Thanks @whatsername ! That is super helpful! I have the same symptoms and will check around to see what I can find. I had another night with what felt like almost no sleep last night, so I am highly motivated just now to check into it all again.
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The difficulty with research into any aspect of women’s sport performance is that there’s so little of it at this stage, which leads to results of individual studies being overemphasized and applied as blanket statements simply because there’s not a diversity of information to go off.
As a disclaimer: I have no issue with Stacy Sim’s work itself, the problem is more that one researcher’s body of work is wildly insufficient to cater to such a broad demographic- ultimately it should be taken as a jumping-off point and an identification of areas of interest, not a conclusive recommendation on how all women should eat. The ultimate goal is that women (and a broader variety of athletes, in general) are well represented such that recommendations can be effectively tailored to individual athletes, and those considerations go far beyond gender. Currently it’s more like if you’re a male, you get guidelines customized to your specific goals/needs, and if you’re a woman you get guidelines based upon being a women. But I bet the most successful approach would be pretty different even for just those of us represented in this thread.
Hence concludes my diatribe.
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@timpodlogar and his colleagues are excellent and have a very strong grasp on women’s nutrition, at the very least up to perimenopause. Maybe beyond, but I’m just speaking from the perspective of what I knew about him and his company from back in 2019 or so when I looked into what they specialized in.
He’s not half the marketer that Stacy Sims is. Nor has he conducted the breadth or depth of science on women athletes that she has. But he’s highly attentive to the needs of women athletes, and has several women on staff with him.
I almost asked him to coach my wife (unbeknownst to him), who I have coached in full since 2018. She’s fully capable of coaching herself in both sport & nutrition since she has an MS in sport science and is a Registered Dietitian, and soon-to-be CSSD. But, coaches need coaches too, and Tim (now Dr. Tim Podlogar) and his crew were some of the best I found for highly competitive women.
All this to say: Stacy Sims is awesome. I’ve long respected and appreciated her work, as has my wife. She’s just SO good that she ends up dominating the advertising-to-women game so much that it hides the expertise and interest of other highly qualified coaches and scientists in women’s sport.
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I’ve read Roar but not Next Level and I both like Sims’s work and get a bit annoyed by it. I found the basics really useful - the impact of the menstrual cycle on training, the importance of protein during perimenopause and after - but in other areas she’s quite dogmatic even though I’m pretty sure the evidence base in many cases is thin (eg re fasting). I have really increased my protein consumption (mostly through whey) and I take fish oil which the cat likes too. For those of you who can access BBC content, here she is on a recent podcast 28ish Days Later - Day Twenty Three: Exercycle - BBC Sounds
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I’m really glad you have found something that works for you. I did take Valarian root after reading Roar and it really helped. But since I had issues related to estrogen balance it is likely that it made a condition worse and I had to stop taking it.
I would take what you are taking if I thought it was safe for me.
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Same.
Good to know there’s another source of information. I will take a look at Tim Podlagar.
My issue is that I would like to take herbal supplements to help me with menopausal symptoms. They need to be safe post breast cancer.
Page 272 of Next Level talks about DIM supplementation
From what I can gather Stacy is saying that DIM reduces “undesirable” estrogen forms and increases “friendly” estrogen forms.
She concludes with: “there is some scientific evidence that DIM may reduce breast cancer risk”
The research paper she cites refers to a “prospective clinical trial.” not results.
When I google search I find this kind of information:
Is DIM Safe? Your Questions Answered
May 14, 2021 0 Comments
The world of supplements is a confusing one. There are so many supplements out there, so many miracle cures, so many brand names, so many products that it’s almost impossible for a regular person, even a highly intelligent one, to sort through all of the information and make an informed decision about which supplements are effective and which are safe.
If you’ve landed on Diindolylmethane (DIM) as a possible antidote to conditions and issues related to hormone imbalance, then you know that it has been used quite effectively to prevent cancer and balance sex hormones. There is, however, the lingering question…is it safe?
The best way to answer this question is to understand what DIM is and how it works.
Eat Your Veggies
Let’s start with cruciferous veggies. Cruciferous vegetables like brussels sprouts, cauliflower, broccoli, and cabbage contain plant enzymes. There’s nothing particularly special about these enzymes until the acids in your stomach take over and convert them into indole-3-Carbinole, which then converts into Diindolylmethane(DIM). When absorbed by your body, DIM actively influences the activity of estrogen and can also regulate the activity of genes.
DIM and estrogen have a complex relationship. For one thing, sometimes DIM blocks the effect of estrogen. And other times, it enhances estrogen levels. It may also affect testosterone levels.
Estrogen performs many beneficial activities in the human body. For example, it regulates the growth and development of reproductive organs, controls the growth of the uterine lining, assists in fertilization and pregnancy, maintains the normal structure of skin and blood vessels, maintains bone structure, and regulates various metabolic processes. On the contrary, excessive estrogen can cause serious health problems.
Furthermore, a woman who has a high level of estrogen circulating in her bloodstream is more likely to get breast cancer. Also, certain estrogen metabolites are directly associated with the development of several types of cancer.
The Good Side of DIM Supplements
DIM contributes to a better metabolism in the most natural way possible because it works with your own hormones and adjusts their action to avoid hormonal imbalance. Furthermore, DIM produces more ‘good’ estrogen metabolites, which increases the ratio of “good” estrogen over “bad estrogen. Increasing production of “good” estrogen has many benefits, one of which is that it helps to maintain a slightly higher ‘free’ testosterone level. The ‘good’ estrogen metabolites combined with higher free testosterone levels increase fat mobilization and a fat-burning metabolism.
DIM supplements are used to promote beneficial estrogen metabolism and help restore a healthy hormonal balance. In addition, DIM can help prevent or slow the growth of some types of hormone-sensitive cancers, including cervical, breast, uterine, and prostate cancers.
Although studies have shown that increasing the ratio of good estrogen can inhibit the growth of malignant tumors, DIM doesn’t just have anti-cancer properties. It also:
- Balances hormones
- Provides antioxidants to prevent damage from free radicals in the body
- Supports weight loss
- Improve memory
- Boosts your mood
- Supports strong bones
- Enhances energy
- Reduces PMS symptoms
- Helps to balance estrogen dominance
- Improves cardiovascular health
- Increases healthy muscle development
- Improves prostate health in men
But Is DIM Safe?
People have taken DIM as a dietary supplement for many years with no reports of adverse effects. However, although DIM supplements have no serious side effects, they interact with hormones and affect genes associated with cancer. A study published in 2014 found that the outcome of DIM interacting with hormones and genes may be good or bad, depending on the amount of hormones and DIM in the body.
While DIM is often used to support hormone balance in premenopausal women, it also may cause hormonal disturbances. While DIM can lead to positive effects on various types of hormone-sensitive cancers, it can also lead to negative ones.
The perfect example of this duality can be found in these two studies. According to a study in “Thyroid” in March 2011, DIM has an anti-estrogenic effect, which may reduce the risk of developing thyroid cancer. But, on the other hand, a report in “BMC Cancer” in July 2014 found that DIM stimulates the growth of certain breast cancer cells. This is why more research needs to be done to get the nitty-gritty details of dosage, hormone interactions, etc.
And that’s just the start of the rabbit hole I go down…
Pick any “adaptogen” and it would be a similar story.
And the problem is, the only way to have a conversation about this with Stacy is to spend a lot of money on a consultation. She ignores requests for research studies etc when she is responding on FB, the same way she ignores questions about how much a course is going to cost.
It’s difficult to ask health care providers guidance on supplements, as they can only respond to current guidelines and can’t answer questions about individual research studies, or quite honestly don’t know - adaptogens are not a scientific class of medications. They are a theoretical concept which is not fully understand and is unregulated in both the US and Europe.
@Dr_Alex_Harrison do you have any advice on how to navigate this please?
I just looked up Tim Podlogar.
Much more accessible and affordable.
I’ll book a consultation
I was unaware of this practice. Seems antithetical to truly intending to cause the greatest good. Not that all folks must have that as their primary goal in business. But it rubs me the wrong way for sure.
Does Stacy sell or is she invested in any company that sells DIM?
If yes, I’d encourage taking her words with a grain of salt + some healthy skepticism. Sellers of powders and supplements, to my knowledge, are never completely unbiased.
It’s a troubling path in this field. And it poaches much of the nutrition expertise from us. Here’s how it goes.
Step 1: gain true best-in-class expertise, (as Stacy and others have done in sport nutrition)
Step 2: realize that profit margins in the carbohydrate & sodium, and other non-protein supplement niches, are massive.
Step 3: sell such products.
Step 4: downplay any science which might refute the utility of what you’re selling.
I hope to change that, if only by precedent, and not by the actual success of our own company. I think one of the things that has made @trainerroad so truly valuable (not just monetarily but in actual service to its users) is that they’ve done a very nice job with openness of discussion, and education, alongside their training platform.
Consult an expert who doesn’t have a dog in the fight. (ie. who doesn’t sell a powder or supplement)
Be prepared for them to say “none of this is worth your time or money… but maybe this one is worth trying, but be very very honest with yourself”
Too many of the studies which support certain products are too closely tied to the companies that make the products, and the science is disastrously complex, such that unless you’re truly expert in a field, you’re very likely to come to the wrong conclusion, even if you spend obscene amounts of time down a Google Scholar rabbit hole.
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Totally agree with this. As someone with a PhD myself (though in archaeology 
) I always like seeing critical discussions of data, even when it’s not my field. I get very frustrated at blanket recommendations (do x to solve y problem) if I can’t see what kind of evidence they’re based on.
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I don’t know, but I have sat in the audience at a conference while Sims gave a presentation about hydration without disclosing significant conflicts of interest.§
Saying that Sims is the “only” voice in the field is inaccurate. She is certainly one of the loudest. She markets herself well. In my experience, she is very willing to extrapolate theoretical findings to promote her products and services. Most other experts in the field are of the consensus that there are insufficient data to support a menstrual cycle† approach to training, nutrition, and competition. Obviously, this doesn’t sell powders or consultations. NB that this does not mean that a cycle-based approach may not emerge later–ie, I’m not saying that men and women are the same, just that we don’t know how to appropriately give guidance.
Other experts in this field include Kirsty Elliott-Sale, Kate Ackerman, Louise Burke, Trent Stellingwerff, Jorunn Sundgot-Borgen, and more.
§ My COI: I am a medical researcher in this field with significant private grant money and have been paid by corporations to write on this topic.
† For what it’s worth, in my medical clinic, my biggest concern is making sure female athletes get normal menses before we even think about designing their training around their cycles.
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Considering that most pre-menopausal women are on hormonal birth control, isn’t training ‘according to your menstrual cycle’ a bit irrelevant anyway? I know that Sims discusses bc a bit but mostly as something that’s negative for training which is not that helpful.
Training according to “menstrual cycle” while on bc is a bit of a misnomer (edit to add for clarity: it’s a universal misnomer by way of simplicity of speech, and not something I’m proposing we change!) It might more properly be called making training decisions based on the timing of various hormone fluctuations (which still do happen while on bc), and making training decisions around when you’re on or off the drug which might compromise certain aspects of performance more than others.
But yes, industry consensus is that “we don’t know enough to do this well yet.” I’d posit that some very smart coaches who remain very open lines of comms with their athletes can manage at the very least training modifications which can take advantage (or at least avoid some of the disadvantage) of the hormone changes across a monthly cycle in a pre-menopause athlete.
Stacy is correct though, if she’s saying that most (all current?) systemic hormone therapies hurt performance from a mechanistic standpoint. In many cases, the tradeoffs are worth it, and can help performance. My wife chose copper IUD for a long time because it was the only option that didn’t harm performance, systemically. I could make the case that it harmed performance in other ways (as would she).
Severe cramping + stabbing discomfort and increased blood loss aren’t exactly conducive of wanting to push hard in training!
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Thank you for dropping those names. Would love to see/hear more from other folks in the field.
I saw a lot of discussion about this over the last week after Evie Richards published her experience with REDS. Hope it resonates with people. I have an active tween daughter who seems to both never eat and always eat at the same time - and it most certainly hit home with me.
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Prelude: the following papers are required reading:
Both are open access!
What I’m about to advocate for is going to sound ridiculous, but the current evidence points us towards a vibes-based approach to the cycle and training. Hear me out.
I think the biggest utility of cycle manipulation with systemic hormones is that an athlete can time her menstrual symptoms to her most important competitions. Some people like competing while they’re bleeding. Some hate it. Planning this requires foresight and medical supervision and, if sexually active, regular use of a second form of effective contraception.
Agreed. Again, this is going to be based on how the athlete feels at different points in her cycle rather than any true evidence for performance changes/training responses. In another life, I sat in a coaching seminar for track and field coaches. There were about 75 of us in the room. The speaker asked who among us were in-tune with our athletes’ cycles. I was the only one who raised my hand.
With teenage athletes, this is a really difficult line to walk, especially as male coaches. While it’s very important, some parents (and administrators) can view this as an invasion of privacy. I know of coaches who have dictated hormone use for their high school athletes and the nicest thing I have to say about that is that it’s practicing medicine without a license.
Mechanisms ≠ real-life observations. See the second link.
Additionally, the hormones from progestin IUDs are not systemically absorbed and are only active in the uterus, which does not have any feedback mechanisms to the rest of the HPG axis. The biggest advantage of the copper IUD is that you’re guaranteed to have accurate representation of the woman’s natural menstrual patterns and can use that as a surrogate for energy status, overall health, etc. The Skyla (lowest dose IUD) is pretty good at giving us a good read on the cycle while still eluting progestin.
Of course, unplanned pregnancy can throw quite the wrench into training!
No, no they are not! And this gets back to the vibes approach. In lieu of any concrete evidence, the best way to tailor training to the menstrual cycle is based on how the athlete feels at certain points in her cycle. The same holds true for contraceptive choice.
Most overtraining is RED-S. They are not the same and understanding which one an athlete is suffering from is vitally important.
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I’m not sure that’s ridiculous at all. How an athlete feels is tremendously important in predicting performance. And the more that athlete tends to rely on emotion to psychologically fuel their athletic performance, the more important those “vibes,” as you put it, become.
I don’t know about you, but when I was a teenager, there was nothing but vibes and feelings! I’ve since drifted a bit from that. (I hope.)
I’m not sure I need to!
Reason: I already agree wholeheartedly!
But I look forward to reading your comments and rationale.
@michelleihowe and I must not have been at that one!
Michelle (my wife) and I had a similar experience at a USATF coaching certification course… also in another life. (>10y ago).
Yup. Absolutely.
Isn’t that the truth!
Working in partnership with Michelle was very handy, in our former life of track and field coaching and running our youth performance facility primarily serving girls aged 12-17.
Much safer for her to open the conversation, or just handle it entirely, but sometimes, if desired by all parties (her, athlete, sometimes parent when pertinent) invite me into the foray.
A somewhat common experience I had with a few of our female athletes was that they’d experience uncertainty if it was acceptable to bring up that they were suffering with horomone/cycle-related symptoms, while I was coaching them.
Of course, being 14 years old, and wearing emotions a bit on their sleeves as girls & boys of that age tend to do, it’s not the hardest thing in the world to read.
Thank goodness for Michelle’s conversational ability to break bone-chilling ice. I hope many youth girls have this experience as athletes these days, but I’m very cautiously optimistic about that, given the lack of awareness many of our peers in sport science have had with regard to this issue.
Here’s how it sometimes went for us:
- Michelle coaching alongside me.
- I say “hey, you doing alright? is there anything you’re dealing with right now?”
- Girl looks at me like “you couldn’t possibly get it, and aint no way I’m telling you.”
- Girl glances at Michelle
- I side-eye Michelle.
- Michelle, with perfect comedic timing, “girl, ugh, me too!”
- → ensue laughter.
- Michelle lets her know it’s totally normal to tell a coach who will listen that 'hey this week just sucks are there modifications we can make? I’m suffering. Is any of today’s training less important stuff that can we can just cut out"
- → ensue more laughter and open conversation.
I’ve never considered what I’d have done without Michelle because I’ve only coached adults since we closed our brick and mortar facility.
Woah. Seriously not cool.
I’d want to get those folks fired so fast it’d make their heads spin. Either that or mandatory, ultra-rapid, zero-tolerance coach reeducation with substantial follow-up oversight, indefinitely.
Whether any science was on the side of their recommendations being in line with performance enhancement is entirely irrelevant.
I can see why “practicing med without license” is the nicest thing you can say!
I think we should be friends! Here’s why:
This is one of my favorite points to make in physiology! I have the following as canned text in my TextExpander:
BEGIN CANNED TEXT
“Mechanism, therefore application” is the fastest way to folly in exercise and sport science.
It works better in limited-dimension systems, like engineering and physics. Not so much in infinitely multidimensional biological systems that have a nasty little thing called homeostasis to maintain. Negative feedback loops often shut down acute responses to anything, and totally negate and erase any potential gain that might theoretically exist if the acute effect were to continue indefinitely without interruption.
4 prominent examples that has gotten loads of folks in the sport science community caught with their feet in the mouths:
- Low-rest hypertrophy training causes a larger post-exercise testosterone and growth hormone increase, therefore it’s better or even essential for muscle growth. Truth: More inter-set rest is better >90% of the time.
- Post-workout carb:protein intake ratios like “4:1” results in higher circulating anabolic hormones, therefore bigger muscles or better recovery. Truth: Ratios don’t matter.
- Fasted training increases fat-burning during training, therefore it will result in more fat loss or weight loss chronically. Truth: There is no body composition or weight benefit chronically.
- Higher fat oxidation rates with high-fat low-carb chronic diet, therefore improved exercise performance. Truth: there is no benefit and may be harm to performance.
Pesky homeostatic mechanisms!
END CANNED TEXT
100% agree.
I’ll add to that that it’s often a combination of RED-S & not enough sleep. 8.5hr/night is not enough for a teen (or many adults) to feel fully recovered during intensive training. I often recommend 10+ hrs of sleep when youth or youth parents ask me “what else can we do to get faster/fitter/stronger/better?” Early school schedules mandating even earlier waking schedules are disastrous for a lot of kids who don’t have good sleeping practices. (which is most of them)
Speaking of RED-S, @michelleihowe and I just recorded a very long deep dive look into disordered eating from a combination of personal and professional perspectives for our youtube channel. Might be worth a watch for you @unmountain_biker if it’s a topic you’d like to know more about. It’ll post next week, most likely. FWIW: Michelle is an athlete, has personal and professional experience with RED-S and disordered eating, and is now an RD and holds a couple exercise science degrees too.
If she sees this post I’m certain I’ll be told not to speak so highly of her. Sorry! Can’t help myself!
One final note regarding the meta-analysis portion. It’s a shame they are statistically forced to claim that the detriments of OCP are trivial. I don’t know if I completely agree that the results are trivially meaningful, though yes, as defined by traditional statistics they are statistically trivial.
I absolutely do agree with the authors that there should be an individualized approach, and that there are many many cases where the performance benefits of OCP use outweigh any negatives.
Admittedly, I had not seen this meta-analysis and hadn’t looked into the most recent summaries of the research. It had been since about 2018 that I had reviewed the topic in depth. So, thank you for sharing this.
I’m actually surprised at the effect sizes found for all these studies. These are very meaningful effect sizes in terms of sport performance changes. For anyone who takes their training as seriously as many on this forum do, it’s worth noting that the median effect size here is 0.17, which is pretty large in the sport science world, when comparing a binary. (taking contraceptive hormones vs. not taking them)
When you’re grasping at small percentage gains in performance over time, 0.17 effect size is a big deal.
The reason the authors can’t claim statistical significance is that there is such a wide inter-subject variability and often low subject number within each study. It’s a statistical power issue more than an “is there a difference” issue.
I can now see very clearly why Michelle was so adamantly against the use of OCP as an athlete. If I were in her shoes, I’d have been equivalently staunch in my position against using it. Both of us are admittedly on the extreme end of “how much we care about our sport performance” so read all my comments with that lens.
That said, when you’re not at the pointy end of the performance-obsession spectrum, or when there are “vibes” based differences in favor of taking an OCP, it is still absolutely worth making an informed and individualized decision.
Unfortunately, in sport science land, marketing and advertising skill or interest is not often a trait found in the best and brightest scientists.
I can vouch for Louise Burke. She’s legendary in the sport nutrition world among “those who know.”
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Agreed.
Agreed
Thanks Alex 
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Wondering if any of the women here take creatine and if you’ve noticed any effects, positive or negative?
Just following up on my earlier comments. https://www.youtube.com/watch?v=iVVdEHPNuKs
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I’m looking forward to watching/listening. I’ve somehow made it through almost 40 years of endurance sports (high school runner, to triathlete & cyclist) without any disordered eating or RED S but I feel like I’m in the minority and have a few friends who have recently shared that they are still battling in this area. I’m so glad that more athletes are speaking out. Thank you for providing these resources.
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