10:05
  that that's not at all true and it is not normal if somebody's
• 10:08
  over the age of 15 not having regular monthly cycles.
• 10:11
  And unfortunately in medical school, this is not a topic that
• 10:14
  people are getting adequate education and training in.
• 10:17
  So people that are interested in the field really do have to seek
• 10:20
  it out separately. So there are a lot of people in
• 10:22
  the medical field who you know best of intentions and really
• 10:25
  just don't know that not getting regular periods is not a normal
• 10:28
  thing for women over the the age of 15.
• 10:31
  It is important. Sometimes you need to advocate
• 10:33
  for yourself and say, you know what, I haven't been getting a
• 10:35
  period. I would like to get my hormones
• 10:37
  checked and we can talk a bit about, you know, the sort of
• 10:39
  testing that I like to send and make sure that, you know, you're
• 10:42
  getting your health taken care of.
• 10:43
  And that's often a first step. In addition to lab testing, we
• 10:47
  also like to look at things like your vital signs and that
• 10:50
  includes your heart rate at rest, your blood pressure at
• 10:52
  rest. And then we do something called
• 10:54
  orthostatic vital signs or you stand up and we compare the
• 10:57
  difference between lying and standing vital signs and and we
• 11:00
  also look at kind of height, weight and trends over time
• 11:03
  there as. Well, why is this a big issue?
• 11:05
  We both as athletes, you heard this growing up and competing
• 11:09
  and swimming and I also heard this growing up playing soccer
• 11:12
  that you know, not having a mental cycle is normal.
• 11:14
  Why is this an issue? What are some like the long term
• 11:17
  and short term risks of not having a normal mental cycle?
• 11:20
  Yes, so I like to say most of the complications that we see
• 11:25
  with Reds and hypothalamic amenorrhea are not getting a
• 11:28
  period are reversible, which is great, especially if you can get
• 11:31
  prompt and evidence based treatment.
• 11:33
  And most of my athletes that I see really do go on to regain
• 11:36
  their cycle because they're in treatment, they're actively
• 11:38
  working towards it, which is fabulous.
• 11:40
  The one piece that sometimes can be a permanent effect is related
• 11:45
  to bone density. So in order to build up proper
• 11:48
  bones, you really do need to have your body needs to be
• 11:51
  making the proper hormones to lay down bone.
• 11:54
  And we know that, you know, a lot of athletes tend to be young
• 11:57
  people and they are in these years where they're able to
• 11:59
  build up bone until about the mid 20s or so.
• 12:02
  You kind of are adding bone in an ideal world and you live off
• 12:06
  that bone for the rest of your life.
• 12:07
  So if you are a young athlete not getting a period, those are
• 12:10
  kind of peak bone building years.
• 12:12
  And if you miss out on years of bone building, that can set you
• 12:15
  up for decreased bone density and conditions like osteopenia,
• 12:19
  osteoporosis, sometimes later in life, sometimes it can hit
• 12:21
  earlier than that, depending on lots of factors, including
• 12:24
  genetics. So the bone piece is the one
• 12:26
  that that's one of the reasons why we tend to act with a sense
• 12:30
  of urgency in a way, right? Because we want to address this
• 12:32
  quickly so that we can set people up for success to have
• 12:35
  good strong bones for the rest of their lives.
• 12:36
  Another physician I actually was speaking with and collaborated
• 12:39
  on an athlete with mentioned osteoporosis is actually a
• 12:43
  childhood disease. And I was like, Oh my gosh, we
• 12:47
  don't think about that. Because, you know, when you're
• 12:49
  1516, you're not thinking about your bone health.
• 12:52
  In your 60s and your 70s, you're thinking about, you know, your
• 12:54
  tests that's coming up, your practice that you have maybe
• 12:57
  what your friends are doing on Friday night.
• 12:59
  You're not thinking about bone health.
• 13:01
  Percent, and I know virtually no teenagers who do until they
• 13:05
  educate themselves on, if they do have Reds and they educate
• 13:07
  themselves on it, then some of them start to think about it.
• 13:10
  But you're absolutely right. This is not something that your
• 13:12
  typical teenager or young adult is really thinking a lot about.
• 13:15
  But I will say, when people find out what I do, elder women do
• 13:18
  come up and say, gosh, I really wish I had known about this
• 13:21
  sooner. I was an athlete.
• 13:22
  I didn't get a period for a long time and now I do have
• 13:25
  osteoporosis. And so the goal here is can we
• 13:27
  help prevent this so that no more athletes have to struggle
• 13:30
  with this when they're older? You mentioned early intervention
• 13:33
  for helping prevent some of these long term effects.
• 13:36
  At what point should an athlete visit their physician when they
• 13:38
  don't have a period? Is it after one miss period, 2
• 13:41
  miss periods? What are you looking for for
• 13:43
  that to consider it something that we should be having some
• 13:46
  type of an intervention? Yes, great question.
• 13:48
  So for the first one to 2:00-ish years after somebody has a first
• 13:53
  period, it can be normal to have some variation in cycles.
• 13:56
  After two years from the first period, you really should be
• 13:59
  having regular monthly cycles. And we define that as being
• 14:02
  between 21 days and 35 days. If it's going beyond 35 days on
• 14:07
  a regular basis, then that might be a time, even the first month
• 14:10
  to get checked and just make sure everything's OK.
• 14:13
  Because again, early intervention, early treatment is
• 14:16
  really the way to help prevent the long term complication.
• 14:18
  So it's never really too early. If you're somebody that has
• 14:21
  irregular periods, absent periods, I would say it's never
• 14:23
  too early to go in and get your hormones checked and get checked
• 14:26
  out by a physician if you can. On that topic, what should
• 14:29
  people be asking for advocating for from a blood work
• 14:32
  perspective when they do go and ask for their hormones to be
• 14:34
  checked? I think we hear a lot of
• 14:36
  pushback or rhetoric online about when you go in and
• 14:39
  someone's asking for hormones to the physician will then ask for
• 14:42
  what hormones, Why do you want them?
• 14:43
  What would be a good response for an athlete to ask?
• 14:46
  Yeah, great question. And if this is an athlete who I
• 14:49
  will preface by saying, if you are on hormonal contraception,
• 14:52
  the hormone tests will not be accurate.
• 14:54
  And so this advice sort of applies to people who are having
• 14:57
  irregular periods, absent periods, and they want to get
• 15:00
  kind of a basic hormone panel. I would want to check LH,
• 15:03
  luteinizing hormone, FSH, follicle stimulating hormone,
• 15:06
  and estradiol, which is estrogen essentially.
• 15:08
  Those three are the most important.
• 15:10
  I also as part of a Reds work up, like to check some other
• 15:13
  things as well. So especially for my athletes, I
• 15:15
  like to get a complete blood count and an iron studies panel.
• 15:18
  Oftentimes we're finding some iron deficiency anemia.
• 15:21
  Sometimes there can be anemia due to the Reds itself.
• 15:24
  I like to get a comprehensive metabolic panel and that looks
• 15:26
  for things like your blood electrolytes, your kidney and
• 15:29
  liver function. I like to check T3 hormone,
• 15:32
  which is a type of thyroid hormone, and if it's low, it
• 15:35
  doesn't necessarily mean you have a thyroid condition.
• 15:37
  What usually we see is other thyroid tests come back normal
• 15:40
  and the T3 can be low in states of Reds.
• 15:42
  Sometimes I'll check a vitamin D, particularly if we're worried
• 15:45
  about bone health. That's something we like to try
• 15:48
  to optimize if we can, and that's sort of my standard panel
• 15:50
  that I usually get. We've all been talking a little
• 15:53
  bit about like Reds and HA. Do you mind defining those terms
• 15:57
  and then maybe comparing them? Because I do think there's a lot
• 16:00
  of confusion in the space is like HA always Reds is the Reds
• 16:03
  always involve HA. So if you don't mind defining
• 16:05
  those. Absolutely, yes.
• 16:07
  There is a lot of overlap. I think hypothalamic amenorrhea
• 16:10
  is specific to the effect we see for the hypothalamic gland in
• 16:15
  the brain. So the hypothalamus is a gland
• 16:17
  that lives in your brain, and when you haven't been fueling
• 16:20
  your body appropriately, that leads to suppression of hormones
• 16:23
  from that gland, which then downstream leads to irregular
• 16:26
  absent periods and inadequate hormone production.
• 16:29
  I would say hypothalamic amenorrhea is suppression of
• 16:32
  hormones being produced from the hypothalamus, which then lead to
• 16:36
  irregular messing periods. Reds is, I guess you can
• 16:39
  consider it a much broader framework to describe the other
• 16:43
  medical findings and complications.
• 16:44
  We can see when somebody's in a state of energy deficiency.
• 16:47
  And I like the Reds framework because it also includes males,
• 16:49
  which this is also very common in male athletes as well, which
• 16:52
  a lot of people don't. And it really can impact every
• 16:55
  organ system in the body. So the Reds framework looks at
• 16:58
  GI complications and cardiac complications and mood symptoms
• 17:02
  and all sorts of different things.
• 17:04
  So I guess it's just a broader framework.
• 17:06
  Obviously we want people to have some type of a treatment if they
• 17:10
  are missing a period or something like that.
• 17:12
  A lot of times we have athletes that are put on some type of
• 17:15
  contraceptive pill to help them bring their period back.
• 17:18
  Does that actually work for period recovery?
• 17:21
  I'm so glad you're bringing this up because I see this all this
• 17:23
  time. And I think often times if
• 17:25
  somebody is going to a medical provider who's not Reds in form,
• 17:28
  this is often what I see is somebody coming to me saying I
• 17:31
  didn't have my period, so I got placed on birth control so I
• 17:34
  could, quote, help regulate my period.
• 17:36
  And unfortunately, the data just does not show that going on the
• 17:40
  birth control pill when you're in a state of Reds or you have
• 17:43
  hypothalamic amenorrhea is actually going to help with your
• 17:46
  bones. And it's also not a real period.
• 17:48
  And there's a few other problems too.
• 17:50
  We aren't able to track hormone levels when somebody is on
• 17:53
  hormone contraception and it also sort of masks if somebody's
• 17:57
  body is in a place to be able to produce their own natural
• 17:59
  hormones. So in an ideal world, somebody
• 18:03
  is working on their nutrition 1st and weight restoring.
• 18:07
  And this is something that I often see not talked about
• 18:09
  enough in the sports world, is this concept of weight
• 18:12
  restoration where oftentimes when somebody's in a state of
• 18:15
  Reds, their weight is down from whatever their baseline is.
• 18:18
  And often in order to get a period back and to be able to
• 18:21
  produce hormones adequately, that person does need to get
• 18:24
  back to that weight or close to that weight where they were
• 18:26
  before in order for everything to work properly.
• 18:28
  I guess all this to say, going on the birth control pill to
• 18:31
  quote, regulate your periods is not really the best strategy and
• 18:35
  it hasn't really panned out in studies to show that the birth
• 18:38
  control pill will improve bone density anyway.
• 18:41
  So in my opinion, there's not really much benefit to go on
• 18:44
  them for this problem unless there is a birth control need.
• 18:47
  If you need to be on birth control for other reasons, you
• 18:49
  know that's potentially where risk benefit for everything,
• 18:53
  right? But so I wouldn't, if somebody
• 18:55
  needed birth control, I wouldn't not prescribe birth control.
• 18:57
  But it just makes a little bit tougher to figure out when
• 19:00
  somebody's body is in an adequate place.
• 19:01
  I get asked about birth control all the time.
• 19:03
  And I always say like great at controlling birth right, because
• 19:06
  that's what the purpose of it. Like not great at overcoming low
• 19:09
  energy availability. Doctor Hill, you mentioned
• 19:12
  weight restoration. I think this is very scary.
• 19:15
  I guess this concept is very scary for many athletes.
• 19:18
  Can you talk a little bit more about this weight restoration
• 19:21
  piece? Yes, definitely.
• 19:23
  And I will preface by saying that most of my clinical
• 19:26
  training and experiences in the world of eating disorders where
• 19:29
  this is really talked about very commonly and known to be the
• 19:33
  single best thing you can do to get somebody to recover from an
• 19:35
  eating disorder is prompt weight restoration kind of as quickly
• 19:39
  as you can. And then somebody is way more
• 19:42
  likely to go on to recover. And because there is such an
• 19:45
  overlap between what happens to your body in a state of Reds and
• 19:48
  what happens to your body when it's not getting enough
• 19:50
  nutrition from an eating disorder, and often a lot of
• 19:52
  overlap between those two things.
• 19:54
  I mean, but medical complications are essentially
• 19:56
  the same. And so just kind of
• 19:58
  extrapolating from the eating to sort of research and what I've
• 20:01
  seen clinically as well is that it really is a prerequisite to
• 20:04
  getting better and to having your body work properly if
• 20:07
  somebody often does need to weight restore and get their
• 20:10
  weight closer to where it was prior to losing weight.
• 20:13
  I do want to ask a little bit more about oral contraceptive
• 20:16
  and the labs, because you mentioned when we were talking
• 20:18
  about lab work that you typically order.
• 20:20
  Does the oral contraceptive kind of mask alter those hormonal
• 20:25
  labs that you're checking for? It does, and that's why we don't
• 20:29
  check or we shouldn't check hormones when somebody is on
• 20:32
  hormonal contraception because it just changes the numbers and
• 20:36
  we're not sure is this from the pill or is this your own body's
• 20:38
  production? It just is, you know, not
• 20:40
  accurate information for us. So generally, if somebody's on
• 20:42
  the pill, I won't check hormones and we'll look at other markers
• 20:45
  of are you in a state of energy deficiency?
• 20:48
  But it is really helpful when we can get that data and kind of
• 20:51
  know where somebody's hormones are.
• 20:53
  That gives us a good estimate of how close they might be to being
• 20:56
  able to get their periods back. I think this really goes to show
• 20:59
  that there can be athletes that exist with normal cycles or what
• 21:04
  appears to be a normal cycle and they can still have low energy
• 21:07
  availability. So involving A physician to be
• 21:09
  able to kind of track those other markers that you're
• 21:11
  talking about and looking for is extremely important because we
• 21:15
  do see a lot of athletes that do have a period, whether that be
• 21:18
  from having a bleed from contraceptive or natural period,
• 21:22
  but they're still under fueled. And those are a lot of the
• 21:24
  people that Riley and I work with from like a fueling
• 21:26
  perspective. But having a physician be able
• 21:29
  to kind of track whether or not we've overcome that low energy
• 21:32
  availability is so important. Yes, absolutely.
• 21:34
  We do see, I mean, Reds can have just a number of different
• 21:38
  symptoms and sometimes people do have regular periods, but their
• 21:42
  heart rate is 39 or, you know, sometimes they have regular
• 21:45
  periods, but they're like really, really, really light and
• 21:48
  maybe not the period that they're meant to be having.
• 21:51
  And their hormones are still on the lower side, lower than the
• 21:53
  they should be. And maybe they're not getting
• 21:55
  the bone benefit that they really should be getting and
• 21:57
  they're having stress fractures and things like that.
• 21:59
  So you can have Reds and have regular periods, and irregular
• 22:02
  periods or absent periods are a sign but not the only sign of
• 22:05
  Reds continuing on, like the subject of maybe birth control
• 22:08
  or oral contraceptives. We get a lot of questions about
• 22:11
  a 10 day progesterone challenge for period recovery.
• 22:15
  Can you chat a little bit about that?
• 22:17
  Yes, another word for that is called the Provera challenge
• 22:19
  because the medication that's given is also brand name is
• 22:22
  Provera, but it is progesterone essentially.
• 22:24
  And this can be a tool that can be used if somebody, let's say
• 22:28
  somebody has been really working on their nutrition and we think
• 22:31
  they're feeling appropriately and their hormone levels are now
• 22:34
  looking adequate. And I usually look at LHFSH and
• 22:37
  estradiol. And if estradiol or estrogen is
• 22:40
  in the 30 to 40 plus range and has been sustained there for
• 22:43
  quite some time, you know, we start to think is this person's
• 22:46
  body in a place where they can start having periods again, they
• 22:49
  just haven't had it yet. Because that is another thing
• 22:52
  that I like people to know is that it can take a very long
• 22:55
  period of time, many, many months, sometimes even longer to
• 22:58
  get a period back, even when you are kind of where you need to be
• 23:00
  nutritionally. So the Provera challenge can be
• 23:03
  a tool for those sort of people where we think they're in an OK
• 23:06
  place. And it's sort of as a test to
• 23:08
  the system. And basically what you do is you
• 23:10
  take this progesterone pill for 10 days and if your body has
• 23:14
  enough estrogen, it will build up a uterine lining.
• 23:17
  And when that 10 day course of progesterone is done and your
• 23:21
  body no longer sees it or it anymore, you should get a
• 23:25
  withdrawal bleed if estrogen is adequate.
• 23:27
  And so if you don't get a withdrawal bleed, that's kind of
• 23:29
  an indicator that maybe we're not where we need to be
• 23:32
  hormonally, nutritionally, etcetera.
• 23:34
  If you do get a withdrawal bleed, that's sometimes an
• 23:36
  indicator that, OK, we might be where we need to be.
• 23:38
  We just need more time to kind of wait for your cycles to
• 23:42
  restart up again on their own. And I will also say sometimes we
• 23:45
  also need to look at other causes for menstrual
• 23:48
  irregularities or absent periods.
• 23:49
  So, you know, if somebody is sexually active, a pregnancy
• 23:52
  test is never a harmful thing to check, just to make sure.
• 23:55
  That's probably worldwide the number one cause of amenorrhea,
• 23:58
  right? And also looking at things like
• 24:01
  PCOS and there's some other, you know, kind of genetic things or
• 24:04
  anatomical reasons why somebody may not be getting periods.
• 24:07
  So there's other reasons as well, but just want to throw
• 24:09
  that out there. What about HRT?
• 24:11
  So hormone replacement therapy? That is another question that
• 24:15
  we're often getting about synthetic hormones.
• 24:17
  Yes, this is such a great question and there is some
• 24:19
  research coming out from Boston on looking at HRT for female
• 24:24
  athletes who have had prolonged amenorrhea.
• 24:26
  What I have found because I am trained as a pediatrician, so I
• 24:29
  am seeing children, adolescents and young adults, is that almost
• 24:33
  always if somebody is seeking appropriate care, they can get
• 24:36
  their period back with nutrition, right?
• 24:38
  And so it's often worth giving them that chance since they are
• 24:41
  still in their bone building years within reason.
• 24:44
  Now certainly there are the patients who go on and they have
• 24:47
  amenorrhea for one year, 2 year, three years and they're not
• 24:49
  getting their period back. You know, I think I would
• 24:51
  absolutely consider an estrogen patch or something like that in
• 24:54
  those patients. But most of my patients are able
• 24:56
  to get their periods back with adequate nutrition.
• 24:58
  So because of, you know, my pediatric training in the
• 25:00
  patient population I see, I usually like to give them a
• 25:03
  little bit of time before we go to that route because I've also
• 25:06
  seen it used sort of as a way to justify being at a lower than
• 25:10
  healthy weight And that, OK, well, we'll just put a patch on
• 25:12
  it quite literally like this is a patch.
• 25:14
  So, you know, it definitely has its time.
• 25:15
  It definitely has its place, but it's definitely not for every
• 25:18
  situation. Every athlete who doesn't have
• 25:20
  periods, I prefer to get them weight restored and, you know,
• 25:23
  fueled. And often their periods do come
• 25:26
  back. I'm so glad that you clarified
• 25:28
  that nutritional piece because we have worked with athletes who
• 25:32
  have been on a Reds recovery journey or have been prolonged
• 25:35
  under fueling and we've actually seen benefit with the patch with
• 25:39
  bone health. But they have to be weight
• 25:41
  restored. They have to be making
• 25:43
  nutritional challenges. And I loved that you said that.
• 25:46
  It can't be like an excuse or a patch or a Band-Aid to continue
• 25:49
  to stay under fueled. Yeah, exactly.
• 25:51
  Sounds like with a lot of those the nutritional piece to come
• 25:54
  first before there's even benefit for that.
• 25:56
  Like almost secondary like treatment, if that makes sense.
• 25:59
  Absolutely yes. If we can get somebody
• 26:01
  nutritionally replete and nourished, then the other things
• 26:05
  like the hormones and the periods will follow usually.
• 26:08
  For those athletes listening, there might be some confusion
• 26:11
  because we just talked about like hormone replacement
• 26:13
  therapy, we talked about the patch, and there's even like
• 26:14
  estrogen pills that athletes can take.
• 26:16
  What's the difference between that and maybe estrogen that's
• 26:20
  found in the birth control pill? Because we just talked about
• 26:22
  maybe the patch. With nutritional changes can
• 26:24
  help with bone health, but a oral contraceptive has not been
• 26:27
  shown to help with bones. Yes, and I will say there's some
• 26:31
  really exciting fairly new data on the estrogen patch that has
• 26:35
  shown some improvements in bone density.
• 26:37
  And I think it's due to it is a slightly different formulation
• 26:40
  of estrogen. It's also a different delivery
• 26:43
  of estrogen. The birth control pill may not
• 26:45
  have the right amount of estrogen and not the right type.
• 26:48
  So it's hard to know why one is panned out and the birth control
• 26:51
  pill really hasn't panned out. Improving bone density.
• 26:54
  But it's probably a combination of the type of delivery and the
• 26:58
  type of estradiol in the patch. What?
• 27:00
  Ways are you watching from a recovery standpoint for an
• 27:05
  athlete other than like maybe an obvious sign of actually getting
• 27:08
  a period, but what are ways that athletes show that they're
• 27:10
  making progress towards recovery?
• 27:12
  Yes, love this question. So I love working with athletes
• 27:16
  because they're just so innately motivated to get back to doing
• 27:20
  the thing they like to do. And often times with Reds, it
• 27:23
  really is sort of a win win, like they're feeling rotten when
• 27:26
  they're in a state of Reds, they're fatigued, they're not
• 27:28
  training well, they're not recovering well, they're not
• 27:30
  performing well. And then once they start to feel
• 27:32
  better, they actually do start to improve in all different
• 27:36
  areas, including their health, including their performance,
• 27:38
  including the way they feel. And oftentimes there's sort of a
• 27:41
  transition period where you know, somebody has been out of
• 27:44
  their sport, not training fully where they need to kind of get
• 27:46
  back. And so I say let's give it a
• 27:49
  good amount of time before you get, please don't get frustrated
• 27:52
  with yourself in the early months red recovery because this
• 27:54
  will take time to get back to your kind of athletic peak.
• 27:57
  But oftentimes people are able to come back a better athlete
• 28:01
  than they were previously because they've learned these
• 28:03
  proper fueling techniques. I think that's one of the most
• 28:06
  like rewarding pieces is to see that once athletes start to
• 28:10
  properly fuel the same things that were holding them back in
• 28:12
  recovery, where the same things that were holding them back from
• 28:15
  like progressing with performance.
• 28:17
  And so it's like a a nice benefit or a nice outcome
• 28:20
  because they finally are performing like at their peak.
• 28:23
  And Riley and I talk about it a lot, but like if you're
• 28:25
  performing this well as an under fueled athlete, just imagine
• 28:29
  what you could accomplish as a well fueled athlete. 100% yes.
• 28:33
  I see it as a win win. And oftentimes, you know, I'm
• 28:36
  meeting with patients and it's almost feels like the lights
• 28:39
  have come back on. And people around them say that
• 28:41
  too. Their family members say that,
• 28:42
  their significant others, their friends, they say, Oh my gosh,
• 28:45
  you just seem like you came back, like you were sort of
• 28:47
  operating in the state where you were not OK, Right.
• 28:51
  There's often mood changes and, you know, people are feeling
• 28:53
  lots of fatigue and they can't concentrate in their studies or
• 28:57
  they're at work. And it's just really, really
• 28:59
  cool to see people kind of the lights are coming back on.
• 29:02
  They have that glow back. And you know, it's just, it is
• 29:05
  one of the most rewarding parts of this job is when we can get
• 29:08
  people truly back to health and feeling better again.
• 29:10
  We can even see it virtually, like we do all of our work
• 29:13
  virtually. But we can just tell, like when
• 29:15
  an athlete is more well fueled because they just have that
• 29:18
  glow, like you mentioned, Doctor Hill, like their skins brighter,
• 29:21
  They're smiling more, they're laughing.
• 29:23
  And sometimes, you know, in the past when they are a little bit
• 29:26
  of a shell of themselves, they don't even realize all these
• 29:28
  negative things are happening because they're just in the
• 29:31
  middle of it. They're in the thick of it.
• 29:32
  Absolutely. And I think athletes are very
• 29:35
  prone to this because they tend to be such driven people.
• 29:38
  And almost in every case I can recall, red starts from places
• 29:43
  with really good intentions, right?
• 29:44
  This usually starts because an athlete is trying to improve
• 29:47
  their performance and they're they're listening to their
• 29:49
  coach, They're doing all the things they think they're
• 29:51
  supposed to be doing. And they're told, you know, it's
• 29:52
  it's normal to not have a period.
• 29:54
  That means you're working hard, right?
• 29:55
  With proper education and teaching them about Reds, being
• 29:59
  able to kind of see those lights come back on is the coolest
• 30:01
  thing. I think Riley even shared this
• 30:03
  on a recent episode where she shared about her own HA journey
• 30:06
  about how when she didn't have a period when she was younger
• 30:09
  because it just wasn't talked about, she thought she was
• 30:11
  fitter. She thought she was making
• 30:13
  progress towards being a better soccer player because she didn't
• 30:16
  have a period. Which we obviously know is not
• 30:18
  the truth. But how do we expand this
• 30:20
  conversation and educate more people about the loss of a
• 30:22
  period being a conservative and not something that's actually
• 30:25
  indicative of like good health or even proper performance?
• 30:28
  Absolutely. And this is something I know we
• 30:30
  all here are very passionate about getting the word out and
• 30:33
  educating. And I think it starts with
• 30:35
  educating athletes, educating the families of athletes,
• 30:38
  educating coaches and you know, medical providers, I think is a
• 30:41
  whole other topic. But if we can start there and
• 30:44
  have athletes find the right content on social media and and
• 30:48
  get reputable information from real clinicians, I think that's
• 30:50
  a start. Athletes can also educate their
• 30:53
  own coaches and some of my most awesome patients do this.
• 30:56
  They, they, their coaches don't know about Reds.
• 30:58
  And so all sometimes athletes have to advocate for themselves
• 31:01
  and, and educate their teammates and their coaches on Reds.
• 31:04
  And you know, sometimes the coaches will say, I've never had
• 31:07
  this, an athlete with this before.
• 31:08
  I always have to laugh a little bit because it's like, of course
• 31:10
  you've had an athlete like this before because it's just so
• 31:12
  common. Every sports team I'm sure has
• 31:14
  at least an athlete with Reds at any time, no matter what the
• 31:17
  sport is you're talking about. So sometimes athletes have to
• 31:20
  become their own best advocate, and that's something that I know
• 31:24
  the three of us all like to help them out with as well.
• 31:27
  Yeah, just because it's common doesn't mean it's normal.
• 31:30
  I mean, when you even look at the endurance population,
• 31:32
  there's studies that have shown that up to 80% of athletes have
• 31:37
  like menstrual irregularities. It can feel sometimes like
• 31:40
  you're not part of the crowd if you know you're feeling yourself
• 31:44
  properly or you have a regular menstrual cycle when everyone
• 31:47
  around you is doing something different.
• 31:49
  Yes, totally. And I think that can be really
• 31:52
  hard to when you're trying to fuel your body properly and
• 31:55
  you're on a team trip and no one around you is feeling their body
• 31:57
  properly. I see that a lot.
• 32:00
  And it can be really, really challenging to be the athlete
• 32:02
  who is doing things the right way.
• 32:04
  And sort of there's this process of reeducation that has to
• 32:07
  happen through red recovery, through period recovery.
• 32:10
  And yeah, that's something I, I really enjoy working with
• 32:13
  athletes on is sort of getting them educated, getting up to
• 32:15
  speed. And once they do have the proper
• 32:18
  information, most of them are able to go on and and thrive,
• 32:22
  which is is really cool to see. I think I have had clients in
• 32:25
  the past who have shared with teammates or shared with coaches
• 32:28
  that they're going through a Reds recovery process and then
• 32:31
  they will have other teammates that then confide in them that
• 32:34
  they're also missing a period. So I think it's one of those
• 32:36
  things that if you feel comfortable and you have a voice
• 32:38
  to share and you want to share, it can really open a door to
• 32:42
  like even some community within your own team that maybe you
• 32:44
  didn't even know existed from a recovery standpoint. 100%, I
• 32:49
  love this younger generation because I think they're talking
• 32:51
  about these issues and mental health concerns and physical
• 32:54
  health concerns more than any generation previously.
• 32:57
  I know that my generation of athletes didn't really talk
• 32:59
  about it. It just wasn't something that
• 33:01
  was talked about, right? And so I do have a lot of hope
• 33:03
  now for the future that with all these, these younger athletes
• 33:07
  getting the word out, trying to educate their teammates, their
• 33:10
  parents, their medical providers, sometimes their
• 33:12
  coaches on what this is. And I I just think that's the
• 33:15
  coolest thing. Before we jump into ending
• 33:17
  questions, we have some fun questions to ask you about carbs
• 33:20
  and pre and post workout fueling.
• 33:22
  Do you have any last like 2 to 3 tips that you would recommend
• 33:26
  for athletes and families who are listening?
• 33:28
  I mean, I think the advocacy piece is, is an important one
• 33:32
  and, and one that, you know, obviously not everybody is in a
• 33:35
  place to be able to advocate for themselves and that's OK.
• 33:39
  But if you are an athlete out there who's struggling with aim
• 33:41
  and Aria and Reds, you know, I think you can really help things
• 33:46
  out for your teammates, for your future athletes, if you are
• 33:49
  willing to get out there and advocate for yourself, getting
• 33:53
  everyone around you educated on these topics.
• 33:54
  So yeah, I guess that's that's one one piece.
• 33:57
  Second, yeah, we talked about the importance of early
• 34:00
  intervention, ideally with a multidisciplinary care team for
• 34:03
  Reds. At a minimum, that should
• 34:05
  include a registered dietitian and a medical provider who has
• 34:08
  some savviness related to these conditions because we know the
• 34:12
  prognosis are really good. People do really well when they
• 34:15
  get proper treatment with the right clinicians early on.
• 34:18
  So most people go on to get back to their sport if that's what
• 34:21
  they want to do and don't go on to have these long term
• 34:24
  complications that we talked about at the beginning.
• 34:26
  So yeah, I, I think those would be my 2 tips for for take home
• 34:30
  today. I.
• 34:30
  Echo that we get so many questions of people who reach
• 34:33
  out and like, I've lost my period.
• 34:34
  Where should I start? And like our first
• 34:36
  recommendation is always like, go see a physician, like go see
• 34:40
  your medical provider because this is a medical condition.
• 34:42
  So thank you for saying that as well.
• 34:45
  Now we're going to jump into our ending questions.
• 34:46
  And the first one, of course, because this is the Eat More
• 34:49
  Carbs podcast. Doctor Hill, what is your
• 34:51
  favorite carbohydrate? So I will preface by saying I've
• 34:54
  celiac disease so I have to eat gluten free, but I would say
• 34:57
  maybe like a gluten free spaghetti with like a bolognese
• 35:02
  sauce or something like that. Are you making that or are you
• 35:05
  going out and grabbing it? I have recently started, I used
• 35:08
  to just kind of go grab it but I've recently started making my
• 35:12
  own sauce chachi. DT turns out has really good
• 35:14
  recipes, so. I'm not.
• 35:16
  I'm not. Ready for opening a restaurant
• 35:18
  or anything like that. But my kids like it so.
• 35:20
  You got a secret sauce? I like it.
• 35:21
  What is your favorite pre work out?
• 35:24
  A maybe pre swim fuel option. These days I'm usually working
• 35:29
  out in the morning after I drop my kids off from school, so I
• 35:31
  usually try to get get a really good breakfast and it might be
• 35:35
  like a bagel and cream cheese with lox or avocado toast and a
• 35:37
  couple of fried eggs or something like that since the
• 35:40
  mornings are usually when I'm trying to get my workouts done.
• 35:42
  We love a performance plate with all the goodies.
• 35:44
  What about afterwards? What about like your post
• 35:47
  workout fuel? Yeah, lately I've been enjoying
• 35:50
  like a apple with peanut butter where you like dip it in the
• 35:53
  peanut butter or something like that.
• 35:54
  That's that's kind of what I've been into lately.
• 35:56
  Are you team crunchy or are you team creamy peanut butter?
• 35:59
  I will do either. Honestly.
• 36:01
  I am. I do not discriminate against
• 36:03
  different types of peanut butter, but I do like peanut
• 36:05
  butter. I think over some butter or
• 36:08
  almond butter, you know some of the other ones.
• 36:09
  I'm with you on that. Same.
• 36:11
  All right, here's our hardest and easiest question.
• 36:14
  Maybe depending on who you are, but we are both big shoe people.
• 36:18
  Jenna was on a running shoe hunt, but I think you solved
• 36:21
  that issue a while ago. So, but we'd love to hear what
• 36:24
  your favorite pair of kicks is. Yes, I guess I recently got a
• 36:28
  pair of Nikes that have a Stanford logo on them, which I
• 36:32
  love because that's my alma mater and they're like a in the
• 36:36
  Stanford colors, like they're white and red.
• 36:38
  Yeah, they're just kind of fun. I'm not a big, big runner, but
• 36:42
  they're definitely get me through my workouts.
• 36:44
  We didn't talk about this the other day when we were chatting,
• 36:47
  but we're both black as schools. I didn't even know.
• 36:49
  Like, I didn't even remember that because everybody always
• 36:51
  thinks if I ever wear like NC State block, they're like, oh,
• 36:54
  you went to Stanford? And I'm like, no, I'm not that
• 36:56
  good. Like I'm not on Doctor Hill's
• 36:58
  level. Oh my.
• 36:59
  Gosh, well, no, they're the they're the same, almost the
• 37:02
  same logo and same colors too, right?
• 37:04
  Yep, Yep, yes. And I've had the opposite people
• 37:06
  like, oh, NC State. Like no.
• 37:08
  Doctor Hill, thank you so much for being on this episode, for
• 37:11
  sharing all that you shared. I know that it was incredibly
• 37:13
  helpful for everybody that listens to this podcast.
• 37:16
  Where can people find you, follow you, reach out to you?
• 37:19
  How can people start working with you?
• 37:21
  Well. I am licensed as a now in 50
• 37:24
  states so I should be able to see people pretty much
• 37:27
  throughout the country. Since I am trained in
• 37:29
  Pediatrics, I only see up three young adulthood, late 20s or so.
• 37:32
  But young athletes, bleated athletes, that's my jam.
• 37:35
  You can find me on my practice website whichisathletemd.com.
• 37:40
  But we spell it a little funny cuz there's a little play on
• 37:43
  words there with a THLEATEAT meaning eat, you know, cuz
• 37:47
  nutrition. So it's a THLEAT md.com.
• 37:51
  And then we also have Instagram pages and I've got a personal
• 37:54
  Instagram as well, Catherine under score, Hill under score MD
• 37:58
  and yeah, try to post stuff up there periodically and would
• 38:02
  love to have any of you follow me if, if this has been helpful
• 38:06
  for you today. We are going to leave all of
• 38:08
  Doctor Hill's contact information and links to her
• 38:10
  website in the podcast show notes.
• 38:12
  That way you can easily find her and reach out to her.
• 38:14
  Doctor Hill, thank you so much for being on this episode.
• 38:16
  We so appreciate you being here and taking some time out of your
• 38:18
  morning to spend with us. If you do have questions for
• 38:21
  Riley and I, you can always reach out to us.
• 38:23
  You can find US online. You can find Riley at Riley
• 38:25
  Beatty Nutrition and you can find me at Jenna dot Fisher dot
• 38:28
  nutrition. Thank you so much for listening
• 38:30
  to this episode. Please make sure you rate,
• 38:32
  subscribe and review. And as always, remember to eat
• 38:34
  more carbs.