Working with a Nutritionist (focused on Sports & Performance Nutrition)
Working with a Nutritionist (focused on Sports & Performance Nutrition)
The MPT Team: The Nutritionist
Building an ‘MPT Team’ (I call the menopause transition ‘MPT’) takes time, and takes work. For me my ‘team’ was not built all at once, it was an evolution over time. Finding a team skilled in what they do, and who you trust, is incredibly important ~ but knowing that you have indeed found ‘your’ team might take awhile. I consider the core of my ‘MPT Team to be my doctor, my coach, my nutritionist, and most recently my physical therapist ~ all of whom I will be sharing my journey’s with separately. On the heels of ‘Is Steak the Answer?’, let’s start with the Nutritionist.
Why Did I start working with a Nutritionist?
It has been just over two years since the idea of working with a nutritionist was introduced to me. When I first started working with a nutritionist, it was to ‘fix’ the fatigue issue/iron problem I had, not to learn how to eat ‘better’ or what to eat, or to deal with menopausal weight gain (because initially menopause in general was not on my radar 100% as a reason to work with a nutritionist), and most certainly supplementation (other than vitamin D) was definitely not on my radar.
I worked with a nutritionist on a regular basis from July 2022 - May 2023. I learned a lot in the process, and continue to learn from the process.
One of the biggest things that I have learned from working with everyone on my ‘team’ is that there is never just ‘a fix’ ~ usually multiple things are going on in your body that overlap and improvement is a continual evolution. Especially as a peri/menopausal athlete.
How I found ‘my’ nutritionist
As I discuss in ‘When the Wheels Fell Off’, my nutritionist was recommended to me by my coach, Sophie. I had never in my life thought about working with a nutritionist, and I definitely was not thinking about working with one for my fatigue issue. But I was desperate to figure out a solution. After yet another not so great bike ride, I made the call.
Who is my nutritionist?
The nutritionist I worked with during 2022 and 2023 is Rasa Troup. Rasa is a former Olympian, has worked with the Minnesota Vikings, is an immigrant to the US, and much much more. Those are all great parts of her story, but why I chose to work with her is the personal referral from my friend and coach Sophie, as well as the conversation we had on that first call I made.
The Call
Immediately during that first phone call with Rasa (July 18, 2022) I knew I was talking to someone who listened, who understood my issues, who was knowledgeable and made very good suggestions, and who would help me. I discuss in ‘Is Steak the Answer’, on that first call Rasa made suggestions on what bloodwork to get done before we even had a first meeting. That was the beginning.
First Meeting
After I received the results of my bloodwork, Rasa and I met virtually for our first visit on August 8, 2022 (even though Rasa is local to me, it was still ‘covid times’). We talked a lot about my iron deficiency (see ‘Is Steak the Answer?‘), but we also began to talk about other things, like how much I exercised (and what type), if I was eating enough to support the exercise I was doing (hmmmm, never thought about it), the importance of protein, my stage of life, hormones, supplements, and moving differently (which will come into play in a later story).
I learned a lot of new things. And although I was still pretty laser focused on that ‘iron issue’, some new ways of thinking and eating started to slowly settle into my brain and then my daily practices.
Let’s back up here a second
If you will recall, I did not call myself an ‘athlete’ until I was 51 years old. That was early in 2022, shortly before I started working with Rasa. Nutrition around exercise was never something I paid attention to, I knew Kurt did ~ but he was a bicycle racer ~ I wasn’t. So drinking electrolytes, eating before/during/after exercise, paying attention to protein ~ absolutely none of that was going on until quite late in my lifestyle as an athlete. When I was younger and started cycling more seriously, I drank water on my bicycle rides, I didn’t ever worry about food around exercise, and I certainly never ever had a protein shake (that was for serious athletes). My advice to myself now would be ~ get there sooner. You ARE an athlete, you need to think about what you put into your body and why; because it matters. But you don’t know what you don’t know, until you know it ~ and then fortunately, you can’t unsee/un-know it.
I did change those habits, eventually beginning to drink Skratch in my water bottles on cycling rides. But I didn’t start thinking much about eating around exercise really until my late 40s, particularly when I started doing virtual training with The Fix Studio in late 2020 and started to think more about eating around my training and drinking protein shakes after a workout. So I was starting to head in the right direction…
Let’s also remember, I am a selectarian, so that alone means I was typically not getting the nutrition I needed through the food I was eating pretty much most of my life, especially my adult athletic life.
And I am a ‘light’ eater. I eat, but not a lot. And I eat only when I am hungry. I love vegetables, so I eat a lot of them, but having protein on my plate wasn’t something I thought about. I got away with my way of eating, until I didn’t. Hello MPT. Hello Rasa education.
My Goals
After our first meeting, I emailed Rasa on 8/19/22:
I had some time this week to sit down and put a list together of what I feel I could use some help with. I think it would be a good use of my time and money to do some additional appointments with you.
Attached is a list I put together of issues and goals. Let me know your thoughts, if you feel continuing to meet is a good plan, and if this fits into your package plan, and best next steps.
Iron
a. Follow up on Ferrasorb progress
b. Long term strategy
Protein
a. Do I need to make adjustments?
b. Intake and times (i.e. in regard to #4 ~ workout fueling).
c. Using Protein Powders. Currently using this.
Perimenopause/Menopause transition
a. Is that affecting #1 & #2?
b. Adjusting diet accordingly
c. Belly fat emergence in 2020, how to reduce and stay healthy
Workout Fueling
a. How to fuel before/after workouts, depending on type of workout
b. Protein Balance (see #2)
Diet
a. This summer I have noticed an increase in appetite, which leads me to believe I
am not getting what I need out of my current diet. I am frequently hungry, which
leads to ‘b’.
b. Snacking.
I. I try to snack on nuts, prepare healthy muffins for a mid-morning snack, etc. But this Summer I have often felt like I am starving, which is frustrating when I am hoping not to have a big weight gain as I head into menopause.
ii. What are good snack options?
c. We eat mostly a vegetarian diet, so I may not be getting everything I need. How
to adjust?
Hip Soreness. Is my diet contributing to this issue? What can I do to improve.
a. I can’t find when exactly this started, but I have been talking to Sophie most of
this year about trying to improve. We have been trying to address through
exercise, which does help ~ but not 100%
b. Could this be a dietary issue?
Vitamin D
a. I currently take typically Oct - April. My levels were good in my blood test, but in
the past I tested low (a number of years ago).
b. Any adjustments that need to be made?
Fatigue
From this point I bought a package of six visits with Rasa that was discounted, and refundable if I did not use it all (I used it all).
What I learned working with a Nutritionist
Protein
I am sure I read about protein in Next Level, but I think I stopped reading that book around the time the Crash Pad work started getting pretty intense, and as I got consumed by ‘fixing the iron issue’ (I will talk about that book in another story). What I began to learn from Rasa is that protein is important, especially for an athlete. And as I now know, especially for my stage of life. And not just protein, many things.
I was definitely not incorporating enough protein into my diet, and it is still a struggle as someone who doesn’t eat much meat and doesn’t like many sweet things. Rasa really helped me with putting together a list of protein food options for my palette. We looked at what I was generally eating on a daily basis, how much protein certain items had, and discussed ways of incorporating more protein into my day.
Kurt and I have the same diet, and he exercises more than me, so he has been super open and interested in increasing his protein as well. We realized we were frequently eating meals without any protein (like pasta) and have made an effort to ensure our plate is more balanced at each meal. We also try to have better protein snacks around so we aren’t always grabbing chips when we want a snack (still working on that one).
Next Level has good baselines for MPT women to start with your protein guidance, but I would also suggest working with a sports nutritionist to fine tune for your specific needs.
LEA (Low Energy Availability)
It was highly likely that I had been under fueling my daily activities for years. And for many years I got away with it, but things amp up and change in the MPT and suddenly you may realize what you have been doing no longer works. Rasa and I discussed that part of my fatigue issue might likely be because I was not giving my body what it needs for the level of activity I was doing.
Just two years later LEA is being discussed much more and athletes are having to accept that to perform better they need to eat better (here is a good recent article). Changing how you eat is likely to lead to body composition changes that have been culturally denigrated for women for decades (particularly GenX women who grew up with diet and exercise culture where looking thin was more important than feeling good and performing at your best). Layer LEA and cultural perceptions on to an already changing body during the MPT and it’s a bit of a perfect storm.
I do not think that LEA was my only issue with fatigue, I also think it was my iron issue, hormone fluctuations, and sleep issues. I still have a higher fatigue level than I used to, so keep trying to figure that one out (if it can be ‘figured out’). You will also hear the term ‘Red-S’ used in the LEA conversation, I certainly heard that from Rasa and that was the first time. Red-S is discussed a lot with the MPT I have come to learn.
LEA was a tricky one for me. Because I was having such a hard time with cycling, I created the perfect storm for myself. I started eating more (like Rasa said I should), BUT I began exercising less (because I was desperate to feel better and felt I had been overtraining). I put on far too much weight for me and had to realize I had gone too far. In my desire to get an ‘A’ in LEA, I was eating too much fatty proteins while I was not exercising much. So a word of caution, really understand what you are doing. Eating more is not in itself a bad idea for an athlete, but what you are eating and what is going on with your exercise is important to monitor. I don’t think I ever have fully lost that weight because of my continued struggles the last few years with exercise (more on that later), but I did lose quite a bit of it. Unnecessarily putting on weight I didn’t need during an already difficult time mentally and physically made the whole MPT weight shift more complicated for me. I think more could be written and researched about LEA and menopausal athletes for sure.
Exercise Diversification
For years cycling 4-5 days (sometimes more) a week was my norm. I have mixed in periods of yoga during my adult life, but it has ebbed and flowed. Until I started working out with the Fix in 2020, I did not do any strength work or weight training.
At my first session Rasa said I might want to consider moving differently with shorter and more intense exercise sessions (this is well researched and discussed for MPT women, particularly by Stacey Simms), and that I might have to think about other ways of exercising that would bring me joy. I remember feeling pretty devastated when she said that and didn’t really listen to that advice until I couldn’t cycle as much as I wanted to.
The last couple of years as I have struggled through my various challenges, I have realized how important mixing it up is to my recovery and ability to have good rides consistently. I am thankful that I was already incorporating yoga and core + strength classes, as well as walking, into my routine; I have been trying to be consistent with these activities and use them as tools to recovery. I have had to reduce the number of days I cycle, but it gives me more time for these other activities. I have also set a goal this winter to do an additional day of weight training every week.
SUPPLEMENTS
Rasa and I had talked about vitamin D in our second session, but it was not until our fourth session we talked more about other supplements to aid in some of the issues I was having. I did not grow up taking vitamins or supplements. In my 20s I took a multivitamin for a time, but at some point stopped that. In working with Rasa I began to understand the benefits of taking certain supplements to help me in some of my challenge areas ~ recovery and sleep. Because I am a selectarian it is difficult to get a lot of what I need from food (ideal source), in which case supplements are helpful (as I found out with the Ferrasorb for my iron deficiency).
This is the list of supplements I began to take (and am still taking):
Ferrasorb
Vitamin D
Omega 3
Magnesium
I will discuss each of these separately.
Ferrasorb (see Is Steak the Answer?)
Vitamin D
After I moved from California to Minnesota in 2006, I learned at an annual exam I had extremely low vitamin D, so I began taking vitamin D annually October - April. Rasa and I discussed vitamin D at our second session and that I should check my levels at the end of winter and adjust if necessary. I was taking 2000u daily.
When I started taking Omega 3 with vitamin D (see below), I cut down my vitamin D pills. But in my bloodwork this Summer, Rasa noticed my vitamin D levels had gone down, she said above 50 was optimal. I looked back at my results and saw my levels had gone down almost in half! They had been between 54-60 consistently. When I started taking Omega 3, I went down from taking a 2000u vitamin D tablet to a 1000u tablet because the Omega 3 has 1000u in two tablets. So I stepped the vitamin D back up to 2000u daily (in addition to the Omega 3 with vitamin D). I will have new bloodwork done this winter and see the impact of the additional units.
I looked back at a menopause class I took earlier this year and the nutritionist in that class also recommended levels from 50-80 (More on that class in a separate post).
Omega 3
In our fourth session Rasa and I discussed Omega 3. Rasa told me that Omega 3 provides a fatty acid our bodies need, and it also helps with inflammation and muscle soreness. She also told me I could have my levels tested if I wanted to and shared this article with me. After this session I ordered the Omega 3 she recommended and have been taking two a day ever since (per her recommendation).
Not surprisingly, I have since learned a lot about the benefits of Omega 3 supplementation in the menopause podcasts I have listened to (Heather Hirsch and Hit Play Not Pause), as well as the menopause class I took.
Magnesium
I had been sleeping pretty poorly starting in my mid-40s, not knowing I was in Perimenopause and that it was a common symptom (I attributed it to work stress). I was really not sleeping well when I started working with Rasa and she recommended taking Magnesium for that, as well as its other benefits. The Magnesium she suggested was not in stock at the time, so she said it would be okay to take this one (I never did switch to the powder and have been taking the pill ever since). I instantly noticed an improvement in my sleep.
I realized about a year after starting to take Magnesium that I was only taking one pill, which is 135 mg, and nowhere close to the 400 mg Rasa had suggested. When I realized that earlier this year, I moved up to a second pill, so am up to 270 mg. I realized later the pill recommendation for what I am taking is 1-3x/day. I take the Magnesium pills before bedtime with other pills, so moving up to 3 pills at a time seems like a lot, but I am committed to getting there. My goal is still to get closer to the 400 mg by either taking another pill or switching over to the powder.
Not surprisingly, I have learned in the same podcasts linked above, and in my menopause class, that magnesium is very important.
Supplement Certification
I learned from Rasa’s recommendations, and later menopause educational sources, that it is extremely important to take supplements that are 3rd Party certified; it is a flooded market without much regulation, so if you want to take an effective and tested supplement you should be sure it has had adequate certification. I look for ‘NSF Certified for Sport’, Thorne has an info page about it). When I learned about the importance of 3rd Party certification, I switched my vitamin D to Thorne (I had previously been buying it at Whole Foods which I noted did not have any information about 3rd party certification).
Is it Worth the Money?
Supplementation Cost
When you are trying to get the MPT under control and start learning about the things you need to do for yourself, it can add up quickly! I’ll put together a story eventually on the cost of MPT, but for now as it relates to supplements, they are a new expense I definitely did not have before. As I said earlier, because I need these supplements and am unlikely to get them through my diet I consider the cost both part of my medical expenses as well as my grocery bill.
The downsides of not taking the supplements I am taking I feel are personally too great for me based on evidential research I have read and been educated by. And if there is one thing I want to do for the next phase of my life, it is give my body what it needs so I can enjoy doing the things I want to do ~ like cycling. And thanks to cycling, I sought out a nutritionist who helped educate me on how I could give my body what it needed. I owe so much of my journey to cycling.
Nutritionist Cost
I bought a 6 visit package from Rasa which was $100/visit. Any unused visits were refundable, but I used them all. Each visit was 45 minutes. We have a high deductible insurance plan, so I had to pay out of pocket. But your insurance may cover an expense like this. I feel that paying the fee was worth it for Rasa, for her time and her knowledge and guidance.
I plan to continue to work with Rasa on at least an annual basis to stay on top of the inevitable changes I will go through and to make sure I stay on top of my iron deficiency. Because having a nutritionist is another expense, it can be hard to include in your budget when you have a lot of other expenses going on (for me it has been many things related to building a cabin). But I do believe the cost is a worthwhile investment. Unfortunately this year I have not been able to budget for the expense; I am hoping after my next round of bloodwork we can touch base (which will be a session I have to pay for).
Would I pay for a nutritionist again after taking the menopause class and having access to a nutritionist in that class? I would because I was having specific issues I needed help with. I learned a lot in my class that I had already learned from Rasa so it was great to have the generalized information for navigating the MPT for sure. But if I was going through the other specific challenges like I was, I would definitely work with a nutritionist to deal with my challenges.
Where your doctor fits in
What I learned is that although my doctors (I have had two during this process) may not initiate bloodwork, if you have a good nutritionist working with you requesting bloodwork and advising what testing to have done, your doctor will work with you and send in the requests for you. And it should be a three-way conversation once you get the results, talk to your nutritionist, but also make sure your doctor knows what is going on with you and what your nutritionist is advising. My new doctor has been great with having an ongoing conversation with me and sending in the tests I request, keeping a record in my files, and keeping an eye on the results and offering feedback. In my experience, as with so many things ~ you do need to be your own best advocate. No one knows your body like you do. Your doctor is relying on you to be in tune with your body and also having conversations with your nutritionist if you are monitoring specific things ~ like I was with my iron deficiency.
That said, when I switched to a new doctor in 2023 I felt like I had another partner on my team who was paying more attention, and who understood the complexities of what is going on with my body and what I am looking for in my results. My new doctor and I were able to have a conversation about what tests I wanted, what she might want to add, etc. Meanwhile, my nutritionist and I would discuss the results and targets and next steps.
Do not discount the importance of the doctor in the conversation. Before I switched doctors, my previous doctor was very open to sending in tests and letting me tell her what was going on, but I didn’t really feel like she was helping me to monitor what was going on (for example getting told by her nurse that first time that my ferritin results were ‘within range’). I didn’t really feel like my doctor had my back or was paying attention. With my new doctor I know she is part of the ‘team’ and keeping track with me and is likely to catch some red flags if I happen to miss them. My new doctor has also put in additional testing for me she felt I needed with my bloodwork, and made suggestions we discuss, which makes me feel like she is there for me. I will be writing about my new doctor as part of my MPT Team in an upcoming story.
Conclusion
At first I found working with Rasa challenging because I am an ‘A’ student who always looks for the ‘answer’. I like a recipe laid out in front of me to get to an end result (that is ideally perfect). Rasa’s approach seemed open-ended and organic and I couldn’t see a clear path I was on and what ‘final result’ I was going to achieve; that was hard for me to wrap my brain around. But I have come to understand that that is exactly the right approach.
Subsequently my menopause course made everything Rasa said ‘click’ at a higher level. I was lucky to be exposed to another great sports nutritionist, Dina Griffin, whose knowledge sharing reinforced what an amazing resource I have in Rasa, and had at exactly the right time. Rasa helped open my mind, taught me to better feed my body, helped me understand sometimes the body needs a bit of help (supplements), and that nothing will ever be static. As Rasa said, “inevitably our bodies will change’. I know now that to expect a ‘fix’ is not the right mindset; to find aids to help you through the twist and turns and be open to adjustments is a better way to think.
Rasa gave me number of good nuggets:
“Trust your body.”
“What you are experiencing is a very normal experience, a very human experience.”
“Keep it simple.”
“You don’t have to be perfect.” “It is okay to be a C student. C work means making mistakes.”
“Everybody is an athlete regardless of what level you are doing.”
“Restriction can increase midsection.” Rasa talked a lot about body trust and acceptance, which didn’t always feel at the time like it was an issue for me. But MPT body change has happened to me and it can be a huge challenge to ‘accept’. That’s a much bigger topic that I will be discussing in another story.
In June of 2023 everything Rasa had taught me started to sink in and this is what I emailed her:
My perspective is you have nailed it on every single thing over the last year.
My iron was/is low.
I do have LEA.
I do need to think about dialing back exercise and diversifying because it seems this year I have over trained.
I do need to eat more.
All of it - you are right. I think it just took me a year to absorb all that, and understand it.
You are also right - this will be an ever changing landscape since the body is not static. I have admitted that to myself now :p.
Thanks for being so smart and supportive!
Rasa’s reply:
So much goodness in this email. I am happy to support you and provide space for you [to] find your journey.
I am very proud of you.