The following is a guest post by a fellow health blogger – Kate – who had an infertility problem then fell in love with leptin.
I used to have a bit of a body fat phobia. Although at 13% body fat, I didn’t really have that much to worry about from what other people would think. I was impressive right?
Problem was, along with no body fat, I also had no period, no ovulation, and, no fertility. I was diagnosed with hypothalamic amenorrhea. I looked “healthy”, but my reproductive dysfunction indicated otherwise. I knew I had to get this sorted, and fast, as my partner and I were trying to conceive.
I consulted a few of my health practitioner friends. They all suggested that maybe putting on a bit of body fat might help kick things back into gear. As a group fitness instructor who was paid to stand up in front of others in skimpy lycra, this was the last thing I wanted to do. Being the stubborn person I was, I needed justification as to why, and how, fat would help to restore my fertility. Cue leptin.
Leptin is one of the more recently discovered hormones and is often referred to as the “anti-obesity” hormone. In fact, the word “leptin” is derived from the Greek term “leptos” meaning “thin”. This little hormone, which is produced predominantly in adipocytes (fat cells), conveys information to the brain about the amount of energy available in the body. Leptin levels rise with increasing food intake, telling the brain “Yay! All is well. We have sufficient nutrients to do our thang”, and the fall in times of food deprivation, telling the brain “Things aren’t so good. Looks like we’re in a famine and need to shut off non-vital functions”. Unfortunately, reproduction is one of those non-vital functions. We do not need to reproduce in order to survive. Simple as that.
But really, it’s not as simple as that.
We now know that leptin acts as more than just an energy thermostat. Indeed there are over 19,000 papers that have been published on leptin (no, I have not read them all, sorry), showing that leptin has various physiological roles. But back to the case in point – aside from signaling energy sufficiency to my brain, how would body fat and, as a by product of increased body fat, leptin help me to recover from hypothalamic amenorrhea and restore my fertility?
That depends on what’s going on during a healthy menstrual cycle.
During the first half of the cycle, otherwise known as the “follicular phase”, follicles (in the ovaries, which house an egg that has the potential to be fertilized) develop. The pituitary gland releases Follicle Stimulating Hormone (FSH) to, as the name suggests, stimulate the follicles to mature and secrete estrogen, which will have the lovely effect of producing fertile cervical mucus. Sorry, we’re getting graphic now.
Once FSH and estrogen have things looking all fertile and sexy, the pituitary gland releases Luteinizing Hormone (LH) to stimulate ovulation, where an egg will burst out of a follicle and wait patiently (for about 12-24hrs…pretty impatient, really) to be fertilized. Meanwhile, the follicle that was left behind becomes the corpus luteum, which secretes progesterone and prepares your body to house a mini-human (think pro-gestation).
So FSH and LH (also called gonadotropins) are pretty important. Without them, your sex organs would not receive the message to produce your sex hormones, or to ovulate, or to menstruate. But we are missing an important step. FSH and LH need a little encouragement too, and this comes in the form of another hormone – Gonadotopin Releasing Hormone (GnRH), which is released by the hypothalamus. Are you lost yet? Female hormones are confusing! Quick recap – GnRH stimulates the release of FSH and LH, which promote ovarian function and a healthy menstrual cycle.
Now here’s the kicker – leptin has been found to play a regulatory role on GnRH secretion and hence, overall reproductive function. Whether this is a direct or indirect role remains to be discovered. However, what we do know is that women with hypothalamic amenorrhea (when menstruation ceases due to dysfunctional signals between the hypothalamus and the pituitary) tend to have lower leptin levels than women with healthy, ovulatory cycles, as a result of low body fat and/or increased physical activity and/or insufficient food intake often found in amenorrheic women. These low levels of leptin then contribute to alterations in GnRH secretion, as evidenced by disruptions to LH secretion (Ackerman et al, Goumenoua et al). Interesting, right? Thought so.
Now I know what you’re thinking – what happens if we give someone leptin? Will that get things back on track? Well yes, Welt et al (2004) treated a small number (n=8) of women with hypothalamic amenorrhea with leptin over a period of 3 months and found that the treatment did restore menstruation, ovulation and hence, fertility.
Similarly, Mantzoros et al (2011) boasted this: “Our results indicate that leptin therapy resulted in resumption of menses….in 70% of the subjects [and] 60% of these women also ovulated”
Woo hoo! Let’s all go and get us some leptin to inject….
OR we could just eat more, exercise less and embrace our booty!?
[Stefani notes: You cannot get leptin over-the-counter, or have it tested for in a blood test. I’ve tried both.]
After 2 years of being in denial about the importance of body fat and desperately holding on to my 8-pack abs, which I had thought was my defining feature, I succumbed. I put on (quite) a bit of body fat. I ate more. I exercised less. And I realized that my friends and family probably loved me for more than just my body. Doctor Seuss was right after all when he said:
Smart man that Dr Seuss.
I put on weight. That was the goal, after all. And I definitely was no longer 13% body fat, as evidenced by my increasing bust line (yay) and decreasing (absent) thigh gap (also yay, I think – that shit is just not normal for my body.). One other lovely effect – my period returned. Hurrah! It just goes to show that with a little dedication and a (pretty big) mental shift, beautiful things can happen.
Ladies – your period is a luxury, not a right, and definitely not an inconvenience! If your lady holiday is MIA, see it as the canary in the coalmine and do something about it before the shit really hits the fan (think osteoporosis, heart problems and infertility). Stop trying to reach some warped perception of the “ideal” body and start embracing your natural feminine curves. And remember – you are so much more than what you look like. Be kind to yourself for once.
References for all you fellow nerds out there:
- Ackerman, K.E. et al. (2012) “Higher ghrelin and lower leptin secretion are associated with lower LH secretion in young amenorrheic athletes compared with eumenorrheic athletes and controls”, The American Journal of Physiology – Endocrinology and Metabolism, 302: E800–E806
- Goumenoua, A.G. et al. (2003) “The role of leptin in fertility”, European Journal of Obstetrics & Gynecology and Reproductive Biology, 106:118-124
- Holtkamp, K. et al. (2003) “Reproductive function during weight gain in anorexia nervosa. Leptin represents a metabolic gate to gonadotropin secretion”, Journal of Neural Transmission 110: 427–435
- Mantzoros, C.S. et al. (2011) “Leptin in Human Physiology and Pathophysiology”, The American Journal of Physiology – Endocrinology and Metabolism, 301: E567–E584
- Moschos, S. et al. (2002) “Leptin and reproduction: a review”, Fertility and Sterility, 77(3): 433-444
- Quennell, J.H. et al. (2009) “Leptin Indirectly Regulates Gonadotropin-Releasing Hormone Neuronal Function”, Endocrinology, 150(6):2805–2812
- Rexford, S.A (2004) “Body Fat, Leptin and Hypothalamic Amenorrhea”, New England Journal of Medicine, 351 (10): 959-962
Kate is a Holistic Nutritionist, Personal Trainer and Lifestyle Coach specializing in hormone healing. Kate has over 13 years of experience in the health and fitness industry. She is passionate about helping others achieve optimal wellness through nutrient-dense traditional whole-foods, adopting mindful and sustainable life practices, and moving in ways which rejuvenate rather than deteriorate the body. Kate’s goal is to educate, inspire and empower others to live life to the fullest each and every day. Kate can be reached at www.theholisticnutritionist.com
One thing about being a health blogger that drives me nuts is being asked about supplements. Mostly I don’t like it because I never know what to do or say. According to some studies, certain supplements have certain benefits for certain people, but according to other studies the effects are more ambiguous.
How can I give a blanket recommendation? Even in specific cases I am wary. Some people need heavy doses and others need very little. Julia Ross says sometimes people only need to touch a pill to the tip of their tongues for the right dosage.
Another thing that I don’t like about supplements is the herbal class. Magnesium citrate — okay, yes, I know what that is and it’s specific chemical formula.
But chasteberry? Spearmint? Holy basil?
There are very few rigorous studies done on herbal supplements. This is particularly important for fertility, as just about every herb is recommended for some sort of fertility-related use, but only credible via anecdotal evidence and tradition.
The only thing I can say to people who want to try chasteberry for PCOS is “well, it’s said to have hormone balancing effects.”
Whatever the hell that means.
BUT – okay – we’re getting to the important part of the post now.
There’s one supplement I get asked about a lot, and I am always happy to answer, since its not only been shown to be fairly harmless and symptom-free, it also may in fact improve your health in a fair number of ways. It may:
Improve skin quality
Mitigate PMS symptoms like depression, breast tenderness, cramping, and weight gain
Lessen the severity of periods
Regulate hormone production
Improve insulin sensitivity
And best of all – cool systemic inflammation.
EPO is not a miracle cure — nothing is! — but there’s a lot of cool biochemical theory behind why it has its place in anecdotal cultural lore. Knowing the biochemistry is awesome because it can help you understand the whole omega6/omega3 relationship and why their balance is good for your health.
Here’s the skinny on EPO, and why you might want to experiment with it for your hormonal and inflammatory needs.
What is Evening Primrose Oil?
Evening Primrose Oil is a pressed plant fat – much like canola oil is. It’s composed largely of omega 6 fat. If this fact raises red flags for you – that’s good. Omega 6 fats, by and large, are fats worthy of trepidation. Most of them cause inflammation in the body. But not all.
In order to understand what’s good about EPO fats, we’ve got to take a step back and look at what your body needs in order to be healthy and happy.
Just about every body process is regulated by hormones and prostaglandins
Hormones are molecules that are made in one place of the body and that typically travel through the bloodstream to act on cells in another place. LH, for example, is produced by the pituitary gland. LH then runs south to tell the ovaries what to do.
Prostaglandins have the same bossy behavior as hormones… but they act entirely within the confines of a single cell.
Body functions that require proper prostaglandin regulation include:
-monitoring blood pressure and viscocity
-managing cell growth and division
-promoting a healthy metabolic rate
-supporting the immune system and
-regulating secretion of hormones
Prostaglandins are synthesized out of fatty acids
So we talked a bit about omega 6s before. Omega 6 and 3 are two kinds of essential fatty acids. Your body cannot produce them. You must consume them. These polyunsaturated essential fatty acids are therefore where it all begins.
Afer you consume a fatty acid, your body uses it to make prostaglandins. Prostaglandins each have different effects on the body. Therefore: the different kinds of fatty acids you consume directly impact your health via prostaglandin activity.
Different prostaglandins and their cellular effects
In general, omeag 6 fatty acids and omega 3 fatty acids go on to participate in production of either inflammatory or anti-inflammatory prostaglandins.
Omega 6 prostaglandins are usually “series 2 prostaglandins,” which inflame the body hard and fast. This is their job. They help with acute swelling, clotting, and dilation.
In small doses, the series 2 inflammation that comes from consuming omega 6s is a good thing. It helps heal wounds. Most of us do not just consume small doses of AA (the culprit omega 6 fatty acid), however. Estimates of American consumption of fatty acids put omega 6 fatty acid consumption, on average for Americans, between 10 and 30 times the amount it should to be.
It is worth noting at this point that saturated animal fats like eggs, butter, and lard can also contribute to series 2 prostaglandin activity. The majority of paleo leaders, however, consider prostaglandin activity in series 2 from natural animal fats to be a perfectly appropriate part of a healthy diet, and I count myself as one of them.
Omega 3 fats like EPA and DHA cause the production of “series 3″ prostalgandins, which slow down the inflammatory response. Most researchers and authors who write about these things liken series three prostaglandins to the “slow lane” of inflammatory activity. Series 2 are the fast lane; series 3 the slow lane.
Series 3 prostaglandins are synthesized out of EPA, which is the omega 3 oil found in fish. Now you can see why it’s so important to keep omega 6 and 3 fats in proper balance. You need your rate of inflammation to be just right. You need some inflammation, but not too much! So eat fish plentifully for its slow-healing effects.
(Do not, however, consume fish or fish oil to extremes, since it’s ideal to keep total omega 3 and 6 intake reasonably low.)
In addition to these two basic categories of prostaglandins, there is one more type. It’s called “series 1″ by some thinkers. Instead of simply participating in fast or slow inflammatory processes, series 1 prostaglandins actively block the fast inflammatory processes of the omega 6 series 2 prostaglandins.
In sum: how Series 1, 2, and 3 prostaglandins interact
Series 2 prostaglandins inflame the body quickly; Series 3 prostaglandins slow the inflammation process down…
and series 1 prostaglandins put the breaks on series 2.
Series 1 prostaglandins can actively halt the hyper-inflaming, hyper-stimulating activity that comes from series 2.
(Hint: guess which series evening primrose oil supports?)
The relationship between Evening Primrose Oil and Prostaglandins
Evening Primrose Oil is composed of fatty acids.
Now, Evening Primrose Oil is mostly omega 6 fatty acid. BUT, one kind of omega 6 found in EPO is pretty special. It’s called Gamma-Linoleic Acid. Evening Primrose Oil contains more GLA than any known substance. GLA may comprise 75 percent of the fatty acids in EPO (!). Other estimates put GLA in the oil at only around 30 percent, which seems a bit more reasonable. Regarldess of the variance, Evening Primrose Oil is one of the only sources of GLA around.
Other good sources of GLA include blue-green algae, hemp, and black currant oil. I am probably not going to be eating any of these any time soon.
GLA is the fatty acid most supportive of series 1 prostaglandin activity. Remember, this is the stuff that can help put a break on inflammation in the body.
GLA is anti-inflammatory and may promote healthy hormone production
Series 1 prostaglandins help prevent hormones from going into hyper-drive, since they down-regulate the frenetic activity of series 2 prostaglandins. This means that estrogen levels – if estrogen dominant – may be able to come down some, and that insulin and testosterone levels can also be brought back down into check.
Now – this is all based off of biochemical theory. No significant studies have been done regarding the effects of EPO on people’s health. Nonetheless the biochemical theory is fascinating, and it seems to support hundreds if not thousands of years of people using EPO to increase fertility, to increase lubrication in their vaginas, to reduce PMS, to clear their skin, to support uterine health, to reduce headaches and to sooth joint pain.
So therefore Evening Primrose Oil…
-has been recommended by people like Robb Wolf and Liz Wolfe (no relation, by the way, if you never knew that) to sooth acne
-is thought to reduce PMS symptoms and heavy periods
-may help blunt insulin resistance
-can help the body regulate its immune response and sooth gastrointestinal inflammation
-can boost fertility via calming insulin and testosterone production, and keeping estrogen and progeterone in better balance
-may not do anything at all, but who knows?
You can check out some EPO on Amazon @ here. I’m not trying to sell you on the stuff, honest. It doesn’t matter to me. I personally don’t take it. Then again, however, I don’t take any supplements save for the occasional magnesium. It’s only that I’ve been asked about EPO a lot, so I thought I’d share my thoughts on it. I am also excited to share the fatty acid information with you, which is helpful for understanding what everybody means when they say “systemic inflammation” and advocating omega 6 and omega 3 balance – bearing in mind that there is of course a lot more to the whole story.
Featured image from wethechange.com.Read More
What are the biggest red flags for different kinds of hormone imbalance? And more science and hijinks on The Paleo View with Sarah and Stacy
Last week Sarah and Stacy had me as a guest on their podcast The Paleo View. They said that it was a moral imperative for them to have me on — other people were starting to come on the show more often, and they needed to keep me as their most frequent guest. This made our fourth episode together, I think.
And what an episode, too!
Let it stand by way of an introduction that I love and admire these two women beyond words. Sarah’s The Paleo Approach, the ultimate guide to autoimmune disease that was released last month and which has made gigantic waves in the paleo and holistic health scenes, and Stacy’s Beyond Bacon and Eat Like a Dinosaur are just some of the many reasons these women inspire me daily.
They also happen to be sassy, and strong, and smart, and mmmmmm yay!
So in this podcast we focus on hormone balance.
What are the primary kinds of hormone imbalance, and what are the signs and symptoms?
What role do hormones play in other health conditions like autoimmune disease? Is there a connection? (Answer: you bet!)
What’s up with birth control and how can it negatively affect hormone balance both in the short and long term?
And boatloads more.
And don’t forget the opportunity to win a free, pre-release, signed copy of Sexy by Nature, by submitting your completion of the sentence “I love my body because…” in the comments at the blog post http://paleoforwomen.com/sbn.
And check back in a few days as I gear up to give away big.
The one thing that we talk about most in this community is how to be in hormone balance. How to be fertile. How to enjoy being a woman instead of constantly fighting the basic facts of natural womanhood. Every day I send emails to women making recommendations regarding food choices, lab tests, and self-love and body image issues. I thought it perhaps best, then, to share with you the differences I have experienced at different points in my life regarding my hormone balance.
Pre-weight loss; pre-exercise-binger; pre-paleo
As an adolescent and very young adult, I had some but not extreme acne. I weighed 137 pounds at my “heaviest,” which at 5’2 is approximately a size 7, and on my larger days a 9. I was also quite stressed out so did not menstruate super regularly, but still menstruated on a fairly regular basis. My periods were not always, though sometimes, incredibly painful, and lasted approximately 6-8 days. I do not have any good photos from the time (and I deleted off of my facebook any of the ones that actually showed my body fatness… choosing to leave tagged only those photos that were most flattered). But here is what I looked like, more or less:
(College “I’m drunk meditating on the side of the road in Beijing” phase)
(College “I’m dressed as a fairy holding the ‘make out’ hat” and “this photo is actually super flattering” phase)
Yet I dug up one from another angle in which I appear a bit less flat:
(Yes, I’m kissing someone, not a phase.)
(College ”I’m a crunchy hippy” phase)
In the fall of 2009 I finally achieved the momentum I needed on my low fat, low calorie, vegetarian diet, 90-minute-sprint-workouts-every-day regimen to shrink down to, at my lowest, I think I was probably around 105 pounds. I bounced back up to 115 for the next few years but I still wore size zero, 25 inch waist pants.
In this time period, I experienced:
-the complete cessation and continued absence of anything resembling a sex drive
-an vagina that was, all of the time, as dry as Oscar Wilde (if not more so-if such a thing is possible)
-a completely absent menstrual cycle
-constant hunger (though I did not know it at the time since I had yet to experience the real cycle of intuitive eating yet)
These five bullet points might not look like much – but when you’re a woman who prided herself on her voracious sex drive and then it completely vanished, and you became infertile, and had acne… the thing was, I always suspected that my weight was to blame for my acne, at least in part, but I always thought it still worth the trade off. I’d rather have acne and be thin than be fat with clear skin.
This is what I looked like in this time period:
(“I cover my face because the sun burns my acne” phase)
(“I have eight pack abs, so what, b*tches?” phase)
(“Thigh gap!” phase)
(“Holy crap I’m so comfortable in this tiny body please don’t take it away” phase)
Lots of women probably menstruate at the size I was in the photos above. They probably had sex drives. I did not. All I had managed was to salvage my skin, mostly by reducing the fiber and protein contents of my diet, as well as by adding a topical probiotic to my daily regimen and ceasing to use conventional soaps and such. I had also managed to ovulate a few times, mostly by radically reducing stress or by having a particularly potent sexual encounter, but I did not have a true menstrual cycle, not by a long shot.
I also ate paleo the whole time, so anyone who says all you need to be healthy is a paleo diet is woefully uninformed.
Then came a time in which I prioritized my work and energy over everything else, and was extraordinarily stressed out. I gained weight. fast. And surprise of surprises, I menstruated. (Literally, it smacked me right out of the blue.) My sex drive had steadily increased up until that day, and has remained not just “oh thank god sex doesn’t disgust me anymore” or “well sure I’ll kiss you I guess” but “holy crap I want to do it now” since then. I have continued to cycle since. And my skin has cleared, almost entirely (to be fair: my stress has also been radically reduced), and I have, to my mingled dismay/resignation/fear/acceptance, continued to gain weight.
This is what a Stefani that can menstruate looks like:
(“I’m such a big deal I do photoshoots and holy crap I’ve got hips” phase)
(“Holy crap back fat stomach fat” phase)
(“Bear in mind that the camera on my phone elongates and I’m not nearly this tall or slim” phase)
If you want to see a video of me partner dancing in a body that menstruates (which is, still, a size or two smaller than I am now, I am more than happy to invite you to do so, here).
Looking at these photos, you might hardly see a difference. So what, you say. ”She’s not overweight.”
No, of course not. I agree. I mean — there is definitely a difference, and just about everybody in my life has remarked upon it. My thighs are about 3 inches thicker, each. My face “fuller.” My abs, gone. My periods, pain free, and quite short (thanks to paleo!). I used to be a size 26 jean, and last night I wore a 30. I can no longer wear any outfit with carefree abandon — I now have to worry about placement and what the most flattering cut is and how to handle the parts of my that jiggle.
Some people say I look better. I don’t know. Can I compare? I don’t know. I know I look different, and that’s all that has mattered, and all that made this, while on one hand the best thing in my life, also, on the other hand, one of the harder things I have done (at least in 2014 ).
It’s been a small difference, but I had to read my own writing, and reach out to others for reassurance, and make a deliberate effort to arm myself against the tides of psychological baggage that tells me putting on weight makes me a failure, marks me as lazy, and renders me unfit for love. I believe so strongly in allegiance to our natural bodies, but that does not mean that I still did/do not have to fight for it on my “bad” days. Only because the gains I have had have been so great – I’m never giving up sex again — and because I have such loving, supportive people in my life, and because I’m currently finishing editing a book all about self-love, was I able to fall asleep peacefully at night rather than in a fit of frustrated, frightened tears.
Our society makes it hard. Even at my own relatively small weight gain and size. It makes it hard to “lose ground.” It makes it hard to “backslide.” But that doesn’t mean we give up. We remind ourselves of our own inherent worth, and we push through, and we change the face of womanhood one woman at a time.
I am no longer a fitness champion. I can no longer compare myself to Victoria’s Secret models. But I am different. I’m a new kind of sexy (more about which in coming days). I am me. And I am happy, and fertile, and healthy, and alive.
Hell. Yes.Read More
Contrary to the popular dermatology mantra that lotions solve everything and food solves nothing, there is nothing more powerful for skin health than improving the quality of your diet. If you eat garbage, your cells will swim in it, and they are not going to be able to help it if they get red and sick. If you eat nutrient-dense foods and support healthy hormone function with an anti-inflammatory diet, your skin will heal, glow, and radiate.
How skin works
The skin is the largest organ in the body. It is also one of the key players in keeping you toxin free, as it is the primary barrier between you and the outside world. If you have skin disturbances, it is completely understandable, and you are definitely not alone. The skin does a lot of heavy lifting, and in this toxic, inflamed world, it’s no wonder that this incredibly multi-faceted and important organ often struggles to keep up.
The skin is composed of three layers: the epidermis, which is the thinnest of the three layers and sits on the very top; the dermis, which sits in the middle; and the hypodermis, which connects skin to bone and muscle. Contrary to logic, the epidermis—the layer everyone gets to see—is not all that important. It is composed of dead skin cells that are in a constant state of being replenished and sloughed off. This process takes approximately 35 days.
The real action takes place in the middle layer, the dermis. This is where collagen provides firmness to the skin and is where hair follicles, sweat glands, nerve endings, and blood vessels reside. Most important for acne sufferers, inside the dermis sit the sebaceous glands, which secrete oil onto the surface of the skin. This oil normally performs a good, protective function. In excess, however, it can create oily skin and acne. When inflamed, it exacerbates acne and leads to skin disorders such as eczema and rosacea.
Topical elements can affect your skin, too. You can abrade your skin with harsh chemicals, for example. But far and away the most important thing you can do is to correct the problems of hormone imbalance and inflammation from the inside out.
Acne in three steps:
hormones, inflammation, and infection
Conventional dermatological wisdom is that bacteria are the primary cause of acne. This has a grain of truth to it, since bacteria do play a role, but it is minimal compared to the internal conditions that start acne in the first place. Acne in reality develops in three steps. First, male sex hormones can cause excess oil production in the dermis layer of the skin, which clogs pores (though surface debris can also clog pores, rendering hormones less important in this case). Second, inflammation attacks the clogged pores. Third, bacteria infect the clogged pores and cause low level inflammation to increase to large, painful, irritated pustules. The two primary causes of acne are hormone balance and inflammation, and bacteria are only a tertiary concern.
Male sex hormones can dominate female sex hormones in the blood a number of different ways. Insulin resistance, blood sugar spikes stress, starvation diets, or the menstrual cycle are all potential culprits, many of which often occur simultaneously. It is also possible for progesterone (albeit, while a female sex hormone) to cause acne, and this occurs as a result of the menstrual cycle and birth control pills.
Insulin resistance and hormone imbalance
Insulin resistance gives millions of women hormonal acne every year. It occurs by a simple mechanism: insulin stimulates testosterone production in the ovaries. Chronically elevated insulin levels lead to chronically elevated testosterone. Testosterone is a male sex hormone that directly stimulates oil production in pores. If you are insulin resistant and experience acne, testosterone is likely a primary contributor to your acne woes. This explains why so many women with polycystic ovarian syndrome experience acne. A high testosterone level is one of the primary characteristics of PCOS.
Blood sugar and hormone imbalance
Blood sugar spikes contribute to acne largely because they elicit an insulin response, which in turn spikes testosterone production (in addition to causing inflammation). This phenomenon is not confined to women—it occurs in men as well. It is so common, in fact, that it partly explains why many people break out around the holidays—large quantities of sugary foods lead to blood sugar disasters. It is also part of the reason why many people have skin reactions to dairy, particularly milk: dairy is highly insulinogenic.
Stress and hormone imbalance
Stress is a major player in skin health, and for a wide variety of reasons.
First, the skin contains stress-hormone receptors. When you are stressed out, your skin knows it. It has the ability to panic under stress just as much as your brain does.
Stress is also inflammatory. It inflames the gut, incites the immune system, and makes the skin leap into overdrive. This point is brief, but it is a big deal and needs to be taken seriously. Both psychological and physiological stress contributes to inflammation in a big way.
Finally, stress performs a function in the body known as pregnenolone steal. In this process, the stress glands steal the hormonal resource pregnenolone that would otherwise be devoted to making estrogen and other female hormones and instead directs its use to stress hormones such as DHEA-S. This is problematic not only because estrogen has a balancing effect against testosterone and is great for your skin, but also because DHEA-S acts similarly to testosterone with respect to the skin and stimulates oil production.
Starvation and hormone imbalance
The reproductive system does not like being toyed with, so denying it nourishment does not go well. Restricting calories, exercising too much, and radically depleting fat stores are three surefire ways to signal starvation.
The female sex hormones estrogen and progesterone are hit particularly hard by these starvation signals, which is unfortunate, because estrogen is one of the most powerful molecules for healthy skin. If estrogen levels decrease far enough relative to testosterone or DHEA-S, acne often results. It is also worth noting that estrogen is produced in fat cells. If your fat stores fall below a healthy level, your estrogen levels may end being up too low for healthy skin.
The menstrual cycle and hormone imbalance
Many women experience breakouts in connection with their monthly cycles. Unfortunately, hormone balance functions differently in different women, so I can’t make any overarching statements about the precise events occurring in your body. However, there are some clues I can point to.
The first two weeks of the menstrual cycle, which include the week of bleeding and the following week, are generally quite calm for women and entail great skin health. At the two-week mark, however, or during ovulation, testosterone levels spike. For women for whom oil production is a problem, or for whom testosterone levels are already out of balance from insulin resistance and the like, ovulation can cause acne outbreaks.
The second half of the menstrual cycle can be problematic, too. Estrogen and progesterone levels both fall and rise periodically throughout this time in delicate balance. If one leaps out ahead of the other or drops through the basement, skin changes can occur. Estrogen is generally regarded as a balm for the skin. In contrast, unnaturally elevated progesterone causes acne. What is the best thing you can do to reduce monthly breakouts? Achieve better hormone balance between testosterone, estrogen, and progesterone by eating an anti-inflammatory, hormone-balancing diet like the Sexy by Nature diet.
Birth control pills and hormone imbalance
Because all these hormone irregularities can lead to acne, many women begin taking hormonal birth control in the hope of clearing their skin. Sometimes it works. But sometimes it doesn’t, and instead makes it much worse. For this reason, some women go through several different pills before finding one with the “right” combination of estrogen and progesterone that enables them to have clear skin. Others never achieve clear skin on birth control, but accept acne as a necessary component of their birth control regimen. This is unnecessary. Not only do several dozen birth control options exist, but a few of them require no hormonal interference at all. The vast diversity of birth control options are explored in depth on page XX.
Acne is perhaps the most visible symptom of systemic inflammation. If an individual has significant acne, there is inevitably at least some amount of inflammation in her blood. Without inflammation, the pores that hormones clog would never become the nasty lumps they are, or at least not quite so big.
For this reason, healing your gut and cooling inflammation is perhaps the most powerful step you can take to overcome acne. Focusing on antioxidants, which fight inflammation, in your diet (such as those found in fruits and vegetables) and in your skincare routine will also go a long way toward soothing your acne. Both supplemental and topical antioxidant use has been shown to reduce breakouts by as much as 50 percent.
Bacteria’s role in acne: not guilty!
Bacteria live in and around the layers of everybody’s skin. Many dermatologists insist that the key to clear skin is killing off these bacteria, so most topical acne treatments do just that. The thing is, however, that not only do bacteria exist naturally all over the surface of everybody’s skin, but they can even promote healthy skin.
Sure, it is the case that bacteria infect clogged pores. But this is only the case if the bacteria on your skin are in an unhealthy state. The role bacteria play in acne is much like the role it plays in the gut: there are both “good” and “bad” bacteria on your skin. You can develop acne only if you have a significant imbalance between good and bad, which occurs as a result of both topical and internal stressors.
Many strains of harmful bacteria are present almost exclusively on the skin of people who have acne relative to those who don’t, which demonstrates that bad bacteria are the ones responsible for infecting pores. Yet even more remarkably, some healthy strains of bacteria are only present on the skin of people who do not have acne. This indicates that good bacteria can actually fight acne. Topical probiotics may soon become an important component of skin care regimens, and some of them are already on the market.
the role of touching, picking, cleansers
Counterintuitive as it might sound, one of the best things you can do for your skin is to stop washing it.
Much like with food, today’s culture has this idea that skincare products designed in a laboratory are better for us than natural methods. The chemical barrage to which we subject our skin on a daily basis is unnecessary and often harmful. First, consider the fact that benzoyl peroxide, one of the most popular topical acne treatments available over the counter, reduces antioxidant activity in the skin. Antioxidants are crucial for reducing inflammation. Consider too that the skin has natural oils and cleaning and healing processes that work delightfully well on their own. Washing the skin removes those natural oils, so the skin often dries out in response. With dry skin, women often turn to lotion. However, the skin also tries to rectify the dryness on its own by increasing oil production. At this point, both you and your skin are engaged in efforts to increase lubrication. Too much lubrication clogs pores, so your washing and moisturizing routine is counterproductive.
The act of washing your face can make it either too dry or too oily, depending on how your skin reacts. Rarely does washing leave it in tip-top shape. And moisturizers that contain unnatural chemicals often don’t heal the skin; they just cover it up. Many natural alternatives to washing and moisturizing, such as apple cider vinegar, baking soda, coconut oil, lard, cod liver oil, and vitamin blends provide real healing to the skin and can be protective in times of dryness or oiliness.
In all fairness, there are probably some manufactured toiletries that do not aggravate your skin. It is not absolutely necessary to “go all natural” and expressly forbid cosmetics. It is only important to note that they can be problematic, and to do your best to find a product—natural or not—that works for you.
In my experience, the only way to know if a lotion, if you choose to use one, is a good match for your skin is to try it for a few days and see. A different, more specific test is to apply lotion to one side of your face and not the other in order to witness its effects, or to apply it to the sensitive skin on your wrist or neck before using it on your face. I do not forbid using any manufactured cosmetic products—in fact, I use a lotion I buy at a mall. But it took me a long time to find one that did not irritate my skin. I opted to use it because it has white tea extract in it, and white tea is a powerful antioxidant. Applying antioxidants such as white tea, green tea, vitamin C, and B vitamins to your skin can help reduce inflammation in your skin as long as you are certain that you have found a lotion that does not aggravate your skin.
Another way to aggravate your skin is to pick at it. Just as with scabs and wounds, the skin does best when it heals on its own. Have you ever noticed that breakouts often occur near each other? This is because wounds act as beacons for inflammatory molecules. The more aggravated a wound is, the stronger the inflammatory response becomes, so pimples become bigger and nastier the more you touch them. Even worse is the fact that picking causes new pimples to crop up around old ones. Keeping your hands off your face is one of the harder habits to practice, but the less you touch your zits, the more your skin will thank you.
Even the simple act of touching clear skin can lead to the development of acne. Fingers carry all kinds of bacteria, dirt, and oils. When you touch your face, you put these dirty oils directly in contact with your pores. When I was in high school and college, I always had acne around my mouth, particularly on the right side of my face. It took me years to realize that I was breaking out because I rested my chin on my hand while I studied. Once I broke that habit, the acne faded away.
What to do for radiant skin
Eliminate sugar and insulinogenic foods and focus on reducing inflammation.
Eliminate gut-irritating foods such as grains, legumes, and dairy.
Include gut healing foods such as fermented foods or consider probiotic supplements.
If you eat a lot of fiber, consider reducing the amount of fiber in your diet, particularly insoluble fiber. Lots of fiber can irritate your gut lining if you are already dealing with inflammation or a sensitive gut.
Keep protein intake on the lower end of the spectrum—at 50 to 75 grams per day. Excess protein is a key player in oil production and oxidation.
Eliminate (or experiment with) hormonal influences on your skin. The most important hormonal foods are dairy, particularly milk, and phytoestrogens, especially flax and soy.
Eat to meet the needs of your metabolism: estrogen levels are at their best when you assure your body that it is being properly fed.
Consume plenty of fat to assure adequate collagen stores.
Consume at least three servings of fatty fish such as salmon every week. Alternatively, consider supplementing with cod liver oil, which delivers vitamins A and D—crucial vitamins for healthy skin—as well as anti-inflammatory omega-3 fatty acids.
Consume liver on a regular basis. Liver is the densest source of vitamin A available in the human diet.
Consume homemade bone broth—that is, a broth made from simmering bones in water—which is rich in collagen, calcium, magnesium, and other nutrients necessary for skin health.
Consume a diet rich in antioxidants, such as leafy greens and other vegetables and fruits.
Manage your specific health issue: PCOS and hypothyroidism are particularly problematic when it comes to skin health. PCOS because of its hormonal effects; hypothyroidism simply because cells lack the energy they need to heal.
Discontinue the use of soaps and abrasive cleansers, consider natural alternatives to conventional products, or make your own remedies from natural ingredients such as baking soda, coconut oil, and olive oil. Store-bought alternatives may work fine. The trick is to find one that works for you.
Consider using a topical probiotic spray on your skin. Topical probiotics add “good” bacteria to your skin that have the ability to offset the “bad” bacteria that inflame pores.
Consider applying an antioxidant lotion that includes green tea, white tea, vitamin C, or B vitamins to your skin.
Exfoliate with a clean washcloth once a week.
Do not pick at your skin.
Use a clean pillowcase.
Keep sunburns and harsh sun exposure to a minimum.
Consider supplementing with zinc, an antioxidant that has been shown to be particularly helpful for clear skin. N-acetylcysteine, milk thistle extract, and selenium have also been shown to have powerful effects on skin.
Consider supplementing or focusing on other nutrients that are crucial for the skin, such as vitamin A, vitamin C, vitamin E, omega-3 fatty acids, sulfur, B vitamins (particularly niacin), and vitamin K.
The above text is an excerpt from my book on women’s health, hormones, and love, Sexy by Nature, which is available on Amazon here.
Far back in the very beginning weeks of this blog, I wrote a long series of articles on the sources of infertility. In terms of the kinds of infertility caused by diet and lifestyle, there are two primary categories: PCOS and Hypothalamic Amenorrhea. Long time readers of this blog know that I believe the relationship between these two disorders is much more complicated than regular doctors and medicine would have us believe. Nonetheless, while I was writing about PCOS and HA (read more about HA here and here and here), I promised to write a post on how to overcome HA.
I never did.
The reason I didn’t write it is because the answer is both way too complex and way too simple. I couldn’t come up with anything coherent to say.
Hypothalamic Amenhorrhea is the fancy way of saying “stress-induced loss of menstruation.” The hypothalamus is the part of the brain that determines if you are in a safe enough environment to bear children. If your body receives signals that you are not “safe” enough, then your hormone production will decrease and you will stop menstruating. You may also suffer symptoms of low libido, depression, anxiety, insomnia, acne, and fatigue.
“Safe” means both physiologically and psychologically. Mental stress can hurt your fertility just as much as physical stress. Unfortunately, these two stressors commonly occur in women today, and commonly in paleo dieters. Mental stress comes from pressure and ambition and work and life as well as body image issues, low-self-esteem, and disordered eating. Physical stress comes from low body fat levels, rapid fat loss, excessive fat loss, fasting, over-exercising, under-sleeping, and under-eating. It’s no wonder that so many women struggle with this.
Estrogen, progesterone, LH and FSH — all female hormones — decrease with hypothalamic stress. LH and FSH come directly from the pituitary and fall off the wagon, and then estrogen and progesterone, which take their cues largely from LH and FSH, fall off of it, too.
Can it be overcome?
Is it easy?
The thing about HA is that its severity and “cure” are different for each woman. The trick is to address all of the kinds of stress that play a role in HA, and to focus on the type of stress that caused your problem in the first place.
For example: say you recently dropped from 130 to 110 pounds. The primary problem — the thing that if it looks like a duck and quacks like a duck, it’s a duck, so stop fighting the reality of your weight loss — is that you lost too much weight too fast. Your body couldn’t keep up with your changing leptin levels. And you likely underate calories and gave your body starvation signals while you were losing. So that needs to take precedence. You also, however, exercise a fair bit and have a fairly stressful life. To that end, you should also reduce your exercise, work on your priorities and your stress level, and be sure to eat as much as you need to. Address all of the ways in which you can increase your body’s detection of “safety.” Focus on perhaps gaining a little bit of weight back, however, since that was your primary “problem.” The faster you can convince your body you are no longer starving, the faster you’ll regain hormone balance and fertility.
Other women, on the other hand, might have to focus on stress, or might have to give up marathoning for a while.
HA is all about convincing your body that it’s no longer in danger. It doesn’t need to stress. It doesn’t need to shut down hormone production to prevent a poorly timed pregnancy. So you have got to nourish it as best you can. Err on the side of over versus under eating. Dial down your exercise — particularly the sprint based kind — and do only what feels comfortable. Stop pushing through being so tired. Don’t wake up in the morning to an alarm after a short night’s sleep to go for a run. Be sure to eat plenty of carbohydrates — at very minimum 100 grams of carbohydrate a day — and make sure to eat even more if you are an athlete. Learn to move more slowly, to eat more gently, to be less hard on yourself. Relax, eat, relax, eat, relax, eat, repeat. Don’t eat garbage– no way! Some women do, and find that their fertility comes back. But go wild with your diet, and eat as much as you are craving. Your body has been starved, and it’s important to respond to hunger signals when you have them. That is, if you want your fertility back.
To that end, there’s a simple answer to HA:
-Eat more. Relax more. Repeat.
On top of that, we can get more specific:
-Focus on nutrient-rich foods that support healthy hormone production. Liver, egg yolks, other organ meats, bone broth, leafy greens, fruits, and vegetables are all great.
-Make sure to eat plenty of fat. At minimum 40 grams a day. This amounts to approximately three tablespoons of your favorite paleo oil (such as coconut oil) — one for each meal. Including saturated fat is particularly helpful since it is the backbone of hormone production.
-Make sure to eat plenty of carbohydrates. Your body can think it’s starving if it doesn’t get enough for a significant period of time. Eat at least one piece of fruit or serving of starchy carbs with every meal. Make sure to do more on active days.
-Eat when you are hungry. Do not go hungry. Ever.
-Only exercise when you feel energetic and excited to do so, and refuel appropriately afterward.
-Do not sprint more than a couple of times a week.
-Consider eating a fuck ton of calories. Many women have spent ages on different forums learning about what works, and debating how many calories should be eaten at any given point in time. Some argue you need as many as 3000 calories a day to recover. Others assert 2000. I wouldn’t go crazy, but consider the fact that there’s a good chance you are undereating relative to your needs.
-Consider weight gain. Anywhere from 1 pound to 10 might be necessary, or 30, depending on where you are. How much did you weigh when you stopped menstruating? Is it much more than where you are now? How much more? What else was going on in your life? You may need to close the gap a bit between where you are now and where you stopped menstruating in order to do so again. Each woman’s body is different and requires a different level of fat to feel safe and be fertile.
-Sleep as much as possible. 9 hours a night!
-Consider supplementation. Magnesium supports hormone production. Calcium is helpful with the magneisum. Take the magnesium and calcium in a 1:1 or 1:2 (at most) ratio. Vitamin D can support functions with magnesium and calcium. Fermented cod liver oil will never hurt.
Which is all that I’ve got. I know it’s a lot and also a little at the same time. Hypothalamic amenorrhea is all about you and your body and your own particular needs. You’ve got to think deeply about the kinds of stress you might be dealing with, and then go ahead and rectify it.
And then give it time.
It takes time to recover from this sort of thing. Hormones don’t leap ahead of us, they follow behind, peaking around all of the corners, making sure it’s safe before they come out and play. I can say, however, that your recovery will be faster the more you nourish yourself, the more you eat, and the more you relax. You can go more slowly if you are fearful of the process. This is what I did. And it’s good — the body learns to adjust to new leptin levels over itme. But know that it takes longer the more slowly and cautiously you move forward with your hypothalamus.
I highly recommend checking out the Fertile Thoughts forum on hypothalamic amenorrhea. It contains 108,000 posts and counting. Women all across the world come to this forum to share their experiences with HA and infertility. Definitely worth the read if you’re interested in HA at all.
One of the biggest hormone problems that plagues women is having low progesterone levels. On some level this is natural: it happens during menopause, perimenopause and in periods of hormonal flux. These natural fluctuations can be mitigated with diet and lifestyle to an extent, but they may on some small level just have to be tolerated for a while. Some women supplement with progesterone cream throughout menopause and find that this eases their symptoms. On the other hand, many women on natural paleo-type diets find they can stop supplementing progesterone and remain symptom-free.
Nonetheless: a diagnosis of low progesterone is fairly common even among women of reproductive age. This occurs to two classes of women: first, the estrogen dominant, and secondly, the stressed.
If you are estrogen dominant, you may have other symptoms: these include being overweight, experiencing PMS, experiencing menstrual cramps, decreased libido, bloating, breast swelling and tenderness, fibrocystic breasts, PMS-related headaches, mood swings, and thyroid malfunction.
A couple decades ago, most researchers thought that these symptoms were a result of high estrogen levels alone. Today, researchers typically acknowledge that it is more a problem of imbalance with progesterone rather than high estrogen in and of itself that causes most of these problems, such that the diagnosis “high estrogen” may also mean “low progesterone.” It is hard to tell: the variables are too closely linked.
For this reason, if your true diagnosis is estrogen dominance, you may want to experiment with the guidelines I outline in The Estrogen Dominance Post.
If, on the other hand, your problem is not high estrogen per se but actually low progesterone levels, you have few avenues available to you.
Progesterone is synthesized fairly early in the hormonal cascade, and it’s activity is highly influenced by the level of stress–either physical or emotional–a woman is experiencing. I wrote about this in a post about a year ago, titled “The HPA axis: what is pregnenolone steal?”
Another way to describe pregnenolone steal is as progesterone steal.
Pregnenolone is the primary “precursor” hormone. It sits at the top of the food chain and is directed to be used by the body however it sees fit.
If a woman is stressed, her body “steals” the pregnenolone for stress hormone production instead of progesterone production. This means that other female hormones also take a hit — accounting for why some women have low hormone levels across the board — but progesterone is one of the hardest hit. If a woman has low progesterone in her labs, it’s a pretty good bet that her body is using her resources to produce cortisol rather than the good stuff.
For this reason, reducing stress is actually the only clinically well-known way to increase progesterone production.
This isn’t an easy answer. Stress reduction takes real work. We cannot just promise to sleep more or to spend more time with ourselves or our families, and then let these promises drift away as life marches on. Instead, we have to make concrete changes to our schedules, to our jobs, to our relationships, to our feelings about our existence. Often, psychologists can be uniquely helpful, as can group involvement, friendship, spiritual communities, and yoga and meditation.
Stress levels can also be reduced by making sure to eat a nourishing diet that doesn’t have any kind of a starvation component. Eat when you are hungry, and do your absolute best to assure your hypothalamus that it has nothing to stress about.
Symptoms of low progesterone (without estrogen dominance) include classic hypothalamic amenorrheic symptoms: irregular cycles, infertility, anxiety, low libido. If you reduce your stress levels, you may see these problems slowly tick away. Perhaps most delightfully, progesterone is well-known as carrying with it significant libido-enhancing power. Reduce your stress, and your sex life make thank you, too.Read More