Oral Contraceptives Impact On Athletic Performance
By Drew Mulvey MS, CDN, CNS, CLT, PNL1, CISN
This has been a very hot topic recently, especially as I have been digging deeper into the impact of one’s cycle on athletic performance. There is a follicular phase where estrogen is more elevated and a Luteal phase where progesterone is more elevated. This hormonal shift can drastically shift the body’s needs for particular nutrients, especially around training. (Check out this blog post for more information on this topic!)
Women’s Health Nutrition: The Ovarian Cycle and Athletic Performance
What about those that are on oral contraceptives? How does this affect one’s training? What if this has to do with some sort of disordered eating patterns? Let’s focus on the latter.
Under-fueling and Hormones
Under-fueling, disordered eating or REDs, relative energy deficiency in sport, can lead to overtraining, improper sleep, and nutrient deficiencies. As the body is not getting it’s needs met, it increases the body’s stress load and starts to send signals to the body to produce more cortisol instead of estrogen and progesterone. When this happens for a prolonged period of time, one of the most common occurrences in female athletes is amenorrhea, or lack of one’s period. Why should we pay attention to this?
Lack of a period can lead to improper bone metabolism, as estrogen regulates calcium metabolism.When stress on the body is elevated from lack of proper fuel to support one’s activities, it can lead to a decrease of estrogen and an increase in cortisol. This leads not only to more bone turnover but lack of muscle tone and can even inhibit proper brain function. Lack of a period is one sign of low estrogen levels which can then lead to weakened bones and an increased risk for injuries and bone fractures.
To help stimulate a period, these girls are commonly prescribed, in conjunction with nutritional therapy, oral contraceptives. Why? Delivering synthetic hormones doesn’t just stimulate a period but can help to maintain bone mass because the body as estrogen is responsible for maintaining bone density. Though this hormone does not peak when using oral contraceptives, it still raises just slightly as it does during the luteal phase.. Yet, what are the ramifications and how do we train around this? Is it just a bandaid? Let’s check this out.
Oral Contraceptives
There are several different types of hormonal contraceptives, those that are more progesterone dominant and those that are a mix of estrogen and progesterone. I will be focusing more on mixed hormone contraceptives. How do these affect hormones differently than if one were to have a natural ovarian cycle?
Oral contraceptives regulate one’s cycle by spiking both progesterone and estrogen, about 2 hours after taking the pill. At the end of the day, estrogen and progesterone decrease, just as they would at the end of the luteal phase when menses is about to occur. Thus, it is set up with 3 weeks of pills and then 1 week of sugar pills as estrogen and progesterone are decreased. This can also affect the natural production of each of these hormones, which can affect other body processes. The problem? This may not have the same beneficial effects of these particular hormones.
Check out the graphic here:
Nutrition During Training
From this chart, you are in a constant luteal state, where progesterone is elevated and estrogen never reaches “peak levels.” This may have an impact on the athlete’s ability to get stronger and handle HIIT workouts. Why is that? Progesterone is peaking which switches the body from utilizing carbs to utilizing more fats. In fact, progesterone can promote hyperinsulinemia, meaning that you are less insulin sensitive, and can stimulate deposition of body fat.1 Estrogen is important for developing strength while in a follicular phase, harder workouts such as sprints are better as the body is pulling from carbs. Thus, if there were hard workouts, adding in a little more carbohydrate pre, intra or post workout will help your body pull directly from them for energy.
Progesterone also exhibits catabolic effects to protein metabolism, which could have an impact on muscle strength and recovery.2 Therefore, before workouts, incorporating EAAs are important to preserve muscle tissue, decrease stress on the body and give your body a little extra pep to prevent early fatiguing. It is also recommended to consume a bit more calories during this phase can help to offset the negative effects of progesterone.
Other Effects of Oral Contraceptives on Health
I have commonly heard that oral contraceptives can have an impact on your gut. Thus, I looked a bit deeper into this. In a recent study, subjects placed on oral contraceptives as opposed to the control, had less alpha diversity of bacteria in their gut.3 Alpha diversity is the abundance of specific bacterial strains that are in one’s gut. This may increase one’s risk of developing candida and other gut related issues.3 Candida can increase fatigue, brain fog and impair one’s immune system. This is due to the increase in a strain known as Lactobacillus fermentum.
How does this correlate with other nutrient depletions? Oral Contraceptives can deplete levels of certain B vitamins, including folate (vitamin B9), Vitamin B6, and B12. How? This decrease in alpha diversity in the gut previously mentioned affects certain strains of gut bacteria responsible for folate metabolism. These strains include Lactobacillus plantarum and those of the genus Bifidobacterium sp., particularly B. adolescentis and B. pseudocantenulatum.4 Lack of this, and these other B vitamins, can significantly impact one’s recovery, protection from inflammation and clearance of internal and external compounds which could pose as problematic to the body if not removed.
Other vitamins and minerals that were found to be depleted include zinc and vitamin C.5 Zinc can lead to impaired fatty acid metabolism, which can affect your ability to recover and think properly; protein metabolism, and overall digestion as zinc is needed for the parietal cells to release hydrochloric acid. Vitamin C is a potent antioxidant, incredibly important for adrenal health as it regulates the production and release of epinephrine and norepinephrine; and for bone and joint health, as it is a cofactor for collagen cross linking. Other vitamins and minerals commonly depleted include selenium, magnesium and Vitamin E. 5
The Whole Food Approach
What I work on first is establishing a firm foundation of proper eating and fueling habits that help the body escape from the stress state and into a more parasympathetic state, or rest and digest. This is monitoring food intake to be at or above maintenance calories. (With those with disordered eating, we use a “ballpark” method and food exchanges). When this has been firmly established, and a good relationship with food has been restored, I encourage the athlete to wean off and rely own the body’s own production of hormones and utilize strategies to keep their body in good shape.
Nutritional Strategies
Omega-3 Fatty Acids: Omega-3 fatty acids, particularly EPA and DHA, have been associated with reduced menstrual pain and inflammation. In fact, it helps to decrease the production of prostaglandins which commonly causes those PMS symptoms. Less PMS symptoms can lead to better training sessions during one’s menses. Include fatty fish (like salmon and mackerel) and plant-based sources (like flaxseeds and chia seeds).
Hydration: Progesterone can cause the body to retain sodium, which, in turn, leads to water retention. It can also increase the body’s core temperature. It is thus essential to incorporate adequate amounts of water and electrolytes to maintain proper hydration.
Protein Intake: Protein is essential for tissue repair and muscle recovery, especially if you are in a more intense stages of training. This is also important during luteal phase of the cycle as progesterone is catabolic, which oral contraceptive exhibit.
Sources: organic poultry, fish, grass-fed beef, grass fed dairy, beans, lentils, organic tofu, high quality protein powders. I personally like Orgain Chocolate Vegan Protein and Designs for Health Bone Broth Protien, Hemp Yeah Hemp Protein
B Vitamins (Folate and B6): As mentioned previously These are important for several metabolic processes such as energy metabolism; stamina, brain health and clearance toxins out of the body.
Sources of Folate: leafy greens, legumes.,
Sources of Vitamin B6: fish, poultry, bananas, sweet potatoes, avocados and chickpeas.
Zinc: As mentioned about, zinc is important for regular digestion and digestion of proteins. This mineral is commonly depleted during times of increased stress and can thus have a greater impact on the athlete’s ability to assimilate nutrients for proper recovery.
Sources: Pumpkin seeds (my favorite!), sprouted whole grains, clams, soaked/sprouted legumes, nuts and seeds, eggs, dairy, shellfish, oysters, dark meat chicken
Vitamin C: As mentioned above, Vitamin C is important for joint health, immunity and adrenal health. Low vitamin C can lead to poor recovery and an increase in illness frequency.
Sources: Broccoli, red peppers, citrus fruits, camu camu(one of the richest sources), strawberries, kiwis, guava, green leafy vegetables
Probiotic Rich Foods
Lactobcillus planatarum is responsible for the production of folate, which can be depleted in those with oral contraceptives. This is a cofactor for a process known as methylation, responsible for clearing toxins and protecting proteins and DNA from oxidative damage. The latter is commonly elevated if the athlete is overtraining and underfueling.
Sources: Sauerkraut, pickles, kimchi, sourdough, and other fermented plants.
Bifidobacterum sp. are the main species that are responsible for the production of folate. As described above, folate is incredibly important for our health and well being.
Sources: Complex carbohydrates such as chickpeas, whole grains and yogurt.
Fiber: this is direct food for the bacteria and can help it to proliferate more in the body. Why is this important? These bacteria produce compounds that help to maintain the integrity of our guts, improve out mood and mental performance as well as aid in digestion and assimilation of nutrients. As mentioned before, folate is important for energy metabolism, and thus incorporating direct food for these bacteria may help to improve energy production and protect the body from reactive oxidative species generated from training and other stressors.
Sources: (Soluble) Fruits such as avocados, apples, bananas, kiwis, organic blueberries; Vegetables such as eggplant, potatoes, carrots, green beans, artichokes, onions, organic summer squash and zucchini; lentils, chickpea, grains such as oats.
Ask yourself these questions:
Have you found yourself in this scenario?
Are you drained of energy and stamina during your workouts? Are you fearful around food or are unable to embrace it as the proper fuel for your body?
Have you lost touch with yourself or others around you?
Are you getting frequent illnesses or sickness that cuts into your training?
Are you ready to break these chains and ignite your athletic potential?
From the nutritionist that has been there and gotten to the other side, I am here to help get you there! Explore my programs, or set up an Ice Breaker Call today!
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References:
Kalkhoff RK. Metabolic effects of progesterone. Am J Obstet Gynecol. 1982 Mar 15;142(6 Pt 2):735-8. doi: 10.1016/s0002-9378(16)32480-2. PMID: 7039319
Landau RL, Poulos JT. The metabolic influence of progestins. Adv Metab Disord. 1971;5:119-47. doi: 10.1016/b978-0-12-027305-8.50024-2. PMID: 4934165.
Mihajlovic J, Leutner M, Hausmann B, Kohl G, Schwarz J, Röver H, Stimakovits N, Wolf P, Maruszczak K, Bastian M, Kautzky-Willer A, Berry D. Combined hormonal contraceptives are associated with minor changes in composition and diversity in gut microbiota of healthy women. Environ Microbiol. 2021 Jun;23(6):3037-3047. doi: 10.1111/1462-2920.15517. Epub 2021 May 6. PMID: 33876556.
Rossi, M., Amaretti, A., Raimondi, S. Folate Production by Probiotic Bacteria. Nutrients. 2011. 3(1): 118-134. Doi: 10.339/nu3010118.
Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1804-13. PMID: 23852908.
