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Posts made in May, 2012

Carbohydrates for Fertility and Health

Posted by on May 31, 2012 in Blog, HPA axis, Hypothalamic Amenorrhea, PCOS, Sleep | 109 comments

Carbohydrates for Fertility and Health

I spend a disproportionate amount of my time telling women to eat carbohydrates (read: “safe starches”–see below).  The thing is, a low carbohydrate diet (<50g/day) can do wonderful things for people.   This we all know well.  It’s a quick way to lose weight, to sharpen insulin sensitivity, and to reduce appetite in the short term, and it can be hugely therapeutic for people with cancer, migraines,and  chronic infections or psychological disorders.

On the other hand, low carbohydrate diets can be a significant tax on people, women especially.

Because low carbohydrate diets are so popular for weight loss, it is common for women trying to lose weight and to “look good” to exercise often, eat very few carbohydrates, fast, and restrict food intake.  The more of these restrictions a woman undertakes at once, the more and more her body reads this as living in a starved, stressed state.   The results are significant.  Her adrenals fire heavily, her liver gets tired from performing so much gluconeogenesis, her insulin sensitivity drops, her body fat levels fluctuate, her leptin signalling gets off, she stops sleeping soundly, and she stops menstruating regularly.

I cannot say that this applies to everyone.  Many women undertake low-carb diets–Peggy the Primal Parent comes to mind as a fierce advocate (recently, however, she has, in her own words “scrutinized” and weighed evidence against the diet)–and feel great energy, life, and liberation from symptoms of their previous lifestyles.  But women who are experiencing low-thyroid symptoms, menstrual dysregulation, sleep and or mood and mental health related issues may find significant relief from adding carbohydrates back into their diets.

Here’s why:

-Glucose is necessary for the conversion of T4 to T3 in the liver.  Certainly, the liver is capable of producing its own glucose with gluconeogenesis, but that process can become taxed over time, particularly if the woman’s liver is already taxed from poor eating habits in the past, mineral deficiencies, stress, or caloric restriction.   Instead, when a woman ingests glucose, she assures that her liver does not have to work overtime.  She provides the glucose that her brain needs, rather than forcing her body to make its on its own.  This helps the body function more efficiently and with less stress in general, but it also specifically optimizes thyroid activity.  Hypothyroidism is implicated in mood disorders, reproductive irregularities such as PCOS and amenorrhea, in skin conditions, and in weight gain, among other things.   Many women, contrary to popular paleo belief, in fact lose weight once they add carbohydrates back into their diets.

This is true of clinical hypothyroidism, as well as sub-clinical hypothyroidism.  Note that in many studies, women with cystic ovaries and sublicinical hypothyroidism see the resumption of regular ovulation when they correct their thyroid issues.

-Glucose elicits an insulin response, which in turn spikes leptin levels in the blood.     This is a short-term spike, so eating carbohydrates should not be used as a replacement for body fat, which is the primary long-term secretor of leptin.  However, moderate, regular consumption of carbohydrate spikes leptin frequently enough to help signal to the hypothalamus that the body is being fed.   Recall that leptin is absolutely crucial for reproductive function.  Without leptin, the hypothalamus does not tell the pituitary to produce sex hormones.   At all.

-Moderate carbohydrate intake is associated with better mood, stress-reduction, and sleep, pretty well across the board.   I see this in my work and in anecdotes, as well as in many controlled studies.    The carbohydrate-well-being connection also plays out decently in biochemical theory.  Carbohydrate intake (via insulin and albumin) boosts tryptophan levels in the brain, and tryptophan is the protein precursor to serotonin.  Presumably, then, carbohydrate intake helps with the vast array of issues associated with serotonin deficiency which include moodiness, stress, and insomnia.  For a look at the details and complexities of the issue, see Emily Deans  here and here. The primary takeaway of this point being that while the exact mechanism of carbohydrates boosting mood and sleep quality is unknown, carbohydrates still appear to be a healthy, and in many cases necessary, macronutrient.

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The whole point being that carbohydrates are not just okay but important.  For women who have appetite control problems, sugar addictions, and a lot of weight to lose, absolutely I believe a low-carbohydrate diet can do them wonders.  For women who struggle with menstruation, fertility, stress, exercise performance, or stress, along with any other hormonal oddities, carbohydrates help assure the woman’s body that she is healthy and fed.  This is crucial for reproductive health.  

In all cases, diet is a matter of personal physiology and experimentation.  If a woman’s body works better on carbs, she should eat them, and delight in those joys rather than worry needlessly.  At the very least, they are not harmful, and at their best, they are life saving.

Carbohydrates to eat:

I recommend glucose-containing carbohydrates rather than fructose for a wide variety of reasons, least of which are appetite control, liver function, and the prevention of metabolic syndrome.  Many studies seem to be indicating that fructose is the real culprit in all of these problems.  Glucose, on the other hand, when eaten absent of fructose has real satiating power.

I also recommend starchy glucose, since it is a “complex carbohydrate” and is broken down more slowly during digestion, which prevents blood sugar from rising or dropping too sharply.

Of course, grain-based carbohydrates are a no.

Finally, I recommend carbohydrates that contain nutrients over empty carbohydrates.

This means that I recommend eating:

Starchy tubers such as sweet potatoes, batata, jerusalem artichoke, cassava, tarot, and bamboo.  Regular potatoes are fine, too, but they contain fewer vitamins than their sweet counterparts.  Of the sweet potatoes, Japanese sweet potatoes are the most delicious, in my opinion, followed by white sweet potatoes and then yams and regular orange sweet potatoes.

For fruits, I recommend berries and cherries, which contain more glucose than fructose, and also bananas, which are pure 100 calorie glucose bombs.

Both white and brown rice are fine, but are fairly nutrient-poor.  Brown rice contains anti-nutrients in it’s shell, so white rice is more innocuous in terms of nutrient absorption.

Vegetables of course are great, but they do not count for carbohydrate consumption.  I know that much of carbohydrate content is indeed processed as glucose, but much of it is also tied up in fiber, which is broken down and turned into short-chain fatty acids by gut bacteria.  For this reason, vegetables alone cannot make up a woman’s carbohydrate consumption.  Instead, starchy tubers and low-fructose fruits work the best.

How much to eat: 

For a woman recovering from stress, metabolic distress, and hypothalamic amenorrhea, I recommend eating between 100-200 g/day.  That goes for athletes as well.  And for pregnant women.  At least 100 g/day.

Moreover, carbohydrates taken later in the day help with insulin sensitivity (since that gives the body the longest amount of time throughout a 24 hour period to operate at low insulin and leptin levels).  They also, anecdotally, help put people to sleep.

Carbohydrates elsewhere in the paleo blogosphere:

Chris Kresser and Chris Masterjohn: Cholesterol, mostly, also: Telltale signs you need more carbs

Jimmy Moore: Is there any such thing as a safe starch?

Jamie Scott: A Week of It

Paul Jaminet: Higher Carb Dieting Pros and Cons (includes a discussion of the “longevity trade-off”)

Cheeseslave: Why I ditched low carb

Beth Mazur: Why I don’t eat low carb

Julianne Taylor: Okay, People, Carb’s Don’t Kill

Melissa McEwen (always a badass on women and fertility): What the bleep do we know about carbs

While you’re at it, go read Melissa’s post on Why Women Need Fat.  Now.

Still afraid of carbohydrates and insulin?  Read Weightology’s take on insulin, or, better yet, Stephan Guyunet’s thoughts on fructose being the sole driver of insulin resistance, rather than glucose.

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Book Review: It Starts With Food by Dallas and Melissa Hartwig

Posted by on May 29, 2012 in Blog | 9 comments

Book Review: It Starts With Food by Dallas and Melissa Hartwig

Let me begin my review by stating outright that I don’t like most books, philosophies, and things.  It’s a matter of quality in a vast variety of realms.   Intelligence, rationality, common sense, scientific-coherence, clear communication of ideas.  Love, feminism, equianimity, no-nonsense approaches to life.   Hard-hitting and real and down-to-Earth all at the same time.  These are a few of my minimum standards for acceptability.

I don’t like most books.

I love It Starts with Food.

The rockstar couple of Dallas and Melissa Hartwig wrote this book like they meant it, and, god damnit, it shows.  

Melissa and Dallas approach food in a way that optimizes the best of all worlds.   Food is not a convenience; it is not an indulgence; it is not an enemy.  It is not even medicine, in that certain foods are not proscribed for healing particular ailments.  Instead, food is nourishment.  Food is a blessing.  And food, when interacted with properly, assures all people–no matter how sick and fatigued they might be–the health, confidence, energy, and vitality that each individual has the potential to realize, but that has gotten so lost in the modern world.

It Starts with Food is based on the premise of four “good food” standards.  These standards must be met by all allowed foods, and if the standards are compromised in any way, the food needs to be eliminated (at least in the strict 30-day “clean” phase of the Whole30 program).   This may sound alarming at first– that probably eliminates a lot of foods!– and many might cry.  And sure, if you consider things like Whoppers and Snickers as food, then it does eliminate a lot.  These principles do not, however, eliminate anything that nourishes, anything that is real, anything that comes from the Earth and can be plucked (or butchered) right from the grounds of a local farm.

These four food standards are:

1) That the food promotes a “healthy psychological response.”

2) That the food promotes a “healthy hormonal response.”

3) That the food supports a healthy gut.

And, therefore, 4) That the food supports healthy immune function.

These four food standards, and the order in which they fall, are the precise reason that I love and advocate this book so fiercely.   I’ll get to that in the bulleted list below.  First, I’ll air my “critiques” –if in fact they can really be called as such.   They’re honest, but minimal, and anyway no review is critique or believable without them.  Secondly I’ll list all of the delightful things to look forward to in It Starts with Food, and why this is the perfect book to get someone moving on the path of self-healing and -love.

Points of difference/critique:

  • Some things in the book that are relevant for health are glossed over, such as fitness, sunshine, and sleep.  More than anything I would like to see sleep addressed.  However– the title of the book is It Starts with Food, so we can presume that the book is going to be about Food first and foremost.  I appreciate this focus, and honestly poor food choices are the primary reason everyone’s in this mess anyway, so it’s appropriate to be real and address this issue first.
  • Seed oils were not quite villianized enough for my tastes.  Though they do receive their own chapter of concern, later on in the book the big things to be avoided are always “grains, sugar, dairy, and legumes.”  Legumes are much more innocent than O6s, in my opinion.
  • Fiber!  The Hartwigs advocate fiber.  Disagree!
  • Re-introduction of toxins.  The Hartwigs start bringing things back into the diet on day 30, starting with dairy for three days, then gluten grains for a day or two, etc.  While this may work on a short-term evaluative basis, for people with hormonal issues, the negative effects of these products are far more long-range and far more insidious.  For example, for women with androgen issues, I would never recommend putting dairy back into the diet, especially at 30 days.  It takes months for hormones to readjust to different diets.  However, the Hartwigs do caution about longer-term effects, so kudos to them for hitting on this important point.
  • Caveats for “paleos not working” and “help!”  I would have liked to have seen more instruction for people who still struggle after the Whole30 with their health.  Dallas and Melissa instruct people to hold onto the program longer, but there are also specific health (mental and physiological) issues that endure through a paleo diet and need to be addressed in a specific and perhaps separate way (a la the hormone issues I mentioned above).    On the other hand, the Hartwigs do have a whole chapter on “special populations” and recommend that people with real health conditions consult their doctors and remain in conversation with them as they move forward.

as for the meat of the book, and why I enjoyed it so thoroughly:

  • ‘Tough’ love.  The Hartwigs are full of love and encouragement and sympathy.  It’s amazing.  What’s even more amazing is how they manage to integrate this with lighting a hard-lined, radical fire in your soul.  ”It is not hard.” They write.  ”Please don’t tell us this program is hard.  Quitting heroin is hard.  Beating cancer is hard.  Birthing a baby is hard.  Drinking your coffee black . Is . Not. Hard.”  Food cravings are a nightmare, and certain situations and health problems are frightfully challenging, but the approach the Hartwigs take to this issues–that of positive strength, steadfastness, and encouragement–disarms the power of toxic foods, and in turn encourages an individual’s belief in her ability to do it.
  • Honesty.  The Hartwigs tell their readers straight up the limits of the research, and encourage experimentation and skepticism.
  • The world’s most accessible analogies.  I’ve gone through this science with a fine tooth comb several times, but I still found their analogies helpful.  Some examples include the immune system as firefighters, intestinal lining as human skin, in that abrasions permit the passage of toxins, and eating meals properly is likened to becoming accustomed and then automated to driving a car in driver’s training.  Brilliant, accessible, and yet scientific to a T.
  • Explanatory sidebars and diagrams.  The sidebars are a huge help, and enable the Hartwigs to deal with complex issues without fuddling around in the details.  Definitions, specifications, and clarifications are all designated special spots in sidebars that are super helpful.  Diagrams are simple and easy to understand.  Sidebars also include practical tips.  For example, getting sunflower oil instead of peanut oil for peanut butter, or talking about celiac and gluten with respect to wheat proteins.
  • Humor.   The Hartwigs are great.  Hard-hitting, sarcastic, and down-to-Earth all the while.  EG, regarding protein portion sizes:  ”Also, for the record,” they write, “one and two sized palm portions are not your only options. You’ve also got 1.25  palms, 1.5 palsm, 1.942 palsm, and every possibility in between.  This should not be overwhelming.  You all have palms.”
  • Simple food plan.   The food plan is awesome: one palm of protein, fill the rest of the plate with vegetables.  ”Um, that’s it.”   And then adding in thumb sizes for the fats.  Honestly– as someone who has spent the last ten years of her life trying to figure out how much to eat and when, it’s surprisingly helpful.
  •  Food quality.  The Hartwigs emphasize food quality, particularly the quality of animal foods, as the primary aim of nutrition.  That’s so important.  So often people let conventional meat-buying go by unmentioned, but it really is problematic in the long-term, especially for people with hormone problems, and any kind of liver burden and toxicity.
  • Radicality.  The Hartwigs insist on being completely clean for the Whole30.  They’re not throwing punches.  They are serious about health.  If you want to get better, you need to avoid food toxins for at least 30 days.  Thank you, Dallas and Melissa, for bringing that reality to people in an accessible, loving, empowering way.

And for the aspects of the book that make it truly fabulous, and the best diet book I have ever read:

  • Stress.  The Hartwigs beg you not to stress about your food.   Stress is psychologically but also physiologically important.  While they’ve thrown lots of science, concerns, and diseases at their readers, in the end all they want is for you to undertake a life of eating real food, and to relax into and trust that decision.
  • The eating experience.    The ”how” of eating is important.  The Hartwigs encourage their readers to think of eating as a “nourishing experience.”  Nourishing!    Yes!  Moreover, I love how reverently they talk about food and the eating experience.    For them, eating is about focusing on a single pleasure, taking a break out of the day, preparing food for and treating one’s self, relaxing into and enjoying the gift of nature’s brilliance.
  • Restoration of health and hormones as the true path to health.    The Hartwigs don’t tell their readers how much to eat or how much of anything to eat because the point of it all is to trust in natural hormones.  I love this.  This is what I believe about food, and I am so glad to see it trumpeted.   Bodies are designed to work, and treating them well and with the proper nourishment is all most people need in order to heal, slim down, and become radiant, energetic beings.   ”In addition,” they write, “you won’t be weighing, measuring, or tracking your calories at all.  We think those are all unnatural, unsustainable, psychlogically unhealthy processes that take the joy out of food and eating.”  And in the end, they assert that hormones are more important than calories, that it is okay to be uncertain at the outset–but that trust is crucial because if we cannot trust natural foods and our bodies, what can we trust?  ”For perhaps the first time in your life, you can rely on your body to tell you what it needs.”
  • The emphasis on health, particularly on psychological health.  This is the most important point of the whole book.  The first of the good food requirements is that the food be psychologically satisfying.  This is amazing and so important, and I am so so so so so happy about this book for this reason.  A healthy body is nothing without a healthy mind.   The Hartwigs emphasize psychology with this food category, but it doesn’t stop there.  Throughout the whole book they caution against stress, they advise their clients to never step on a scale, they speak directly to food cravings and disordered eaters, and they don’t use the word “cheat” because eating should always be guilt free.   Amen!  Their diet is not a diet, it is not about restriction, and it is not even about losing weight.  So many diet books out there slap the “lose weight!” subtitle onto a book in order to sell more copies, and the Hartwigs do mention weight loss (because it happens! automatically and unintentionally in 95 percent of their clients!), but they don’t really care.  What they care about is health.  And with health, a healthy weight always follows.
  • Love.  The fire and passion Melissa and Dallas have for their work are obvious over and over and over again throughout this book.    It shows in how reverently they talk about food and the eating experience, in their fire and their tough love, and in their affinity for and closeness with all of their clients.  Thank you, Melissa and Dallas, for caring so much about people and their holistic health to go through the trouble of putting together this fantastic book.

I do not like most books about food.

But this book–It Starts with Food–by Dallas and Melissa Hartwig, being released this June 12, 2012– is full of excellent science, easy to follow plans, an emphasis on real, vital health, psychological well-being, passion, humor, reverence, relatability, and love.    I would really like to see a bit more love and attention for people for whom the program does not work wonders, but the general message of positivity, progress, and love, and their unique and powerful emphasis on psychological health earns the Hartwigs six million stars.

 

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Paleo and Sex: How to Have a Ravenous and Kickass Female Libido

Posted by on May 23, 2012 in Blog, Sex | 26 comments

Paleo and Sex: How to Have a Ravenous and Kickass Female Libido

Sex is one of the most important things we do.

Desiring sex, therefore, is one of the most important things we can feel.

According to a Journal of the American Medical Association (JAMA) study reported on in February 1999, about 43 percent of women (compared to 31 percent of men) suffer sexual inadequacy for one reason or another.  Interestingly, this is thought to actually underestimate the real level of sexual dysfunction in the U.S.  Yikes.

What follows is a description of the physiological components of libido, how to maximize those components, and then a discussion of the psychosocial components.  The psychosocial components are the trickiest to get a handle on, but they are also treatable with proper therapy (if necessary), love, empowered embodiment, and raging, well-deserved confidence.

Factors playing a role in libido

Specific foods are not in reality relevant for libido, except for how they may temporarily increase testosterone levels (a la oysters).  Instead, for both women and men, all of the physiological factors that influence libido boil down to long-term sex hormone levels and balance.   First, absolute levels of hormones are important: for example, the greater amount of sex hormones in the blood, the sexier a woman will feel.  Secondly, Balance is also crucial.  For example, estrogen is not typically considered important in arousing a woman’s sex drive.  But having clinically low estrogen levels–that is, estrogen levels below the baseline for proper sexual function–prohibits absolutely any kind of sensation a woman might have in her clitoris.    That’s scary.

This is the effect that all hormones have on sex drive, generally:

Testosterone: Increases libido.  Testosterone is the hormone primarily responsible for sex drive in both men and women.  When women with hypoactive sexual dysfunction disorder are treated with testosterone, for example, they often experienced increased sex drive.  Higher testosterone levels also enlarge the clitoris (good to know if yours is shy!), but unfortunately if other hormone levels do not rise along with testosterone, symptoms of hyperandrogenism such as facial hair and acne may manifest themselves.  For this reason, testosterone supplementation is not an advisable method of increasing libido.

Estrogen: Crucial at baseline for sexual function.  It is also the primary hormone responsible for vaginal lubrication.  However, estrogen is a testosterone antagonist, so the more estrogen a woman has in her system, the less testosterone she has available to pump up her libido.  Estrogen dominance therefore is one of the greatest culprits in contemporary Western sexual dysfunction.

Progesterone: Another testosterone antagonist.  Having elevated progesterone levels relative to the rest of the sex hormones prevents a woman from achieving orgasm.

Prolactin: Not talked about very often, since it’s primary role is in lactation, but it is also involved in pituitary-ovary signalling.  Increasing prolactin levels increase vaginal lubrication and sex drive.

Luteinizing Hormone: Highly correlated with sex drive.  LH is a pituitary hormone that triggers ovulation in a woman.  Many researchers believe LH is one of the primary game-makers in sexual arousal.

Because of the role each of these hormones play in libido, the menstrual cycle demonstrates a clear pattern in fluctuating libido for most women.

The Menstrual Cycle and Libido

Testosterone levels rise gradually from about the 24th day of a woman’s menstrual cycle until ovulation on about the 14th day of the next cycle, and during this period women’s desire for sex has been shown, in general, to increase consistently. The 13th day (the cusp of ovulation) day is generally the day with the highest testosterone levels.  It is also the day on which LH spikes.   Ovulation, therefore, and no surprise here, is typically the randiest time of the month for a woman.  In the week following ovulation, the testosterone level is the lowest and as a result women experience less interest in sex.

During the week following ovulation, progesterone levels increase, and this often results in a woman experiencing difficulty achieving orgasm. Although the last days of the menstrual cycle are marked by a constant testosterone level, women’s libido may boost as a result of the thickening of the uterine lining which stimulates nerve endings and makes a woman feel aroused.  Also, estrogen levels are at their lowest throughout menstruation and into the follicular phase (the first two weeks of the cycle) so women experience the least vaginal lubrication at this time.  Because testosterone and estrogen are both increasing, however, sexual desire is ramping up again in time for ovulation.

What factors influence these hormone levels, and how do we make the best of them?

Estrogen Dominance:   As I mentioned above, estrogen is a testosterone antagonist.  When estrogen levels are too high relative to testosterone levels, libido plummets.  Women can become estrogen dominant by consuming too much soy (since soy acts as an estrogen in the body), by being overweight (since estrogen is produced in fat cells), and by being stressed out (since estrogen can act as part of the inflammatory response).  Women with estrogen dominance often experience symptoms of PMS, too, which does nothing to help libido.

Birth Control Pills: Birth control pills are another way that women can become estrogen dominant.  But that is not the only way they negatively effect libido.  Progesterone levels are often elevated out of the normal range on birth control pills, and testosterone sometimes plummets.   Yet the effects of birth control pills on women is wholly unpredictable.  Increasing levels of one hormone might decrease another, or might increase them exponentially, depending on how the woman’s HPA axis and ovarian feedback mechanisms work.  Women also experience a whole range of side effects on birth control pills ranging from acne to suicidal depression.  Birth control pills are no laughing matter, and their effect on libido is wide ranging.

All that said, since birth control really is so unpredictable, birth control can play a stimulatory role on libido for a woman, especially if she has chronically low levels of sex hormones in her blood.  Some women feel like a million bucks on estrogen pills.  If that is the case, however, birth control pills are only putting a band-aid on the problem, rather than solving it at its core.  That often requires looking at physiological problems that deplete sex hormone levels such as low body fat, stress, and energy deficits.

Testosterone blockers:  Some women get on testosterone blockers to help them with symptoms of hyperandrogenism or problems in their menstrual cycles that come from high testosterone production.  However, blocking testosterone is as good as eliminating it entirely.  Spironolactone and flutamide are the two most commonly used testosterone blockers.

Hypothyroidism:   Up to ten percent of women have clinical or sublicinical low thyroid issues.   Hypothyroidism is significantly linked to low libido.   T3, the active form of thyroid hormone, is crucial for the proper functioning of cells and organs.  Without T3, the reproductive system barely manages to inch forward.  Sex hormones suffer greatly, both at the ovarian level as well as in production at the hypothalamic and pituitary levels.

Hypothyroidism is caused by a wide variety of problems.  Hashimoto’s thyroiditis is a an autoimmune condition that accounts for the vast majority of Western hypothyroidism.  This can be mitigated by eliminating modern toxins, specifically wheat, dairy, and omega 6 vegetable oils, from the diet, and also by paying attention to gut health with gut-healing diets such as the GAPS diet.     Iodine-deficient diets can cause hypothyroidism.  This used to be uncommon in western countries, since western countries iodize their salt, but sea salt often does not contain much iodine in it.  Moreover, many Americans are now eschewing salt for “health benefits” (this is misguided), so their iodine levels are suffering.  The solution to this is to consume iodized salt, or to perhaps supplement with kelp for a while.  Iodine supplementation is tricky, however, and should build up slowly a la the recommendations of Paul Jaminet.   High intake of raw cruciferous vegetables can hurt an already suffering thyroid gland.   Yet more importantly, Low-carbohydrate diets contribute to hypothyroidism.    Glucose is required for the conversion of T4 to T3 in the liver, so without adequate glucose supplies the body’s thyroid functioning suffers.  This is a problem that many paleo women wrestle with.  Adding just 50 or 100 grams of starchy carbohydrate to a daily diet, however, can increase energy, improve sleep quality, improve quality of skin and hair, and also boost reproductive function.  Repairing sub-clinical hypothyroidism has also been shown to remove ovarian cysts and help anovulatory women both ovulate and menstruate.  For more on hypothyroidism, see Chris Kresser‘s work.

Stress:  Stress is a psychological libido-killer, but it also has a physiological analog.   When stressed, the body produces cortisol.  Cortisol has a negative feedback effect on the hypothalamus, and it can inhibit all of the hormonal signalling that comes out of the hypothalamus.  The hypothalamus is responsible for inciting pituitary function, so stress plays a very real role in inhibiting reproductive function.  As many as five percent of women suffer reproductive symptoms of chronic stress.

Low Dopamine:  Dopamine is the most important neurotransmitter for sexual prowess and reproductive function.  Fortunately, dopamine deficiencies are very often corrected with the introduction of exercise into someone’s daily life.  Almost nothing increases dopamine levels as well as exercise does.  (Although sex also has potent dopamine-releasing effects: skin-to-skin contact shoots dopamine levels through the roof.  But then dopamine levels plummet post-orgasm, creating withdrawal-type symptoms.  This is how the body reinforces sexual behavior.)

Some women have reported to me personally the return of menstruation from amenorrhea after resuming regular sexual activity.   They were as surprised as I was.  Yet perhaps we should not have been so surprised.  Dopamine is a potent neurotransmitter and, coupled with serotonin, can significantly up-regulate sex hormone production.

Low serotonin: Though excess serotonin has been linked to decreased arousal, serotonin also increases prolactin levels.  Prolactin is important for vaginal lubrication and for sexual arousal.  Ways to increase serotonin levels include adequate protein ingestion (.5 g/lb of lean body weight each day), adequate sun exposure, and perhaps most important of all, adequate sleep.

Low Body Fat/Excess Exercise/Energy Deficits:  These three phenomenon almost always manifest in tandem.   Yet the end result is the same: with low body fat, with excess exercise, and with caloric deficits, the body detects starvation.  Leptin levels plummet, and the hypothalamus stops thinking that the body is sufficiently fed.  Without leptin, the entire pituitary sex hormone cascade is not enacted.  No LH, no testosterone, no estrogen, no prolactin, no progesterone.  Body fat is unquestionably crucial for all reproductive function.  Libido just happens to be the one that’s the most fun to explore once proper body fat levels are restored.

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Psychological factors:

There remain the psychological aspects to increasing libido.  And of them there are many.  Perhaps a woman’s libido has been killed by a negative sexual experience.  Or perhaps the woman is too stressed out by other factors to care about sex…or perhaps sexual relations between two people are strained because they can’t stand each other outside of the bedroom even more than they can’t stand each other inside the bedroom.  Perhaps a woman’s lover is an ugly lump.

Many of those factors are outside my realm of expertise.

Some of them are inside of it, however, and fiercely.

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Women need first to think they are sexy.  I am so tired of women comparing themselves to others, and always thinking that beauty as relative.  Beauty is not relative.  It is everywhere.  And in everyone.   If she is beautiful it does not mean that you are less so. Period.  I don’t care if you have a chubby stomach.  I don’t care if you think your hair is boring.  I don’t care if your right boob is larger than your left.   Not a single other person cares either.  At all.  The only person who cares is you.   No one wants to make you “perfect” but you.

You don’t have a single thing in the world to apologize for.  No one is looking for apologies.

Instead, people are looking for statements.  They are looking for fun.  They are looking for inspiration, for character, and for life. 

In that way, what other people want from each other is not necessarily for them to meet some ridiculous standard but instead to make them feel good.   Whether that’s through sharing of your self-love, through your wicked personality, or through your liberated and unapologetically wild fantasies is totally up to you.  The point being that confidence and self-love are the most important factors for actually being attractive.  Sure, classic “looks” may follow, but only after a woman has convinced others that she is worth looking at.

Not a single person in the world wants to sleep with an apologizer.  ”Sorry, I don’t like who I am,” does not necessarily read like a 5-star resume.   People won’t be throwing themselves at that.  What they will instead throw themselves at is: “I am different from what you expect.  But that’s an asset.  I am worthy like you wouldn’t believe, and I am going to rock your world.”

Confidence is key.  Beauty is key.  And the thing is– damnit–it’s not faked confidence.    It’s not faked beauty.  You really are beautiful.  You really are unique.  You really are a natural, sexual, alive, vibrant woman.   You do not have a thing in the world to apologize for.  You are who you are, and you love being yourself, and you can share yourself powerfully and joyfully with others through sex.

This kind of self-love is why people get laid.  It’s not because they have perfect torsos and racks as big as wombats.   It’s because they have hot souls.

So confidence is important.  There’s one other crucial aspect I can speak to.   It’s this:

SEX IS AWESOME.

IT IS NOT DIRTY.

Look.  Sex is natural.  Sex is so natural, in fact, that it’s the very reason we all exist.  And sexual desire is natural.  It is, by extension, the very reason we all exist.  For that reason, along with many others, there is not a single immoral aspect to having sexual desire or having sex.  Period.

And sex is not gross. 

And a woman’s desire is not gross.

And a woman’s vagina is not gross.

And a woman having sex is not gross and not a slut.  

Or maybe she is a slut, but that’s cool because that’s natural, too.

Men who don’t understand any of that are not real men.

The whole point being that American culture is a culture in which sexuality, and female sexuality in particular, is a dirty thing.

That is not okay.

It’s so not okay.

It is, in fact, plain old wrong.  Sex is natural.  If a woman (or man!) wants to be delighting in it, and more power to her.    She is embracing her natural body.  She is embracing her natural desires.  She is owning her own confidence.  And she is exalting in the vibrancy of her very existence.

If that’s not hot, I don’t know what is.

 

High fives for sex!

 

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Paleo and Amenorrhea: How Extremity Can Make even the Best Diet Fail

Posted by on May 22, 2012 in Blog, HPA axis, Hypothalamic Amenorrhea | 80 comments

Paleo and Amenorrhea: How Extremity Can Make even the Best Diet Fail

The volume of emails I receive from women who start having menstrual problems on a paleo diet is staggering.    It is not an enormous volume, no.  But it is enough to give a woman pause.  What gives?  Aren’t we supposed to be healthier on a paleo diet?

Yes, we are, and really, we are.  In the vast majority of women who eat a Standard American Diet, specifically those who are overweight, a paleo diet does wonders for balancing hormone levels.  It is usually only when a paleo/whole-foods diet is coupled with restrictive norms that women start running into problems.  Too little food, too much exercise, and too much stress are really what it all boils down to.   The whole foods are not to blame– not in the slightest.  What are to blame, instead, are the obsessive ways in which people interact with these foods.

There are several mechanisms that may be at play in the physiology, depending on each woman’s genetics and how each woman undertakes her paleo diet and lifestyle.

What happens in the body when it stops menstruating

The female reproductive system runs off of a sensitive fleet of circulating hormones.   When one or several of them is disrupted, many of the others fail at their jobs, too.

During the menstrual cycle, hormone levels in the blood signal to the hypothalamus to signal to the pituitary to release FSH and LH, two hormones that in turn tell the ovaries what to do.    FSH–follicle-stimulating hormone– is released in the first part of the menstrual cycle to incite egg development.  LH–luteinizing hormone–is released in the second part of the cycle and prepares the endometrium to be shed.  Without proper FSH and LH levels, the female body can never convince the ovaries to do their job.  FSH and LH are crucial, and they rely on proper functioning of the HPA axis.

This job of the ovaries is to produce the follicles and the eggs, but in doing so it also produces estrogen and progesterone.  This fact is important for signalling menstruation, because it is partly the rise and fall of estrogen and progesterone levels throughout the month that signal to the hypothalamus to release FSH and LH at different times.   This is, in essence, a circle of signalling.  LH and FSH from the hypothalamus to the ovaries, estrogen and progesterone back to the hypothalamus, and so forth.

Hormone malfunctions that cause amenorrhea

-Decreasing estrogen levels stop the pituitary from being able to send out FSH and LH.

-Decreasing leptin levels stop the pituitary from being able to send out FSH and LH.  This is because decreased leptin levels signal to the hypothalamus that the woman is lacking energy stores and is, in essence, starving.  When the hypothalamus thinks the woman is starving, it puts a halt to normal reproductive functioning.  Leptin levels decrease proportionally with fat mass decreases.   On the other hand, leptin can also go undetected when an individual is leptin insensitive.   Insensitivity is in general a larger problem for overweight women, and low absolute leptin levels are in general a greater problem for thin women.

-Increased testosterone production interferes with estrogen levels.

-Increased stress and cortisol levels put a halt to hypothalamic and pituitary function.

Cause 1: Weight loss

Both estrogen and leptin are produced in fat cells.  These are the two blood serum hormone levels necessary to signal to the hypothalamus that a woman is fed and happy, and that it should go ahead with normal reproduction.   Without these two hormones, reproduction ceases.  It is well known in the medical literature that the low body fat of anorexic women, models and athletes is what accounts for their amenorrhea.   Without fat, a woman simply cannot menstruate.

What is discussed less often in the literature, but is still true (see Wenda Trevathan’s Ancient Bodies Modern Lives) is the fact that a woman’s reproductive system is set up to run on the nutrient basis she has as a young girl.  Throughout puberty, if a girl has a higher-than-average or higher-than-healthy body fat percentage, her ovary to hypothalamus signalling may develop as ‘handicapped’ by these fat stores.    Because fat cell estrogen is so high, the ovaries do not have to produce as much.   For example: If the body’s estrogen set point is 100 units, and fat cells produce 80 units, then the ovaries only need to produce 20 units.  Then, if the woman loses weight, the set point remains around 100 or falls a bit to a healthier level (unique to each circumstance), and the fat cells production falls to around 30 units, such that estrogen from the ovaries is then expected to make up for the rest of the estrogen deficit.   Many women have no problem with this. Their ovaries jump into higher gear.   Many others, on the other hand, do struggle.  Their ovaries never end up rising to fill that gap.  The thing is– the set point is not stuck precisely at 100.  It will decrease to a healthy level.  But it might not decrease as far as a woman bent on meeting social expectations of body image is hoping.

The alignment of a woman’s sex hormone levels with the amount of nourishment she has during puberty accounts for why women who live their whole lives on the edge of starvation can still have babies, but women whose body fat percentage decrease from 28 to 21 cannot.

This is not to say that an overweight woman will stop menstruating when she loses weight.  Each body is capable of menstruating within the healthiest range of body fat percentages, from around 20 percent to 30 percent.  But a woman who has always erred on the side of heavier might  find that she cannot dip below 23 or 24 percent body fat without losing her period.  23 or 24 percent body fat is healthy, so this is fine.  It might not fly is the woman is trying to meet ridiculous standards of Western body image, but it is optimal for her to have the appropriate serum hormone levels.

Other factors that can hurt estrogen and leptin signalling may also play a role.  If a woman can correct those, then she may be able to decrease her body fat levels without hurting her reproductive system.  For example, chronic stress hurts hypothalamic signalling.  So a stressed out overweight woman is going to have a harder time with reproductive fitness while losing weight than a totally relaxed overweight woman.  This is a fact.  For menstruation to take place, estrogen and leptin levels must be high enough.   Body fat plays a significant role.  There are some other factors that can be addresssed and help as well.

Cause 2: Exercise

Weight loss can cause decreased leptin signalling, but exercise can, too.   Body fat is the major player in leptin levels, but energy deficiency in general hinders leptin.  When a woman is burning more calories than she is consuming–or when she is burning a high quantity of calories while under emotional and physical stress–her body calls it quits.  Instead of directing energy towards reproduction, it conserves it for other functions.

Cause 3: Low Calorie Diet

A low calorie diet performs the same function as both weight loss and exercise.  It stresses the body and puts the woman in a state of energy deficit.  The hypothalamus does not like being in energy deficit, so it tells the ovaries to stop working until it can get itself out of the energy deficit.

A low calorie diet is more of a problem for thin women than it is for women trying to lose weight.  Leptin levels first and foremost are reliant on fat stores.  The body can eat it’s own fat.  That is in fact how weight loss occurs.   So if a woman is eating her own fat, she is not starving.  Once her body fat levels dip too low, however, and if she is maintaining a low-calorie, starvation-type diet, then she may stop menstruating.

Cause 4: Low Carbohydrate Diet

Many, if not most, women have a real need for carbohydrates.  This cause is the most common cause of amenorrhea in the paleo world next to weight loss, in my experience.

Carbohydrates are necessary for the conversion of T4 into T3 (the active form of thyroid hormone) in the liver.  The liver is capable of producing its own glycogen when it’s not being fed sugar, but this process can become fatigued over time, especially if the woman is under any kind of stress, or restricting calories, too.

Hypothyroidism, or sub-clinical hypothyroidism, is one of the primary causes of ovarian malfunction.  Without sufficient levels of T3, organs shut down, and the reproductive organs are the first ones hit.  Without T3, estrogen cannot be produced, and follicles cannot develop.  Without T3, a woman cannot menstruate.

For this reason, many paleo women supplement their diets with iodine and find that their amenorrheic symptoms ease.  However, many others do not.  Instead, they have to add carbohydrates back in to their diets.

Another role that carbohydrates play is spiking leptin levels.  Whenever insulin spikes in response to blood glucose, leptin levels rise, too.  This means that carbohdyrates help signal to the hypothalamus that the woman is fed.  However, this is a short-term elevation.  It only spikes in bursts and with meals, so it cannot be used as a long-term solution to health.  It is important to note, however, that a high fat, low carbohydrate diet is consistently associated with the lowest leptin levels possible.

Cause 5: High-Dairy Diet (an influence, at least)

Dairy is full of hormones.  Even cows raised on pasture cannot help but produce certain hormones that influence a woman’s reproductive system.   Dairy is the most androgenic food.  It contains a protein that inhibits normal inhibition of testosterone in an individual’s body, such that when someone ingests dairy their testosterone levels can rise unchecked.  This is in fact why so many people experience acne when they eat dairy.  Even men.  It really can increase testosterone levels that much.

Moreover, much of the dairy consumed in today’s world is not organic and grass-fed but is instead choc-full of unnaturally injected hormones.  Farms and the US government are touchy about telling the public what goes into their animals, and they claim that these hormone profiles are insignificant.  However, anecdotally, myself and with some other women, it seems as though these hormones really can influence women who already have compromised reproductive function.  Conventionally raised animals can cause real problems.  This goes for dairy, and this goes for eggs and meat products as well.

Cause 6: Altered Phytoestrogen and Hormone-Ingestion Profile

This cause is related to the cause above.   We ingest hormones on a regular basis.  With a healthy reproductive system, this is not a problem.  Hormones from food are far less potent than hormones from the ovaries.  Please keep that fact in mind.   A healthy reproductive system has very little problem with phytoestrogens in foods.  But some women have struggling reproductive systems for one reason or another, and they need to be aware of what hormones they have been and what they are now consuming.

Phytoestrogens are plant estrogens.  They look a lot like estrogen, but are not identical.  This is why phytoestrogens should never be consumed as a replacement for estrogen.  Sometimes they relieve certain symptoms of estrogen-deficiency such as hot flashes, but they also fail to act exactly like estrogen does in the body.  This means that other signals and connections are not being made, potentially crucial ones.  Hot flashes may cease, but acne may continue to run on unchecked.   And other problems can ensue.  For example, breast cancer.

Phytoestrogens are primarily in legumes, nuts, and seeds.  Soy is the most potent phytoestrogen, and should be avoided at all costs.

There are other sneaky ways in which hormones can infiltrate a woman’s diet, especially if a woman undertakes a paleo diet with compromised reproductive function and inattention to the quality of her food.  For example, if a woman goes on an egg-heavy diet when starting paleo, but the chickens are fed a soy rich diet,  she is actually eating a soy-rich diet.  This is not normally a danger, but with a compromised reproductive system and a soy- or hormonal- influence from poorly treated animal products, it is worth taking into consideration.

These effects, I need to emphasize again, are not usually relevant for women with healthy reproductive systems, and should only be considered in severe cases. Only when hormone levels have dipped so low or have skyrocketed so high that the body becomes sensitive to these normally tolerable and easily managed fluctuations from food.  Certainly, conventionally-raised cows are not optimal, but I would not discourage anyone from eating them (in terms of their health) at all if they have no other options.  Sincerely.  Far, far more important is the quality of hormones being sent through leptin and estrogen signalling within the body.

Cause 7: Stress

The final cause should come as no surprise to anyone.  Stress halts reproduction: stress from toxic foods, stress from eating disorders, stress from social life, stress from exercise, stress from work, stress from existential despair… the list is vast.  The physiological result of all of the possible stressors is roughly the same, however.  Cortisol levels rise and these levels prevent the hypothalamus from sending the appropriate reproductive signals to the ovaries.   This may, in fact, be the most important of all the factors I’ve discussed.  There is no way to quantify it, and it burns ubiquitously throughout the Western world.  What if all of us calmed down?  What if we all lived in harmony, and peace, and did not fret?  Stress is significant, and stress is real.  Hundreds of thousands of American women do not menstruate because they are stressed.  How many more experience hindered reproductive function because of stress?  I suspect the number lies in tens of millions.

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The Evolutionary Perspective: Liberating and Empowering a Woman’s Self-hood

Posted by on May 18, 2012 in Blog, Self-love-spiration, Uncategorized | 8 comments

The Evolutionary Perspective: Liberating and Empowering a Woman’s Self-hood

The modern notion of womanhood, in which women eat little, exercise a lot, have eating disorders and body image issues, and are expected to look like rails, fails women time and time again.   The solution to that failure–to all of the pain, to all of the confusion, and to all of the self-loathing in modern America–is to adopt an evolutionary perspective.

Adopting an evolutionary perspective with respect to diet means looking at evolution and trying to align modern practice with what women’s bodies were designed for.  It does wonders for health.  A paleo diet (though not a specific diet, but rather the template in which to experiment and exist) is the only cure, really, to the disconnect that has emerged between a woman and the natural programming of her body.

Yet the paleo diet I advocate falls under a larger umbrella of perspective and meaning.   This is why what I really advocate is the evolutionary perspective more than anything else.  The evolutionary perspective includes eating the proper foods, but it really is so much bigger than that.  It’s about naturalness, about outlook, and about real, proud, embodied womanhood. There are specific aspects of an evolutionary perspective beyond the physiological that arise out of and are necessary for living this way.  What follows in this post is an articulation of what I think those roles and benefits are.

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With an evolutionary perspective, a woman does not work against but instead works with her body.  She understands that her hormones are designed to maintain a healthy body.    She understands that her body is programmed for optimal fitness and fertility.  She understands that war is not the answer.  How could a war ever be sustained?  How could victory ever truly be won?  Is there such a thing as winning, and if so, at which price does it come?  That is a scary question, and its one that many of my readers face.  The price of war is eating disorders, body image issues, amenorrhea, infertility, acne, hair loss, fatigue, depression, anxiety, and eventual weight gain.  The answer is instead discerning the foods that the body truly needs, and feeding it those so that it can do its own job.

With an evolutionary perspective, a woman listens to her body.  An evolutionary woman undertakes eating and lifestyle choices that optimize how good she feels, her health, and her well-being.  She does not feed her body toxins.  She does not run it into the ground with excessive exercise.  She does not spend all day hunched over in an office chair under the unrelenting glare of florescent lighting.    These things she knows are not good for her.  They do not feel good, either.  What then really does make her feel alive, embodied, sexy, and powerful?   In order to know, she must listen.

With an evolutionary perspective, a woman does not see herself as separate from her body.  There is no need to fight.  In fact, there is a direct dictum against fighting.  The body is the physiological basis of a woman’s mind, so any attack on the body is in reality an attack on the woman herself.   She is not separate from her body.  If she hates her body, she hates herself; if she loves her body, she loves her self.  What great things in the world were ever accomplished with hate?   What about love?

With an evolutionary perspective, a woman loves and respects her body.  This is not just something she can do, but rather something she must.  And something that comes naturally.   After just a little bit of practice, it becomes easy to love something that nourishes her, that provides the basis for her life, that gives her pleasure, and that enables her to do all of the wonderful feats and have all of the breathtaking experiences of her life.   Isn’t the body an amazing thing?  Isn’t it a powerful organism worthy of love?  Full of wisdom?  Deserving of trust?   Bodies are amazing, and when they are properly nourished their ability to provide a powerful basis for a lived and amazing human life grows exponentially.

With an evolutionary perspective, a woman is free.  She is free from the dictums of the modern world, free from silly norms, free from hate.   She is free from chronic exercise, free from paying money to food factories and food design chemists, free from counting calories, free from the toxins and bullshit in which so much of the modern world swims.  She is free of self-loathing.  She is free of what society wants her to be.  She is instead exactly what she wants to be.  She is free to be who she is, and to be so fiercely.

With an evolutionary perspective, a woman feels good.  This is a fact!  Sometimes women undertake a paleo diet, or at least some form of it, and find that their effort does not work.  I get that.  But the whole point of an evolutionary perspective is to feel one’s way around food and lifestyle until she finds what fits and works best.   The paleo diet is a template, and it provides a toxin-free, hormone-nourishing springboard off of which women can spring.  From here, women find individually what works best for them.  Their blood sugar levels stabilize, their estrogen dominance diminishes, their energy goes through the roof, their libido skyrockets… whatever they need, they can find it with natural methods and an evolutionary perspective.  For women with health problems, it can take a while.  It can take some troubleshooting.  That’s what people like me exist for.    But it’s out there.  Women who love their bodies and treat them well feel damn good.

With an evolutionary perspective, a woman looks amazing and real.  Overweight women naturally lose weight with an evolutionary perspective.  Period.  Easy.  Done.   Eliminating modern toxins from the diet enables a woman to balance her hormone levels and to let her natural mechanisms for weight modulation come into play.  Women with hormonal acne see their cysts fade and turn into scars.  Women who are weighed down by the pains and fatigue of modern diseases straighten their backs, and rise.   But: Nothing in the world will turn everyone into a supermodel.  That’s not the point.   The goal is not to be supermodels.  It is not to be 00s.  The goal is, in fact, the opposite.  Instead, the goal is to throw off the shackles of female expectations.  It is to be fierce and to be confident and to be healthy exactly as nature intended.  It is to be natural, to listen to one’s body above all other things, to be healthy, to be unapologetic, and to be fierce and hot and all of this, again, not because a woman is meeting social expectations of female physicality–whatever those might be for a particular woman–but rather because in natural womanhood there are serious health and serious pride.   The fact that a paleo diet turns a woman into a natural, glowing, fertile, energized machine is a byproduct.  It’s important, because it demonstrates that the woman is achieving greater health, but it’s only truly powerful in this way in that it shows a woman just how beautiful she is in her own unique, natural body.

With an evolutionary perspective, chins come up.  Look.  It’s amazing, being a natural woman.  It’s the healthiest thing a woman can do.  How can that not be empowering?  How can that not inspire?  How can the world not be in awe of someone who owns what she is, and who uses that to her advantage?    An evolutionary perspective demands that a woman not apologize for who and what she is.  It demands that she embrace and love her body, and she does so, proudly.   It demands that she walk with pride in her power and in her womanhood.  With an evolutionary perspective, a woman’s confidence, life, and joy multiply without end.

With an evolutionary perspective, a woman is fierce.  Being empowered, and learning to not apologize for who and what she is, a woman is enabled to pursue her life and her happiness with vigor.  There is a very serious power in being a natural woman.  With a natural diet, a woman has the fuel to burn brightly.  Working in concert with her body, a woman knows how much she is capable of, and what she can achieve.  Being healthy and nourished and totally self-assured, a woman can walk into any room and be a boss.  Norms won’t get her down.  Self-loathing won’t get her down.  Social pressures to apologize for who she is won’t get her down.  Instead, she will own her desires, and can pursue them with all the ferocity and joy inherent in being healthfully alive.

With an evolutionary perspective, things aren’t perfect.  A paleo diet is not a miracle cure.   I advocate paleo diets, but they will never make someone a super human. Instead, it is about moving forward one day at a time, and about doing everything possible to be alive.  This means eating well, and it also means living freely, and it means each individual chooses what is best for her.  It means moving forward with love and with positivity, and facing an imperfect world and a self– a self perfect in its imperfections–with all the power and wisdom garnered from natural womanhood.

 

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