CR affect on menstruation and amenorrhea?

[kelseymillia]

Hello!

 

I am a woman of reproductive age and am interested in the idea of CR. I am looking for information on how this affects the hormonal profile and function, and whether it causes amenorrhea, and if so, whether this is by default a bad thing. Most of the information on amenorrhea I can find tends to refer to anorexic or overly athletic individuals and classifies this as a non-desirable or pathological occurrence. However, I have read before that having fewer periods and lower levels of female hormones can have a protective effect against cancers.

 

If I go on a CR diet, will I be at risk of losing my periods, and is this dangerous to my health if so? What is the experience of other CR women, and have their been tests or studies on this particular topic?

 

Any help pointing me in the direction of resources on this topic would be greatly appreciated.

 

Thank you!

[Dean Pomerleau]

Hi Kelsey - Welcome to the CR Society Forums!

 

I don't feel qualified to speak to the issue of amenorrhea, and I'm sorry to see you haven't got a response yet. I reached out to several women CR practitioners hoping they'd respond, but apparently they haven't had a chance to yet. This thread has the only mention of amenorrhea that I could find on these forums, and it isn't especially helpful for the questions you pose. 

 

From my understanding of CR's effects on hormones, it is definitely possible that serious CR (and the associated low body weight) could result in amenorrhea, although I'm hoping to hear more from women who're actually practicing CR about their real-life experience. Regarding studies, there have been several studies of the health effects of amenorrhea in both female anorexics and athletes. They paint a rather negative picture with respect to bone health [1] in particular. While [2] suggests fracture risk may be increased by anorexia-induced amenorrhea, study [3] of (alas mostly male) CR practitioners (as opposed to anorexics) show our bones are lighter, but perhaps of good (better?) quality, and therefore not more prone to fractures. Here is a post about bone health and CR that you might be interested in.

 

On the plus side, it appears from [4] that anorexic, amenorrheic women may be at a lower risk for breast cancer (but not other cancer types), likely due to reduced exposure to female sex hormones. Below is the table of cancer risks from a large cohort of anorexic women (and men!) from the full text of [4].

 

I hope this helps on the scholarly side. As I said, perhaps some women CRers may chime in about personal experiences in this regard.

 

--Dean

 

 

 

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[1] Int J Adolesc Med Health. 2002 Oct-Dec;14(4):297-306.

Correlates of low bone density in females with anorexia nervosa.

Schneider M(1), Fisher M, Weinerman S, Lesser M.

Author information:
(1)Division of Adolescent Medicine, Department of Pediatrics, North Shore
University Hospital, New York University School of Medicine, Manhasset, New York,
USA. MarcieS@greenhosp.org

The objectives were to delineate those factors which correlate with low bone
density in patients with anorexia nervosa and in turn to predict those at
greatest risk for osteopenia.DESIGN: Bone density was evaluated by dual energy
x-ray absorptiometry in 28 postmenarchal females with anorexia nervosa who had
never received hormonal therapy. Bone density results were correlated with
specific historical and physical factors utilizing descriptive statistics,
scatter plots, and the Spearman correlation coefficient.
RESULTS: Mean age was 18.6 years, mean age at menarche was 12.9 yrs, mean length
of illness was 19.8 months and mean duration of amenorrhea was 13.4 months. Mean
% ideal body weight was 84% at the time of bone density, 75% at minimum weight
and 100% at maximum weight. Mean lumbar spine bone density was -1.69 standard
deviations from the norm; mean lateral spine bone density was -1.45 standard
deviations from the norm; mean femoral neck of the hip bone density was -1.18
standard deviations from the norm. There was a strong negative correlation
between duration of amenorrhea and bone density at the lumbar spine (r = -0.50, p
< .01) and a mild correlation at the lateral spine (r = -0.49, p < 0.05) and
femoral neck (r = -0.41, p < 0.05). There was also a strong negative correlation
between length of illness and bone density at the lumbar spine (r = -0.53, p <
0.01) and lateral spine (r = -0.77, p < 0.0001), and a mild correlation with the
femoral neck (r = -0.48, p < 0.05). Scatter plots of lumbar bone density versus
duration of amenorrhea, and versus length of illness clearly showed not only that
longer duration of amenorrhea and longer length illness correlated to bone loss,
but also strikingly that within a short time of being ill and amenorrheic,
significant bone loss was seen. Age, and age at menarche correlated mildly with
osteopenia at the lateral spine; age correlated mildly with osteopenia at the
femoral neck as well. There was a trend for minimum BMI to correlate with
osteopenia at the lateral spine. There were no correlations of bone density with
% IBW at bone density, minimum % IBW, maximum % IBW, change in % IBW, BMI at the
time of the bone density, maximum BMI or change in BMI.
CONCLUSIONS: Low bone density, especially in the lumbar spine, correlated with
both a longer duration of amenorrhea and longer length of illness, but not with
other factors, in our patients with anorexia nervosa. As many of these patients,
even those with a short duration of illness and amenorrhea, were osteopenic, it
is advisable to continue to perform bone density studies in all patients with
anorexia nervosa, on both a clinical and research basis.

PMID: 12617062

 

 

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[2] Rev Rhum Engl Ed. 1996 Mar;63(3):201-6.

 

Osteoporotic fractures revealing anorexia nervosa in five females.

 

Maugars Y(1), Berthelot JM, Lalande S, Charlier C, Prost A.

 

Author information: 

(1)Rheumatology Department, Nantes Teaching Hospital, France.

 

Anorexia nervosa affects 0.5% to 1% of female adolescents. The course is chronic 

in 50% of cases, causing substantial bone loss with osteoporotic fractures after 

a few years of amenorrhea. This is probably an underestimated problem. The

diagnosis of anorexia nervosa is readily missed, as illustrated by five cases

reported herein. The five patients were females aged 17 to 44 years who were only

slightly underweight (mean weight, 43.6 kg; body mass index < 20 kg/m2). The

first fracture occurred seven to 24 years after the onset of anorexia nervosa.

Three patients had vertebral crush fractures, and two had peripheral

insufficiency fractures. Bone mineral density measured by absorptiometry was very

low (mean lumbar z-score, -3.7 SD). Three patients, who were all members of

health care professions, knew that they had anorexia nervosa but failed to report

this condition. In the other two patients, the amenorrhea had been mistakenly

ascribed to other causes (Stein-Leventhal syndrome and psychogenic anovulation). 

None of the patients was receiving medical follow-up. Anorexia nervosa should be 

considered routinely in women who are slightly underweight. The patients often

deny abnormal menstruation or eating behaviors. The diagnosis rests on

determination of the body mass index, a thorough history emphasizing current and 

past gonadal dysfunction, and evaluation of the diagnostic criteria for anorexia 

nervosa. Osteoporosis is probably a common but underestimated complication of

anorexia nervosa, particularly before the menopause. Enhanced awareness of this

condition should allow earlier detection of a greater number of cases.

 

PMID: 8731238

 

--------------------

[3] Aging Cell. 2011 Feb;10(1):96-102. doi: 10.1111/j.1474-9726.2010.00643.x. Epub

2010 Nov 15.

 

Reduced bone mineral density is not associated with significantly reduced bone

quality in men and women practicing long-term calorie restriction with adequate

nutrition.

 

Villareal DT(1), Kotyk JJ, Armamento-Villareal RC, Kenguva V, Seaman P, Shahar A,

Wald MJ, Kleerekoper M, Fontana L.

 

Author information:

(1)Division of Geriatrics and Nutritional Science, Washington University School

of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.

 

Calorie restriction (CR) reduces bone quantity but not bone quality in rodents.

Nothing is known regarding the long-term effects of CR with adequate intake of

vitamin and minerals on bone quantity and quality in middle-aged lean

individuals. In this study, we evaluated body composition, bone mineral density

(BMD), and serum markers of bone turnover and inflammation in 32 volunteers who

had been eating a CR diet (approximately 35% less calories than controls) for an

average of 6.8 ± 5.2 years (mean age 52.7 ± 10.3 years) and 32 age- and

sex-matched sedentary controls eating Western diets (WD). In a subgroup of 10 CR

and 10 WD volunteers, we also measured trabecular bone (TB) microarchitecture of

the distal radius using high-resolution magnetic resonance imaging. We found that

the CR volunteers had significantly lower body mass index than the WD volunteers

(18.9 ± 1.2 vs. 26.5 ± 2.2 kg m(-2) ; P = 0.0001). BMD of the lumbar spine (0.870

± 0.11 vs. 1.138 ± 0.12 g cm(-2) , P = 0.0001) and hip (0.806 ± 0.12 vs. 1.047 ±

0.12 g cm(-2) , P = 0.0001) was also lower in the CR than in the WD group. Serum

C-terminal telopeptide and bone-specific alkaline phosphatase concentration were

similar between groups, while serum C-reactive protein (0.19 ± 0.26 vs. 1.46 ±

1.56 mg L(-1) , P = 0.0001) was lower in the CR group. Trabecular bone

microarchitecture parameters such as the erosion index (0.916 ± 0.087 vs. 0.877 ±

0.088; P = 0.739) and surface-to-curve ratio (10.3 ± 1.4 vs. 12.1 ± 2.1, P =

0.440) were not significantly different between groups. These findings suggest

that markedly reduced BMD is not associated with significantly reduced bone

quality in middle-aged men and women practicing long-term calorie restriction

with adequate nutrition.

 

PMCID: PMC3607368

PMID: 20969721

 

 

--------------------

 

 

[4] PLoS One. 2015 May 22;10(5):e0128018. doi: 10.1371/journal.pone.0128018.

eCollection 2015.

Cancer Incidence among Patients with Anorexia Nervosa from Sweden, Denmark and
Finland.

Mellemkjaer L(1), Papadopoulos FC(2), Pukkala E(3), Ekbom A(4), Gissler M(5),
Christensen J(6), Olsen JH(7).

Author information:
(1)Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen,
Denmark. (2)Department of Neuroscience, Psychiatry, Uppsala University, Uppsala
University Hospital, Uppsala, Sweden. (3)Finnish Cancer Registry, Institute for
Statistical and Epidemiological Cancer Research, Helsinki, Finland; School of
Health Sciences, University of Tampere, Tampere, Finland. (4)Clinical
Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital,
Karolinska Institutet, Stockholm, Sweden. (5)National Institute for Health and
Welfare, Helsinki, Finland. (6)Statistics, Bioinformatics and Registry, Danish
Cancer Society Research Center, Copenhagen, Denmark. (7)Research Management,
Danish Cancer Society Research Center, Copenhagen, Denmark.

 

Free full text: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0128018

 

A diet with restricted energy content reduces the occurrence of cancer in animal
experiments. It is not known if the underlying mechanism also exists in human
beings. To determine whether cancer incidence is reduced among patients with
anorexia nervosa who tend to have a low intake of energy, we carried out a
retrospective cohort study of 22 654 women and 1678 men diagnosed with anorexia
nervosa at ages 10-50 years during 1968-2010 according to National Hospital
Registers in Sweden, Denmark and Finland. The comparison group consisted of
randomly selected persons from population registers who were similar to the
anorexia nervosa patients in respect to sex, year of birth and place of
residence. Patients and population comparisons were followed for cancer by
linkage to Cancer Registries. Incidence rate ratios (IRR) were estimated using
Poisson models. In total, 366 cases of cancer (excluding non-melanoma skin
cancer) were seen among women with anorexia nervosa, and the IRR for all cancer
sites was 0.97 (95% CI = 0.87-1.08) adjusted for age, parity and age at first
child. There were 76 breast cancers corresponding to an adjusted IRR of 0.61 (95%
CI = 0.49-0.77). Significantly increased IRRs were observed for esophageal, lung,
and liver cancer. Among men with anorexia nervosa, there were 23 cases of cancer
(age-adjusted IRR = 1.08; 95% CI = 0.71-1.66). There seems to be no general
reduction in cancer occurrence among patients with anorexia nervosa, giving
little support to the energy restriction hypothesis.

PMCID: PMC4441362
PMID: 26000630

[LizC]

Hi, Kelsey-- I'm a woman but at 62 I'm post-menopausal, so I didn't feel qualified to chime in. Menopause was induced abruptly by chemotherapy for lymphoma when I was 53. I had been officially practicing CR for 5+ years before that though, and unofficially most of my life by "dieting." I never experienced amenorrhea but I kept my body fat around 17% and never dropped below that. My overall health is excellent now, but I definitely noticed rapid and dramatic aging of my skin following menopause. I've noticed a similar effect in younger anorexic women I've worked with, the loss of estrogen is hard on the skin.

[kelseymillia]

Thanks for the excellent resources Dean. I appreciate that information! It is very helpful! I am naturally very concerned about bone health, and I am glad to see what has been found about it.

 

Thanks for chiming in Liz. I am glad to know that you had 5 years of CR without amenorrhea. 17% seems like a good body fat % and I am glad that the hormonal cycles were not affected at that level.

[HillCindy]

Thank you for sharing such useful ideas. It is really good to read such new concept.