Dear Sue:

My wife is training to gain a bit of weight (she's 5'7" and 113 lbs) In the past she's missed repeated periods apparently because of thinness, but she's had them steadily now for a year. There is also a very high incidence of breast cancer in her family so we're trying to stay on very low fat "Mediterranean" diet, which is nice for me because I'm losing weight, but hard on her, because she's losing a bit too. Any ideas or suggestions? Thanks!
--Mike

Dear Mike:

Lack of periods, or irregular periods in women is due more to level of body fat than it is to weight, although thin women tend to have lower levels of fat. Two thin women of equal weight may have very different percentages of body fat. Body fat levels of less than 15-20% may trigger amenorrhea and increase the risk of premature bone loss and stress fracture. Your wife should get her body fat level checked. If she falls into to below that range she needs to work slowly to increase her weight, probably in the form of body fat. It may be that a less strenuous weight training and exercise program is needed with a simultaneous increase in calories (mainly in the form of carbohydrates).

Increasing her level of body fat slightly to ensure normal menses by eating more low-fat foods should help her keep down her dietary risk of breast cancer.

If your wife does not wish to decrease her training, she will need to make a concerted effort to take in enough calories to match her energy expenditure and add weight. It sounds like your wife is a "hard gainer," in that she has difficulty putting on extra weight. Her metabolism may be adjusting itself to maintain a predetermined genetic weight. Is the rest of her family tall and thin? If so, she may be facing an uphill battle. Regardless of obstacles, the best way to put on weight is by consistently eating larger than normal portions at meals, and including two to three substantial snacks throughout the day.

Here are some tips that may help:

• It may be easiest if she eats frequently throughout the day -- stashing snacks wherever she goes, in the car, desk at work, gym bag, etc. She should have a bedtime snack.
• She should eat calorically dense foods. E.g., a low fat granola for breakfast over puffed rice. Other good ones are wheat chex, grape nuts and raisin bran.
• Top the cereal with walnuts (they contain healthy fats), raisins or bananas.
• Drink juice instead of water for thirst.
• Eat lots of dried fruits, which are small in size but high in calories. Fig bars, and other dried cereal bars are dense snacks foods.
• Instead of plain milk, have chocolate milk (made with fat free syrup), or drink non-fat hot chocolate instead of tea or coffee.
• Eat larger portions.
• Choose the heartier soups like split pea over thinner broth types like vegetable.
• Eat salmon, a fish high in healthy fats.
• Find ways to add calories to foods, e.g. put dried skim milk powder into homemade muffins, add grated non-fat cheese to baked potatoes, make hot cereal with milk instead of water and add some maple syrup.
• Have a glass of wine with dinner to increase appetite and add calories.

In sum, your wife needs to increase her calories over her energy expenditure in order to add body fat, which is important to guarantee proper hormone balance and regular periods. You did not mention if you have children, or are planning for any, but if you are hoping to have children in the future, achieving and maintaining a proper body fat level will be necessary for conception and a healthy pregnancy as well.

Lots of luck to you both!

Sincerely,
Sue Gilbert