Nutritional Differences for Women

Until recently, research had not provided us with meaningful differences between the sexes—the big rocks were largely unaffected—and there is still a lot to uncover to fully comprehend the unique nutritional needs of females and males.

Nutritional Differences for Women

By: Jeremy Partl, RD

As a dietitian, I try to focus on the big rocks for most people—those big nutritional issues that form the framework of a person’s diet. The big rocks are things like total caloric intake over nutritional timing, macronutrients over micronutrients, etc. For most people, getting these big rocks in place has the most impact on their goals and allows us to work on the more nuanced, individualized parts of their nutrition. I am consistently asked questions about whether or not there are real and meaningful differences between men’s and women’s nutrition needs.

Until recently, research had not provided us with meaningful differences between the sexes—the big rocks were largely unaffected—and there is still a lot to uncover to fully comprehend the unique nutritional needs of females and males.

This article will highlight some of these differences and provide a practical overview of key physiological and nutritional considerations for the active female. I will also provide some evidence-based recommendations that can be incorporated into women’s daily lives.

The Primary Differentiator

Before puberty, most males and females are physiologically similar. Puberty brings the start of females’ regular menstrual cycles and predictable fluctuations of ovarian hormones (assuming adequate caloric intake).[1]

© BioMed Central Ltd. 2021. From, Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female-specific nutritional strategies: a narrative review. J Int Soc Sports Nutr 18, 27 (2021). https://doi.org/10.1186/s12970-021-00422-8

The start of regular menstrual cycles has a significant impact on metabolism and performance. This may further impact athletic performance, substrate utilization, thermoregulation, fatigability, soreness/recovery, body composition, and bone density:[2]

  • During the follicular phase, fat and protein oxidation decrease while carbohydrate oxidation increases. This tends to flip during the luteal phase when hormones like estradiol help to spare muscle glycogen and promote the oxidation of free fatty acids. Studies support that this may potentially support prolonged exercise during the luteal phase while favoring performance during intense exercise within the follicular phase (related to aerobic events and not strength and power events).[3],[4]
  • Recovery rates may be impaired during the follicular phase, evidenced by the finding of significantly increased “markers of muscle damage (creatine kinase) and inflammation (interleukin-6)” during the follicular phase compared to the mid-luteal phase.[5]
  • Higher core body temperatures, greater cardiovascular strain during submaximal steady-state exercise, and a heightened threshold for the onset of sweating are observed during the luteal phase, potentially making it important to increase fluid intake during that particular phase.[6],[7]
  • With regards to body composition, “men are more susceptible to gaining abdominal fat (android), whereas women usually carry more fat in the hip (gynoid) region.”[8] In addition, data has suggested that women are less likely to lose lean body mass during times of caloric restriction and dieting.[9]
  • Bone mineral density seems to be significantly lower in adult to elderly women compared to men, which may lead to an increased risk of fractures and osteoporosis.[10]

If we even want to think about optimizing nutritional strategies for females, we cannot neglect the significant impact of the menstrual cycle on metabolism and performance.

Nutritional Needs for Women

Basic nutritional requirements and the starting points for overall dietary considerations have been fairly universal, especially without much evidence that suggests that women have different nutritional needs than men. I would still argue that the big rocks of nutrition are, with some slight nuance, very similar between sexes.

Big Rock 1: Total caloric intake

Regardless of training status, one should try to get adequate calories to maintain their weight for a majority of their lifetime in order to support normal physiological processes. It’s often observed that many women tend to do the complete opposite by chronically “under fueling” themselves. In our slim-obsessed culture, women perpetually tend toward perpetual “dieting,” which can result in negative physiological consequences, especially when you factor in hard-training athletes.

Underfueling and not getting enough calories has been observed in both sexes but is a more frequent concern for females.[11] It could be one of the reasons that the “female athlete triad” was recognized as a major issue years before “relative energy deficiency” was developed (to highlight that it is a concern for both sexes). Low energy availability can be a major contributor to impairments in physical performance, increase the risk of osteoporosis, fractures, and other injuries, as well as cause amenorrhea (among many other detrimental health considerations).[12] If you want to read up more on that, make sure to see my article on the dangers of underfueling.

Data suggests a slight variability during the menstrual cycle, with some women experiencing an increase of up to 2.5–11.5% of resting energy needs during the luteal phase.[13]

To determine overall calorie goals, start with reputable formulas like the Mifflin St. Jeor or Harris-Benedict equation to find resting energy needs. Then, factor in activity levels and goals. The above formula can help to find a total caloric intake that aims to maintain weight and support normal physiological processes regardless of training status, activity levels, and goals.

Big Rock 2: Macronutrient Intake

Protein

The current RDA of 0.8 g/kg/day of protein is outdated and only serves to minimize muscle loss for sedentary individuals. When it comes to determining ideal protein targets for the active female trainee, we have to consider a variety of factors.

First are the variations that occur during the menstrual cycle. Elevations in estrogen and progesterone during the luteal phase can increase protein oxidation, especially during exercise, compared to the follicular phase, making it best to err on the side of higher protein intake during this time of the month.[14],[15] It is recommended that female strength and endurance athletes consume a minimum of 1.6 g/kg/day, with additional protein to retain lean mass during dieting phases, and up to about 2.6 g/kg/day if hypertrophy is the main goal.[16],[17]

Protein should be distributed throughout the day in three to five servings of at least 20–30 grams to meet the daily requirement.[18]

Fats

Typical recommendations suggest that females should consume at least 20% of their daily calories, with up to 35% of energy intake coming from fats.[19] In addition to maintaining sex hormone concentrations and absorbing fat-soluble vitamins, adequate fat intake may help to sustain normal menstrual cycles.[20],[21]

There are two female-specific attributes that make fat intake even more important. Research has found that elevated estrogen levels during the luteal phase promote upregulated fat metabolism at this time of the month.[22] -, Additional research has also shown that females exhibit lower RER (representing greater fat oxidation) than males during submaximal endurance exercise.[23]

Thus, it is again essential that fat intake goes no lower than about 15-20% of calorie intake for women, even during dieting phases.

Carbohydrates

Carbohydrate needs typically fall in line with standard nutrition guidelines for most women. I am a fan of setting carbohydrate targets after fat and protein goals are determined. Instead of basing them on 45-65% of total daily intake, I like to recommend that carbohydrate goals make up the remaining calories once protein and fat calories are assigned.

The main consideration for females is that the female body’s capacity to restore muscle glycogen stores is at its peak during the follicular phase of the menstrual cycle.[24] Thus, carbohydrate intake may be slightly higher during this time of the month.

Summary

Below is a figure from a recent paper describing the sex differences and considerations.

© BioMed Central Ltd. 2021. From, Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female-specific nutritional strategies: a narrative review. J Int Soc Sports Nutr 18, 27 (2021). https://doi.org/10.1186/s12970-021-00422-8.

  • This is example assumes a 38-year-old female whose primary goal is weight loss. The researchers used the Harris-Benedict equation to determine her basal metabolic rate and used an activity factor and factored in her goals to overall calorie goals.
  • Because energy expenditure is increased by 2.5–11% in the luteal phase, her caloric estimates were increased by ~5%.
  • The standard potential macronutrient targets were 1.8g/g/kg protein (30%), 30% fat (~ 8 g/kg), with the remaining 40% coming from carbohydrates.
  • Because of increased protein and fat oxidation during the luteal phase (which is often reflected by a desire to eat saltier and sweeter foods), the distribution was altered very slightly to 32% protein, 32% fats, and 36% carbohydrates in the luteal phase.

Potentially Beneficial Supplements

Every time I discuss supplements, I reiterate the same opinion: supplements are not required, and I strongly favor a whole food-focused approach to ensuring nutritional adequacy. At the same time, there are a few supplements that may benefit women in some specific ways.

Creatine

As I touched on in a previous article, creatine is probably one of the most universally recommended supplements regardless of sex or age. It’s notable for improving everything from athletic performance, mental health, bone health, and physical health at nearly any point in life.[25]

The research suggests that males and females store, metabolize, and utilize creatine in a sex-specific manner. Although, because the data is still very inconclusive and not very meaningful, recommendations for creatine intake are similar regardless of sex.[26],[27]

Fish Oil

As an anti-inflammatory supplement, omega-3 rich fatty acids play a role in decreasing the risk of many chronic diseases.[28]For women, the benefits of increased omega-3 fatty acid intake seem to be particularly important for the health of the infant and mother during pregnancy.

It counteracts the symptoms of the female athlete triad and – reduces the risk of symptoms of depression and anxiety.[29],[30]

Again, standard recommendations for omega-3 fatty acid intake remain similar between sexes—1-3 grams per day.[31]

Protein Supplements

For both sexes, protein supplementation can help people meet their protein goals. This benefit may be especially relevant for women during the luteal phase, when protein needs may be slightly higher.[32]

Anecdotally, women tend not to eat as much protein in their daily diets. They may struggle due to overall calorie intake/portion sizes, food preferences, etc. Thus, protein supplementation may help them meet the minimum recommended amount of ~1.6 g/kg/day.

Probiotics

In the past, I have touched on a few of the benefits of the “beneficial” bacteria that line the gastrointestinal tract in a few articles. Summing up briefly: probiotics help regulate immune and digestive function and improve urogenital tract and skin health.[33]

For women, there is potential for probiotics to counter recurring urinary tract infections (UTIs) in some women.[34] Possibly more important, the combination of a probiotic supplement and iron supplement was found to improve iron levels and absorption, which is particularly important for women, who tend to be twice as likely to be anemic than men.[35],[36]

Typical recommendations for probiotic supplements are 10 to 20 billion colony forming units per day of a clinically validated strain of probiotics.[37],[38]

Vitamins and Minerals

With regards to females, the most relevant vitamins are the B vitamins, specifically folate, riboflavin, and B12. In combination with iron, these may help counteract anemia and poor performance due to losses of vitamins and minerals during the menstrual cycle.[39] Those effects could extend to neural defects during pregnancy and other physical health side effects.[40],[41],[42]

Finally, calcium and vitamin D work synergistically to promote bone health, which is particularly important because women tend to develop osteoporosis and osteopenia and tend to suffer fractures at rates two to four times higher than men.[43]

Summary

While the data has been scarce in the past, there is emerging evidence supporting “sex-specific nutritional strategies and recommendations for females, particularly active females,”[44] to optimize health, performance, and body composition.

This is an excellent example of how forthcoming sports nutrition research can further help practitioners who work with high-level clients. When it comes to your general population clients, the magnitude of these differences in dietary recommendations should be considered against making recommendations too complex for overall adherence to the big rock principles of nutrition.


Notes

[1] For those who like science, here is a brief summary of the menstrual cycle from Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female specific nutritional strategies: a narrative review. Journal of the International Society of Sports Nutrition, 18(1), 1-20:

  • A regular menstrual cycle lasts an average of 28 days (ranging from 21 to 45 days), consisting of two main phases: the follicular phase and the luteal phase.
  • The cycle begins with the follicular phase (which lasts ~14 days).
  • At the beginning of the cycle, menstruation occurs and hormones, including estrogen, estradiol, progesterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH) start to come up from their lowest levels.
  • Around the day 4-5 day mark, estrogen and FSH levels rise to prepare the body for ovulation.
  • At the end of the follicular phase, LH spikes and induces ovulation, while estrogen rises and then falls following ovulation.
  • Following ovulation the luteal phase begins.
  • LH and FSH decline and return to baseline levels while progesterone and estrogen levels peak around day 20–24 to prepare the body for pregnancy.

If pregnancy does not occur, hormone levels return to baseline and induce menstruation, signaling the beginning of a new menstrual cycle

[2] Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female specific nutritional strategies: a narrative review. Journal of the International Society of Sports Nutrition, 18(1), 1-20.

[3] Nicklas, B. J., Hackney, A. C., & Sharp, R. L. (1989). The menstrual cycle and exercise: performance, muscle glycogen, and substrate responses. International journal of sports medicine, 10(04), 264-269.

[4] Campbell, S. E., Angus, D. J., & Febbraio, M. A. (2001). Glucose kinetics and exercise performance during phases of the menstrual cycle: effect of glucose ingestion. American Journal of Physiology-Endocrinology And Metabolism, 281(4), E817-E825.

[5] Wohlgemuth, supra (2021) (citing Hackney, A. C., Kallman, A. L., & Ağgön, E. (2019). Female sex hormones and the recovery from exercise: Menstrual cycle phase affects responses. Biomedical human kinetics, 11(1), 87).

[6] Pivarnik, J. M., Marichal, C. J., Spillman, T. H. O. M. A. S., & Morrow Jr, J. R. (1992). Menstrual cycle phase affects temperature regulation during endurance exercise. Journal of Applied Physiology, 72(2), 543-548.

[7] Inoue, Y., Tanaka, Y., Omori, K., Kuwahara, T., Ogura, Y., & Ueda, H. (2005). Sex-and menstrual cycle-related differences in sweating and cutaneous blood flow in response to passive heat exposure. European journal of applied physiology, 94(3), 323-332.

[8] Wohlgemuth, supra (2021) (citing Bredella, M. A. (2017). Sex differences in body composition. Sex and gender factors affecting metabolic homeostasis, diabetes, and obesity, 9-27).

[9] Pearson, A. G., Alexander, L., Witard, O. C., Coughlin, T. E., Tipton, K. D., & Walshe, I. H. (2021). A hypoenergetic diet with decreased protein intake does not reduce lean body mass in trained females. European Journal of Applied Physiology, 121(3), 771-781.

[10] Blunt, B. A., Klauber, M. R., Barrett‐Connor, E. L., & Edelstein, S. L. (1994). Sex differences in bone mineral density in 1653 men and women in the sixth through tenth decades of life: the Rancho Bernardo Study. Journal of Bone and Mineral Research, 9(9), 1333-1338.

[11] Areta, J. L., Taylor, H. L., & Koehler, K. (2020). Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. European Journal of Applied Physiology, 1-21.

[12] Mountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., … & Budgett, R. (2018). International Olympic Committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. International journal of sport nutrition and exercise metabolism, 28(4), 316-331.

[13] Henry, C. J. K., Lightowler, H. J., & Marchini, J. (2003). Intra-individual variation in resting metabolic rate during the menstrual cycle. British Journal of Nutrition, 89(6), 811-817.

[14] Kriengsinyos, W., Wykes, L. J., Goonewardene, L. A., Ball, R. O., & Pencharz, P. B. (2004). Phase of menstrual cycle affects lysine requirement in healthy women. American Journal of Physiology-Endocrinology and Metabolism, 287(3), E489-E496.

[15] Draper, C. F., Duisters, K., Weger, B., Chakrabarti, A., Harms, A. C., Brennan, L., … & Van der Greef, J. (2018). Menstrual cycle rhythmicity: metabolic patterns in healthy women. Scientific reports, 8(1), 1-15.

[16] Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., … & Phillips, S. M. (2018). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British journal of sports medicine, 52(6), 376-384.

[17] Bosse, J. D., & Dixon, B. M. (2012). Dietary protein to maximize resistance training: a review and examination of protein spread and change theories. Journal of the International Society of Sports Nutrition, 9(1), 1-11.

[18] Schoenfeld, B. J., Aragon, A. A., & Krieger, J. W. (2013). The effect of protein timing on muscle strength and hypertrophy: a meta-analysis. Journal of the International Society of Sports Nutrition, 10(1), 1-13.

[19] Dietary Reference Intakes For Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.

[20] Manore, M. M. (2002). Dietary recommendations and athletic menstrual dysfunction. Sports medicine, 32(14), 887-901.

[21] Volek, J. S., Forsythe, C. E., & Kraemer, W. J. (2006). Nutritional aspects of women strength athletes. British Journal of Sports Medicine, 40(9), 742-748.

[22] Isacco, L., Duché, P., & Boisseau, N. (2012). Influence of hormonal status on substrate utilization at rest and during exercise in the female population. Sports Medicine, 42(4), 327-342.

[23] Froberg, K., & Pedersen, P. K. (1984). Sex differences in endurance capacity and metabolic response to prolonged, heavy exercise. European journal of applied physiology and occupational physiology, 52(4), 446-450.

[24] Nicklas, B. J., Hackney, A. C., & Sharp, R. L. (1989). The menstrual cycle and exercise: performance, muscle glycogen, and substrate responses. International journal of sports medicine, 10(04), 264-269.

[25] Ellery, S. J., Walker, D. W., & Dickinson, H. (2016). Creatine for women: a review of the relationship between creatine and the reproductive cycle and female-specific benefits of creatine therapy. Amino Acids, 48(8), 1807-1817.

[26] Ellery, S. J., Walker, D. W., & Dickinson, H. (2016). Creatine for women: a review of the relationship between creatine and the reproductive cycle and female-specific benefits of creatine therapy. Amino Acids, 48(8), 1807-1817.

[27] Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female specific nutritional strategies: a narrative review. Journal of the International Society of Sports Nutrition, 18(1), 1-20.

[28] Simopoulos, A. P. (2002). Omega-3 fatty acids in inflammation and autoimmune diseases. Journal of the American College of nutrition, 21(6), 495-505.

[29] Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female specific nutritional strategies: a narrative review. Journal of the International Society of Sports Nutrition, 18(1), 1-20.

[30] Swanson, D., Block, R., & Mousa, S. A. (2012). Omega-3 fatty acids EPA and DHA: health benefits throughout life. Advances in nutrition, 3(1), 1-7.

[31] Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female specific nutritional strategies: a narrative review. Journal of the International Society of Sports Nutrition, 18(1), 1-20.

[32] Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., … & Phillips, S. M. (2018). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British journal of sports medicine, 52(6), 376-384.

[33] Jäger, R., Mohr, A. E., Carpenter, K. C., Kerksick, C. M., Purpura, M., Moussa, A., … & Antonio, J. (2019). International society of sports nutrition position stand: probiotics. Journal of the International Society of Sports Nutrition, 16(1), 1-44.

[34] Akgül, T., & Karakan, T. (2018). The role of probiotics in women with recurrent urinary tract infections. Turkish journal of urology, 44(5), 377.

[35] https://www.medscape.com/answers/202333-153111/why-is-iron-deficiency-anemia-more-common-in-women-than-in-men

[36] Axling, U., Önning, G., Combs, M. A., Bogale, A., Högström, M., & Svensson, M. (2020). The effect of Lactobacillus plantarum 299v on iron status and physical performance in female iron-deficient athletes: a randomized controlled trial. Nutrients, 12(5), 1279.

[37] Jäger, R., Mohr, A. E., Carpenter, K. C., Kerksick, C. M., Purpura, M., Moussa, A., … & Antonio, J. (2019). International society of sports nutrition position stand: probiotics. Journal of the International Society of Sports Nutrition, 16(1), 1-44.

[38] Kligler, B., & Cohrssen, A. (2008). Probiotics. American family physician, 78(9), 1073-1078.

[39] Manore, M. M. (2002). Dietary recommendations and athletic menstrual dysfunction. Sports medicine, 32(14), 887-901.

[40] Wan, J. J., Qin, Z., Wang, P. Y., Sun, Y., & Liu, X. (2017). Muscle fatigue: general understanding and treatment. Experimental & molecular medicine, 49(10), e384-e384.

[41] Green, N. S. (2002). Folic acid supplementation and prevention of birth defects. The Journal of nutrition, 132(8), 2356S-2360S.

[42] https://ods.od.nih.gov/factsheets/Riboflavin-HealthProfessional/

[43] Alswat, K. A. (2017). Gender disparities in osteoporosis. Journal of clinical medicine research, 9(5), 382.

[44] Wohlgemuth, supra (2021)

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