The Importance of Carbs in Hypothalamic Amenorrhea Recovery
As I explain the post What Should I Eat During Hypothalamic Amenorrhea Recovery? you must include all food groups in your daily diet to recover from HA. In this post, I explain in more detail the importance of carbohydrates and their positive impact on your Hypothalamic Amenorrhea Recovery.
What is carbohydrates?
Starch, sugar and fiber belong to the macro-group carbohydrates. Starch and sugar are broken down into smaller components when we eat them and are absorbed into the blood. Fiber on the other hand is not broken down but passes straight through to the gut. It is rare that a food contains only one type of carbohydrate. If we take a carrot for example, it contains both starch and fiber. An apple contains glucose, fructose and some fiber. The higher the proportion of fiber a food contains, the less blood sugar is affected when this food is eaten.
Carbs and insulin
When you eat carbs, your body will break these down into smaller pieces. Once the carbs are reduced to their most basic forms -- lactose, sucrose, fructose or maltose -- then your intestines can absorb them and send them into the bloodstream as glucose, or blood sugar. As a response to rising blood sugar, the pancreas releases insulin. Insulin helps bring sugar into the cells from the bloodstream, where it is used for energy. The insulin leads to:
Liver cells absorb sugar in the form of glucose or fructose. They consume part of the sugar themselves and the rest is stored in the form of glycogen. Glycogen is a form of "stored" sugar. If a sugar deficiency occurs later (e.g. during fasting), the glycogen can be broken down into glucose which is released into the bloodstream.
Fat cells absorb sugar in the form of glucose or fructose. They consume part of the sugar themselves and the rest is stored as fat.
Muscle cells absorb sugar in the form of glucose. What is not needed for the work of the muscles is stored in the form of glycogen.
Without proper release of insulin, more sugar remains in the bloodstream and blood sugar levels become unbalanced.
Carbs and cortisol
If you don't eat enough carbs your blood sugar will be low. When the blood sugar gets too low, Cortisol, our fight-or-flight hormone is released to assist in getting our blood sugar back to baseline. Cortisol is as you know going to down-regulate non-life essential functions as digestion and reproduction. It also inhibits insulin production in an attempt to prevent glucose from being stored, favoring its immediate use. These hormonal responses to the low blood sugar may last for 6-8 hours.
The same might happen when blood sugar levels drops fast. This might be the case if you eat processed carbs without coating.
Coat your carbs
If you eat pasta, you usually serve it with a sauce. If you eat bread, you have butter and cheese on it. This is something that often happens completely intuitively and is called "coating carbohydrates". By eating carbohydrates together with fat, protein and/or fiber, the glucose will be broken down and absorbed more slowly by the body. You will thus avoid excessively high sugar peaks and excessively deep valleys. Thereby, you reduce the risk of ending up so low in blood sugar that cortisol has to be released. Here I want to point out that the most important thing is that you make sure you eat regularly; there is no reason to get stuck in a focus on optimized intake or how best to combine different foods. Just listen to your body and it cravings.
You cannot replace carbs
Trying to replace carbohydrates with proteins or fats is not such a good idea. For all not in HA Recovery. Carbs are the body’s preferred energy source, including your brain’s main source of energy. Consuming carbs contributes to the production of the brain chemical serotonin, an important mood-boosting neurotransmitter. Further, carbs are the most readily available energy to support your body and its daily activities and bodily functions. Among others carbs are involved in the menstrual cycle by stimulating our glucose sensing neurons in the ovaries. Eating enough overall and eating sufficient carbohydrates tells these neurons to communicate with signal substances involved in activating Gonadotropin-releasing hormone (GnRH). This is a hormone made by a part of the brain called the Hypothalamus (as in ha Hypothalamic Amenorrhea). It causes the pituitary gland in the brain to make and secrete the hormones Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). Both these hormones are in turn crucial for ovulation.
The work of the carbs does not end there. When you eat carbs, they are broken down into glucose. Glucose can either be immediately used or stored in the form of glycogen. A low storage of glycogen due to a low a low intake of carbs reduces the availability of easily accessible fuel to the body (remember, carbs are the body’s preferred energy source). This has been showed to cause disruptions in normal pulses of - you guessed it - luteinizing hormone (LH) and elevations in cortisol, both strongly associated with the development of HA. This goes both way. When we eat (sufficient amount of) carbs, insulin is released to break them further down into glucose. This signals energy availability to our Hypothalamus, and GnRH is fired more often.
When your body doesn't have enough carbohydrate on hand, it will turn to protein and fat to make glucose. This reaction happens in the liver instead of the digestive tract. Your body breaks down the proteins, fats and enzymes it has to make glucose in a process called "gluconeogenesis,". The down side to gluconeogenesis is that your body will either tear down existing muscles to make what it needs or it will use the proteins in your food, which will prevent those proteins from helping you make new muscles and repair tissue damage. And this repair is absolutely crucial in HA Recovery.