Mini Pause #21: How Caloric Deficits Impact Your Bones, Muscles & Tendons

TL;DR (too long, didn’t read)

Caloric deficits impact the trajectory of women’s bone density and muscle mass. Caloric deficits also can impact women’s height, ability to build muscle, and menstrual cycle. We must reframe our thinking from being as skinny as possible to being as strong as possible.

WHY

Oh, look! I have more to say about chronic caloric deficits. Hold my beer.

Just kidding. I never drink the stuff. But… I have been thinking about chronic caloric deficits and the impact it has on a woman over her lifetime. Specifically, I want to talk about not getting enough calories in and how seriously it affects your bones, muscles, tendons, and joints, and injury risk.

Last week, I touched on the idea that eating in a caloric deficit can have deleterious effects not only on your gainz, but also on other important areas of female health like menstruation, bone health, brain health, and hormone production.

Let’s tuck into this a bit.

WHAT

One of the things I couldn’t shake after writing last week’s Mini Pause #20 is that most of us have been on some kind of diet for all of our lives. That means that for many women, we have been trying in some form or another to starve ourselves skinny. So at best, we have underestimated our calories thinking we are in a deficit, and at worst, we’ve fostered a real, chronic caloric deficit that impacts organ function and tissue remodeling and maintenance.

I wanted to expand on last week’s newsletter because it has real consequences on our body’s ability to function normally.

Most obviously, chronic caloric restriction is going to affect the regularity and cadence of our menstrual cycle. I write about this extensively in The Betty Body and why women are still getting periods (no matter how irregular they may be).

If your body fat percentage is too low, you run the risk of depriving yourself of ovulation, which is the main point of your menstrual cycle. In doing so, you also deprive your body of progesterone. This sex hormone is only produced when you ovulate.

Progesterone has wide-sweeping effects on the body like promoting good sleep, calming anxiety centers in the brain down, and supporting thyroid function–all three of which perimenopausal women tend to struggle with.

But there are other, perhaps more deleterious effects of prolonged caloric deficits, such as the effects it has on your bones and muscles.

Young women who under-eat and have lost their menstrual cycle as a result of over-dieting are at risk for developing irreversible damage to their skeletal system because 90% of our bone mass peaks at about 18 years of age [*]. This means that without adequate nutrition, a teenager who is undereating will impair her bone strength; change the architecture of the bone itself, causing it to have a higher affinity for bone fractures; and can even change her final height [*]. It puts this young woman at a higher risk of vertebral fractures throughout the rest of her life, even if she resumes normal eating patterns.

Having seen my fair share of vertebral fractures in my clinic, this is something you want to avoid at all costs. It is painful and disruptive, and the rehab is incredibly difficult from both a physical and mental point of view.

Amenorrheic episodes (months without ovulation) also impact your anabolic hormones like estrogen. Without a regular menstrual cycle, you would be considered hypoestrogenic, which is not too dissimilar to what we see in the final stages of perimenopause and menopause.

In both age groups, we see a fraying of the bone architecture, an increased susceptibility to fractures, and reduced bone strength. We want bones that are more “bendable” to withstand the forces on them. The more brittle and less “bendy” a bone is, the more likely it is to snap.

The other deleterious effect chronic caloric deficits have are on our body’s ability to repair and grow new muscle tissue. Muscle is so much more than aesthetic, as you know. Undereating is associated with impaired myofibrillar and sarcoplasmic muscle protein synthesis [*], compared to training with optimum energy availability.

Being on a chronic diet for YEARS is going to measurably impact your muscle mass, bone density, injury risk, and organ health. And it will catch up to you eventually.

HOW

I wish I could snap my fingers and wake us all up from the collective spell of wanting to be skinny, but the truth is, each of us will have our own paths to this awakening. What I can say to the well-intentioned woman (possibly the one reading with a touch of cynicism who gets what I’m saying intellectually but emotionally still desires to be small) is that your worth is not what the scale says.

If you have a lot of muscle mass, you are likely going to be heavier than whatever arbitrary number you have in your head. That number by the way has been subtly implanted from reading Cosmo, Teen Cosmo, and whatever other junk we grew up reading.

Think deeply about the images of thinness growing up. Women in perimenopause know this intimately because if you are around the same age I am, you grew up with Kate Moss and the advent of the grunge and heroin-chic look.

I distinctly remember as a teenager who was studying fashion magazines, that my body was just not built like the girls on these pages. I have thighs that are always going to touch. I have hips made for childbearing. I am just built differently.

Of course, these physical qualities have been in vogue as of late, which also just goes to show you the standards of beauty are always changing. So find the beauty in your own damn self and stop looking for external validation. Love your freckles, your scars, your hair color. Because soon stars will take out their BBLs, strong Roman noses will be the new ideal, and thin eyebrows will be back.

Point is–the house always wins. So be the house. Not the player.

NOW

  • Play India Arie’s “Because I Am a Queen
  • Think about your relationship with food and dieting and what messages your daughters and sons are receiving. Is it good? Bad? Neutral
  • Contrast that with how you would like to show up for yourself, your family, and your community.
  • Can you experiment with eating a little more? What if you started with simply 100 calories more of protein? Could you make that work?

Q: I know I need more calories in my luteal phase. Can I increase fat? Or do I need to add more carbs?

Short and to the point for Divie3 from Instagram today.

Yes, if you are hungrier you definitely need more calories. I usually recommend something like 10 to 15 percent more than you are eating in your follicular phase. The first thing is to make sure your protein intake is adequate. Typically something like 1g of protein/per ideal pound of body weight. After that you can dial up fat or carbs; whatever tickles your fancy!

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

What I Recommend: Red Light Therapy

I’ve added another component of light therapy to my recovery practice. (Yes, that’s really me lying on it in the photo).

While my Bettys know how much I rely on science when it comes to all things wellness, I’m going to admit that the PEMF Mat by Bon Charge both soothes and energizes in ways I wasn’t expecting–and I loved it right away.

It’s a pulsed electromagnetic field mat that works with your body’s natural magnetic field and uses bioactive wavelengths combined with red and near-infrared light. An additional far-infrared light component warms your body.

You can use the PEMF Mat during yoga, stretching, or grounding while lying down. You can even read a book or take a nap. The Mat’s programming allows you to choose sleep, grounding, focus, or meditation and relaxation.

And ever searching for ways to be more efficient, I combined my Red Light Face Mask and Red Light Neck & Chest Mask with time on the PEMF Mat. It’s a triple win for wellness. Speaking of triple, the PEMF Mat now comes in three sizes: a sitting pad, a demi size, and the full size.

View the entire Red Light Therapy Collection here and use code DRSTEPHANIE to save 15% off sitewide.

How Peptides Combat Collagen Loss

As if we didn’t have enough to deal with managing low energy, mood swings, and brain fog, within the first five years after menopause, we can expect to lose 30% of our skin’s collagen — and collagen production continues to drop another 2% every year for the next two decades!

Even if you aren’t concerned about the aesthetic impact of collagen loss (namely lines, wrinkles, and sagging skin), there’s a health component involved, which I explain in more detail below.

But what triggers these changes? Just like other symptoms common in perimenopause and menopause, it’s due to shifts in estrogen and progesterone.

The Role of Estrogen and Progesterone on Skin

  • Skin Barrier: Estrogen stimulates the production of several key proteins in the skin, keeping your skin barrier healthy and strong. However, as estrogen levels decrease, your skin can become thinner over time [*], which puts you at greater risk for moisture loss, infections, and UV damage.
  • Oil Production: Declining levels of progesterone can lead to skin that’s drier and more sensitive since this hormone is involved in the skin’s oil production.
  • Free Radicals: As estrogen levels drop, the body’s natural defense [*] against free radicals becomes less effective, leading to accelerated skin aging.
  • Hyaluronic Acid: Estrogen also stimulates the production of hyaluronic acid. Without a strong skin barrier and the estrogen-stimulated production of hyaluronic acid, the skin will feel more dehydrated [*].
  • Sun Sensitivity: When estrogen levels decrease, so does melanin, the pigment that helps protect skin from UV rays. This means, you might notice that your skin becomes lighter and that you’re more sensitive to sun damage [*].

How I Keep My Skin Healthy After 40

In addition to eating foods rich in antioxidants, using broad spectrum sunscreen, and getting quality sleep — which can all affect the health of your skin — I recently found a skincare line developed by a team of female scientists.

The company is called OneSkin. And their products, called “topical supplements,” are powered by their proprietary OS-01 peptide which is scientifically proven to counteract some of the factors caused by estrogen decline during menopause.

In lab studies, they found that OS-01 increased collagen and hyaluronic acid production in skin (1), improving firmness, elasticity, and hydration and strengthening the skin barrier (2). Not only that, their peptide is proven to reduce cellular senescence (3), one of the hallmarks of skin aging, so your skin stays younger and healthier as you age

I’ve shared with my Bettys that I’m completely up-leveling my skin this year. I’d love for you to consider how you can do the same. My absolute go-to product from the OneSkin line is OS-01 SHIELD Protect + Repair SPF 30+. This mineral-based sunscreen comes in both tinted and clear. If the science of peptide skin care intrigues you, visit oneskin.co. (Use code DRSTEPHANIE at checkout to save 15%.)

1) Shown in lab studies on human skin samples by measuring collagen production biomarker, COL1A1, and hyaluronic acid production biomarker, HAS2. Treatment with the OS-01 peptide displayed a significant increase compared to no treatment. (Zonari, A., et al. npj Aging, 2023)

2) Shown in a clinical study performed by a third party research organization. Skin barrier and hydration measured by a vapometer. Elasticity and firmness analyzed via double-blind expert clinical grader evaluation. Significant improvements were observed on skin treated with OS-01 FACE for 12 weeks versus baseline. (Zonari, A., et al. Journal of Cosmetic Dermatology, 2024)

3) Shown in lab studies on human skin samples and/or cells by measuring the number of senescent cells via SA-Bgal staining, senescence biomarkers (CDKN2A/P16, CDKN1A, H2A.J), and SASP biomarkers (CXCL8 and IL-6).  Treatment with the OS-01 peptide displayed a significant decrease in all mentioned markers compared to no treatment. (Zonari, A., et al. npj Aging, 2023)

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