Mini Pause #24: How to Make Friends with Carbs

Food, Female Athletes & Fertility

TL;DR (Too Long; Didn’t Read)

Women need to eat more overall calories to appropriately fuel and perform in their workouts. We want to think about how to maximally take advantage of food by strategically thinking about total calories (and in particular) carbohydrates in the peri-exercise time. In other words, carbs are your friend.


If you’re an active female who is either lifting weights, engaging in cardiovascular activity, or both, there is a chance you may not be eating enough calories to fuel adequate performance in your sport of choice and your basic, day-to-day functions. This is commonly referred to as Low Energy Availability or LEA.

Lack of food intake is rampant in female athletes because of societal pressures to look a certain way as a female athlete [*][*]. This might be coming from media, including social media (and the dreaded comments section), as well as teammates and coaches who may believe there are perceived performance enhancements if the athlete is leaner.

And you don’t need to be on a team or in a competitive environment to also feel this pressure.

Many women begin working out for aesthetic reasons (I was one of these women), and there is an inherent expectation of body composition changes when combining energy manipulation in the form of caloric restriction and an exercise intervention.

Dieting can mess with our heads.

I have seen this firsthand in females who initially participate in a ketogenic or a low-carbohydrate diet. The results are immediate and welcome! A drop in water weight, the scale moving in the right direction, and we can make the cognitive error that we have found the diet for us.

And it does work.

It works wonderfully while we are metabolically unhealthy or consuming too many calories. Restricting carbohydrates works to reduce total calorie intake, decrease inflammation, and fuel weight loss.

Until it doesn’t.


I’ve seen this countless times with women–they love the results of carb restriction so much that they hold onto the idea that that is the only way to drop weight and keep it off.

Clinically I have seen this NOT be the case. After a time, excessive carbohydrate restriction begins to wreak havoc on the thyroid. Dom D’Agostino and I [*] discussed this on the podcast a few years back–excessive carbohydrate restriction often leads to a hypoactive thyroid.

I like to explain this phenomenon–a diet working and then over a period of time it stops working–as exhausting the area under the curve [*]. While this term is used in pharmacokinetics (how long should a drug be dosed for), we can also apply this term to the therapeutic intervention of diet.

Said another way… the diet that heals you isn’t the diet you should follow long term.

When women restrict too aggressively with the same intervention for too long, maladaptions can occur.

When you’re in a chronic energy deficit–either through over-exercising or under-eating –your reproductive capacity is downregulated via nutrient-sensing pathways [*], which also can affect your metabolism and body composition.


After a long period of carbohydrate restriction, if you notice that your weight loss has stalled, or it is feeling harder and harder to stick to it, it might be time for a change.

Change might mean increasing total calories, and reintroduction of carbohydrates specifically.

Realizing the anxiety this may invoke in some of you, think about strategic dosing of carbohydrates in the peri exercise time. Either immediately preceding a workout, immediately after a workout, or both (!) is a fantastic time to consume your carbohydrates.

Remember your muscle is one of the primary sites for insulin activity, glucose storage, glucose utilization, and fat utilization. So timing your carbohydrates around your exercise ensures this fuel will be sequestered and used for muscle activity. You are the most insulin-sensitive immediately after a workout!


If you are a cycling woman, consider initially increasing carbohydrates (and therefore total calories) in the luteal phase of your cycle. This is the 12- to 16-day period after ovulation, and before your period begins. I detail this in “The Betty Body,” which also has meal plans to show you exactly how to do this.

Typically I am for an initial increase of 10% of total calories to be increased.

If your cycles are irregular and unpredictable, or you are menopausal, you can increase your calories right now irrespective of where you are in the cycle. See how that affects your performance and endurance in your gym sessions.

Question of the Week:

Q: Can you clarify some questions about sunscreen?

This question from Doris about sunscreen comes at a great time. She writes, “Thanks for your podcast episodes on skin health–love them all! Regarding sunscreen: I am a proponent of wearing it daily, but I have some clarifying questions.”

  • If you work indoors all day but in front of computer screens, does that still warrant daily use?
  • How often is it recommended that one reapplies sunscreen?
  • When you are indoors, and then when you are outdoors (and outdoors, when it’s April in Toronto and we might not be outdoors for long and the sun isn’t strong, and when it’s truly summertime)?

Sunscreen is such a polarizing topic, isn’t it?!

I would say that timing and dosing of sun (and of course light) is what’s most important to consider here.

On the one hand, chronic UV exposure (sitting out on a beach all day in the middle of summer, with no sunscreen) is going to increase your risk for skin cancers. And if you do require surgery to remove the cancer, it’s awful, usually induces bad disfigurement and scarring, and the recovery is more difficult than I think people realize.

On the other hand, insufficient sun exposure is a real problem [*] and has direct consequences for human health. As we have moved to working primarily indoors, we do have to be mindful of getting adequate sun exposure.

Here are my best recommendations:

  • Get early morning sun exposure. Go outside in the morning when the sun is low in the sky, full of blue and green lights that rev up our circadian rhythms. You can opt for sunscreen if you like (I do).
  • Indoors, it is less important to be concerned with the application and reapplication of sunscreen if you are not exposed directly to sunlight coming in.
  • Avoid sunbathing between 10 am to 2 pm when the sun is typically at its highest point in the sky and at its strongest. Personally, if I do spend time in the sun, it is usually after 4 pm.
  • Wear a hat with a brim and sunglasses to avoid squinting.
  • If you are lighter skinned and pasty pale from the winter months, be very cognizant of your initial weeks in the sun as you are hopefully developing a little base of color without turning into a tomato.


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

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