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
Estrogen dominance — the condition of having higher estrogen relative to progesterone levels — is one that plagues millions of women at all ages. It can occur during reproductive years, perimenopause, and menopause. It can also be coming from a wide variety of sources within a woman’s diet and lifestyle. This makes estrogen dominance a bit of a complex nut to crack. But a holistic approach to health should at least get everyone on the right track, and provide a proper learning environment in which you can figure out precisely where your dysregulation is coming from.
Estrogen dominance occurs when estrogen levels run too high, or on the flip side when progesterone levels run too low. There are some natural swings throughout a woman’s life that can make estrogen dominance more or less of a problem. Progesterone tends to fall during perimenopause, for example, so this can be the primary source of hormonal discomfort for women cresting age 35 or so. Progesterone levels also fall during menopause, though estrogen levels should be low at that time, too. The reasons estrogen may remain relatively high in a woman’s later years are largely to do with the same mechanisms that occur in the reproductive years. In each the reproductive years, perimenopause, and menopause, a woman is subject to be influenced by her dietary and lifestyle choices.
Estrogen dominance is a big deal. It can cause a wide variety of symptoms, as well as put us at greater risk for a wide variety of diseases and conditions. Symtpoms associated with estrogen dominance include:
High emotional sensitivity
Conditions we find more often in women with estrogen dominance and that may in fact explicitly develop as a result of estrogen dominance include:
Hypothyroidism (estrogen is antagonistic to thyroid hormone)
These aren’t problems we can just shrug off of our shoulders. In many ways, we can reasonably view estrogen dominance as contributing to the deaths of thousands of women every year.
The causes of estrogen dominance
The causes of estrogen dominance are wide and varied, but largely have to do with metabolic dysregulation and organ malfunction. Some dietary factors may also offset the balance.
1) Being overweight:
Fat cells perform a function called “aromatization” which converts testosterone to estrogen. The more body fat we have on us, then, the more and more our bodies tip their balances towards estrogen and away from testosterone.
Now, this doesn’t mean testosterone levels will be necessarily low in overweight women. To the contrary: testosterone levels also happen to climb the higher and higher insulin levels are. For this reason, a woman predisposed to insulin insensitivity will likely experience increases in both testosterone and estrogen levels. Progesterone receives no bump from weight gain, however: progesterone thus remains incapable of offsetting the estrogen increases associated with higher body fat percentages in overweight women.
2) Overburdening the liver:
The liver is responsible for clearing the body of “old” hormones, especially estrogen. If the liver is overburdened with a hyper-caloric diet, with high volumes of sugar, with high volumes of alcohol, or with high volumes of processing chemicals, then, it becomes sluggish in it’s ability to process everything. When the liver slows down, estrogen ends up becoming back-logged in a way, and wreaks havoc on the reproductive system as it waits for the liver to heal and to catch up in it’s bloodstream clearing capacity.
This effect is interestingly even more pronounced in men than it is in women, and it accounts largely for the development of breast-like fat deposits in heavy drinkers. Being overweight and being stressed may also contribute to this process in men.
Stress wreaks havoc on all of our bodily systems. Perhaps most pressingly for women, however, it decreases the production of progesterone in the body. When a woman is stressed, her adrenal glands “steal” the precursor to progesterone and instead use it to produce cortisol, the stress hormone. For this reason, high volumes of stress can yank the rug out from under progesterone, which can precipitously tip hormonal balance in favor of estrogen.
4) Consumptions of phyto and xenoestrogens:
Much as I have difficulty with soy in my own life, I typically preach caution when talking about soy. I honestly belieeve that it is a good therapeutic tool for some women, and each of us needs to use it appropriately.
In every single case, however, soy, flax, legumes, and other sources of estrogen outside of the body interfere with our bodies own production of estrogen. In the case of estrogen dominant women, it may be causing too much estrogen to be produced. Phytoestrogens can increase the aromatization process in fat cells that I described above. They can also simply just dump an increased estrogen load into the body, which automatically tips the balance. In a properly functioning metabolism, the liver should probably be able to clear out this increased estrogen load. But sometimes the load is too heavy or the liver not quite strong enough, and that becomes an impossibility.
5) A low fiber diet:
Estrogen is processed in the liver, but it is also processed partly by gut flora, and also excreted through the digestive track.
It has been shown time and time again that low fiber diets are associated with estrogen dominance. There are many cofounding variables that may play a role here, but the general idea is that estrogen can be reaborsed through the intestinal walls. With poor gut flora and with slow intestinal motility, estrogen sits too long in the gut and gets reabsorbed back into the bloodstream.
Fiber is generally correlated with improved digestive pace and motion, though not exclusively. A proper amount of fiber helps push things along in the digestive track. Too much fiber can obviously be damaging. It causes something health advocates like to call “roughage.” It is abrasive, and it can lead to gut deteriorating conditions such as diverticulitis. In any case, however, meeting a minimum requirement for estrogen processing such as regularly consuming fruits and vegetables can be quite helpful for gut motility and health.
Increasing fruit and vegetable intake can also, of course, increase nutrient status, which can boost liver function, hormone function, and the processing of all of these chemicals.
Moving beyond estrogen dominance
How do we mitigate estrogen dominance, then? We eat diets designed to cool inflammation, to support organ- and particularly liver- function, to minimize phytoestrogen intake, and to maximize nutrient status.
This means that we want to eat a paleo-template type diet, which includes animal products, both the protein and the fat, seafood, fruits, vegetables, olive oil, coconut, starchy vegetables, and to some extent seeds and nuts. However, in an estrogen dominant system, seeds and nuts can act as phytoestrogens and tip the hormonal balance in favor of estrogen, so they should be carefully stepped around. Foods that support thyroid health such as seafood and seaweed should also be quite helpful for boosting metabolic health and hormone clearance. Foods to be avoided are of course all processed sugars, grains, omega 6 seed oils, phytoestrogens which include soy, flax, legumes, seeds, and some herbs, which I list in great detail here, and alcohol.
Foods to emphasize for estrogen clearing are the ones that are the most nutrient dense, particularly those that boost B vitamin levels, omega 3 levels (fermented cod liver oil!), choline (for the liver!), zinc, magnesium, calcium, and vitamin D. For that reason, eggs (choline), fish (omega 3 fats, iodine, selenium, and vitamin D), liver (vitamin A, B vitamins, and iron, zinc, manganese, etc), other organ meats, and high quality animal protein may be your best companions in this journey.
Some supplements have also been rumored to be helpful, and I thought Dr Hoffman (one of the estrogen dominance heroes) summarizes them well:
Lecithin (a phospholipid) and the sulfur-containing L-taurine and L-methionine amino acids are compounds that will promote bile circulation, which enhances estrogen’s excretion out of the body. These lipotropic formulas support the liver metabolism of estrogen. A typical formula might provide the following, sometimes in a base of liver-stimulating herbs like milk thistle, black radish, beet, or dandelion, for twice-daily consumption: choline (a concentrated form of lecithin), 500 milligrams; inositol, 250 milligrams; taurine, 250 milligrams; methionine, 250 milligrams.
Exercise should also be high on your list, since exercise can sharpen insulin sensitivity, boost weight loss, help mitigate mood swing problems associated with estrogen dominance, and reduce levels of stress hormones in the body.
Stress reduction is huge. I cannot emphasize enough how important this is. Without progseterone in our bodies, it is nearly impossible to rectify estrogen dominance. Every other aspect of estrogen mitigation can be in place. But without sufficient progesterone, symptoms of estrogen dominance may persist.
Estrogen dominance plagues a wide variety of women, and at all stages throughout the reproductive lifestyle. Supporting organ health, reducing stress, and generally focusing on healthful foods should get us most of the way there towards greater hormone balance. There are, of course, many other things you can to do help mitigate problems associated with estrogen dominance– for example, experimenting with neurotransmitter supplementation or boosting neurotransmitter health with diet and supplements in order to mitigate mood swing problems– but those are wide and varied and left for their own places in this blog at an upcoming time.
In the meantime: what is your experience? Does paleo help with these symptoms? What parts of your diet and lifestyle are best for keeping you hormonally balanced and healthy? What’s worked, and what hasn’t?Read More
More questions about PCOS this afternoon! No surprises here. Below are some thoughts on endometriosis and PCOS, quinoa, feeling restricted, allergies, and moving forward with hypothalamic amenorrhea.
If you find that a question you asked me is below and I have not stripped it enough of your personality to post it here, please let me know.
Help! I have both endometriosis and PCOS. I don’t understand– I thought endometriosis was a condition of high estrogen levels, and PCOS a condition of low estrogen levels. What gives?
There are two ways to answer this question. First, PCOS patients can have high estrogen levels, and in fact many of us do. For this reason, you can have both endometriosis and PCOS without rocking the boat of your theory. On the other hand, I also believe it is entirely possible to have endometriosis and to have low estrogen levels. This is because endometriosis and endometrial pain is related to high estrogen levels, but there are a variety of other factors in the development of endometriosis. Having an impaired immune system and inflammation are two big ones on the list. Once those things happen together, and you plant endometrial tissue somewhere in your abdomen (and in all likelihood aided by having high estrogen levels), then you have endometrial tissue that is going to be very difficult to weaken. That is just the nature of the tissue. It does not just shed off effortlessly. In this time period your estrogen levels can drop and your immune system can improve, but your tissue may still cause you pain. This is how you can have low estrogen and endometriosis. The solution is to mitigate the problems as best you can, reducing stress and inflammation, healing your gut, boosting your immune system, and eating a hormone balancing diet such as the paleo diet.
I wrote about endometriosis at great length here.
I stumbled upon your website researching the Paleo lifestyle and was pleasantly surprised to see the tie in to PCOS! I’m sure you’re wondering why I’m commenting on this article but being an avid consumer of marijuana, I had to click and read. Admittedly, I was quite disappointed in what I read not about marijuana but more about seeds, nuts and quinoa. I was under the impression that quinoa was NOT a grain but rather a seed. I’ve successfully omitted all grains, beans, soya from my diet and this was a major bummer to read. I am feeling very deprived right now thinking of the possibility of having to omit this as well. Thank you for the great article however and keep up the great work.
Quinoa is in fact not a grain. It is called a “psuedo cereal” because it does not come from grains or grasses, but is rather the seed of a plant. It is gluten free. That being said, it also has many properties that seeds do, such as having a relatively high amount of phytoestrogen content (and will contain many of the phytates inherent to legumes, beans, and grains all). Phytates are also a bit of a problem for PCOS because they have the potential to limit calcium and magnesium absorption– two ions quite crucial for the development of healthy and fertile corpus lutea. All of which is to say that seeds are not great for PCOS, but unless you are eating buckets they will not make or break your case. Probably, at least, in my opinion.
My thoughts about restriction are of course always complicated. If quinoa is something that is necessary for you to feel good about food and your body, then I advocate keeping it in your diet at least for a while. Clean up as much as you can, and relax into your food choices. Try eating less whenever it seems easy to do so. If it’s a battle, don’t fight it. Just phase it out only as you can let it go with peace. This will happen over time with patience and with love. And if it does not, I really think that’s okay, too. Take care of your brain first and foremost. It is going to be your most important tool by far for taking care of your body for the rest of your life.
I have question. I had a hysterectomy in May 2012. I struggle with endometriosis, hashimoto’s, Sjögren’s syndrome & celiac. I’m on estrogen therapy & the autoimmune protocol but my allergies are getting worse! I eat meat, non starchy vegetables & fruit. I can’t tolerate any spices or starches & my allergies continue to worsen. Any suggestions?
You may wish to try eating a GAPS diet to heal your gut further. Allergies are not my specialty– but I highly recommend first doing everything you can to assist your immune system, since this is where allergy problems are rooted. This includes reducing stress, getting as much sunlight and/or vitamin D as possible, eating organ meat often–I’d advocate at least once each week–getting as much sleep as possible, and potentially getting your micronutrient levels checked to see if you have any deficiencies that are hindering immune function. Boosting immune function will help your immune system react appropriately to foods without leaping into panic mode. It also depends very much on what your allergies are and how you are reacting to them. Are they definitely allergic reactions, or are they food intolerances? This is a crucial difference. An allergy is rooted more in immune issues and food intolerance is rooted more in the gut. Allergen-specializing docs are probably the best place to go for troubleshooting this sort of issue. You also want to make sure you are taking care of your hypothyroidism appropriately — are you supplementing with thyroid hormone? because with Hashimoto’s you may need to be, so speak with your doctor about it — because thyroid hormone is crucial for immune function, for cellular repair, for probably energy usage, and just about everything else cells do.
I have had HA since february, since I stopped taking the birth pill. I am really underweight (5’10 and 100#). I lost a lot of weight when I started crossfit and doing a low-carb diet for two years. I am now trying to conceive. My hormone levels are all very low. I haven’t worked out for several months. I only walk daily for one hour. I started seeing a therapist about my anxiety, who is helping me gain weight. She makes me track my calories in order to gain weight. I have to eat more than 2,000 calories but rarely go over. I am a bit scared of carbs. Gaining weight is not working although I eat more and stopped working out. I keep counting the carbs and feel bad having potato chips and a cookie (too much carbs). I do eat a good amount of fat (teaspoons of coconut oil, nut butter bacon, greek yogurt etc…). What should I do?
Since your primary concern– and biggest obstacle– in getting pregnant is convincing your body that you are fed, you want to err on the side of eating more rather than less. This should be the case all of the time. Also, I recommend that you eat whatever you want. Anything you want. I personally eat a very high carobhydrate for extended periods of time to zero ill effect. Do your absolute best to stay within the range of non-toxic foods (ie, skip the gluten, deep fried foods) and eat heartily. The more frequently you can hit your 2000 mark, or even better, go over, and the less you obsess, the faster you’ll regain hypothalamic health.
I cannot stress to you how much all of the factors of relaxing, reducing your anxiety, and gaining weight are all important for your ability to conceive. This takes a lot of work. You are going to have to have patience, and to forgive yourself as much as possible for all of the difficulty you are having moving forward. The thing is that it is not your fault. You have become inordinately thin as a result of psychological pressures put on you by an external environment, and now you are stuck with fighting that. Keep your chin up and move forward as lovingly as possible. Accept yourself as a natural body with natural needs. When you look in the mirror, don’t obsess. As a matter of fact, don’t look in the mirror. It is way too easy to start seeing ourselves as bigger than we used to be– and even while we need to gain weight to be and even look healthier, by the simple fact of being “bigger” we think we look huge. Don’t let your brain trick you into such radical subjectivity. Do your best to put your evolutionary need and your fertility at the front of your mind, and be excited when you see yourself put on a bit of weight. Do it slowly and make sure to protect your brain in all of this, but embrace your needs. You are a woman with some strong ovaries and the power to carry children. Nourish yourself as your body is crying out for, and take as much pride in that as possible. Being thin doesn’t make you worthy. Being a badass and tackling these problems with as much love and determination as possible does.
Eat carbohydrates!!!! Carbohydrates a) do not make you overweight, they just don’t, period, and b) are supremely healthful for you, especially in a state of metabolic distress. Start eating them slowly and learn bit by bit the lessons I am telling you. You will see that they make you feel and look better without making you balloon in some ridiculous fashion. They are just food, same as fat and protein. Period. Eat them whenever, however, and however much of them as you want.
Be patient, however, love. These things can take time depending on how much damage has been done and how diligent you are about allowing some weight gain and calorie intake. Increase what you are doing as much as possible, and make sure that you are erring on the side of nourishing yourself more rather than less. Believe it or not you have already made radical progress. You have started therapy– something most women never do!– and you have admitted that you need to work on some of these issues. And you have really cut back on your exercise, and you are working on eating more and gaining weight. These are all awesome things. You are doing it, and you have so much to be proud of moving forward. You will get there, especially with love, forgiveness, and harmony with your natural body on your side.
You can read more about my work and opinions and plans for PCOS in the manual PCOS Unlocked.Read More
Which progesterone blockers are in your diet? Bloodroot, oregano, tumeric, and the skinny on phytoprogestins
When doing some research on phytoestrogens earlier last month, I came across information on molecules that perform the same antagonistic activity but this time with progesterone. I hadn’t thought of this before, though it seems obvious to me now. If some herbs and foods are going to interrupt with estrogen receptor activity, then some are going to interrupt with progesterone, too. These effects are less dramatic and less well-known than those of estrogenic compounds, but worth investigating, still.
Dr. David Zaba is somewhat of an expert on the progesterone issue, and the bulk of the information I have dug up comes from his research. This article is based primarily on his article estrogen and progestin bioactivity of foods, herbs, and spices. That’s the pub med link, at which you can read an abstract. I had a horrible time finding the whole thing, but finally did here!
Zaba’s investigation found that there exist a wide variety of progesterone-inhibitors (as well as estrogen inhibitors, though I have discussed those at length already here and here).
Tables for the results can be seen here.
Using soy for a benchmark, with a value of 8 micrograms of estradiol equivalents per 200 g of substance, we can see how progesterone-binding compounds with values of 100 (that is, half as much as soy, so 4 micrograms of progesterone equivalents), 8, or 4 might be problematic for consumption in high quantities. I would guess that only the ones that rank as high as 100 should even be considered blips on someone’s radar, especially someone with a fully healthy pituitary gland, but what follows is all of the information, just in case. After all, a value of “8″ listed below has around 1/12 the capacity of soy according to this research, which could be something someone would want to take into account. That’s still higher than zero.
The herbs with the highest progesterone inhibiting activity are:
It is supremely important to note, however, and in my opinion, that these effects may be compensated for by the pituitary gland and not constitute any noticeable changes in complete body chemistry. They may play a role in extraordinarily sensitive bodies, but this research is by and large quite limited.
There is some other interesting information in this article.
Aside from demonstrating that progesterone- and estrogen- containing compounds exist in a variety of herbs, this research also shows that they actively inhibit hormonal activity via tests done on women’s saliva. All estrogen-related herbs were negative antagonists. Most, though not all of the progesterones, were as well.
Some of the herbs and spices found to contain high phytoestrogens and phytoprogestins were further tested for bioactivity based on their ability to regulate cell growth rate in ER (+) and ER (-) breast cancer cell lines and to induce or inhibit the synthesis of alkaline phosphatase, an end product of progesterone action, in PR (+) cells. In general, we found that ER-binding herbal extracts were agonists, much like estradiol, whereas PR-binding extracts, were either neutral or antagonists. The bioavailability of phytoestrogens and phytoprogestins in vivo were studied by quantitating the ER-binding and PR-binding capacity of saliva following consumption of soy milk, exogenous progesterone, medroxyprogesterone acetate, or wild mexican yam products containing diosgenin. Soy milk caused a dramatic increase in saliva ER-binding components without a concomitant rise in estradiol. Consumption of PR-binding herbs increased the progestin activity of saliva, but there were marked differences in bioactivity. In summary, we have demonstrated that many of the commonly consumed foods, herbs, and spices contain phytoestrogens and phytoprogestins that act as agonists and antagonists in vivo.
This shows, again, that the antagonistic effects of phytoestrogens and phytoprogesterones are real if complicated, and the true effects of them in the context of the whole body unknown. It’s worth re-stating the bold section of the abstract: “Soy milk [an example of a phytoestrogen] caused a dramatic increase in saliva ER binding components without a concomitant rise in estradiol. Consumption of PR-binding herbs increased the progestin activity of saliva, but there were marked differences in bioactivity.” Soy displaces true estrogen, which blocks estrogen activity, and signals to the body to down-regulate production of estrogen. This was my hypothesis in this article, as well.
The relative “different activity” seen in progesterone-binding activity is as follows. The results are largely elevated over controls — neutral conditions — though some compounds inhibit activity in the saliva more strongly than others.
|Figure 3 – nmoles PNP formed/min / µg protein
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|Figure 4 – fmoles Estrogen Receptor/ µg DNA
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|Figure 3 Induction of alkaline phosphatase by progesterone plus RU486, and PR binding herbal extracts, with and without progesterone. Near confluent cells in 96-well plates were exposed to increasing doses of progesterone, 10-9M progesterone plus 10-7MRU486 or 1/500 dilution of herbal extracts (as indicated) without or with 10-9M progesterone. After 48 hr, cells were fixed and alkaline phosphatase measured directly in the plate as indicated in Methods||Figure4 Down regulation of ER by progesterone and herbal extracts in the absence and presence of RU486. Near confluent cells in 24-well plates were exposed to progesterone and herbal extracts, without or with 10-9M RU486. After 48 hr. ER wa measured directly in the plate by incubating cells with 2nM [125l]-estradiol. Following incubation, the cells were removed from the plate with trypsin and the radioactive binding of [125l]-estradiol was meansured in nuclei as decribed previously. (11)|
All of which is to say, as in the case with phytoestrogens, that these are not serious health threats in the slightest. Unless you consume grams worth of these herbs every day you should not witness a difference–and perhaps not even then, depending on your personal physiology and response to these herbs. This information is, again, just a note for those of us doing some serious personal experimentation and investigation, or otherwise interested. It all just goes to show how imtimately we are what we eat. On the other hand, this kind of data and the overwhelming complexity of it all may be an indication that we should throw nitpicky nutritionism out the window and just instead focus on eating real foods in decent balance.
Whichever suits you, your body, and your soul at this point in time.
Phytoestrogens are a topic of hot debate in the medical literature. To eat, or not to eat? To cure cancer, or to beget it? As chemicals that act–but are not similar to–estrogen in the human body, phytoestrogens complicate a lot of biological functions. Sometimes it appears as though they have a helpful role, but many other times, as in the case with female fertility and typically with PCOS, phytoestrogens can cause a lot of harm.
Phytoestrogens are found in plant foods. They can also move up the food chain into animal sources, which is a consideration for women with endocrine issues who eat factory farmed animals. They are reasonably well tolerated by people with “healthy” hormonal systems and livers. The body responds easily to these semi-natural disturbances and can flush the phytoestrogens out of the system. OR the body responds easily by maintaining estrogen production even while phytoestrogens are consumed. This is not always the case for women. Some are extraordinarily sensitive to phytoestrogens.
For more on the science of phytoestrogens, and specifically how they relate to estrogen deficiency and dominance in the female body, check out my post Phytoestrogens in the Body, and How They Interfere with Natural Hormone Balance.
What I say in sum is that phytoestrogens take up places on estrogen receptors in the body. This has big time implications. Many medical professionals hypothesize that this is helpful for estrogen deficient women. This would be by filling up unused estrogen stores, and therefore hypothetically increasing estrogen levels. But other health researchers (including myself) believe that supplementing with phytoestrogens plays a reverse role: instead of increasing estrogen activity, the increased phytoestrogen load (especially given the fact that phytoestrogens are far less efficacious in performing bodily functions) tells the body to stop producing it’s own estrogen, which ultimately results in a decline in estrogen-related power in the body.
Phytoestrogens can also be harmful for women with estrogen dominance, if their bodies do not respond to the increased estrogen load and instead end up over-burdening their systems.
All that being said, I still believe phytoestrogen intake can be helpful for some women if their bodies respond in a hormonally healthy way. This may particularly be the case for menopausal women, whose bodies have more or less stopped produced estrogen in the ovaries anyway. Phytoestrogens may alleviate the pains of menopause while not causing any pituitary-related damage. However, this is an issue, again, of individuality. Some women may find it works, while others find it horrific.
My personal experience is that I am enormously sensitive to phytoestrogens. I have narrowed down over many years the list of foods that give me acne, and aside from dairy, they are all phytoestrogens. This past summer I achieved clear, soft skin for the first time in three years (save for the scars). I experience small acne bumps when stressed, which is something I am okay with and working on slowly. The only times, however, in which I have experienced cystic breakouts are when phytoestrogens I didn’t know I was eating were sneaking into my body.
These were flax, soy protein isolate (did you know it’s in virtually all brands of chewing gum?! and tootsie rolls?! and also that I consumed tootsie rolls?!), and thyme.
We all talk about the dangers of soy and phytoestrogen intake, but the list of phytoestrogenic foods is long and complicated. Many different studies list different foods as having different phytoestrogen content. My inability to navigate them has been the bane of my skin for years. But now I have compiled, however, a list of all of the foods, herbs, and substances that seem to be the most problematic and crop up in continuous studies.
They can be summed up as: virtually all beans, peas, seeds, and nuts, some herbs, and a handful of fruits and vegetables.
They are as follows, with the most potent foods listed with an asterisk:
**Flaxseed and flaxseed oil (3 x as potent as soy in some studies!)
**Soy, soy oil, soy protein isolate, tofu, textured vegetable protein, and all of it’s derivates
*Sesame, sesame seeds, and sesame oil
*Red Clover leaf and extract
Apricot (especially dried)
Whole grains: Rye, *Oat, Barley, Millet, Wheat, Corn, Quinoa
And to a somewhat lesser extent the fruits and vegetables…
And the substances…
And, yes! Marijuana and hops (a primary ingredient in beer) are both phytoestrogens. It is worth noting that crude marijuana extract smoke and not just the physical plant matter competes for the estrogen receptor in receptor studies. This means that inhaling marijuana, whether through one’s own cigarette or in the company of others who are smoking, counts as potential estrogenic activity. All that being said, these chemical results were not replicable in vivo on rats, so it’s as yet undecided in trials if it has an effect on humans. Personally, I don’t risk it these days.
Sorry. I’m sad, too.
And as I final note, I strongly encourage you to check the label on anything processed you are considering consuming. Like I noted above, Tootsie Rolls are made out of soy. I had three on a road trip with my family and woke up the next morning with a painful cyst. I didn’t think to check– I though the risk small– but it turns out I was wrong. It took me a week to figure out what I had done wrong, and when I finally checked the ingredients in Tootsie Rolls I face palmed myself in a big way. Lots of anxiety over nothing at all.
Other big sources of soy protein and phytoestrogens in a processed diet are protein bars, cereals–particularly “protein plus” cereals, oat-based cereals, granolas, flax-containing granolas, granolas or cereals made with any kind of seed oil, triscuits, wheat thins, every kind of chewing gum, the more chewy types of candy, and probably most baked goods.
All of which is to say, again, that phytoestrogens are complicated. I don’t advocate that you go crazy controlling your intake of all of these substances. Absolutely I do not. Please keep eating broccoli. But for those of us who are particularly sensitive to estrogen flucutations, such as I am, it can be enormously helpful for understanding why we are getting breakouts, experience fluctuations in our sex drive, or failing to produce as much vaginal discharge as we normally do on occasion. Huge doses of peas or garlic over a couple of days can make a real impact, as can the accidental consumption of soy. So if you’re into the nitty gritty of troubleshooting, this list should be helpful.
If I’ve missed any phytoestrogens that should be on the list, please let me know!
More about progesterone competitors coming soon.
And finally: what is your experience with phytoestrogens? Anyone as sensitive as I? Or the total opposite, and robust?
Are they helpful? Harmful? In menopause, or at reproductive-age?
Menopause is inevitable. It happens to every person near 50 years of age, and nothing we do short of serious medical intervention will ever stop it. The body has supremely intelligent biological clocks in it. When the time comes to stop, it stops.
Yet through experimentation with serious medical interventions, we have learned more and more about the precise nature of that clock. We have known for some time that estrogen supplements mitigate menopause symptoms. This is because menopause is largely tied to decreases in estrogen levels, and most of menopause’s irritances such as hot flashes come from having low estrogen levels. Yet what causes the clock to spring and estrogen to decrease in the first place?
Scientists have recently begun exploring a method of feritlity extension that deals primarily with ovarian implants. Surgeons can now surgically extract tissue from a woman’s ovaries in her twenties or early thirties, and then re-insert slices of it at regular intervals in later life. What this does is it keeps the ovarian tissue pumping estrogen. While sounding vastly unnatural, this is actually a better and more natural method of menopause delay than estrogen supplementation. This is for two reasons: 1) the estrogen is completely natural, produced by your own body, and 2) this method actually prolongs fertility in addition to acting as a bandaid to symptoms, which is the only thing estrogen supplementation can do.
These experiments have demonstrated that it is the state of tissue health and egg availability that determines the onset of menopause.
The female body starts off with around two million eggs. By puberty, this number has decreased to 300,000 eggs. It then releases these eggs slowly over time, with each menstrual cycle. Usually in the mid-thirties, women’s fertility naturally decreases. By age 35, 5 percent of women are already infertile. This means that fertility drops off before menopause symptoms set in, a stage called perimenopause. This is important for all women thinking about having children into their later 30s and 40s to take note of. Menopause symptoms might not settle in until until your 50s, but perimenopause can be a significant reality by 35.
Factors that accelerate ovarian aging include…
Smoking (by about two years)
Never having children, or having children later in life
Having short menstrual cycles
Low socioeconomic status
A vegetarian diet (by about two years)
That’s right! According even to conventional wisdom, vegetarian diets are linked to increased ovarian aging at nearly the same rate as smoking! No one knows precisely why, though it may have to do with nutrient status, with fiber content of the diet (high fiber can decrease estrogen levels), soy intake, or correlations with restrictive behavior. None of these ideas are proven– they’re just hypotheses I am posing.
Shortening menstrual cycles and decreasing the age of and amount of time a woman spends pregnant ages the ovaries because it makes them work longer and harder throughout life. Having a shorter menstraul cycle increases the amount of eggs released over time. This accelerates the onset of both perimenopause and menopause.
Factors that delay ovarian aging include…
Irregular menstrual cycles
High socioeconomic status
Giving birth early and/or frequently
Moderate alcohol consumption (correlation?)
Longer menstrual cycles
All of these factors act in contrast to those listed above. They promote longer menstrual cycles and/or a decreased amount of menstrual cycles, which means they can decrease the amount of eggs released over a lifetime. This both prolongs fertility and postpones menopausal symptoms.
Factors that have unknown effects
Age of menarche (onset of puberty)
Oral contraceptive use
Endometriosis and/or estrogen dominance
All of these questions are exacerbated by the fact that we’re looking at two slightly different phenomena. Perimenopause is the onset of infertility characterized by decreased egg production and fluctuated estrogen levels. Menopause is the cessation of menstruation characterized by very low estrogen levels and almost entirely absent egg production.
Postponing perimenopause requires optimizing the health of your ovaries, preserving eggs, and decreasing amount of menstruation enacted throughout a lifetime. This means it is entirely possible that having a condition such as hypothalamic amenorrhea–which halts egg production–early in life will delay perimenopause, presuming that the woman has recovered between then and now. The effect that PCOS might have on this is tricky because each woman is individual. Some women might still produce a lot of eggs with PCOS, but others might not.
One this we do know with absolute certainty, however, is that increased health, stabilized hormone balance, and decreased stress are all key players in postponing perimenopause.
Postponing menopause, on the other hand, requires not just optimizing the health of your ovaries but optimizing your estrogen production. How do you do this? How do you optimize estrogen production?
This means that having a low estrogen condition such as hypothalamic amenorrhea might accelerate the onset of menopause. On the other hand, having a high estrogen condition such as estrogen dominance or endometriosis might do the opposite. This is why eating soy can be helpful for women struggle with menopause symptoms. It replaces estrogen where otherwise it has gone missing.
Yet, again, those are uncertain phenomena, and no one knows the precise effects of PCOS, hypothalamic amenorrhea, or endometriosis on menopause. What is certain is that optimized health, reduced stress load, having happy adrenal glands and a normal range of body fatness are all significant boosts to menopausal wellness.
So does the paleo diet help?
Yes. Being happy and healthy seems to be the best way to simultaneously delay perimenopause and menopause. The paleo diet is also supremely good for hormone balance, for healthy egg development, and for a regular and fertile menstrual cycle. This is because a diet built around evolutionary foods evades the insulin-poisoning effects of high calorie, high sugar, and inflammatory meals. It avoids soy, which is complicated, but can be definitively detrimental to fertility status. It decreases the risk for reproductive diseases such as PCOS, endometriosis, and hypothalamic amenorrhea, as well as metabolic and autoimmune diseases such as diabetes and celiac. And it is finally because paleo foods maximize nutrient status, which is necessary for reproductive success (for example, without sufficient calcium and vitamin D, a woman’s eggs will never full develop).
Stress reduction and play are also crucial. I consider these a part of the evolutionary framework–what does my body demand of me? Yes, it does demand laughter– so we can throw that on top of the paleo wagon as well.
All of which is to say that a wide variety of factors influence the onsets of perimenopause and menopause. But the specific health- and reproduction- enhancing and balancing effects of a paleo diet are a serious help. No studies have come out so far as I can tell that deal with whether or not the average ages of these events have changed in recent years. I wouldn’t be surprised at all, however, if in coming decades we find out that the landscape of menopause and perimenopause shifts along with the rapid decline in public health.