Female Fat Loss

Rewind a couple of years and I was waking up at 4.45 a.m. to get from Bondi, Sydney, to the Central Business District, where I worked in a Fitness First. My first client would be at 6 a.m., so I needed to wake up, hop on the train and do my ‘LIVE’ video on Facebook. For a long time, I couldn’t really afford a fancy camera or a new laptop; and I didn’t know how to edit, so I just pressed ‘go live’ and I’d answer people’s questions as they came in. It became a ritual, and each day I’d go live without fail. When the Australia daylight savings kicked in, a 5.30 live was 8.30 p.m. in the UK.

I’d set up in a food court called ‘Australia Square’, and we’d joke about how the floor cleaners would always turn their machines on as soon as I started answering questions. Most questions I answer are the same every single day. People often ask if I get fed up of being asked the same questions day in and day out, and the answer is of course not. I don’t think anyone out there is asking for the sake of it; they’re not getting a kick out of me repeating myself. It’s hundreds of individuals, even thousands, who ask, then go away with more knowledge than they had before. We all repeat ourselves in our different lines of work; no one truly has something different every day. A barista makes the best coffee he can, but there are only so many combinations, and although people walk away happier and caffeinated, I like to think I can offer more – not just knowledge, but liberation.

So there I was, reeling off the answers to questions, then one hit me right in the face, and for the first time in weeks I had no idea how to answer it: ‘James, do you know how our menstrual cycle affects our diet and our training?’

Long pause … ‘No.’

I was preoccupied with this question for the entire duration of my 6 a.m. client. I thought to myself, James, mate, you have pretty much only trained females for nearly three years – how do you not know this? I googled some stuff at lunch, then looked for podcasts, books, whatever I could find to upskill myself on the menstrual cycle and how it affects female physiology. The rabbit hole went deeper than a clown’s pocket. It used to take me about thirty minutes to get home from the CBD after work, and I found myself taking longer and longer routes to try to learn what I could.

I came to realize that I’d uncovered a very big flaw in my own personal training. I was training women simply as smaller men. This did not stem from a consciously patriarchal or misogynistic mindset; I quite simply never knew how the variable factors around the menstrual cycle could affect a woman’s diet and training.

On the floor, with my clients, I’d had many conversations I didn’t expect – topics ranging from infidelity, wealth, professional life, unprofessional life and even anal sex – but never had the subject of periods really come up. If it had, I’d probably have been very confused as to why and changed the subject to ‘how hard is that out of ten?’ – the rate of perceived exertion saving me from having to talk about ‘that time of the month’.

If I were to give an elevator pitch on female physiology now, I’d say this:

A woman’s physiology is unique because it is solely responsible for the survival of the human race. Women get pregnant whereas men do not. Because of this, women must store body fat in a ‘readiness’ state for getting pregnant between the years of the first menstruation (adolescence) to the last (menopause). It’s estimated that a woman will require 50,000 calories’ worth of stores to survive the duration of pregnancy, so dieting a woman is much different to dieting a man.

Men burn calories quicker than women. If a couple go to dinner and have the same burger and chips (where calories are matched), then the next day they go to burn that number of calories ‘off’, they would lose the same amount of fat in theory. However, it would take the woman about a third longer to do so. This means the woman having to train for ninety minutes as opposed to the man’s sixty-minute workout.

Not only this, women ‘push back’ a lot harder during periods of extreme food restriction from a physiological as well as a psychological perspective. That’s without mentioning their menstrual cycle.

The menstrual cycle

Let’s see the cycle as the length or period of time between the first menstruation (bleeding) and the next. And let’s imagine this occurs on the first day of the month, to make things easier, especially for any men reading.

Let’s say this cycle is twenty-eight days (usually a normal cycle is twenty-five to thirty days – anything longer could be an underlying sign of PCOS, which I’ll get on to a little later).

In the middle we have ovulation – this is where the eggs are released from the ovaries, therefore making this the most fertile phase for pregnancy to occur. The period leading up to this middle point is known as the follicular phase.

It’s interesting to note that during ovulation – around Day 13 or 14 of their cycle – women have their highest amount of testosterone, which plays a large part in libido and sex drive. I’ve heard from my female clients over the years that they report being hornier during this period, and also manage some of their best lifts/performances. It makes complete sense from an evolutionary perspective to have a heightened sex drive at this time, so that the chances of pregnancy are increased. Men do have ten to thirty times more testosterone than women, but I’ve dated quite a few girls where you’d think that statistic was the other way round come the middle of their cycle.

Let’s take a quick glance at the first part of the cycle, the follicular phase, approximately Days 1–14. Looking at the diagram, you’ll notice that oestrogen is the dominant hormone on this side. (In some literature you’ll see it called oestradiol.) Over the years, oestrogen has been blamed for a lot of things, and it’s almost been seen as a ‘bad hormone’ for things like skin and water retention. But oestrogen actually has proved helpful with muscle soreness in studies, and there is now a large body of research into its impact on improving insulin sensitivity. When oestrogen drops significantly during menopause, which I’ll discuss a little later, people can run into a lot of trouble trying to lose fat with lower levels of it.

I’ve found over the years that my clientele respond better to training, find technical lifts the easiest, and mood, morale and adherence to dietary protocols much easier before and during ovulation.

Now, without sounding pessimistic, after ovulation, things … well, they feel like they go to shit. Welcome to the luteal phase: the second half of the menstrual cycle. This phase is typically fourteen days long in most women.

Hunger cravings usually shoot up in this second half, and it’s believed this is due to women’s metabolic rate increasing their calorie needs by around 100–300kcals a day. Some women find themselves consuming about 500kcals more a day. With cravings in mind, for my James Smith Academy members I factor in some extra fruit during this part of the cycle. Easy, convenient, cheap and socially acceptable to eat on a train, Tube or even in a meeting, fruit can have a massive impact on hunger cravings, especially when you want something sweet. You could easily have three pieces of fruit a day just to match the increase in your metabolic rate.

In the luteal and progesterone-dominant part of the menstrual cycle we see a rise in insulin resistance, a decrease in performance and even a higher chance of dislocation and injury. If you’re a man reading this and you have to compete in a sport on a certain date, just realize how lucky you are that you don’t have to worry about where you are in your cycle. Men have pretty much the same physiology every day of the month, and the only decline that’s noted is related to ageing (or lack of sleep, remember?). But some women note that their performance lifts are half what they were a week before. Following on from progressive overload, we must take into consideration how deflating this could be for someone whose plan doesn’t take this into consideration, or if a trainer lacks the necessary empathy for fluctuations in performance related to the menstrual cycle.

Since learning about this and continuing to have in-depth conversations with my female clientele and members, I often get them to look at their training programmes, keeping in mind that sometimes adjustments need to be made on the exercises: a squat may become a leg press; a bent over row may become a TRX row; I’ll move them on to more machines instead of free weights; and I will make sure they’re fully prepared to go into the gym not expecting miracles or personal bests. They’re fighting their physiology in this period and the last thing they need are high expectations on their performance when, quite simply, they’re not going to get them.*

Here are some important strategies that I implement with my female clients:

I find that the use of performance-enhancing drugs is rife in everything from the Olympics to amateur sports, not to mention the regular gym goer, and they’re very popular with women too. This not only increases their performance and speeds up their recovery, but allows them to manipulate their cycle around their competing days, especially in sports like Olympic lifting, where you need to be in peak condition.

I don’t condone the use of performance-enhancing drugs in sporting events like the Olympics, but I do sympathize with having to deal with managing cycles for performance.

If you think about the difference across most disciplines between fourth and first place, it can sometimes be fractions of a second. Some women report up to a 40 per cent decrease in strength during their luteal phase, and I know that intentional amenorrhoea (discontinuation of the menstrual cycle) is a tactic some women who compete use, while others prefer dieting past the point of amenorrhoea, as their cycle doesn’t affect them as much.

Amenorrhoea

The absence of menstruation in a female between the reproductive ages of approximately twelve and forty-nine years old for ninety days or more is known as amenorrhoea. (Oligomenorrhoea is an infrequent or irregular cycle at intervals of greater than thirty-five days, with only four to nine periods in a year.)

This can happen for different reasons. When testing someone to determine why, you can use the following methods:

Most of the cases of amenorrhoea I have come across are to do with a lack of calories or excessive and strenuous exercise. I am not a doctor, nor am I qualified in this field, but I have learned a lot from my research and from talking to my many female clients about their menstrual cycles – or lack thereof.

I think it goes without saying that not having enough calories in your diet or being too lean could make someone not want to get pregnant, due to the fact that they may not be able to sustain the pregnancy. In the same way that if you’re skint, you’re more likely to say no to a night out with your friends, so to speak. Also, if strenuous exercise is a contributor to the excessive deficit or low body-fat percentages, then perhaps doing less exercise would be a good solution to lower the deficit or to make more calories available for functions such as the reproductive system.

Please seek medical advice if you are concerned about this condition.

PCOS

PCOS – or polycystic ovary syndrome – affects around 10 per cent of women, and is another very common reason for amenorrhoea. It is also associated with infertility. Around 20 per cent of females who struggle to get pregnant are diagnosed with PCOS.

Polycystic ovary syndrome ties in with amenorrhoea because from my own experience training women they can often come hand in hand. Those with PCOS can suffer with amenorrhea and vice versa. PCOS is correlated with weight gain, which I’ll expand on, but from what I know, weight loss between someone who has PCOS and a female who doesn’t can differ, should their deficit be the same.

The criteria for diagnosing PCOS are:

If you have two of these, you’re classified as having PCOS, so what does that mean for most?

PCOS is more prevalent in the overweight, and exercise and weight loss, just like with Type II diabetes, have been proven to improve it. Martin MacDonald (a mentor, peer and friend), who I learned a lot of this from, made a great point when he said that although you could argue this is outside the scope of what a PT has to deal with, where else can we direct people? See a doctor? Most people report to us that they’re not happy with their doctors. Same goes for dietitians – what if their rubbish doctor refers them to a rubbish dietitian? Not only that, but often the very good dieticians and doctors are full, because they’re good. It’s a vicious circle. Exercise and weight loss are key factors in improving the symptoms of PCOS, and both are things that personal trainers are qualified to do, so I’ll carry on.

The insulin resistance part of the problem is worth talking about because it can often be left unexplained during diagnosis of PCOS. So insulin resistance (IR) leads to increased blood glucose and/or increased blood insulin levels (hyperinsulinemia). This then worsens the androgen profile (see footnote) for women, which leads to increased levels of testosterone.

Whether it’s Type II diabetes or PCOS, the objective must be about increasing insulin sensitivity – the opposite of insulin resistance. The main and best way to do this is to decrease total body fat through implementing a calorie deficit alongside training and being active. Training a muscle makes the muscle more insulin-sensitive, which is another reason I would always advise weight training for women with PCOS (or even without), not to mention combining that with all you have learned so far in this book.

Fat gain is a protective mechanism: it’s there to save us not just in the future, but right now too. You can hear about diabetics losing their eyesight and damaging vessels to the point of losing limbs. Too much glucose in the blood will cause damage, so having fat cells to soak up excess ‘energy’ in the blood is a great mechanism to protect us. When we become resistant to this process, however, damage begins to occur and we start to see a deterioration in our health. Too much of anything in life will start to affect our health and fat is one of those.

Key PCOS facts

Something quite powerful here is that even if you’re a male and you’re still reading this far or you’re a fortunate female who doesn’t suffer with these issues, you’re literally in a position of power to help and to educate those around you. Without sounding like I am attacking dieticians or the health system, pointing your friends to these pages could not only be a cost-effective means, but also give them the evidence-based advice that they currently don’t have.

Supplementation for PCOS:

People who suffer with PCOS could potentially be eating what is considered very few calories – say, 1,200 calories each day – and not be losing body fat. In these instances, you should consider trying some out-of-the-box methods, such as full-day fasts – even two-day fasts – and an adaptive 5:2 style of dieting, where you fast for two days a week. This is in order to create a substantial deficit on those days, and then eating would seem a lot more normal on the others, but overall your calories over a week would be lower.

When someone knows the regular amount of food they should eat on a ‘normal day’ (maintenance calories), you could implement alternate day fasts based on this amount, which may be easier to adhere to compared with eating half the ‘normal’ amount every day.

Please note, I wouldn’t usually implement such restrictive protocols, but in some PCOS cases, especially with insulin resistance, it’s essential for fat loss.§

When in doubt always speak to your doctor or medical professional.

Menopause

Menopause: the period in a woman’s life when menstruation ceases.

Roughly half the planet will at some point go through the menopause, so it’s worth talking about.

For any parent it becomes quite obvious when your child hits puberty and they experience drastic changes in their physiology, mood, growth, etc. Parents are clued up quite well: they know their daughter will start menstruating and they know their son’s balls are going to drop and their voice too. I remember when I was about ten or eleven, I got a cold, my dad told me my voice had dropped and I told him it was just the cold. Three months later, he said to me, ‘Son, your voice hasn’t gone back to what it was before’. Only there and then did I realize it had, in fact, dropped. Within the next year, I grew about a foot and became one of the largest guys in my school.

That’s the first part of the picture as far as hormones and physiology are concerned. The latter part is not discussed, nor have any of my female clientele really ever been educated about what is going to happen to their bodies as they get older – when, effectively, their reproductive systems shut down and the associated hormones take a dive, causing a myriad of issues that just aren’t spoken about enough within the fitness industry.

After I’m roughly thirty my testosterone will decline at a rate of about 1 per cent each year. I can influence this a bit with good sleep, good diet and sunlight exposure and looking after myself. (Oh, sorry – you already know this, as you’ve read this far in the book. I do apologize!) However, a woman’s hormones will pretty much shut down as she approaches menopause.

The menopause most commonly occurs when a woman is in her fifties (the average age is fifty-one), but can happen earlier, in the forties, and I’ve even had clients who have gone through it in their thirties, some due to specific circumstances and others not. A hysterectomy, where the womb and sometimes other parts of the reproductive system are removed, will lead to a state very similar to the menopause. A lot of women will end up doing hormone replacement therapy (HRT) to relieve the symptoms of menopause. For more information and to decide whether or not to consider it, you should talk to a medical professional.

The repercussions of having your reproductive hormones discontinue are usually hot flushes, mood swings, trouble sleeping and changes in fat distribution to the midsection. You need a discontinuation of menstruating for twelve months to be in a state of menopause, and the discontinuation occurs due to a lack of production of oestrogen.

The first signs of menopause are in the phase known as perimenopause, or PM (‘peri’, meaning surrounding, close or near). Perimenopause is a transitionary state from menstruating to no longer menstruating. For some it can last years, and for others only months. The common symptoms are a decline in libido, trouble sleeping, hot flushes and moodiness. From a hormonal standpoint, this is very much like the follicular phase (first half of the menstrual cycle), and oestrogen is dominant – it’s usual for people to report PMS being less severe in this period too.

Towards the end of PM, the woman’s physiology will begin to shift towards more of a progesterone-dominant profile, which is more indicative of menopause beginning. The hormonal profile here is similar to the luteal phase (second half of the menstrual cycle). After this occurs, and when there’s been no period for twelve months, the woman is now officially in menopause. There can be changes in body-fat distribution, weight gain, muscle loss and sometimes reports of becoming insulin resistant in this period.

Breastfeeding and pregnancy calories

It’s very important that I put in this book how important nutrition is not only during and after pregnancy, but even before someone becomes pregnant – for the woman’s health and the health of the baby. The composition of the woman during and before pregnancy can cause issues, so striving for a healthy weight before conceiving should be a priority. Training during pregnancy is a recommended practice, but ensure that especially in the second and third trimester, you are mindful of what exercises you are doing. I always advise pre- and post-natal women to seek advice from a pre-/post-natal specialist during training.

‘Caloric intake should increase by approximately 300 kcal/day during pregnancy. This value is derived from an estimate of 80,000 kcal needed to support a full-term pregnancy. (…) However, energy requirements are generally the same as for non-pregnant women in the first trimester, increasing in the second trimester. Furthermore, energy requirements vary significantly, depending on a woman’s age, BMI and activity level. Caloric intake should therefore be individualized based on these factors.’54

With regards to changes in calories required during pregnancy, this is a question I get asked a lot. My advice is always to seek advice from a medical professional, but these are the nutrition guidelines I’ve found:

‘Women who breastfeed require approximately 500 additional kcal/day. (…) During pregnancy, most women store an extra 2 to 5kg (19,000 to 48,000kcal) in tissue, mainly as fat, in physiologic preparation for lactation. If women do not consume the extra calories, then body stores are used to maintain lactation. It is not unusual for lactating women to lose 0.5–1.0kg/month after the first postpartum month.’55

When it comes to supplementing during the planning and/or pregnancy phase, I’d recommend folic acid and Vitamin D, not to mention working closely alongside a doctor or specialist.

I’ve included this section in the book as I have witnessed how the knowledge does not just have an impact on how I am with my clients, but how my clients are with themselves. I’ve got the feeling that, for years, women have been frustrated, confused and unaware of the implications of their physiology on their ability to lose fat and maintain training performance. Being armed with the knowledge of knowing when it’s good to diet and when it’s not so good; preparing for sessions that will be suboptimal; and planning the sessions where you go for a personal best: all these things play a significant role in how women can feel about themselves and their attitudes towards their diet and training.

I wanted to put this in the book for men to read too. In comparison to women’s, our physiology is only really influenced by age, and we need to not only have a basic understanding of how women’s bodies differ to our own, but be able to empathize with that – especially if we are the ones implementing a training plan for them. Whether you’re a personal trainer, brother, son or husband, it’s important to take some of this upon yourself to realize not everyone has it as good as us!

Understanding these things will mean liberation and empowerment for every reader. I want every woman to walk away and be their very own scientist moving forward, armed with the confidence to query the next diet or training advice they see, and empowered to continue educating themselves with the foundations I have set, trialling what works for them and discovering ultimately what doesn’t. If we can have a world where women beat themselves up just that little bit less then I feel I’ve made the impact I wanted to with this part of the book.

* For detailed instruction on every gym and home-based exercise visit www.jamessmithacademy.com.

† Hyperandrogenism is a medical condition characterized by high levels of androgens (known as ‘male hormones’, but also present in females). Symptoms may include acne, inflamed skin, hair loss on the scalp, increased body or facial hair and infrequent or lack of menstruation. This is one of the three contributors towards a diagnosis of PCOS (see opposite page).

‡ GI stands for glycaemic index, which is how fast blood glucose rises after consuming food. The GI rating is scored 1–100, which represents the rise of glucose in the blood two hours after food. Avoiding junk food, sweets, etc. can help with this.

§ A special mention here to Martin MacDonald and his MNU for helping me fully understand the roles of insulin resistance and PCOS.