WHOOP Podcast - Listener Questions: Unlocking Women’s Health with Emily Capodilupo

Episode Date: March 27, 2024

As Women’s History Month comes to an end, we wanted to answer your questions around women’s health. Who better do that than WHOOP SVP, Data Science and Research, Emily Capodilupo. Emily answers questions about menstrual cycle physiology (2:05), how to use WHOOP to better understand your cycle (3:55), nutritional habits during your period (4:50), how cycles can impact HRV (6:35), supplements to take during your cycle (8:58), birth control methods (12:12), long-term impacts of birth control (14:45), birth control impacting athletic performance (16:08), preparing the body for pregnancy (21:03), and sleeping tips while pregnant (24:16).Support the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

Hello, folks. Welcome back to the WOOP podcast. We sit down top performers on what the best and the best they're doing to perform at their peak. I'm your host, Will Ahmed, founder and CEO of WOOP, and we're on a mission to unlock human performance. As women's history month comes to an end, we want to answer your questions around women's health. And who better do that than our own SVP of data science and research, Emily Capital Lupo, Emily has a great slate of questions curated by you, the listener, so thank you for sending in all these questions. Reminder, if you're thinking about joining Whoop, you can visit our website, sign up for a 30-day free trial membership. That's Whoop.com. Literally get to try the whole experience for 30 days for free and see if you like it and you can become a member after that or you can return the product. Pretty great. Okay, the Emily Women's Health Q&A includes how to manage and better understand your menstrual cycle in the WOOP app, managing your diet during different phases, supplements to take to help with your performance during your cycle, how birth control

and contraception can impact the body, you may be surprised on how it can affect athletic performance, tips to help prepare the body for pregnancy, safe workouts to do while pregnant, and tips on how to try to get a good night's sleep when pregnant. If you have a question you want to see answered on a future podcast like this one, email us podcastofof.com. Call us 508, 440. 434-9552. Here is Emily Capital Lupo. Hi everybody, I'm Emily Capital Lupo, WOOP of Data Science and Research, and I am coming to you at the end of Women's History Month

to answer questions submitted by you guys. All month long, we've been asking you what your top questions are, specifically as they relate to women's health. And we've put together some of the most interesting ones for this podcast. So without further ado, let's jump into the things that you are curious about. The first set of questions, all related to how your menstrual cycle impacts exercise,

how you should be working out, what happens when you work out, all of those things. So we're going to jump in to some of those. First question came from Irene. She wants to know how she can use whoop to better understand and manage her hormone cycles. I want to back up before I answer this question and talk about some basic physiology. The menstrual cycle has two roughly 14-day phases separated by menstruation. That's the bleeding part, and ovulation, which is when we release an egg. From menstruation to ovulation is the follicular phase, during which time levels of the ovarian hormones, sometimes called the female

reproductive hormones, estrogen, progesterone are relatively low. And then from ovulation, egg release to menstruation is the ludial phase, during which time levels of those same ovarian are relatively high. And as these hormones fluctuate throughout the month, that shows up in our loop data. So what we typically see during the low hormone phase, that follicular phase, we see lower resting heart rates, higher heart rate variability, marginally lower core body temperatures, and improved sleep quality as compared to the lidial phase where we see the higher resting heart rate, also higher respiratory rate, lower heart rate variability, higher core body temperature and then lower quality sleep as well as impaired performance and exercise. So you're

going to see these things reflected in your whoop data. And interestingly, we also see in subjective data from whoop performance. At the end of your workout on a scale one to five, we ask you how you perform during the workout. And what's really interesting to see that people are self-reporting better workouts during the follicular phase than they are during the ludial phase. And so we think about how you can use whoop to better understand and manage your hormone cycles. Irene is a great question. You can look at your own data and see what we call amplitude, right? So the extent to which your follicular phase and your ludial phase look different,

and the more different they are for you, probably the more you want to be paying attention to how your bodies need differ, because if you have a big difference in, say, your average resting heart rate during the follicular phase versus the ludial phase, that means that you are sensitive to these hormones and are going to want to modulate, you know, your training, you're eating, you're sleeping more in response to your menstrual cycle than if you have a smaller difference because you're less sensitive to your menstrual cycle. So you can look at that data on whoop and then decide how much you want to modulate

and exactly what I mean by modulate and the different ways to modulate I'm going to get to as I answer some of these other questions coming up. This brings me to the next question from Ellie who's wondering how her diet should change during her cycle to help with performance. And there's a couple of different ways. And again, different people are going to have different needs and be differently sensitive to the changing hormone levels. But what we generally know is that progesterone is elevated during the luteal phase. That's that second half of your menstrual cycle. And it causes increased catabolism, just a fancy word for breaking things down. It makes it harder for us to build muscle, harder for us to recover from

exercise and it increases our core body temperature. So it makes us sweat more and lose salt. So this has a couple of different implications for how we think about eating. One, you might want to slightly increase your salt intake, especially if you're exercising in heat, you're going to lose salt faster. So you want to hydrate a little bit more and replace those electrolytes. You can do that just sprinkling a little bit more salt on your food before you work out or kind of more in like supplement form, right? You can think about all the different, you know, electrolyte-enhanced sports drinks and things like that. Probably more important during your luteal phase than your follicular phase. Additionally, because we do tend to have more difficulty building muscle and our bodies are

more primed to breaking down, you know, thinking about increasing things like your protein intake to counterbalance that during your luteal phase can be helpful. So during that second half of your menstrual cycle, it's probably marginally more important to be intentional about what you're eating. specifically as it relates to protein and salt intake. So the next question comes from Sabrina, and I touched on this a little bit in answering Irina's question, but she asks why her HRV is impacted during her cycle, and she said that she notices that it drops during her luteal phase,

and this is totally normal. We published a paper a couple of years ago in British Medical Journal, in partnership with Dr. Stacey Sims, who's one of the leading researchers out of New Zealand and studying the impact of menstrual cycle hormones or female reproductive hormones on athletic performance. And we showed that over, I think, it was 14,000 menstrual cycles. This pattern is very strongly observed.

So, you know, Sabrina, you are not alone. Your HRV is going to be higher when you're menstruating and lower during that luteal phase. And it's nothing to worry about. It's not necessarily a bad thing. It's a normal thing. But it is real in that you will physiologically have a lower recovery score. And that's not an artifact or noise in the system. It is actually harder for our bodies to recover. And so what you're seeing is that during your luteal phase, your body is essentially in this mode of like fingers crossed, I'm pregnant. And I'm going to put all these physiological resources behind attempting to support a pregnancy. And so as we shuttle resources to our uterus to support a hopeful pregnancy, those resources become less available for other things like athletic performance or just recovery in general. And then when we menstruate at the end of our luteal phase, it's basically our body is giving up on

being pregnant this cycle. And so they go back into, you know, resources are available for other purposes, such as athletic performance. And so we see that that cycle in HRV is the cycle of, I super hope I'm pregnant, so I'm going to divert resources to pregnancy, and then, oh, no, I'm not pregnant, so I can divert resources elsewhere. And that shows up in a lower HRV during the ludial phase and a higher HRV during the follicular phase. And I should note that I am simplifying things and anthropomorphizing the menstrual cycle quite a lot. Obviously, many people don't have the goal of getting pregnant, but you know, physiologically, the menstrual cycle is about preparing our body monthly for a potential

pregnancy. And we do put a tremendous amount of resources behind that. One last question, which ties into Ellie's question about diet, is a question from Kalin, who's asking about supplements and how she should think about taking supplements throughout her cycle, asking if there's specific minerals or vitamins that are useful in the different phases. This is where I pause and remind everybody that I am not a medical doctor. I'm not your medical doctor. And any decisions to start or stop taking supplements should be made in consultation with the physician who's familiar with your medical history. But that said, there are some nutrient deficiencies that are common in menstruating individuals that can easily be corrected with supplementation. And you can ask your doctor

to confirm these with a simple blood draw in your next visit. So the three that we think about a lot with menstruating individuals. The first one is iron. We can lose a lot of iron when we menstruate, especially if you experience heavy bleeding. One way to know that you might be experiencing low iron, also known as anemia, is you'll have unexplained fatigue, kind of beyond what your sleeping habits would suggest. So you're feeling really tired, but you feel like you're getting a lot of sleep and the sleep quality isn't the problem. This is a really common, really inexpensive test. So one that if you, you know, explain your symptoms to your doctor, especially if you have heavy bleeding, you shouldn't get a lot of pushback on getting your iron levels tested. And it's just good

to know because it's one of those things that, you know, you can take iron supplements and feel better quickly. Another thing you can do that for most people fairly harmless is just think about trying to increase dietary iron. So obviously, you know, things like red meat have a lot of iron, green leafy vegetables, certain beans can have a good amount of iron in them. And so, you know, if you're a heavy bleeder and you don't already have a diet rich in iron and you're experiencing fatigue, those things could be a good sign that it's worth getting your iron levels checked and to consider supplementation or increasing your dietary intake. But again, talk to your doctor. Another one is vitamin D. Vitamin D, we get mostly from the sun. And so especially if you're like me

and you live in Boston where it's cold a lot of the year, you stay inside, and when you are outside, you're pretty covered up. You know, it can be really easy to become vitamin D deficient. We see that menstruating individuals can struggle more than others to keep their vitamin D levels high. Again, it's something you can get from sunlight. We fortify a lot of our dairy with vitamin D, and that's another thing that's fairly easy to get tested in your doctor's office. And then the last one, and this is particularly important for menstruating individuals who exercise quite a lot is magnesium. Magnesium we consume during exercise, and lots and lots of people are magnesium deficient. It's very inexpensive to supplement with magnesium.

And some signs that you might be magnesium deficient are, again, going to be that you have trouble sleeping, trouble staying asleep, despite spending an appropriate amount of time in bed. The next set of questions are all about birth control and how they impact health. So I'm going to assume that when people say birth control and these next couple of questions, they're specifically talking about the hormonal contraceptives. So generally, there's a couple of different kinds of birth control. There are things like abstinence, so just not putting yourself in that situation. There's things like barrier methods, like a condom that physically separates.

prevents the sperm from reaching the egg, spermacize, things like that, that again, just, you know, prevent the sperm from living and therefore fertilizing the egg. But one of the most common, the ones we get the most questions about, and what I assume all of these questions are referring to, are the oral contraceptives. So there's two different kinds of these hormonal birth control. There's progestin only. So there are two primary ovarian hormones. progesterone and estrogen. Progestin is the synthetic form of progesterone. So progestin only has just the one hormone. And then there are hormonal birth control options that have a mixture of progestin, which is synthetic progesterone and estradiol, which is synthetic

estrogen, and use both hormones. So kind of looking at both of those options, Victoria asks if there's any research around different types of birth control and how they impact strain and recovery. And then she also asks if there is a kind that I would recommend. And again, I'm not a doctor, so I'm not going to make any recommendations here. But this is definitely a conversation you're going to want to make with your doctor considering both generally your health, your goals, and also realistically your lifestyle. One of the things that is challenging with what they call the mini pill, which is the progestion only, is that its success is a little bit more picky on you taking it at exactly the same time every day. So if that's not something that

realistically you're going to be able to do, it might be a less good option for you. So make sure to be really realistic with your doctor about what you can and cannot commit to when picking which option is best for you. Some people like this mini pill, the progestin-only option, because it's overall a lower dose. And when taken correctly is equally effective. But it does have those challenges. So you really want to think about what's important to you and what's realistic for you. Nikki asks if birth control is safe and has long-term impact on the body if it's taken for 10-plus years. The good news here is that loads of people have been taking this for decades. Birth control hormonal birth control is not new. Generally, it is believed to be safe and understood to be safe.

but I really do think this is one area where academic and medical literature is failing us or maybe put gentler could do a lot better because most of the studies that are there are noisy or inconclusive. There's some concerns that have been raised around things like impacts to weight, cancer risk, blood pressure, cholesterol levels. They're all mostly rolled out as, you know, small or inconclusive. But, you know, it's good that those things are, you know, if the effects are there, that they're small, that the studies are inconclusive because it means that there aren't

glaring risks that we need to be super concerned with. There isn't really enough research to say that there's no negative effect. And one of the biggest concerns that we have with super extended use of hormonal birth control isn't so much that the drug itself is, dangerous, but that it could mask other problems. So if you, well-on oral contraceptives, stop menstruating, that can often be totally normal and not a sign of anything to be concerned. In fact, some of them are specifically designed to make that happen. And so nobody is nervous. But if you were naturally cycling and you lost your cycle, you know, sort of separate from something like going through menopause or perimenopause, that would be an extremely important.

you know, significant medical change that you would want your PCP to investigate. And so I think one of the biggest concerns that we are aware of is that if you take these medications for years and years and years, you could be hiding, masking some other underlying condition that, you know, cause you to lose your cycle and you wouldn't know. So, you know, if that's a concern that you have, especially if you are very athletic and very lean, it's something you might want to talk to your trainers and your doctors about, you know, if there's a possibility that you're masking one of these other issues. The next question comes from Maria who wants to know if there are any studies that have shown birth control pills impact athletic performance. So I want to back up a little bit

to where we were in that first section when we were talking about the menstrual cycle and how it affects performance because that'll make the answer in this question a little bit more clear. So we know that in a naturally cycling individual, physical performance changes throughout the course of your menstrual cycle due to a couple of different things. We know that progesterone reduces our functional strength and power by inhibiting cortical excitability, which is a fancy way of saying like our, you know, the our ability to fire our nerves and move our muscles. We have this reduced power when pedestrian levels are high. We also know that. in different phases of our menstrual cycle, we respond to fats versus carbs differently.

We're better at burning fat in our leo phase and better at burning carbs during the follicular phase. And we also know that during our menstrual cycle, we see differences in thermoregulation. So during our ludial phase, that second half, we've an elevated body temperature, so we sweat more and we lose salt. We can overcome that by hydrating more and replacing those electrolytes. but it's still real. And then the last thing is that during our ludial phase, we retain more water. And this actually causes us to temporarily be a little bit heavier. It's not weight gain in the normal sense because you haven't gained any fat, but while you're retaining water, you are heavier. And so when you think about how that's going to impact athletic performance when you are

trying to move a larger mass around that's going to slow you down. So birth control, it's kind of sort of like being stuck in your luteal phase. And so when we talk about, you know, what's going on in your follicular versus your luteal phase, it's all those high hormone luteal phase things that you're going to be experiencing. So many people retain water as compared to their pre-birth control water retention levels. They also have a higher poor body temperature. So they're going to sweat more easily. They're going to lose salt more easily. And then again, they're going to have that like reduced strength and reduce power. And so while they're stuck in that luteal phase, which is your, I hate calling it this, but kind of less athletic or less performant phase, it's going to

slightly decrease athletic performance. That said, you know, when you're on these hormones for a really long time, you do adapt to them. And so, you know, if that sort of becomes your normal and, you know, the way you're training, you can certainly adapt and perform at quite a high level. In fact, loads of Olympic and elite athletes are on hormonal birth control and, you know, still incredible performers. So this isn't to say that these effects are, you know, massive, massive, but when you look at a large population, they do appear. And again, like, different individuals are very differently sensitive to these things. So for you as an individual, these could be totally negligible or for you as an individual, these could be significant. You can use your

own data. Think about your performance data, however you measure that. right mile time if you're a runner or something like that and see you know before I started birth control to after did I notice anything as well as looking at loop data you know to see you know was there any change in my metrics when I started or stopped taking birth control so we do believe that there's this marginal decrease in performance but the extent to which that's going to impact any one individual overall tends to be pretty small but the extent to which it's going to impact any specific individual is hard to predict and going to be pretty personalized. The last topic that you all ask questions about was exercise during pregnancy.

Our first question comes from Linda. She wants to know how she can best prepare her body for pregnancy. She's specifically asking about getting off of birth control and preparing to start trying. And if there's any behaviors or supplements, she should be taking to help improve her odds of success and as well as to get herself physiologically ready. It breaks my heart that this is an area where medical research is seriously lacking. There just is not enough research and true facts around what works here. There's a lot of wives tales and anecdotes and survey data, which isn't great. But we do know a couple things. The most important is folic acid, also known as

vitamin B9. So folic acid is really, really important for healthy formation of our neural tube. And most of this is actually happening in those critical first couple of days and weeks before we would even know we're pregnant. So before you actually would get a positive pregnancy test, you've actually been pregnant for a couple weeks and really important things are happening. And if you don't have enough folic acid in your bloodstream when this happens, you can lead to a neural tube deflex, which, you know, can be devastating and tragic. And so if you are actively trying to get pregnant, we definitely would want to think about increasing our folic acid. So you can do this by starting to take a prenatal vitamin, or you can do this by increasing your dietary

folic acid. It's in lots and lots of my favorite foods, including avocados, green leafy vegetables. There's pretty high concentration in eggs for the carnivores out there. is a great source of folic acid, as well as common things like rice and beans. So it's not terribly difficult to get enough in your diet because there are pretty diverse sources of it, but really, really critical to get enough. So, you know, that would be the one that if you are trying, make sure you're getting enough folic acid. There's that really important sneaky period where you're pregnant and you don't know it

and you want to make sure you have enough folic acid during that period. The other thing kind of beyond that is really just making sure. that you're hydrating well, that you're getting a diversity of fruits and vegetables in order to make sure that you're getting all the different vitamins and mineral and nutrients that you need. Again, like really important things happen before you know you're pregnant and those early weeks of pregnancy, even though you won't have a pregnancy test to confirm it, your body's already starting to work really hard and it's not unusual to be a little bit more tired during that time or just to kind of feel a little off.

I thought I had COVID and then turned out I was pregnant, which was way more exciting when having COVID. But that's what it feels like. So just sort of thinking about eating as if you are preparing to do something hard because you aren't going to be doing something hard if you successfully get pregnant and you want to prepare your body for that as best as possible. The next question is from Sarah, concerned about sleeping habits since becoming pregnant. She says that she has a lot of trouble sleeping since she got pregnant and that it impacts her daily routine and then asks if there are any safe tips or supplements to improve sleep while pregnant. So pregnancy sleep is complicated because it's challenging for different reasons at different points in pregnancy. So I don't really want

to talk about pregnancy sleep as one thing. It's a lot of different things. For example, For example, like towards the end of pregnancy, a lot of what makes it difficult is you have this big bump, which makes it hard to get comfy. You might also have a baby that's kicking or sitting on your bladder, which makes you need to pee a lot in the middle of the night. And that's sort of more of a physical obstruction going on. Early in pregnancy, sleep is difficult because your hormones are shifting so much and you need to adapt to these really high levels of changing hormones. and so it's just that sort of balance being thrown off that makes it hard to sleep. The good news is a lot of people somewhere in the middle when they're pregnant enough that they're used to being pregnant, but not so pregnant that they can't get comfortable,

actually sleep really well. To get to the really critical part of Sarah's question about supplements, I really want to caution people to be careful with supplements for sleep during pregnancy. There are very, very few things that have actually been properly tested or tested at all during pregnancy. It's really difficult to do research on pregnant people because they're protected and because we have concerns around consent when we're doing research on an unborn fetus. So, well, most of this research hasn't been done. And so there are lots of complicated concerns around safety. And even things that seem really, really harmless and common can be

dangerous during pregnancy either to you or to your baby. The one that really shocked me when I was pregnant was chamomile tea, which is just like seems like such a safe like nothing of a, you know, we've all been taking this or I had my whole life right, like, oh, you have trouble sleeping, have a cup of chamomile tea. But it turns out that it's actually pretty controversial for pregnancy and there's evidence that suggests it stimulates uterine activity and can reduce blood flow to the fetus. So, you know, when I say, please be careful with supplements, it even things. that you might not really think of as like possibly being dangerous because they're so common or things like that it's better to talk to your doctor before you add anything than to just assume

something is safe for pregnancy because it's generally safe or not pregnancy. So be careful there. If you haven't already, you should consider eliminating caffeine if you're having trouble with sleep. Caffeine used to be this like big, scary off limits thing for pregnancy. New research shows that a cup or two of coffee is most likely fine. If you're not having trouble with sleep during pregnancy and you're enjoying that one cup of coffee, again, talk to your doctor if you're concerned about your specific situation, but it's probably fine. But we do know that pregnancy can change the way that we metabolize different things. And so even if you were totally fine sleeping with one cup of coffee pre-pregnancy, that might actually be a sneaky culprit behind why you're

having trouble sleeping during pregnancy. So I know it's tough because you're probably more tired than before. And so feel like you need the coffee now more than ever. But if you're having trouble sleeping, it might be worth experimenting with at least if not eliminating the caffeine, trying to finish your coffee earlier in the morning. So further away from bedtime and having a smaller cup than what you've been having. The less caffeine you have in your system at bedtime, the easier is going to be to fall asleep. Finally, I think that it's also important to know that while most likely there are minor lifestyle things you can do that are going to help with your sleep, like, you know, getting a pregnancy pillow or eliminating caffeine or, you know, things like that, you should also know that while it's normal to be more tired during pregnancy, it doesn't have to be that way. And if you really feel like you're suffering to the point of your day-to-day being interfered or you can't do the things you want to do, it's really critical to bring that up with your doctor.

I think that a lot of pregnancy symptoms get dismissed, even by well-meaning doctors. You know, they just sort of say like, oh, that's normal. Like, don't worry about it. But you know you better than anybody else. If you're spending enough time in bed, if you kind of feel like you're doing the right things, your diet is good, you have to advocate. for yourself. And so if you feel like you're just getting blown off by your doctor, make sure they really are hearing you, how much it's impacting your day, that you're sort of, you've tried the whole basics, you know, because there could be an underlying cause. And most

of the time, it's not things that are necessarily harmful, but they are, could be underlying clauses that are just making pregnancy less pleasant. So, you know, it is important to advocate for yourself and to bring these things up and not just say that like, oh, we can, because they're common, that there's no way out. Thank you so much to all of our incredible listeners, especially those of you who submitted questions. Happy International Women's Month and Women's History Month to everybody. If you have any questions that we didn't cover on today's episode,

please still feel free to submit them, and we might just answer it on an upcoming podcast. Once again, I'm Emily Capulupo, SUP of Data Science and Research. Thanks so much for listening. Big thank you to Emily for coming on the WOOP podcast, offering amazing insight on women's health. If you enjoyed this episode of the WOOP podcast, please leave a rating or review. Please subscribe to the WOOP podcast. Check us out on social at Woop at Will Ahmed.

If you have a question, you want to see answered on the podcast. Email us, podcastWIP.com. Call us 508-443-4952. If you're thinking about joining Woop, you can visit Woop.com to sign up for a free 30-day trial and take the first step to unlocking your own best. performance. New members can use the code Will W-I-L to get a $60 credit on WOOP accessories when you enter the code at checkout. And that's a wrap, folks. Thank you all for listening. We'll catch you next week on the Blue Podcast. As always, stay healthy and stay in the green.