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The HA recovery diet: How to eat to get your period back

If you have read my posts in the period recovery series on Why has my period stopped and how do I get it back? and What is Hypothalamic Amenorrhea? you will know that chronic or restrictive dieting is one of the major reasons for missing periods.  So what is the perfect HA recovery diet? What should you eat to get your period back if it has gone awry? In my previous posts I stated that good food and lots of it is the way to go. In this article I want to give a few more tips on exactly how to eat to get your period back.

Just a quick note before we start, I am a qualified Nutritionist, Yoga teacher and Women’s Wellness Coach. My specialty is helping women to balance their hormones and heal their body and metabolism after chronic or restrictive dieting (see My Certifications page for further details). The information shared here is a combination of my nutrition and health education, my personal experience with getting my period back after 8 years of Hypothalamic Amenorrhea. I also learned a lot from the research of Dr Nicola Rinaldi, author of No Period Now What. If you are looking for guidance, support and accountability on your HA recovery journey, please contact me or check out the holistic health coaching packages I offer. 

Now, on with the article!

How much should I eat to recover my period? How many calories in the HA recovery diet?

It is recommended to eat 2500 calories or more to recover from Hypothalamic Amenorrhea. Yes, even if you aren’t exercising 2500 calories is the minimum for HA recovery diet. Your body needs to be in an energy surplus right now. This means you need to take in more energy than you are burning through being alive. Plus extra calories for any physical activities you do and to support your body to heal. If you have dieted for a long time, your body has a whole list of things waiting to repair. I don’t just mean your hormones, this energy will also go towards building healthy bones, teeth, hair and nails just to name a few!

I will stress though that this is a minimum and if you are hungry for more than this then you should listen to your body and eat. When I first started following a HA recovery diet I spent a good few months eating at least 3000-4000 calories a day. Sometimes way more than that. Because that was what my body needed and asked for. Did I gain weight? Yes! I gained 20lbs in the first 4 months of recovery. But again, that was what what my body needed to heal my hormones and restore my menstrual cycle. Over time my appetite settled down. However, even now I rarely eat below 2000 calories and I have maintained a healthy period for nearly 5 years.

I don’t recommend counting calories long term but it can be a good idea in the beginning to get an idea of how much you need to eat. Especially if you have been under-eating for a long time, you will need to recalibrate your idea of a normal quantity of food.

What should I eat to fix my period? What is the perfect HA recovery diet?

When you start recovery, it matters less where these calories are coming from. When you are in a serious energy deficit, it is the calories and macro-nutrients that are most important. As a nutritionist of course I am all about eating well and getting plenty of micro-nutrients into your diet. However, this is something that should be done over the long term. What you do for a few months of recovery is less important. You can choose to re-feed with only “healthy foods” or you can choose to add in more “fun foods”.

Consume a good variety of foods from the different groups and eat enough calories and you will be fine. If you are concerned about nutrient deficiencies, you can work with a nutritionist or dietician. They will help you to check your levels and ensure your HA recovery diet is appropriate to restore balance. My recommendation is to get plenty of nutritious food into your body without obsessing over having a perfectly healthy diet. Make sure you eat foods that taste good and bring you pleasure. If you are going to eat lots of food and gain weight you might as well let go and enjoy it! 

(edit – see my more recent post on the best foods to eat to raise your metabolism and heal your hormones!)

Will eating more fats bring my period back? What about carbs? What is the best macro ratio for HA recovery?

The first question women often ask is do I need to eat more fat to get my period back. The answer here is maybe! Check what you are eating right now. Are you following a low-fat diet? Our bodies need  fats to function optimally and produce hormones so eating more fats could be exactly what you need. The HA recovery diet is definitely not a low-fat diet. Your body needs fats to produce hormones and to protect your nervous system.

On the other hand, the HA recovery diet is also not a high-fat low-carb diet. If you are following a high-fat paleo or keto style diet, adding more carbs may be the answer. Restrictive carbohydrates can lead to hormonal imbalance and missing periods. When you eat a low carb diet, your stress hormone levels are elevated and your body enters a survival state where it can rely on fat for fuel. Eating carbs produces an insulin response which helps our bodies feel safe that there is plenty of food around. This sends the signal to your hypothalamus that it can come out of energy-saving mode.

I fully agree that special diets can be therapeutic for overcoming certain diseases. Metabolically healthy healthy people might also experience benefits when experimenting with restricted diets. However, if you have lost your period, this is a major sign that you are not a healthy person right now. So in short, no, there is no specific HA recovery diet or macro-nutrient ratio to follow. Just make sure you are getting plenty of carbs, proteins and fats and listen to your cravings.  Trust that your body knows exactly what it needs and don’t be afraid to go with the flow.

What about liquids? How much water should I drink?

On that note, I want to talk about water consumption. Many of us fell for the myth that you need to drink lots of water to be healthy. We also listened to the same people who told us to eat less salt to be healthy. For many of us with a perfectionist, all or nothing mindset we took this too far and drank several litres of water per day and ate hardly any salt. This is a recipe for disaster! You need salt to maintain a healthy water balance in your body. Drinking too much water flushes out electrolytes leaving you feeling cold, dizzy and “washed out”.

If you have been doing this, I recommend experimenting with reducing the amount of water you are drinking and increasing your salt consumption. This is something I only learned way after my period recovery journey but it has been extremely beneficial for my overall health. I learned this from reading book Eat for Heat, a book written by Matt Stone, an expert on raising metabolism. He describes a symptom of restrictive dieting that I experienced myself. In particular, needing to pee all of the time as well as a low body temperature and cold extremities.

Especially at the beginning of recovery, or if you are feeling very cold, replace all zero calorie drinks including water and diet soda with things like milk, juice, smoothies or even sports drinks containing electrolytes and glucose. Your body actually needs salts to properly absorb the water which explains why plain water often feels like it goes straight through you. You can even add a pinch of salt to every glass if you are really struggling with hydration. If you notice yourself peeing less frequently, feeling warmer, especially your fingers and toes, and sleeping better then you know you are on the right track to recovery.

Does it matter when I eat during recovery? Can I get my period back whilst intermittent fasting?

There is also is the question of when to eat? Again, there is no strict rule on this but consistency is key. You can eat 3 square meals or you can graze throughout the day. As long as you are getting in plenty of calories it doesn’t matter how you do it. The trick is to not let yourself get too hungry as low blood sugar is perceived as a stress by the body. If you are getting cranky, anxious or panicky before your next meal you have probably left it too long. The solution is to add an extra snack before you get to that point. Often 3 meals with 3 snacks is recommended as a good eating structure. If you have no clue then this can be a good place to start.

One thing I don’t recommend as part of a HA recovery diet is intermittent fasting. Again, there is some research showing fasting to have lots of health benefits but it is really not a good idea when you are trying to get your period back. If you want to practice intermittent fasting I would suggest to do no more than 12 hours fasting e.g. 7am to 7pm eating window. This gives your digestive system a break to heal and repair but doesn’t leave you going for long periods during the day without food. Personally I got really hungry at night during my recovery. Sometimes I would wake up during the night starving and need to eat. It really depends on where you are coming from, how long and how intensely you have been dieting. So, do what you need to and don’t set any rules as really anything goes.

Can I get my period back on a vegan or vegetarian diet? What about gluten-free?

Another question women ask is if it is possible to recover on specific diets such as vegan or vegetarian, gluten-free. The answer to this is yes it is possible! However, I would recommend to examine why you are following this diet. If it is a way for you to continue to restrict then maybe it is time to reconsider. I personally recovered my period on a vegan diet but later decided to incorporate animal products back into my diet. I realised that this was still a way for me to control my food intake and keep my eating disorder alive.

If you are following a particular diet for ethical reasons or due to a health condition then this is fine. But make sure you allow yourself to eat plenty of food and do not restrict any macro-nutrients. Find suitable alternatives for foods that are off-limits so that you don’t feel deprived mentally.

(edit – see my recent post about can you get your period back following a vegan diet?)

What if my diet is limited by digestive issues? Can I still get my period back on a restricted diet?

If you are avoiding certain foods due to digestive issues, it is for you to decide whether you want to include them in your recovery diet. If you have allergies or intolerances then by all means stay clear of foods you are sensitive to. However, I will say that many people on restrictive diets find that they develop food sensitivities over time and end up eliminating more and more foods from their diet. This is a sign of your digestive system shutting down rather than of food sensitivities. It is a signal to increase the quantity and variety of foods in your diet not to continue to restrict further.

Personally after following a high fruit vegan diet for over a year, I struggled with stomach pain, bloating and gas. This happened when I added grains and legumes back into my diet and it was an uncomfortable phase to pass. Funnily enough, this didn’t happen with animal products, despite my fear that dairy and meat were toxic and difficult to digest. Unfortunately it takes time for our stomach acid, digestive enzymes and gut microbiome to re-establish. After a period of restriction it can take a while to settle out.

Again, this is where eating processed foods comes in handy as they are much easier on your digestive system. Things like crackers or rice cakes with nut butter, jam, molasses or hummus spread on top were a big part of my HA recovery diet in the first few months. I also ate a lot of cookies, cereals and sandwiches and found they digested really well. Later on I drifted back towards a more whole foods diet but still ate these foods on a regular basis. The best thing is to listen to your cravings and experiment freely without judgement or guilt.

Do I have to eat processed food to get my period back?

What I will say is that processed foods are your friend, there is no need to be afraid. Foods such as bread, crackers, pasta, nut butters, milk, cereals and jams are easy to digest in large quantities. Eating these foods will help you to get the calories you need into your body without over-stressing your digestive system. Basically you want to increase the energy density of the food you are eating i.e. more calories per volume. I know this is counter-intuitive to everything you hear in the health world but it is a necessary part of healing your hormones and getting your period back.

The reason that a low calorie-density, whole foods diet is so successful for weight loss is because your body can feel full on fewer calories. This is due to the higher amounts of fibre and water in foods such as fruits, legumes and vegetables. This is great for people who need to lose weight and overcome conditions such as diabetes and heart disease. But again, you are not one of those people. You need to give your body the energy it needs to repair and feel safe again. With this goal in mind, processed foods are extremely helpful.

Something that helped me with adding “fear foods” back into my diet was realising that a healthy system is a robust one. A healthy system can digest and thrive on a wide range of foods. A healthy body is not one that can only function on a very specific, limited list of foods. The aim of the recovery process is to rebuild a healthy metabolism so that your body can function optimally again. A person with a healthy metabolism can consume a lot of food and has energy to live an active fulfilling life. Visualise your recovery, the person you want to be and the life you want to lead. Focus on that every day to help you get through difficult choices!

Over to you…

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