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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.

—————————————————————–

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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109 Comments

  1. I want you to know that your blog is very much so needed in this Paleo community. I wonder if you will consider posting something about modes of exercise and the ladies? It has been my experience that HIIT is terible for fertility and lady hormones. I wonder what you think?

    • Thank you. :) Someday we’ll get other people to pay attention to holism and love, too.

      That’s interesting, Meredith. I have a sense of that, too, but I don’t know much about the exercise itself. I have written fairly extensively about hypothalamic amenorrhea, and cautioned women against exercising themselves into energy deficits and stressing their bodies, but I have never written or researched specific ways of doing that. What do you think? What should be said? Do you have any posts you’d like to direct me to, or would you like to write a guest post on the topic?

    • Agreed! There really isn’t another women’s paleo site that is laying what needs to be said to women like you are.

  2. I took low-carb seriously at the beginning of the year – 30 carbs or less with 1500-2000 calories a day. Not only did I not lose weight (at 195) even with addition of lots of extra exercise – sprinting, weight lifting, recreational stuff like snowboarding – but I started having crazy insomnia for the first time in my life. I’ve always been a nightowl, but not an insomniac and I all of a sudden couldn’t get more than 3-4 hours of sleep. Adding carbs back totally fixed it of course. Once I did more research, I realized I’d been making my liver work extremely hard. Actually the main harm was probably to my adrenals, which are already exhausted. Low-carb forces your body to make even more cortisol, which takes the adrenals away from other important tasks.

  3. So I have a quick question on the carb requirements- I have read in the PHD diet that vegetables are not to count towards the 100 min carb requirements- which would make the total carb intake more like 150g with vegetables. Is this correct? It seems like quite a lot of tubers and low-fructose fruits especially when coming from a VLC diet for over a year.

    • Well- you said it yourself, a 100 carb minimum. So why not eat 100 g of starchy carbs, and your 50 g of vegetables? That only puts you at 50 above absolute minimum, and I agree, generally, that a carb intake between 1-200 per day is totally healthy, both physiologically and psychologically.

      If you’re uncomfortable with that many carbs, I’d recommend upping your intake slowly while continually gauging your mental and physical health. Watch as it makes you feel better or worse, etc. No need to do anything you’re not comfortable doing. :)

  4. I’ve been doing a ketogenic diet for months, but had recently upped my carb intake (with sweet potatoes mostly). I have adrenal fatigue/CFS and thought perhaps it would help me with regards to exercise (especially strength training) and recovery. From reading this it looks like my insticts were right. Thanks for the great info!

    • Not a problem. And you’re right– carbs will definitely help you with strength and recovery, as well as with your performance. For the adrenal fatigue, too, I think that is also important. More important for the adrenal fatigue however might be cutting back on the exercise, say, if you’re doing several workouts per week.

      • At this point I’m hoping to be able to exercise only once or twice a week – allowing for lots of time for recovery. Cutting out grains and refined sugar did initially help with my symptoms (I’m guessing it’s because it cut down on inflammation), and I was able to move more, but I want to be strong. I had tried a few times to start a strength program while low carb (50g a day or less) and each time my symptoms got worse. I’m only two weeks into higher carb/higher caloie diet and so far no issues. I do hope I’m still able to lose weight.

  5. My trainer encouraged me to do VLC to bust through a months long plateau. I eat <30g/day for 2 weeks then "carb up" with a cheat meal. After the first 4 weeks I finally lost 4.5 lbs.

    I've experimented with both grain free cheat meals and gluten bombs and while I feel kinda crummy for a couple days after eating wheat, it goes away quickly once I'm back to VLC.

    The first 3 weeks were a huge struggle in the gym, but now it doesn't feel much different from when I was eating 100-150g carb/day. I've been sleeping great and my mood has been stable, yet I'm still a little skeptical that this is "good" for me. Most of the trainer's other clients that have done this diet have been men, and I definitely believe men and women respond differently to different diet protocols. I recently asked him if we can add some fruit in occasionally so we are going to try a midweek higher carb day next week.

    I don't have a carb phobia, and the previous diet was similar to what I'm doing now except with a daily serving of fruit and a sweet potato post workout… but I wasn't losing weight, and on low carb, I am. I just kinda worry about it doing more harm than good in the long term. Do you think staying on VLC with an occasional "carb-up" for 3-5 months will permanently damage my hormones/metabolism?

    • Hi Nicole,
      In all honesty, it’s impossible for me to say. Some women do real well on low carb diets, some don’t. It depends very much on your genetic make up, how much stress you are under right now both physiologically and psychologically, and how much stress you have been under in the past. If you have little stress in your life, and if you are being careful to eat enough calories and rest enough between workouts, and of course if you are feeling good and still making progress, I think you should go ahead and do what’s helping you.
      All that being said, the most important thing I would advise is that you watch your weight loss. If you’re doing VLC to get down to a low body fat, I recommend against that. Dieting to lose weight I think is appropriate so long as the diet is not overly restrictive (some people I trust recommend eating “normal calorie” for a day or two then “reduced calorie” on alternate days.) But being at a low body fat is a significant stressor on the body, so that coupled with low carb– or really with anything– can be real destructive. It’s relatively easy for women to cut carbs and calories and lose weight, but that does not mean that once you pass a certain threshold your body will start to panic. Take care to pay attention to where that threshold is, and accept and nourish it.
      All that being said, if you feel good, and your weight loss is balanced by healthy foods and a healthy, calm life, and it takes place over a long(ish) period of time– just move as carefully and lovingly as possible. You’ll know what to do when the time comes.

      • Thanks for the reply Stefani!
        Stress is the main concern for me I guess. I try to relax as often as I can but I do have an somewhat stressful job and I know that my often intense workouts put physiological stress on my body (even though they *feel* like a “stress-reliever” after a stressful day at work!).

        I am not anywhere near a low bodyfat percentage; I haven’t been measured but I am probably in the 25-29% range? I have a fat roll around my middle that I just want to flatten out a bit–I don’t care about having a 6 pack or looking like a fitness model; I just want to achieve a healthy, sustainable weight.

        Thank you especially for the final comment; I think listening to my body when it comes time to consider making changes is the best policy out there, and I will take that to heart.

  6. Fantastic stuff! I am only recently delving into lots of the research behind paleo, but have practiced a lot of “intuitive eating” for the last 6-8 months. That is, starting with a basic plan and adapting it in response to my body’s response. Through trial and error I’ve discovered almost exactly what you point out here. I do better with a bit of glucose and starch, but eating them in the morning wrecks me for the day, and eating starches for dinner has me waking up in the morning absolutely starving. I can eat glucose or starch at lunch easily and do so just about every day, and I can eat glucose at dinner which I do maybe half of the time. This totally jibes with everything I just read above!

  7. I’m in tears reading this. Thank you so much for writing it.

    • <3

  8. This was so refreshing to read! After trying to lower my carb intake for about a year and feeling awful every time I got too low, I kind of gave up on it. This post gave me a couple of “a-ha!” moments :-)
    So my question for you – would you group starchy veggies like carrots and beets with the “safe starches” or veggies?

    • Nope! This is because vegetables are not in fact starches. They contain glucose (or, in beets case, fructose), and they contain fiber, but starch is a different kind of carbohydrate. No matter how many vegetables I eat, I never feel the same after them as I do after eating starch. The carbohydrate in vegetables is tied up in fiber and therefore difficult to access. It’s also hard to get enough carbohydrate that way. Really, really tough. Starches are great because they provide all the carbs you want but without the huge fiber load and without spiking insulin as much as other carbs since starch takes so long to break down in the intestine.

  9. I’m both excited and apprehensive reading this. I just read Sweet Potato Power! and it is a wonderful book with ways to experiment and figure out what carbohydrate intake is best for you. It also introduced me to the idea of ketosis, which sounds good on paper, but since I have PCOS I’m not so sure it is a good idea now. I eat no sugar, limited fruit, and my primary source of carbs are Japanese sweet potatoes and kabocha squash. Yet I haven’t seen any relief from PCOS yet. I know I have to heal my thyroid too, but I just don’t know what is best any more. It’s too bad I was late in finding your site and can’t sign up for consultations! But thank you for all the valuable information. I’ll be scouring the site today, and it is such a comfort to find a like-minded community with REAL answers.
    Warmly,
    Kate

  10. Your blog is just what I need. Particularly like the point that women are not just smallish men. Over a year of eating paleo and I was starting to wonder what’s going on? Most of my diet is fat (50% or so) so I just don’t feel hungry much, but I do go through times where suddenly I’ll want to eat everything I can get my hands on (all paleo of course!) Then, haven’t been menstruating but the past year it’s menopause time (yay!), and have been inexplicably irritable or anxious. I think eating more starchy carbs and glucose will be the key … not hard to do: I love sweet potatoes :-) Thanks for the links, too.

  11. Stefani, This is one of the best posts I’ve read in weeks. My wife who is a pretty serious paleo-er with me would like to make sure she is as healthy as possible to have a baby. We both have been researching optimal carb intake and fertility and this is very helpful. We eat about 80-120 carbs a day pretty much because we do something every day, crossfit, gym, or walking. So glad I found your site just as I was putting together a Resources list for my website LivingSuperhuman.com. I will be sure to include you in it!

    • I am so glad, Tony, and thank you. :) If you have any questions I would be happy to talk further.

  12. “bananas, which are pure 100 calorie glucose bombs” — do you have a citation for that? I have analyzed bananas in the past and they are 50/50 glucose/sucrose, so this was a shock to me.

    • Ah, I see– my apologies. You are right, bananas do of course have other sugars in them. My point was just to emphasize that bananas have a higher percentage of glucose than other fruits.

      • If u want a glucose bomb, eat dates. They have the most glucose of any fruit.

        Also, grapes are higher glucose, as are pineapple

        My question; what should a good macronutrient range be for most women?

  13. Well, hmmm. Maybe I should be on your show! :-) I was starting to think cranking up my carbs again would help my adrenals. But I did eat 125+ for several years with spike days in there, too.

    Due to endurance races this summer I wanted to try full keto adaptation and see how I felt and performed. About 2 weeks into the transition and I don’t think it has gelled yet. But I bounce around too much so I think I should really get into ketosis before I try yet another thing.

    Oh, and I am 8 years amenorrhreic. Lost it while on high carb but high stress and low energy availability. Classic Ann Loucks case study, I am!

    Thoughts? I really appreciate it!

    • Yes– low energy availability and low body fat are the real killers. Carbohydrates can play a role, I think, but it’s mostly the metabolic (like endurance races!!) and psychological stressors that do it for amenorrhea. Have you surfed my hypothalamic amenorrhea category yet? Anything I’d have to say re: your condition could definitely be found there.

      Def try the keto if you’re into it– but if you find it doesn’t work– okay, wait, as an athelete, 125 g carb and endurance races… you should definitely eat more. In my opinion. If you’re not trying to do it the keto way. If you’re not keto-adapted, you’re going to need carbs to perform optimally. In my opinion.

      And just bear in mind that there is this way of eating, too, if the keto doesn’t work.

      And eating enough to keep up with your exercise! And the stress.

      If you’d like to be on the show, shoot me a comment under the ‘consultations’ tab.

  14. thanks so much for this post. i began my paleo journey (in fits and starts) about 2 years ago when i decided to take control of my hashimotos thyroid disease and not just leave it to the so-called “professionals” i have steadily gotten more and more into it as time passes. i even joined crossfit. my diet is primarily meat, fruit, leafy green veggies, eggs and nuts. i have become keenly aware of how i feel when i eat something i should not, like grains or milk (like most auto immune sufferers, i am intolerant) products, sugar, or even more coffee than usual. i notice when i eat potatoes i feel better. not a lot of potatoes and not every day, but i definitely feel more balanced. and seriously, i don’t think a hunter gather would pass up a patch of wild potatoes any more than they would pass up a honey bee hive.

    • Wonderful. I love that you can feel that, and that you eat the carbs that are appropriate for you. An inspiration, and I mean that in the most sincere sense of the term.

  15. You know, after being so low carb for a long time, it’s actually hard to get to 100 carbs a day. I didn’t realize how much: I thought I’d come off low carb but I’m actually still averaging 60 carbs a day when eating a couple small potatoes and carrots a day. Time to bust out some more squash recipes to add some variety to the fridge. I’m trying to stay away from fruit still since I’m scared I’ll overeat it.

    • I eat one giant sweet potato each day :)

  16. Hi! I just discovered your blog through MDA and it makes sense to me. I’m PCOS and hypothyroid (on levothroxine), post-meno but diabetic, too. I can keep my BG down with low carb, but I’d like to avoid adrenal problems too. I’m going to try increasing my carb intake, which is now <40ecc. I eat meat, vegetables and berries and I will try sweet potato in the mix and cut out IF for a while. Should I be eating dairy?

    What do you usually recommend to diabetics, if you don't mind my asking?

    • Not at all. :) I recommend testing and patience. That’s not a whole lot to go on, but really I would increase carbohydrates slowly if I were you, documenting any changes I felt or experienced. I think there is a range of carby goodness for diabetics, though it varies by the individual. Perhaps 50 g of starchy carbs plus vegetables will be ideal for you. You should be able to feel differences, I think, with that much of an increase, especially since you are hypothyroid. Then try adding more in, and see how it feels. (Up to 100, then 150 I would guess at an upper limit). Then perhaps somewhere in there the benefits drop off, so you move back down to 50g starch +veggies/day.
      Both dropping the fasting and adding a bit of carbohydrate might really help with the hypothyroid. :)

  17. This is a great post, but I am still left sort of confused. Here’s why: I have PCOS, and am at a “normal” weight but have pretty high insulin resistance. My endocrinologist has me on 2000mg of metformin/day which has helped enormously with holding all my fat in my stomach area. I have been eating low carb paleo for over a year to try to help with the insulin issues and try to bring down the last few pounds that my doctor would like me to lose. By low carb I mean around 50g a day, often less. I am wondering how your recommendations coincide with PCOS, high insulin resistance, and recommendations by endocrinologists to eat low carb. Maybe I have a different definition of ‘low carb’ than endocrinologists? I always thought that meant 50g or so. I crossfit 3-5 days a week, strength train, walk a lot, and am generally active. Can’t seem to lose the last 5 or so pounds very easily.

    • Ah, didn’t see the comment above, whoops.
      I should mention that I am also 26 and have an estrogen level of around 22(post menopausal) which won’t seem to go up no matter how much estrogen I take or whatever my doctors do…

      • Have you lost a lot of weight? Historically eaten a lot of soy? Been under a lot of stress? Eat a calorie-restricted diet? Answering YES to any of those questions might help explain your low estrogen and high insulin/testosterone levels. Also: have you looked into thyroid health? Another factor to consider is a physiological problem with your ovaries or in your hypothalamus/pituitary (which can be assessed via MRI).

        • Yes to all of the above, but it has been years now since all of them. PCO and loss of my period happened with a 60+ lb weight loss through vegan starvation diet and obsessive exercise addiction over the course of two years or less. But that was three or so years ago, and since then have gained back 20 lbs of almost entirely muscle, become paleo and taken up eating tons of meat, no soy whatsoever, and have become mostly a strength rather than endurance athlete. I have a fantastic endocrinologist now who runs a gambit of tests on me constantly, though I can’t recall the last blood results from thyroid. He does think that my PCO has a hypothalamic component to it… I am trying to start eating a sweet potato and two servings of low fructose fruit a day now per your suggestions, but since I am on metformin and gain weight by even looking at food, and since I actually am supposed to be losing fat right now(since I gained a lot over winter due to stress/emotional eating) it is a little terrifying to try…

  18. Great blog, very interesting. My partner and I have cut out the grainy carbs from our diet, however we also cut sweet potatoe and rice. I have not slept well for months. Which per doing this I slept like a log. I will re introduce sweet potatoe and rice back to my diet and see what happens. We enjoy paleo eating but I agree that everybody needs to listen to their body and adjust their diet accordingly. Thanks for a great blog.

    • They should be helpful for sleeping, absolutely. This is a particular concern for women, too, as tryptophan metabolism (which helps us sleep) is really only capable with the ingestion of carbohydrate.

  19. Just for clarification, I did not say in the post linked to above that I had “seen the light” with respect to adding carbs. My words including seeing the light were referring to doctors who are Paleo. I am still down with the low carb diet. Personally, I prefer to take it up for short periods from time to time these days. I have never had a problem with fatigue during low carb and haven’t claimed that adding starches gave me more energy. Adding carbs did improve my mood, however. The post was intended to scrutinize the low carb diet, not to rebuke it.

    • Thank you, Peggy. You are right– I missed that. Unfair. Editing now. :)

  20. Thanks for posting this. After many years eating various versions of low carb (and having very slow weight loss, which eventually stopped) I started having problems – turns out my T3 was in the toilet and my E2/Pg ratio is very low. Adding starches back, like sweet and regular potatoes, has really helped my energy levels and mood (which had completely bombed) and has not affected my hunger level or brought on cravings, etc. It’s just nice to hear this talked about, and to know I’m not the only one!

  21. Hello Stefani,

    For the last month or so, I have been following your recommendations to eat at least 100 grams of carbs per day in the form of glucose or starch. I am happy to report that I just got my period for the first time in six months. First off, I wanted to thank you. Secondly, I was wondering how I should eat from now on. I plan on eating at least 100 grams of carbs per day, but does this have to be in the form of starch or glucose? Can it just be from vegetables and berries? Lately I have been feeling like starchy foods and fruits have been making me very irritable and have been making it more difficult for me to sleep well, so I’m wondering how much of them I can tolerate.

    Thank you so much,
    Stephanie

    • I don’t know, Stephanie. Definitely fruits– I would be just wary of vegetables because it is so hard to get significant carbohydrate, calorie, and leptin responses from them. (Aside from beets and sweet squashes, etc) I think that is particular to your own body. Now that you have a better idea of what you need, you can experiment to find the best balance for your physical health and psychological well-being. You can only be on the up and up from here.

  22. Thank you, Stefani, so, so much for this blog. I just discovered it from the comments at Mark Sisson’s blog, and this article in particular has made sense out of my otherwise difficult-to-discern adrenal-thyroid challenges. I used to eat a potato every day in the evening, while I was diligently following an adrenal protocol that required carbs at night before bed, but where I live, potatoes are not available year-round, and run out sometime in March or April, and this last year, I stopped eating them when they stopped coming, and then I just never started again. :(

    And now, after a week of unusual stress, I am finding myself feeling like I’ve lost a year’s worth of adrenal recovery. I was feeling so discouraged, and then I remembered that you write about carbs and women, so I found and read this article. It makes perfect sense, and my man called our neighbours, who have an early potato harvest this year, and I ate potato tonight! Yay!

    Today I tracked my carb intake to make sure I ate enough. It was 112g with potatoes, and cherries. That feels so over-the-top fr me, but I tolerate both cherries and potatoes fairly well- the potatoes must have a fat (coconut oil), and the cherries must also be eaten with some fat source (usually coconut manna). I just cannot eat any carb-heavy food without fat; I get headaches and inflamation in my sinuses especially, and then my belly. I don’t deliberately vlc, but since quitting my already very-low-grain intake 18 months ago, I tend to only eat between 15 and 35g per day left unchecked. Reading your article, that now seems absurd.

    My blood pressure, energy level, and general sense of well-being have improved already just this evening with the added carbs. I actually feel more physically stable on my feet and sitting down. I’m looking forward to what it’ll be like tomorrow.

    I cannot eat many fruits because they typically give me headaches, and have just today begun to wonder if it’s the fructose rather than glucose that bothers me.

    My vlc and IFing has all been incidental. It occurred to me that my low appetite is likely due to being in starvation-mode from very-low-carb intake, ad then it all has just spiraled down from there. My childhood inclination was to shun food when stressed, rather than find comfort in it, so carbs never entered my life as comfort. Perhaps that’s how I ended up doing the opposite to most- *not* eating for comfort, and then inadvertently stressing my body with too little comfort food…

    Is this a good amount to start, do you think? I am not keen to gain weight, but fine with that if it means stronger building blocks for my cells and body- for a time. I have been pregnant 8 times, birthed and nursed 5 children (presently breastfeeding a toddler) over the past ten years, with only 3 months of not doing one or the other or both. I weigh 135lbs at 5’7″, and just lost a bunch of weight and size due to postpartum adjusting.

    I have been slowly healing my exhausted adrenals and low thyroid, and my activity level is probably moderate, owing to being on my feet moving at a steady pace for about 14 hours a day, inclusive of heavy-lifting and other chores related to rural living. I am chronically sleep-deprived, very rarely sleeping through even one cycle- maybe once every six months or so this will happen. I am woken throughout the night by my children’s nighttime needs (my man works overnights).

    My body is suffering, no doubt. There is so much that could improve by just sleeping, but until that is possible, I try to maintain my body as well as I can. I hope adding in carbs will help.

    Anything that you notice about my story that I could do, please feel free to share with me. I’d appreciate it very much.

    Warmly,
    Imogen

    • Hi Imogen. I am also working on recovering adrenal health, so I understand what an enormous challenge and long road it is. Often it feels as though I finally make one step forward and then end up taking three or four steps back.

      One thing that has been salvific for me is carbohydrates, and I see that you are finding the same goes for you. I think ~100 carbs / day is a great place to start. My recommendation with regards to how to go about it is to do what’s best– but also to try and make sure you do not restrict your carbs deliberately to a certain time, etc. So often in the paleo community we hear “Don’t eat carbs if you’re tired because it means you’re just caving to blood sugar swings” but I believe firmly that if we are in recovery and craving carbohydrates, we had damn well eat the carbohydrates.

      I understand the problem with Not Eating being the default. I also understand how a VLC diet hypes up a woman’s energy and makes her feel more focused and alert. But that also comes at a price– so move forward slowly, and integrate carbs to the best of your ability, making sure to maintain mental and physical health all the while.

      That’s interesting about fructose, I haven’t heard that before. I think fructose is pretty good for adrenal health since it is so good at restoring liver glycogen, but honestly glucose is of course powerful in its own right and if that’s what works for you, that’s what works.

      If you cannot get potatoes, why not try white rice? That should be pretty affordable and universally available?

      • Stefani, thanks so much for your reply, and encouragement. It has been a long, lonely road of recovery for me and my adrenals. I’ve been trying to get well since 1998, and only six years ago discovered that my adrenals are, and have been since childhood, exhausted. So, even being reduced to a year’s loss of recovery is still nowhere near the state of illness that I was in before.

        Okay, so 100g felt like a lot of food (though I didn’t eat more food; just different composition), and I realised just now that I’ve been starving myself in a way, because my diet is fat-protein-heavy with lots of veggies, which don’t convert to carbs very well at all, if I’m understanding your post. I mean, I eat veeeery well- high quality, nutrient-dense food! The Yukon soil is so nourishing and I eat wild plants and pastured meats and fats, and have found so many good sources of the foods my family eats, but clearly, I missed the thing I didn’t ever really have an appetite for, and here’s a conundrum for me: I was listening to my body, but it wasn’t telling me what it needed in the usual way. I don’t crave carbs. I rarely crave fruit, but I do crave meat, fat, and leafy greens especially.

        I didn’t avoid carbs before; I just didn’t desire them, so I didn’t end up eating enough.

        Your posts have really opened my eyes and put together a lot of information that didn’t fit together before. This makes so much sense. Amazing. Thank you, thank you, thank you!!! :)

        • Oh, I’ll think about the rice. Will it not cause any of the effects of grain? I’m so sensitive to grain, that I really don’t want to tax my body even a little bit with it. We’re leaving the remote north in September (after 6 years up here), so I should have a regular source of a variety of tubers soon, unlike here.

          • Ah, the Yukon! Amazing. No, it should not have any problems with gluten, etc., especially if you are sure to buy rice specifically for that purpose (processed in a facility that does NOT contain grains, for example.) However, if potatoes are the safe bet for you, I would stick with the potatoes.

            Have you read my post on fasting? That MIGHT speak to you a bit also on why you do not crave carbs or want to eat necessarily very often… I am not asserting that this is the case for you, but perhaps it resonates with some of what you feel when you do not eat.

  23. Hi!
    Here’s another girl who is so glad she found your blog and this post, thankyou!
    I started eating primal in February but never really counted how many carbs I was eating until a few days ago. (I was probably averaging 50g daily..) My husband and I are currently trying to conceive and at the moment I am actually 4 days late, with negative pregnancy tests.. (I have always been irregular and always had trouble sleeping since I can remember) After reading this I am thinking that eating too low carb may have something to do with that.. What I really need is a starting point.. From what I read above, maybe an average sized sweet potato a day would be a good place to start? (the only way I know how to cook them is as fries) And also is there a particular way to go about figuring out how many carbs I do need? Thanks!

  24. Thanks for providing a different perspective to the low-carb view. Could being too thin despite eating large amounts of calories (mostly plant and animal products) be a sign of requiring more carbs in the diet?

  25. Can winter squash replace potatoes? I am on the GAPs diet since March 2012 for digestive issues, and I have lost my period and would also like to put back on a few pounds. Potatoes are not allowed on the program, but winter squash is. I was getting 30-50 grams of carbs a day just in veggies with no fruit, I have been slowly adding in squash/pumpkin/and today I had a banana, but I’m a little scared to add too much because I struggle with sweet cravings (used to binge, even the squash causes me to obsess over when I will next get to eat it) and I do not want to compromise my digestive healing as I also struggle with food sensitivities/adult acne. The acne hasn’t completely gone away, but has cleared very much since cutting fruits. I really really appreciate any input…my body is confusing me!

    • Yes!!

      • Moreover, if you are underweight, that might be significantly contributing to your obsession over foods.

        Best of luck to your in your gut healing. :) Seems as though the acne will keep getting better as your gut does, and your stress. All my best,

        • Thank you! I obsessed over food when I was overweight too, but out may be mostly psychological/my way of comforting but I also attributed it to some sort of gut pathogen which is why I’m afraid to up carbs too much. My plan is to load up on winter squash/occasional potatoes 3 days a week when I work out and 50-100gs carbs from veggies the rest. I try to eat carrots on rest days to up my carb intake without going super starchy, any other recomendations for good veggies like that on rest days? I don’t want to turn orange from all this squash haha.

  26. I’m 19 and have low carbed (30g/day ish) for 3 years, for my skin and health rather than my weight (which has always been low). The thing is, for me, this low level doesn’t seem to cause any of the problems you mention, and I actually seem too fertile. Despite using protection, I’ve managed to get pregnant twice in the last year, and I had been wondering if increasing the carbs might be able to reduce my overfertility. Could it just be that my body is well adapted to a low carbohydrate intake because I started it young, or is it more likely to be a matter of individual variation?

  27. Your website and blog have been so insightful and helpful. I have been living/eating the paleo way for over a year now and have seen great results. BUT, hormonally, I have seen problems. When I began eating paleo back in May 2011 I also stopped taking my birth control (trinessa). Needless to say, my period stopped and I didn’t see it again for about 8 months. I got my period in January, in March, in May and in June of this year. Very irregular as you can see. I just last week was reading all your information on women needing carbs and doing some other research online on the topic. So, several days ago I started eating white rice and upping the amount of sweet potatoes in my diet. And what do you know, today my period has started! In addition to the irregularity of my period, I became lethargic and saw loss of libido. Bummer. I am still dealing with these hormonal imbalances and am hoping I can balance myself with just tweaking my diet. The natural way. Do you have any tips for me??

    I am 29 years old, 5’3″, 120 lbs. When I first started paleo I dropped to 108 lbs during my strict 30 days but now average 120. I don’t exercise as I’ve lost that desire but I do have a pretty active job that keeps me moving. I sleep well most nights, don’t take any supplements, love my morning coffee and struggle with cravings for sugar/carbs. I think about food often.

    Thank you so much for reading and thank you for the very helpful site!!

    -Tara B.

  28. I confess I’m a little confused. How can you recommend rice if you are opposed to grains? I did super low carb (50-60g a day) for two months and lost 15 lbs, and now have been back to a more SCD model of eating allowed carbs, but still not too many. I did allow the occasional potato, and felt guilty. Maybe I should stop feeling guilt about that!

    • Yes don’t feel guilty!

      Rice is free of the proteins in wheat that have the potential to be gut-damaging. :)

  29. After being on GAPs for 6 months and becoming underweight, losing my period, feeling cold and tired, constipated, and now seemingly losing more hair, I have been slowly reintroducing rice and potatoes over these past few weeks. I wanted to thank you for this article. This and finding Paul Jaminet’s perfect health diet finally got me thinking, removed the carb fear, and so far I am having positive results! To listening to our bodies!

  30. Stefani – I am so glad I found all of your information on carbs. I have been eating 80/20 Paleo for about 4 months. I ate way, way too many carbs before. But…the last couple of months my eyes have been extremely dry and now my mouth is starting to feel dry. I believe it may have something to do with not eating enough carbs – I just didn’t know I needed to eat more until I read your blog. Thank you so much. I will be adding more potatoes & bananas this week to see if this takes care of the problem. Wish me luck! Do you think I may be on the right track with this thinking?

  31. Hi,
    I really need your help. I have been diagnosed with leaky gut and suffer severe bowel pains. When I eat Paleo it heals my Gut but makes me over all health really bad. Serious fatigue I can barely move. I have realised the only way I can have a life is to eat 100 percent carbs, so if I was to eat junk food I would feel a million times better BUT in the long run it makes me bowels bad. I have always been a health freak and eaten low carb and have a history if eating disorders is this the reason I can’t do Paleo ? My body is perhaps not letting me get it in that state again?
    Also I can no longer eat protein I feel sick at the thought of it and after, previously I had a high protein diet…
    Really need some advice on this if you can as its taken my life away
    :(

    • Perhaps you really need the carbs for a while. Give your body what it’s craving while staying within a paleo/whole/natural foods paradigm… that’s what I would do, anyway. And constantly re-evaluate for optimal health and happiness. :)

  32. Hi Stephanie,

    I am still breastfeeding and wanted to get to 150g of carbs…I can’t stand squash (texture), I’ve tried it many ways and just can’t eat it. Is it okay to include red potatoes, rice, etc. to get to 150g? I don’t really want to add more fruit, but I can’t possibly eat the volume of non-starchy veggies to get there.

    Thanks!

    • Oh, hell yes!

  33. I am totally confused about carbs! :)
    I always believed “green” stuff was fiberous and on Paleo good luck eating more than 50g a day of these.

    Potatoes…any kind, beets, winter squash & carrots all starches and just bites would put you at 100g of carbs.

    I am hypo (hashi’s), adrenal issues and had a lumpectomy & radiation this year. Now I have CFS.
    I’m overweight, beyond tired, weak and brainfogged.

    Any suggestions where I can understand better which carbs and how much of them I should eat?
    Fructose/glucose???

    Of course any other suggestions to get better welcomed!

    • Hi Stefani,

      Have you experimented our researched the banana girl diet?

      • no? :)

  34. My experience corroborates the essence of this post to a T! You state:

    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.

    …this was my experience. I went on a low-carb diet to loose a few pounds and firm up even though I was already a pretty healthy weight (I think I just needed to get into a regular exercise habit). To make a long story short — I lost more weight than was healthy and I stopped menstruating (for a little over one year!), lost my sex drive, went through a strange psychological fog, lost my interest in the things that had previously held my interest (I’m talking intellectual things), was told by a doctor that I was practically hypo-thyroid, etc . . . I’m almost 28 years old and so this all seemed quite peculiar at my age. A doctor prescribed me progesterone to kick start my cycle, but the pharmacist who dispensed the prescription suggested I just eat more carbs (which is what I had considered doing; I suspected this was the issue all along but had found no information to suggest that I needed more carbs). I never took the progesterone. My cycle started about one month after I applied a high-load complex carb diet; of course I think the extra calories count too. Now I probably consume between 100 and 200 g of carb per day; mostly from bananas and berries.

    I was never strictly palaeo; never cut out any food groups; but discovered that my relatively young, fertile female self needs carbs.

    I have since gained some weight but I’m still a normal weight — I was just trying to get that chic slightly anorexic adolescent boy look that men love so much … stupid me; I’m to old for that nonsense. I’ll just eat bananas and exercise and tell men to love or leave it.

    • Yes yes yes! Thank you for sharing! Yes!!!

  35. Woohoo Stef!

    I’ve been low carb paleo for 12+ years and I and my family would like to thank you. I saw your article in the Dec. 2012 Paleo Magazine article and bought it knowing that this was me. After 2 months of once again no period for my thin, overly emotional body I bought an organic sweet potato and voila, my period started the next day. My pants are tighter, but I’m a lot happier. I don’t look big, but I’m going to have to get used to not being rail thin when our society supports that image. I still get cramps on the first day of my period and was curious if you have any suggestions. Raw milk for calcium magnesium?, allergic though. When I ate raw paleo for a month I didn’t have cramps but I was weak and emotional.

    THANKS!
    Anne :)

    • Wow, awesome!!! :) Yeah– I’d just do best to minimize inflammation. Definitely eat fish, keep the o6 fats down and eat plenty of calories / carbs as that seems to be doing the trick for you. :) Don’t do the milk if you’re allergic, that’s counter-productive. I’d recommend taking an organic magneisum supplement if magnesium helps you.

  36. I have been on paleo low carb and to honestly low calorie diet as I was restricted by food allergies and autoimmune condition. I really didn’t know what I was doing or that I wasn’t eating enough. I lost my period first after 3 months of low carb. Although I feel good, I was experiencing anxiety. I eventually became fatigued in the day time after being able to wake on my own feeling great before. Anxiety kept getting worse. I’m not sure if I had gotten glutened from the pecans I was eating as I had period stomach pain and assumed it was something else. After being paleo vlc for 7 months, and my anxiety symptoms got worse I eventually hit a disrupted sleep cycle. I felt like I was being shot with adrenalin at 7 am. Woke up 4 or 5 times a night. Then one day insomnia hit. It’s been about 3 weeks since I became insomnic. I know my adrenals are affecting me at night. My doctor told be I need more food. I want to gain weight so bad, and get my life back. This soup has affected my social life and marriage. The anxiety is preventing me from doing things I used to. I started to up carbs to 150g with sweet potatoes and other vegies, and feel the anxiety is better to manage and feel a bit better. I’m still not sleeping great but I’m not up all night and not waking up hungry. But I still have the problem of waking between 1 and 3am with full bladder. And now anytime I wake up is like that too. It’s almost been 2 weeks since I started to up my carbs. The last few days actualy hitting 150 to 180g. I wondering how long it could take before my body allows me to sleep through the night again. I get about 100 to 130 g of healthy fats. About 100 to 130 g of protien. I’m currently 102 lb and want to be 110 or higher. I’m not gaining any weight at all right now. But I’m still carrying stress and worry over what has happned to me. I’m sure that isn’t helping. How much sweet potato are you eating. I have been breaking one up into 100g with lunch and breakfast and 180 with dinner. I was eating apple sauce to but winder if I should just eat more sweet potato and squash instead. Because of oral allergies I can’t eat raw fruit. I was hoping that would improve, as I heard of other people recovering from this diet. Although I assume my vlc has stressed my body to much and kept the oral allergies around. Although to my amazement I had a great hay fever season this year and need no meds or tissues. I have a cold right now being down and out but even that has not been as bad as my husband had it, (who isn’t doing paleo). Any advise on weight gain and how muchnof anything is great. I eliminated dairy, grains, eggs, soy, night shades because of autoimmune protocol, and haven’t gotten to try to add the, back as I didn’t trust wether I would know if I was reacting feeling so crappy for so long. I’m actualy angry that I didn’t realize that I was to low carb sooner. Thanks for your great article!

  37. Stephanie,

    What you’re doing is incredible. Thank you for all the information you’re bringing to us.

    I was wondering, also, if it’s especially important for younger women to eat more carbs than the average Paleo?

    Unlike many who start cleaning up their diets, I am only 20, started low-carb paleo when I was 19, lost some fat (still have a bit more to lose), but am now adding more carbs.

    I know that the brain does not stop developing until age 25 or so, and was wondering if this fact is significant in regards to the carb debate.
    Don’t developing brains need more glucose?

    Thanks for all that you do.

    • Your brain is going to get as much glucose as it needs no matter what. I would probably agree with you however that it’s even more crucial for young women to eat carbohydrates than others, simply because reproductive cycles can be delicate, and carbohydrate restriction, as one stressor, can contributes to metabolic stress as a whole. The problem is more with metabolism and the liver and production of thyroid hormone more than the brain, I think, but you are right that women of reproductive age may be more susceptible to side effects of sorts.

  38. Wow … I recently “hit the wall” on my very low carb woe. I’m disheartened at this outcome since all the low carb “experts” seemed to agree that this couldn’t happen from a low carb diet and there is no “minimum requirement” for carbs. I thought I was losing my mind. Became riddled with anxiety to the point that I actually had a full anxiety attack (no clue what was happening as I’d never had one before). Couldn’t fall asleep – couldn’t stay asleep – bolting awake at 4 am full of anxiety and hungry. I asked one of the “experts” directly about my symptoms and was told to have thyroid and adrenal status checked. Why would they suddenly be a problem when they hadn’t been before?? Enter Paul Jaminet who was kind enough to respond when I reached out to him. He explained that my symptoms were that of glucose deprivation and how I should add back safe starch to start and heal. It’s only been a few days of starch but already I can feel changes. I’m warmer and I’m sleeping part way through the night. I’m no longer filled with anxiety and waking up under duress. I am completely mystified how many in the low carb arena can completely dismiss this as true. Their explanation would be I wasn’t implementing my low carb diet correctly (no enough fat – not enough calories). I’m grateful to have found Paul and I’m reading through his book now. I look forward to regaining some “balance” in my life and eating. Thank you for this post – it reaffirms my thoughts that going that low carb IS NOT healthy for everyone (despite what the “experts” say).

    • How many carbs do you eat per meal now? I upped my carbs and it is helping sleep now. Every week I seem to improve how much I get to sleep. But the anxiety that I got from low carb is still hanging on, and it causes the left side of my body to tense and I get this nerve burn and tingling down the whole of my left side. I was too low calorie also, and was this way for 6 months before I crashed so bad I felt like I was dying. Trina, I got that odd scared awake feeling about 5am too. That has stopped at least, although I still wake at 4 or 5am.
      I’m happliy gaining weight back went from 100 lbs to 110lbs in two months of upping carbs. I really need this anxiety reaction to stop, it’s stopping me from living and exercising. I hope reaching my optional bmi is the answer to the anxiety and period loss, but I’d like to know how much of carb/fat/protien others are doing.
      Wish you all the best, lots of love!

      • I get about 130-160g of carb a day, about 160g of fat and about 100-120g of protien. I’m 5-4 about 110lbs now looking to hit 120lbs.

        • Oh, I see! Yes, I can understand that if you are eating a bit more, and bit more healthfully (ie, paleo), then your body would be responding with an increased hormonal response. I would give it a few cycles to see if it levels out before doing anything drastic. Of course, always eating to what feels best is in my opinion the best course.

      • Hi again,
        YES, I think your plan is working. (The carbs are good and you could of course be eating more of them, definitely, if you wanted to. Whatever feels best. I personally hit around 50 percent carb on some days) I would also — I understand the struggle with anxiety as you are moving forward. The thing about anxiety is that it is not just physiological, but also mental. As you move forward with healing, you probably have to overcome a bit of the fear of anxiety, too. If you keep expecting to have it, and keep worrying about it, that is really only going to exacerbate the problem. The trick, then, I believe, is to continue on the path you are on, and to trust it, and to eat as intuitively as possible. What you are doing right now is giving your body what it is asking for, so do your best to listen and let it heal on its own. With this healing and with trust, this anxiety should wane. Patience, too. :)

        • Thank you very much Stefani!

          • Hi, I wanted to leave an update for others looking for help. I’m happy to say I just got my menstrual cycle back after getting 124lb. Also started taking a mulit vitamin two weeks before. Experienced some detox, which I believe was from iodine. Butb believe I was low on something because that helped my anxiety and mood a bit. Still struggling with some anxiety and tension, some sleep disturbances still, and adrenal/thyroid issues(thyroid is healthy but I’m showing low function symptoms). I do eat clean paleo and still on autoimmune protocol with the exception of almonds. It’s been 5 months since I crashed. I keep hoping that once my body temp comes back to 98.6, that my sleep and anxiety will improve. Body temp was 96.6 back in January, and is now between 97.5 to 98.3.

      • Along with adding carbs, ie sweet potatoes and yams to every meal, acupuncture also helped me a ton with anxiety and starting my period. :)

  39. So if you are needing to lose weight and are wanting to TTC what would be a good carb level?

    • I’d say it takes a fair bit of troubleshooting for all women, but keeping it on the low end is probably a good place to start, focusing mostly on veggies and maybe having some fruit from time to time, so long as this feels comfortable for you.

  40. I have the opposite problem…. I have been doing the 80-10-10 diet (low fat, raw vegan, fruitarian) to heal my gut for the last 1.5yrs. It worked at first, but suddenly over the past couple of months, my body started going haywire. I was underwt and needed to gain, but I’ve put on over 20# and tripled my bodyfat in 2 months without changing anything. I also have intense cravings and binges with medjool dates. I cant sleep at all. Did this fruitarian diet screw up myhhormones? I also am constipated now, which had cleared up on the fruitarian diet, but is now back again. I’ve tried adding ineggs and sardines, but it makes my constipation worse. My appetiteis irratic and im either eating dates all day or not hungry at all.

    Idk what to eat anymore. What would u suggest for someone in my situation, who is trying to come off a high carb diet and needs to heal adrenals, hormones, lose body fat/gain muscle, beat insomnia, and restore nutrient balance and heal the gut (gaps didn’t help)?

    What macronutrient ratio and grams of carbs pro fats are best? I’m 5’0, 26f. I used to be athletic but lost it from this darn high carb diet (i was eating low fructose fruits likedates, bbananas, pineapple)

    Thanks

  41. Like everyone else, thank you for this post, and your site. I am new to the Paleo diet and find a lot of the information out there kind of confusing. Some people say this food is ok, others say no way, etc. I was already gluten free for allergy reasons, so making the switch wasn’t brutal. I decided to alter my diet based on the basic philosophy, and I am eating no grains, no dairy, no legumes, and no sugar except what comes from fruits and vegetables. I am NOT however, limiting my variety of fruits and vegetables (except white potatoes). After only 2 weeks, am feeling great. On day 7 I attempted a 1/2 cup of brown rice for dinner and woke up running to the bathroom the next morning, so may wait a little longer (if at all) to try and re-incorporate a grain back in. I am of a healthy weight, but like most women, always have about 10 lbs. I would like to get rid of. For me, most of my weight is in my middle, which will be easy to eliminate if I can get my lazy butt up off the couch and exercise. I have lost 5 pounds in these 2 weeks, which is a great start. That being said, I didn’t start this way of eating as a diet plan, it is just an added bonus. I wanted to try a Paleo-based diet for basic health reasons, and for PCOS. No information was out there about this when I went through 9 years of fertility treatments, and spent a lot of money on trying to conceive (conclusion – my eggs are bad? are they bad to begin with? Does this happen during maturity? I don’t know, and am exhausted by it). I am not looking at this as a fertility treatment, but if that happened, I wouldn’t be opposed since I still have a couple good years of potential baby making left in me at 36. But I would like to have a normal hormone balance, and a period that isn’t induced by medication. Since starting this eating regime, I have been trying to keep my carbs around 100g-120g, and was thrilled to see some verification of this, and knowing I am probably on the right track. All that being said, I am wildly confused on the relationship between carbs and sugar. If all of my sugar is coming from fruits and vegetables, are sugars OK? If yes, is there a number that I should look at keeping them to, like the carbs? I love things like pineapple, and while it gives good carbs, it is really high in sugar. What types of effects could high sugar fruits cause, and are there things I should look out for? Or is this a completely different conversation?

  42. I did a very-low carb diet for a year. It caused me to develop extreme hypoglycemic symptoms. The symptoms went away when I added carbs back in, but then the constant hunger, nausea, anxiety, and insomnia returned out of nowhere two months later, even though I continued to eat starches and fruit. It’s been over a year since I’ve been eating moderate amounts of carbs, and I have constant hunger and have to eat all day. I’ve experimented with macronutrient ratios but I have to eat tons of food no matter what. It’s awful! I think I have damaged my hypothalamus. Any ideas how to get my life back? I’ve been to six doctors who couldn’t help me, plus a few alternative healers as well. My bloodwork is all normal. Thyroid is healthy. I’m at my wit’s end with this. Staying on a very low carb diet for so long was a terrible mistake for me!

  43. Stephanie, do you know if carb cycling would work to help us keep our cycles and lose weight? Like three days on three days off and on the days on really load up on the carbs? I too lost my cycle when I went low carb and dropped a ton of weight. I had to gain all the weight back to get my cycle back. I can’t fathom how it can be that way when a lot of people lose weight, keep it off, and keep their cycles. There’s got to be a safe way to do it right? Thanks!

  44. I’m pregnant thru’ IVF with twins, i weigh 45 kgs now in my 3rd trimester, should i go for protein bars with low carb or high carb as the protein in take is less per day on average.
    Can you please guide me for healthy snack bars, which have protein, iron, calcium & folic acid.

    Regards

    ethayavenkatesan

  45. I wonder what human fertility is “meant” to be? Are we meant to fall pregnant constantly, or is fertility in fact naturally intended to be much lower, as it may have been in a low-carb, paleolithic world?

    Paleolithic people did not have huge swarms of children. The birth rate was very low, typically set at “replacement rate”. People who still live those traditional lifestyles today do not have families of 14 and up. It was only after agriculture, with steady access to carbohydrate, that humans started having enormous families.

    Breast-feeding has always been assumed as the reason for the sparse families of paleolithic people. However, after reading Cheeseslave’s article, in which she talks about the peoples of the Artic who give birth 9 months after eating the fertility-hormone-enriched thyroids of caribou, I got to thinking. Maybe it was paleolithic peoples’ low-carbohydrate diets which limited their fertility, not their breast-feeding.

    In the animal kingdom, it is often access to certain foods which triggers fertility and mating. It makes perfect sense that it would be the same for humans. Steady access to carbohydrate signals to a woman’s body that it is ideal circumstances to have a baby.

    But what if we’re not “meant” to be constantly ready to have a baby? In a low-carb paleolithic world, maybe fertility was much lower than what we currently think of as normal. It’s interesting to consider that evolution may have intended humans to be less fertile than we are in agricultural societies. Also that the level at which fertility may be set in a low-carb paleolithic world may lead to a sustainable human population, as opposed to the out-of-control population growth we have now.

    I’m not sure if anybody has already researched this or discussed it anywhere else. It just occurred to me as an interesting thought.

  46. First of all Stefani, THANK YOU! for this wonderful site. I have been on the paleo style of eating (no grains, lentins & legumes) since the last 10 months. More wonderfully I have lost 76 pounds effortlessly, and at the same time I feel stronger, healthier & happier (mostly!). I have another 20 pounds to go for my goal weight, and hopefully will be there soon. I have always eaten vlc, eating potatoes like maybe as a treat, once in a fortnight. In my desperation I tried the IF two weeks ago, and inexplicably became a cry-baby. I was feeling so low & would cry at the drop of a hat. I never thought it was because of the IF as well as vlc I was doing.

    Hubby to cheer me up, rustled a dish of crispy chilly potatoes for dinner, and suddenly I felt so much happier after the meal, and the mood improvement lasted for 2-3 days. In the mean time, a light bulb went on, I Googled & landed on your site.

    Thank you so much for sharing your wisdom with respect to Paleo & women. I think you are doing something that is vital, and extremely important for the community. May the Goddess Bless You! :)

    • May the Goddess bless you too, Tanveer.

  47. So you don’t count any other veggies? It’s a bit of a leap for me. I’ve been eating Paleo for the past three years and usually eat around 60-80g carbs (but 30g fibre and very few starches…mostly non starchy veggies) I’ve just picked up the PHD in an effort to finally heal my body. After 6 years with no period my adrenals are now rather low, I’ve got low zinc, B6 & vit C, my urinary amino acids are all low (except for taurine), my progesterone/estrogen are almost undetectable now (by blood and saliva) and my cholesterol is all messed up (high Trig/LDL, good HDL and ratios). Strange however that my TSH, T3/T4 are all normal. Any ideas why that may be?

    • Meg, I know you never got an answer from Stefani but I am in a similar situation to you- amenorrhea, progesterone/estrogen undetectable, adrenals on the low side etc. and I would like to get pregnant in the next 3months to a year so it is concerning. I found Go Kaleo and have joined her site and this seems to be the route that is helping me heal. You might want to look into that :) Good luck!

  48. Thanks for the paleo post, I hope you will post about thyroid diet for women as well.

  49. Hi! I just found thus post and I’m so thankful! I hope I get a response :) I need some guidance… It seems I have a hypothyroid, but TSH is up and then down, but it seems that can happen. I wanna follow an auto-immune protocol for Hashimoto’s, but some of the info online recommends not eating starchy vegetables (no to sweet potatoes!) and some (like Chris’s Kresser and Practical Paleo) say to go go it. So I’m confused!! I’ve been waking up at 3 am starving. My heart had a strong beat, and I can’t fall back asleep. And now I’m confused if I should eat a starch at that time, if this is a blood sugar problem, or just hunger. Any help you can give Stephanie would be so greatly appreciated! Thanks!

    • I’d say to go ahead and eat the starches whenever you like. Chris and Diane are smart cookies. As am I ;)

      If you’re waking up in the middle of the night starving (happens to me, too) eat more during the day! And of course feel free to eat at night – any macronutrient you’d like. I’ve found that balancing macronutrients at night is the best however so I don’t get a blood sugar spike, personally

  50. Do you have any recommendations for those of us w/ celiac? I find that more than a small amount of starch will result in awful indigestion, sometimes for days. I’ve been eating a yam or potato, about 8 oz/ a night & definitely find it helps me sleep, but I’m afraid to increase that amount. I struggle to get in 100 grams or carbs a day, mostly from dairy products, veggies, & a piece of fruit. Thank you!

    • Yes, fruit!

  51. Hi! I was wondering about that. In july, I had about 46% of body fat, 206 lbs and 166cm. In october, I was 186 lbs and 36% of body fat. During that time, I was eating <30g of carbs, basically vegetables, avocado, strawberry and slices of sweet potato.

    Since than, I was following the same diet and did not lose a lb. I decided to eat more carbs for 3 weeks, adding 1 banana or apple and some grapes everyday, a bit more of sweet potato and I've introduced yam and tapioca. I lost almost 5 lbs!

    I was so happy that I've decided to join the gym. 3 weeks later, working out 5 days a week (no cardio, only lifting weights) and cutting back to <30g of carbs, I somehow gained those 5 lbs back. That was really frustrating eating so "correctly" and gaining all the weight back.

    Now that I've read your post, I will add one more fruit and yam everyday (: Let's hope it will help me, since I still wanna lose 36 lbs (:

  52. I am thin and I am trying low-carb to help kill off the candida. I feel so tired! I am definitely not doing low-carb for long term, just enough to kill candida and then replenish my body with carbs again. Do you think this is a good idea? How long should I be low-carb for? (I am thinking 2 weeks, it’s been a week already). I am supplementing with plenty of goat butter, raw butter, yogurt with goji and manuka, a few vegetables, with meats…

  53. Hi…I’m 46, perimenopausal, hypo-T. I can never seem to figure out what the balance is of “enough” carbs, but weight loss as well. Do you have any range you might recommend to me? I have 80 lbs. to lose. Thanks. :)

    • What feels best? Lower carbohydrate I would think definitely — perhaps with most of your carbs as vegetables and some slices of fruit or a serving of a carb here and there

  54. Thank you, good info here. I was on a low carb/glycemic diet for about 8mo which really helped with my sugar addiction and yeast infection. I have been thinking for a while now that it’s time for a more complete, balanced diet. I am finding a lot of guidance from the book “Trim, Healthy Mama” and the other ladies I have talked to who are also following that plan. This post is just a confirmation I’m on the right track. :-)

  55. Hi, I’m 21 years old and have been suffering from terrible hair loss, change in hair texture from silky to thin, brittle and straw like, excessive thirst, dry mouth, and loss of natural period since I was 18 years old. Everything started around the time I began a course of accutane treatment for my cystic acne. However during this time I also began restricting my diet and was under severe stress. Ever since then, I have always kept a close watch on how many calories I eat, little to no carbs and eliminating a lot of foods from my diet. I have been on and off birth control just so I’d have my period but I recently decided to stop the bc pills and see if I can get my period again on me own. I’ve always had a feeling all of my symptoms might have been hormone related but doctor after doctor, test after test, they all said everything looked fine and fell in the normal range. I also developed bilateral parotid swelling over the course of this time and has remained constant. My cheeks and salivary glands feel inflamed and I can never seem to quench my thirst. I’m wondering if adding carbs will help this???

    • YES.!!! At LEAST 100g/day. Carbs will help your adrenals, your pituitary, AND your thyroid. YES.

      • thank you so much! This site has been such a huge eye opener to me. Yesterday I had my first bagel and cream cheese in literally YEARS and I had macaroni and cheese for dinner. It feels amazing and so freeing to just eat the foods I’ve forbidden myself from for so long. I’m noticing I’m feeling A LOT more hungry lately also. I’ll start feeling hungry one to two hours after I had just eaten…when before I would always go around 4-5 hours before my next meal/snack. Is that a good sign? Also would adding milk be a good idea to help with my hormones?

  56. I just love you! I lost a ton of weight and put on muscle, eating a paleo diet, with plenty of sweet potatoes and plantains. I work 2 jobs as a bartendar. I’m on my feet constantly, on top of strength training, HIIT and walking/sprinting with my pup. I hit a plateau so I took out the starches of my diet, thinking maybe I was eating too many carbs. That was stupid. I ended up putting most of my weight back on and being tired all the time. I went from waking up, energetic and being excited for the day, to wishing I could stay in bed all day. I couldn’t get through a workout anymore. My mood changed and my all around quality of life. I was so brainwashed by the whole carbs are evil buzz that I tried everything, except adding back a little glucose to give me that extra energy. I finally did this week and I feel so much better already. I’m hoping this helps me get back on track. This article gives me some reassurance.

  57. My partner and I are trying to conceive and I have lowered my carb intake for 3 month so far. Sweet potato is the only carb I use. What amount should I eat to increase or keep up my fertility ??

Trackbacks/Pingbacks

  1. Getting Back in the Swing of Blogginess « HIIT Mama - [...] I read a great post by Paleo Pepper  on carbs and [...]
  2. T or F: Carbs least important at breakfast and dinner? | Mark's Daily Apple Health and Fitness Forum page - [...] At least some women report these things. This article I read today was pretty interesting. Paleo For Women …
  3. carbs blah blah blah my head is gonig to explode - Page 2 - 3 Fat Chicks on a Diet Weight Loss Community Weight Loss Support - [...] for Women site has an interesting take on the low carb craze and how it may not be good …
  4. Plain ol’ Banana Bread | tgipaleo - [...] can be remarkably good for us.  Ditto for the extremely low-carb dealio.  While benefits of very low-carb diets and …
  5. I’m a quitter and a liar. Oh, and a complainer. | Pregnancy 101 - [...] was my favorite Paleo blogger, ironically enough, who posted a link to this article. That article, if you don’t …
  6. What we eat, and why « Edessa - [...] a whole bunch of other nasty things. It seems to be far better to keep the carbs fairly low …
  7. The search for balance: ditching attachments « thehealinghearth - [...] relationship with my body, and the gym is just feeding that.  I’m feeling what this gal and this gal have said lately: …
  8. FAQ: My paleo | [BLANK] of the month club - [...] FTW!).  I don’t severely limit them at other times of the day (especially not after reading this article from …
  9. Carbohydrates for fertility and recovery from hypothalamic ammenhorea | Mark's Daily Apple Health and Fitness Forum page - [...] from an ED take note ladies, 100-150g of carbs at a minimum is recommended for healing. Paleo …
  10. Jan 4th « Eating Well In North America - [...] While I’ve heard that low carb works well for some women, I’d never try to restrict my carb intake. …
  11. TPV Podcast, Episode 23: Fertility, PCOS, and Female Hormones | Paleo Parents - [...] Stefani on carbs for fertility  [...]
  12. Hair loss and thyroid problems from low carb - Page 8 | Mark's Daily Apple Health and Fitness Forum page 8 - [...] I thought this was a good article regarding the …
  13. How do you do, Paleo? | Primal Park Life - [...] folks. Some of us kept our carbs to below 50g per day, others felt better on Perfect Health Diet/Paleo …
  14. A Tale of Carbs « Leo goes Paleo - [...] ik heb hier niet zelf een studie naar gedaan, maar haal mijn informatie onder andere hier, hier, hier en in breder perspectief hier …
  15. Bringing Back Starches: Beef with Broccoli and Roasted Kabocha Squash | Nourishing Nantucket - [...] against you. I have read Stephanie Ruper’s analysis of carbs and fertility for women over at Paleo for Women …
  16. learning more about carbs, hormones, and acne | purelytwins - [...] makes us feel our BEST.   Check out this article if you are interested in learning more about carbs, hormones, …
  17. Hypothalamic Amenorrhea Jan 2013 (PREG, M/C, CHILD MENT) - Forums - [...] to go down easy (: Stephanie Ruper has an interesting post on carbs and fertility on her blog: (Paleo …
  18. More Adjustments from a Dietary Standpoint | - [...] had also come across countless research articles stating the importance of consuming carbohydrates and their role in metabolism and …
  19. Dear America, Get Over Your Fat Phobia | Paleo Parents - [...] of this is unusual, Chris Kresser, Paul Jaminet and Stefani Ruper (my personal favorite) have tons of information on …
  20. Bad Lab Results - Page 3 - 3 Fat Chicks on a Diet Weight Loss Community Weight Loss Support - [...] between 7 and 12 grams most days. I read this blog and this blog post touches …
  21. Shieldmaid’s Guide to PaleoWorld | Shieldmaid - [...] about carbs: please read this article about dietary carbohydrate and female fertility, which is one of the hugest biomarkers …
  22. How to end world hunger | Traditional Christianity - [...] try to keep my carb intake between 100-150 grams per day, depending upon how active I am, which is …
  23. Restrictive Dieting and Menstrual Function: a Canary in the Mine? | Go Kaleo - [...] Stafani Ruper’s discussion of carbs for health and fertility. [...]
  24. How Much Carbohydrate, Protein and Fat You Need - [...] good, that does not mean trace amounts to none is even better. Read this excellent article “Carbohydrates for Fertility …
  25. How To Customize Your Diet - [...] placing on fasting or constant ketogenesis. As I alluded to earlier, you can this article “Carbohydrates for Fertility and Health” …
  26. Hypo-huh? | The Awesome Kiwi - [...] Carbohydrates for Fertility and Health by Paleo for Women <—- Don’t fear zem! Love zem! Love them taters n’ …
  27. Crispy, Oven-Baked Sweet Potato Fries | theclothesmakethegirl - […] are good reasons for me to eat sweet potatoes – like these science-y ones in this blog post about …
  28. getting the balance right - Page 6 | Mark's Daily Apple Health and Fitness Forum page 6 - […] lovely lady just sent me this link and it was very helpful for me - Paleo for Women …
  29. Primal Challenge Journal (MamaGrok) - Page 133 | Mark's Daily Apple Health and Fitness Forum page 133 - […] that women should NOT reduce their carbs too low. I find 1 sweet potato a day makes a difference. …
  30. Rants & Raves 2/22/2014 | theclothesmakethegirl - […] Consider sweet potatoes. And plantains and yucca and jicama. I love this post on Females, Carbohyrates, and Hormones! So …
  31. Hello from Kentucky. Need a couple of opinions please! | Mark's Daily Apple Health and Fitness Forum page - […] a banana?? the carbs, the horror!" days. Robb Wolf - Females, Carbohydrates, and Hormones Paleo for …
  32. Meet your Thyroid: a Paleo Introduction | jsmelo - […] of this response. But the hormonal changes involved also affect thyroid function because the liver needs glucose to convert …
  33. 5 Common Paleo Diet Mistakes You Don’t Know You’re Making - […] with high blood sugar may actually do themselves harm by excessively limiting carbohydrates. Women may be especially prone to …
  34. The Great Starch Experiment | Phoenix Helix - […] out of my way to eat these every week, because I didn’t want to accidentally go low carb and …
  35. Primal people not wanting to lose weight? | Mark's Daily Apple Health and Fitness Forum page - […] being too thin. Has anyone else had to add more carbs back to their diet? I was …
  36. “My” paleo | Heck Yeah That's Paleo - […] veggies.  I don’t severely limit these (especially not after reading this article from Paleo for Women), but I don’t …

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