Episode 11 - Recovering your fertility, HA and Pregnancy Nutrition with Amy Gianotti
Amy Gianotti, registered dietician, intuitive food counsellor, yoga, mindfulness and fitness trainer, speaker and mentor, and mum-to-be joins us for an authentic chat on recovering her fertility, using food as medicine, diagnosing hypothalamic amenorrhea and her bumpy journey to pregnancy. She shares her tips on eating for immunity, health, and pregnancy specific tips on staying on top of your health and staving off morning sickness. A must listen :)
[00:00:00] Welcome to the Mama Matters podcast. Whether you're expecting you've recently given birth or you're just starting along your fertility journey, it's time to get down to the nitty gritty and sort fact from fiction. I'm your host. Rosie Dumbrell, physiotherapist and pregnancy expert. Mama Matters aims to provide an easily digestible up to date and evidence based approach to pregnancy, birth and motherhood with a side dose of humour along the way. Interviews from the industry's leading experts and experience of my own adventures as a mother to three gorgeous boys under four, want to share the stuff that helps to grow confidence throughout motherhood. Mama Matters is a podcast by Lenny Rose Active. And this is what you can expect to hear in upcoming episodes.
[00:00:41] Maybe this, you know, for some women are scared of the weight gain or they start restricting foods. I think that can probably be one of the biggest sources of stress. So looking at the person's relationship with food would be really important, because if you have a good relationship with food, you're more likely to have variety.
[00:00:59] Welcome back, ladies. I am so excited for today's episode. But before we get into that, if you're loving what you're listening to, please give us a shout out on social media. You can screenshot the episode that you're listening to and tag us with the hashtag Mama Matters.
[00:01:16] So today we bring to you the amazing Amy Gianotti. And Amy is a dietitian, an acceptance and commitment therapist and a counsellor, and also has a list of other tools and sort of strengths and skills, including being a strength and running coach, a sports dietician, yoga teacher and an educator, mentor and speaker. And I've known her for a couple of years now, sort of through yoga journey and also just in the sort of health professional setting. And she is now on her own pregnancy journey, being 24 weeks pregnant and couldn't think of a better person to chat to sort of get some insight into what we should be doing to help support our body in a nutritional sense, not only in terms of pregnancy, but we have a really good chat around recovering your fertility if you're hormonally imbalanced or sort of on that hypothalamic amenorrhea journey, which you'll find is a lot more common than is, I guess, known in the general population. So I'm really excited to delve into all of that. And yeah, without further ado. Yes, Amy.
[00:02:21] So you've documented your recovery from hypothalamic amenorrhea. And I'm going to call your bumpy journey to currently being pregnant in such an authentic way. And I know this really resonates with your audience and is so inspiring to me personally as well. Can you give us a background on your sort of, I guess, personal recovery and your journey to pregnancy?
[00:02:43] Yeah, sure. And it is a journey, so I'll try and share it as best as I can. But essentially growing up, I was always really active, you know, quite a lot of sport. It was something I was good at and become part of my identity. I also studied nutrition and dietetics and did my personal training course, and I excelled in running and triathlon. And at one stage I also qualified for the Australian team for sprint distance, Olympic distance triathlon and half Ironman. Back then I had the abs and I was paid for many marketing opportunities for health and fitness brands, and I was also an ambassador for many sporting brands. So for most, I thought I was following all the right signs for health and fitness.
[00:03:25] But there was one thing that never felt quite right, and that was that I wasn't getting a period. In the end, I actually didn't have a period for seven years. And yet the journey to recovering my period was the hardest but most rewarding journeys I've ever been on. It meant overcoming food rules, letting go of my fit identity, healing my kind of addiction or dependence on this high volume of exercise, allowing my body to heal and to feel that it was safe to switch on the periods and the fertility again. And in 2018, I recovered my period even after many people said that I couldn't. It's an area that a lot of people aren't really aware of. It's a bit of - it was at the time was a bit of a grey area.
[00:04:07] And I end up having a miscarriage five to six months after recovering my first cycle and then actually became pregnant exactly one year after recovery. Honestly, I'm so happy for how have things turned out and for all that I've learned to me that I've discovered the peace that I now have with food. No dependence on exercise and truly the appreciation and love that I now have for my body. And now pregnant at 24 weeks, past the halfway mark.
[00:04:35] So that's a little bit of a bit of my journey.
[00:04:41] It certainly strikes a chord with me. Having been through the same journey. But, you know, a very similar kind of early period not to pregnancy, but definitely sort of in my teens and 20s. And, you know, I think so many women can relate to food rules and exercise rules and having this just very backwards kind of society that we're living that is just so aesthetically driven at the cost of life, I guess, normal hormonal balance and fertility. And it's just crazy. So it's so refreshing to see everything you just so authentically do and everything that you share through your social media channels is just - know that it's helping so many women. And, you know, you can attest to that with the amazing number of women I think you posted today that you have helped eight women this year, just this year, to recover their periods and we're in the early days and it's not, as we were talking about before we pressed record.
[00:05:37] It's not something that you can flip a switch and recover overnight from a hormonal imbalance. It's it's months and months in the making.
[00:05:43] So bloody well done.
[00:05:46] But I know there's probably no hard and fast on this based on how common hypothalamic amenorrhea is in Australia and sort of what do we know about it?
[00:05:56] Yeah, so there's no stats on. You know how many people haven't? It is one of those things that is often underdiagnosed or misdiagnosed. So, for example, in the sporting kind of culture or some women, it could be perceived as, you know, quote unquote, normal or okay to not have a period becaus, which is actually a sign that the body is under stress. And it's kind of stuck in this energy conservation mode. And that's why it's switched off, period. So it's definitely not, you know, just a sign of fitness and it's not okay. There's a lack of awareness and education in the sporting area. I think a lot of people also take the pill and that can mask it. So they could be getting a false bleed. And it's not until some women stop taking the pill. Often when they want to try and conceive that their period doesn't return. So they're not actually sure about how long maybe they're they haven't had a kind of a natural cycle or how long their bodies being kind of under stress for a while. And then some people this is more and more common than I'm seeing with you because I'm really specialising in this area is many people are actually misdiagnosed with polycystic ovary syndrome. So we know it, polycystic ovary syndrome, the diagnosis is really about a diagnosis of exclusion and it's a kind of a diagnosis of two out of the three. So with the three being the high androgens, the irregular menstrual cycle and the polycystic ovaries, but that can also there can be some crossover with HA.
[00:07:20] So in H.A., the person can obviously have a lack of menstrual cycle, which is the big the big sign. But also they can have polycystic ovary, but they're totally different. So polycystic ovaries is a hormonal disorder or endocrine disorder is not my speciality, but H.A. is very different in that it is 100 percent treatable, whereas polycystic ovary syndrome is more about the management and the treatment. H.A. is essentially showing the body that it is safe to switch things back on again. So the reason it switches off is because it doesn't feel safe. And the underlying driver is stress from low energy availability. So treatment involves correcting the energy deficit and reducing high intensity, high volume exercise to allow the body to heal because it's kind of like in this injured state. So extra exercise is actually not really helpful for some women who have inadequate body fat stores. They will need to gain some body fat. So, for example, for most women, they need at least 20 percent body fat to have a menstrual cycle. Of course, there's some individual variability there, but that's a guide. So, yeah, it can. It's important to get the diagnosis right. And there's no numbers of how many people have got it. But, you know, from my spreading awareness on social media, I think people like are you know, they're noticing that. Okay. So not having a period is you know, it's not it's not normal.
[00:08:37] It's crazy, isn't. I mean, my experience of that is definitely in treating women athletes who are generally sort of, you know, in that same kind of category as you were that sort of low energy availability. And, you know, we call it RED-S. I think it's it's so under - diagnosed with that sort of in a sporting kind of fraternities and like, it's almost, you know, it's just being on the pill is so common. So so. Yeah. I mean that's definitely rings true for me. I wouldn't have known if I had a period for a million years.
[00:09:09] And you're right, it does fit in. You need to the RED-S that relative energy deficiency in sport. So one of the systems of the body that is switched off or dialled down in an effort to conserve energies is menstruation or your fertility.
[00:09:22] Crazy, isn't it? Anyway, at least we have amazing crusaders out there like you are spreading the good word. And, you know, the journey to fertility can be a really complex one. And this is certainly a really important piece of the puzzle for a lot of women. It's having that hormone balance and that sort of feeling of safety in the body. You are not going to conceive a child if her body doesn't feel safe. So, yes. So what are your top? I guess give us maybe three ish tips on recovering your period and fertility status?
[00:09:54] Okay. So first of all, I just wanted to mention that, you know, we've had a lot of people assume that it happens in people with, like a disordered eating or eating disorders or athletes or people who do a lot of exercise. So I just wanted to make it clear that, HA can occur in any body size. Number one underlying factor is low energy availability. So I hate using BMI, but it can occur in someone who has got a BMI of healthy or even overweight if they're under feeling. So I just thought it was important to mention that. And also sometimes just weight loss or the low energy availability can be unintentional. You know, with a lot of exercise, there is often this blunting of appetite, especially after high intensity, high volume exercise. And then that whole culture of trying to eat really well or eat really only healthy or, you know, quote unquote clean foods. And then, you know, this culture belief that, you know, the leaner I am or the lighter am, the better I'm going to recover. So sometimes it can come from a really or it doesn't always come from a very innocent place. But sometimes it's just that slippery slope with, you know health and performance and yes, it can be quite complex. But to answer your question on recovery for fertility, my point would be more exercise and eating less is not always healthier.
[00:11:11] Number two, no period is not okay. It is a vital sign. And the loss period is a sign that your body is under stress. I talk about it as like your body stuck in this energy conservation mode. And thirdly, the person you need to listen to and trust the most is yourself. So not ignoring your hunger or thinking. Oh, no, I ate an hour ago. So I shouldn't be hungry. You know, we need to trust our appetite, just like we trust our body when it comes to temperature. Like, if I was feeling hot right now, I would take my jumper off or feeling cold, I think, where's that jumper? And I'll put it on. I'd remove the threat and I'll move on with my life. But when it comes to appetite, because of diet culture, too many people are so kind of confused. They're like, oh, no, I shouldn't eat right now. I eat an hour ago. Or there's only those carb foods I can’t have them. You know, all these kind of food rules come up, which really disconnects us from our body. And that's like the underlying cause of this.
[00:12:03] So, yeah, it's such a slippery slope and just a very interesting kind of cultural kind of problem, I guess you're going through. And just back on what you said about BMI and HA not necessarily been related, I think that's really, really interesting because a lot of people, including myself, probably would have associated with that sort of really low body weight type of person. So, you know, obviously someone who is larger may not be eating a lot either. And, you know, they may have that low energy availability to causing them to go into that stress. So that's a really interesting point.
[00:12:36] That's why they can get this diagnosis wondering, says polycystic ovarian syndrome as well, because for a lot of them, they can be in a bigger body, you know, not everyone.
[00:12:47] Yeah. That makes complete sense. Let’s segway into your sort of general practice knowledge, which is in dietetics. And I came to see you when I was in my first pregnancy to get some tips on how to fuel my body properly for pregnancy. And I would love if you could share some tips for our audience around good practices for pregnancy, nutrition.
[00:13:07] Well, I think these ones aren't too small or too expertise or anything. But, you know, my number one would be eating a wide range of foods. So making sure you're eating from all five food groups. I think one of the biggest issues I see with pregnant women is just trying to go overboard with one food group or, you know, focusing too much on organic or kind of getting caught up on the small things that they're not allowing their body to get all the nutrients it needs. So there's no point in having, you know, 30 tools or nutrients or one type of nutrient when you're missing all the others. So your body needs to have all of the nutrients in the right amounts to function its best. Secondly, like I was mentioning before, being aware of food rules that do not serve you. So, you know, some women who I work with are really scared of having carbs, for example. And, you know, they might go crazy on the vegetables and having like eight or nine serves. But there, you know, mine only have one or zero serves of grains over the day. And that can really impact their ability to meet their nutrition and energy requirements. So just being very aware of any food rules that you have and food rules would generally be picked up on if you feel quite anxious. If this food rule is challenged in food, rules could be around to type the volume, the timing or even the environment that you eat in. So, for example, you know, not to have carbs then, is that really serving you? And then thirdly, I suppose a little bit more pregnancy specific- but cooking foods well and enjoying them hot or, you know, fresh. So, um, just to reduce the risk of food poisoning. So you're not eating foods that have been sitting out for four days or, you know, and if you maybe did have leftovers, making sure you're having it within, you know, 12 to 24 hours and it's refrigerated.
[00:14:49] And just on the side of pregnancy, specific stuff like I know the morning sickness is such a horrendous feature for all through pregnancy, but it did get less from one down to the third.
[00:15:02] But I know when I was pregnant with Lenny and I had morning sickness for about twenty five weeks or something quite severely, and struggled to eat much more than like peanut butter on toast.
[00:15:14] And yeah, I think by the time I knew I had I definitely had some lose, some I guess, guidelines around what to eat, but it was at times it was challenging to meet those food requirements based on morning sickness.
[00:15:29] My tips here are smaller, regular meals can be helpful sometimes not heating foods, food know because of the smell can be a bit more enhanced if it's hot or heated. Having less blending things into like a smoothie could be a way to get a lot of your food groups in there. But just thinking quite broadly at the five food groups, like some kind of veggies, whatever it is, you know, put some spinach, I think, go put some pumpkin in soup or you know what? Can you have can you put banana in pancakes or banana in a smoothie or. And then think about the meat, the grains. And then obviously dairy, or an alternative so trying to tick all the boxes with smoothies or just however it can work, really. Not trying to get too caught up on how healthy it is. Whatever.
[00:16:15] Yeah, definitely. I remember you to give me that advice and this sort of eating small meals regularly did quite help and definitely keeping away from the smell. I didn't do much cooking for my husband. Sorry, mate.
[00:16:29] And I also think that sometimes with the aversions, no one really knows why we get them.
[00:16:36] Sometimes you know, it could be from a deficiency or maybe, you know, and that's why you're craving certain foods or, you know, from having the food versions, maybe, you know, they're not possibly safe for you or your body's trying to avoid a possible danger. No one really knows the exact answer, to be honest.
[00:16:58] I just remember I had this orange fetish in the first trimester and my husband came home with like a kilo of orange every couple of days. And then one day he turned up with like three kilos because he was sick of going to the shop so frequently. And I was like, don't give me oranges.
[00:17:12] really I didn't have like over 24 weeks now and I didn't have any cravings. Like I was ready for the cravings. I was excited to be really curious about them, but I did have aversion.
[00:17:26] So you know, certain vegetables were just tasting disgusting. And I went off coffee really early on. There was a few things like that. I just remember broccoli and broccolini and things like that, just tasting foul when I used to not really think they'd had a strong taste or anything.
[00:17:40] But then after the first trimester, things started to taste normal again.
[00:17:46] Another thing was hot chocolate. I'd always have a hot chocolate in the evening, you know, normally after dinner on the couch with something. And I remember going to have, you know, my routinely kind of hot chocolate. It was this like, yuck. It was this like weird taste, so went off that for a few months and reintroduced that recently. So I feel normal now.
[00:18:04] So I'm sorry other than that for now, I'm only 24.
[00:18:09] No, I mean, I always love hearing when women, you know, have not a horrendous time. Obviously, we're living in, you know, potentially a more stressful time for a lot of us at the moment. Can you give us any nutrition tips that can help in terms of reducing the stress on our body and boosting our immune system, knowing that our immune systems are actually suppressed in pregnancy?
[00:18:34] Yeah, well, like I kind of touched on before, I don't believe there's a superfoods. You know, all your nutrients or tools work together. So essentially, we need thirty five essential nutrients or tools for our body and we want to get them all in the right amount so our body can function its best. So how do we do that? Is not just having, you know, this super kale smoothie or whatever, it's about eating from all five food groups. So that's important. And then, like I said before, your relationship with food is far more important than any diet. So in terms of supporting our immune system, we need to meet our energy requirements. We want to get variety in the diets or we're able to meet all of those certain nutrients.
[00:19:11] We know during pregnancy there's some nutrients that are, you know, increase, for example, iron. But then, you know, calcium is also increased as well. But interestingly, our absorption of calcium during pregnancy is actually enhanced. The body is very smart, but I think for a lot of women, it is a stressful time because they know their body is changing. Maybe they're feeling more tired. Maybe this, you know, for some women, they're scared of the weight gain or they start restricting foods. I think that can probably be one of the biggest sources of stress. So looking at the person's relationship with food would be really important because if you had a good relationship with food, you're more likely to have variety.
[00:19:48] And what about, like fats, can having sort of a healthy amount of fats help with any kind of, you know, I guess stress? But in a way, I'm kind of thinking of that bit more from a hormonal balance and that sort of help?
[00:20:01] You know, I just think, you know, meeting your nutrition, like getting a variety, like going overdose in one certain nutrient is not going to provide any additional benefit, kind of like building building a house in in, for example, 35 different tools. There's no benefit of having 35 hammers without any other key tools. You're not going to get a better job. So, yes, we want fats, but we don't need to focus on macro nutrients so much. Just focus on Whole Foods. And if we're eating from all five food groups, again, being your fruits, vegetables, grains, meat and alternatives, dairy and alternatives, then you're going to get all those nutrients in to think about eating foods as opposed to just nutrients because nutrients actually work together.
[00:20:40] And that's sage advice!
[00:20:43] So in finishing and over a lot of your personal practice and teachers are founded in the philosophies of yoga and mindfulness, I able to share a couple of your some mindfulness tips to help with stress and anxiety, especially given that we're going through a bit of a bumpy time with COVID19?
[00:20:59] Yes, this is really specific to my clients who are working through recovery right now, a lot of them with goals of becoming a mum one day. And, you know, through this period, they're breaking through like food rules and like I said, recovering their period. So there are three things that come to mind. First of all, is a sensory walk. So I kind of created this when I was going through my own journey. And essentially, it's like a active mindfulness practice where, you know, you can go for a walk wherever you are. That's allowed at the moment. And it's going through all five senses. So you might start with I see, you know, might be like I see leaves. I see a tree. I see a young child. I see dogs. I see a puppy. And then getting really explorative with what you're seeing with that, like, non judge mental. You're that curious mind. And then I hear. I smell and I taste. And then when you get to that, I taste. Just be really curious about, you know, those sensations like, you know, how is my appetite? Am I hungry? Am I Satisfied, am I full. Maybe you're right about a 10. Maybe you can taste the toothpaste from the morning or some your breakfast left in your teeth.
[00:22:02] But just getting really curious about that and the practice would be really helpful to that present moment, because a lot of people are caught up in that narrative of like, oh, should be doing this or, you know, this worry, worry, worry. But that practice can be really, like I said, thank you to that present moment and not get caught up in a story that's not serving you. The second one would be a gratitude practice. So for a lot of people, again, get caught up in the negative things and the not so helpful store stories. So if they go into a gratitude practice of listing five things they're grateful for each day, that can help to start with a more positive lens that they're looking through, which can promote more positive thoughts, emotions and then actions or behaviours. So, you know, just listing five things everyday, trying not to list the same things. And then lastly, practice under with my clients years a body appreciation practice. So similar to the gratitude, but listing five things that you appreciate about your body and why you do this. And that added little thing would be to rub moisturiser on your body. So a lot of people have areas of their body that they try and avoid, like maybe the hips or their arms or their belly or whatever it is.
[00:23:09] And I think it's important to be really connected and loving of your body, especially during pregnancy and when things are changing. So, you know, by getting into a practice of appreciating things that can again help to promote more positive thoughts, emotions and actions so you can be rubbing your tummy and instead of thinking, oh, my God, that's so fat or whatever, although stretch-marks or you just, you know, go into that negative story, you can be like, wow, I am so appreciated that this is tummy can create a life or there's a life in there or thinking about how these hips are expanding so I can give birth to, you know, forcing it, kind of forcing yourself or keeping yourself accountable to five things, just kind of change the narrative that you default to, because a lot of people, for example, would go look in the mirror and they have like these negative glasses on and just think, oh, my arms or on my hips, you know, and they're not seeing all the other beautiful qualities and parts of their body and so important.
[00:24:01] And yet I'm kind of just brings to mind, I've sort of done some work with Body Confident Mums over the last few months. And they ran a challenge last year. And one of the daily things was to say a body part that you appreciate and why. And it was all we had - people who have already had babies. I don't think it was sort of current pregnancy. The area that women most struggle with or failed to appreciate was their tummy.
[00:24:29] And that's the area that has grown ever since, realising that unlike, you know, other new-found appreciation for my tummy.
[00:24:38] Hopefully other women, too, because I think it's an area that can obviously bear the brunt of some of the changes. But the flipside of that is like, look what it's created and why, you know, why it's had those changes. And if it didn't, then you wouldn't have you know, you wouldn't be be the mum.
[00:24:53] So anyway, I thought that was a pivotal moment there.
[00:24:57] That's interesting as well. Yeah. Because I think, you know, by name, look back on my journey, there's probably an area that I was very focused on, even though I was, you know, had a very low body fat percentage, I never looked at it with appreciation. I was always kind of a bit, you know, there wasn't love that I was giving it. But now my belly is so much bigger and it's actually getting a bit of an ‘outi” belly button at the moment. And obviously it's growing with a baby. And I absolutely love it.
[00:25:22] I love allowing people to touch it. And that's just like flashing people my tummy. I was loving it.
[00:25:30] So you don't have one of those hands off pregnancy T-shirt. I certainly wanted one of those by the end, like here, random strangers rubbing my belly!
[00:25:43] You know, you said, well, you know, a lot of face time these days to family and friends, like show me!
[00:25:51] You like showing them and they might call me when I'm on a walk and I'm like, put my top up and showing my tummy while “check this out” with my you know, my Lenny Rose tights on haha.
[00:26:09] Anyway, thanks so much. Yes.
[00:26:12] Good luck with the rest of your pregnancy - People can find you on [00:26:24] A Healthy Life Redefined, - podcast (on which there is actually an interview with me)
On instagram @amyleegianotti
[00:26:29] Oh, thank you. Thank you so much for having me. And I love everything that you do and come back to you. Thanks.
[00:26:39] Well, that was it really an emotional episode for me. Definitely sort of with my past, just really hits a note and makes me so, so happy to hear. I guess the philosophy that Amy has around recovering our relationship with food and making peace with our bodies. And it's just such a breath of fresh air.
[00:26:57] And yeah, it makes me feel so good in my heart to chat to amazing people like Amy. So I hope that you found the chat with her useful can find her!
[00:27:22] And she covers so much of varied information around so many different sort of elements of nutrition and mindfulness and general wellness. So yes, such an amazing, amazing lady. She does a variety of one on one, a small group coaching and also has online courses that you can do to help with a repair, that relationship with food and in the current climate. It's so great to be able to have that sort of virtual coaching.
[00:27:48] And she coaches clients from all over the world. So it's very easy to get in touch with her for a discovery call or an appointment. I so love sharing with you all of my amazing contacts in the sort of pregnancy and wellness space. And please let us know if there's anyone in particular or a particular topic that you'd like covered. We really are driven by wanting to help and support you through this journey as much as possible and more input we have from you, our amazing audience, the closer we are going to be able to really support that in a great way.
[00:28:18] So I'll catch you guys soon. Bye.
[00:28:22] This episode is brought to you by Lenny Rose, active, Australian owned three times mum and physiotherapist designed luxe Active and technical, where the Pregnancy to Motherhood Journey.