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
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 progesterone 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?
To read more about the book and get your hands on some excerpts, discussions, and tips, check out the Facebook page.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