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HPA axis

Leptin and Why You Should Love Your Booty

Posted by on Aug 5, 2014 in Blog, Hormones, HPA axis | 0 comments

Leptin and Why You Should Love Your Booty

 

The following is a guest post by a fellow health blogger – Kate – who had an infertility problem then fell in love with leptin.

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I used to have a bit of a body fat phobia. Although at 13% body fat, I didn’t really have that much to worry about from what other people would think. I was impressive right?

 

Problem was, along with no body fat, I also had no period, no ovulation, and, no fertility.  I was diagnosed with hypothalamic amenorrhea. I looked “healthy”, but my reproductive dysfunction indicated otherwise. I knew I had to get this sorted, and fast, as my partner and I were trying to conceive.

 

I consulted a few of my health practitioner friends. They all suggested that maybe putting on a bit of body fat might help kick things back into gear. As a group fitness instructor who was paid to stand up in front of others in skimpy lycra, this was the last thing I wanted to do. Being the stubborn person I was, I needed justification as to why, and how, fat would help to restore my fertility. Cue leptin.

 

Leptin is one of the more recently discovered hormones and is often referred to as the “anti-obesity” hormone. In fact, the word “leptin” is derived from the Greek term “leptos” meaning “thin”.  This little hormone, which is produced predominantly in adipocytes (fat cells), conveys information to the brain about the amount of energy available in the body. Leptin levels rise with increasing food intake, telling the brain “Yay! All is well. We have sufficient nutrients to do our thang”, and the fall in times of food deprivation, telling the brain “Things aren’t so good. Looks like we’re in a famine and need to shut off non-vital functions”. Unfortunately, reproduction is one of those non-vital functions. We do not need to reproduce in order to survive. Simple as that.

 

But really, it’s not as simple as that.

 

We now know that leptin acts as more than just an energy thermostat. Indeed there are over 19,000 papers that have been published on leptin (no, I have not read them all, sorry), showing that leptin has various physiological roles. But back to the case in point – aside from signaling energy sufficiency to my brain, how would body fat and, as a by product of increased body fat, leptin help me to recover from hypothalamic amenorrhea and restore my fertility?

 

That depends on what’s going on during a healthy menstrual cycle.

 

During the first half of the cycle, otherwise known as the “follicular phase”, follicles (in the ovaries, which house an egg that has the potential to be fertilized) develop. The pituitary gland releases Follicle Stimulating Hormone (FSH) to, as the name suggests, stimulate the follicles to mature and secrete estrogen, which will have the lovely effect of producing fertile cervical mucus. Sorry, we’re getting graphic now.

 

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Once FSH and estrogen have things looking all fertile and sexy, the pituitary gland releases Luteinizing Hormone (LH) to stimulate ovulation, where an egg will burst out of a follicle and wait patiently (for about 12-24hrs…pretty impatient, really) to be fertilized. Meanwhile, the follicle that was left behind becomes the corpus luteum, which secretes progesterone and prepares your body to house a mini-human (think pro-gestation).

 

So FSH and LH (also called gonadotropins) are pretty important. Without them, your sex organs would not receive the message to produce your sex hormones, or to ovulate, or to menstruate. But we are missing an important step. FSH and LH need a little encouragement too, and this comes in the form of another hormone – Gonadotopin Releasing Hormone (GnRH), which is released by the hypothalamus. Are you lost yet? Female hormones are confusing! Quick recap – GnRH stimulates the release of FSH and LH, which promote ovarian function and a healthy menstrual cycle.

 

Now here’s the kicker – leptin has been found to play a regulatory role on GnRH secretion and hence, overall reproductive function. Whether this is a direct or indirect role remains to be discovered. However, what we do know is that women with hypothalamic amenorrhea (when menstruation ceases due to dysfunctional signals between the hypothalamus and the pituitary) tend to have lower leptin levels than women with healthy, ovulatory cycles, as a result of low body fat and/or increased physical activity and/or insufficient food intake often found in amenorrheic women. These low levels of leptin then contribute to alterations in GnRH secretion, as evidenced by disruptions to LH secretion (Ackerman et al, Goumenoua et al). Interesting, right? Thought so.

 

Now I know what you’re thinking – what happens if we give someone leptin? Will that get things back on track? Well yes, Welt et al (2004) treated a small number (n=8) of women with hypothalamic amenorrhea with leptin over a period of 3 months and found that the treatment did restore menstruation, ovulation and hence, fertility.

 

Similarly, Mantzoros et al (2011) boasted this: “Our results indicate that leptin therapy resulted in resumption of menses….in 70% of the subjects [and] 60% of these women also ovulated”

 

Woo hoo! Let’s all go and get us some leptin to inject….

 

OR we could just eat more, exercise less and embrace our booty!?

 

[Stefani notes: You cannot get leptin over-the-counter, or have it tested for in a blood test. I’ve tried both.]

 

After 2 years of being in denial about the importance of body fat and desperately holding on to my 8-pack abs, which I had thought was my defining feature, I succumbed. I put on (quite) a bit of body fat. I ate more. I exercised less. And I realized that my friends and family probably loved me for more than just my body. Doctor Seuss was right after all when he said:

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Smart man that Dr Seuss.

 

I put on weight. That was the goal, after all. And I definitely was no longer 13% body fat, as evidenced by my increasing bust line (yay) and decreasing (absent) thigh gap (also yay, I think – that shit is just not normal for my body.). One other lovely effect – my period returned. Hurrah! It just goes to show that with a little dedication and a (pretty big) mental shift, beautiful things can happen.

 

Ladies – your period is a luxury, not a right, and definitely not an inconvenience! If your lady holiday is MIA, see it as the canary in the coalmine and do something about it before the shit really hits the fan (think osteoporosis, heart problems and infertility). Stop trying to reach some warped perception of the “ideal” body and start embracing your natural feminine curves. And remember – you are so much more than what you look like. Be kind to yourself for once.

 

-x

 

References for all you fellow nerds out there:

 

  • Ackerman, K.E. et al. (2012) “Higher ghrelin and lower leptin secretion are associated with lower LH secretion in young amenorrheic athletes compared with eumenorrheic athletes and controls”, The American Journal of Physiology – Endocrinology and Metabolism, 302: E800–E806
  • Goumenoua, A.G. et al. (2003) “The role of leptin in fertility”, European Journal of Obstetrics & Gynecology and Reproductive Biology, 106:118-124
  • Holtkamp, K. et al. (2003) “Reproductive function during weight gain in anorexia nervosa. Leptin represents a metabolic gate to gonadotropin secretion”, Journal of Neural Transmission 110: 427–435
  • Mantzoros, C.S. et al. (2011) “Leptin in Human Physiology and Pathophysiology”, The American Journal of Physiology – Endocrinology and Metabolism, 301: E567–E584
  • Moschos, S. et al. (2002) “Leptin and reproduction: a review”, Fertility and Sterility, 77(3): 433-444
  • Quennell, J.H. et al. (2009) “Leptin Indirectly Regulates Gonadotropin-Releasing Hormone Neuronal Function”, Endocrinology, 150(6):2805–2812
  • Rexford, S.A (2004) “Body Fat, Leptin and Hypothalamic Amenorrhea”, New England Journal of Medicine, 351 (10): 959-962

 

Kate is a Holistic Nutritionist, Personal Trainer and Lifestyle Coach specializing in hormone healing. Kate has over 13 years of experience in the health and fitness industry. She is passionate about helping others achieve optimal wellness through nutrient-dense traditional whole-foods, adopting mindful and sustainable life practices, and moving in ways which rejuvenate rather than deteriorate the body. Kate’s goal is to educate, inspire and empower others to live life to the fullest each and every day. Kate can be reached at www.theholisticnutritionist.com

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Kate!

 

 

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I Failed, Gained 15 Pounds and Saved my Life (Or Something)

Posted by on Jan 21, 2014 in Blog, Disordered Eating, Hormones, HPA axis, Hypothalamic Amenorrhea, PCOS | 27 comments

I Failed, Gained 15 Pounds and Saved my Life (Or Something)

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:

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(College “I’m drunk meditating on the side of the road in Beijing” phase)

 

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(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:

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(Yes, I’m kissing someone, not a phase.)

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(College  ”I’m a crunchy hippy” phase)

———-

Enter “success”

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

-cystic acne

-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.

Sad.

This is what I looked like in this time period:

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(“I cover my face because the sun burns my acne” phase)

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(“I have eight pack abs, so what, b*tches?” phase)

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(“Thigh gap!” phase)

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(“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.

———-

Enter “failure”

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:

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(“I’m such a big deal I do photoshoots and holy crap I’ve got hips” phase)

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 (“Holy crap back fat stomach fat” phase)

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(“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. 

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Overcoming hypothalamic amenorrhea

Posted by on Jul 22, 2013 in Blog, Hormones, HPA axis, Hypothalamic Amenorrhea | 62 comments

Overcoming hypothalamic amenorrhea

 

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?

Sure.

Is it easy?

Not always.

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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.

 

 

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Psychological stress and female hormones: a recipe for fertility disaster

Posted by on Oct 10, 2012 in Blog, Hormones, HPA axis, Mental Health, PCOS | 5 comments

Psychological stress and female hormones: a recipe for fertility disaster

While the title of this post may sound hyperbolic, it nonetheless is grounded in truth.  There are a wide variety of dietary and lifestyle factors that affect reproduction.  Stress may be one of the greatest of all.

What

Dozens of studies performed on cynomolgus monkeys, bonobos, chimps, and baboons have demonstrated that having low social status–even while maintaining the exact same diet at high social status individuals–induces impaired fertility in primates.     Human models, while approximations, do not differ.   In some, a simple progesterone-dampening effect occurs,  in others the levels decrease precipitously, in most cortisol levels skyrocket, but in general a wide spectrum of reproductive disorders- from hormone deficiency to full-blown long-term amenorrheic infertility- follow from psychological stress.  This is something about which I have written before, and it’s a serious problem, causing not just outright and obvious infertility but also sneakily impaired and sub-optimal fertility all across the country.

How

Pysychological stress wreaks all sorts of havoc on the body.  Most importantly, cortisol levels rise, and the body’s inflammatory and immune responses become impaired.  Blood sugar levels rise, and insulin levels rise, too.  When these things happen, healing cannot occur, and tissues become progressively damaged with time.  This applies to reproductive tissues as much as it does to the rest of them.   Hypercortisolemia is good for nobody.

Several hormone responses also occur.  Three of the primary ones are as follows:

1)  As I mentioned, due to elevated cortisol levels, insulin levels may rise, and testosterone levels rise right alongside it. This is because insulin directly stimulates testosterone production in the ovaries.  This is bad for reproduction because a proper balance between testosterone and female balance needs to be maintained in order for proper reproductive signalling and tissue development to occur.   One particularly potent way in which this imbalance often hurts women is in the hormone condition Poly Cystic Ovarian Syndrome.  It is not the only thing that contributes to PCOS– definitely not– but it can play a big time role in it.

2)  Moreover, another effect that may occur as a result of stress is an increase in production of DHEA-S, a hormone produced in the stress glands.   DHEA-S is, like all other hormones, an important and very healthful hormone in proper balance.  But if the stress glands are in overdrive, they might over-produce everything, including DHEA-S.  This is detrimental, because DHEA-S is also a classically male sex hormone, and it plays a role similar to testosterone in PCOS.  DHEA-S in excess blocks estrogen signaling, interferes with LH and FSH signaling, and also increases hormonal acne.  DHEA-S can play a role in both type I and type II PCOS.

3) Finally, the brain, via the hypothalamus, sometimes turns off pituitary activity in response to stress.  This often leads to a cessation of LH and FSH signaling–the two primary pituitary signalling molecules–which in turn decreases levels of estrogen and progesterone in the blood.  Recall that reduced progesterone levels are one of the primary markers of reproductive distress in primate studies.  Prolactin levels may also decrease.  These facts make it impossible both to ovulate and to menstruate.

*Graphic extracted from PCOS Unlocked: The Manual.

 

These three categories– testosterone elevation, DHEA-S elevation, and pituitary decreases may occur differently in all women.  And there are a wide variety of other, more subtle, hormonal responses that also occur, especially when considered in conjunction with all of the other bodily stress that follows from psychological woes.

All that being said, STRESS IS BAD.  We know some of the reasons why, as I’ve explained above.  Others likely exist.  Even if you don’t have infertility problems, you may have hormone imbalances or deficiencies, and those can be just as insidious.  Eat right, sleep right, live well, breath deeply.  Repeat.

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Stress is a significant problem for women’s health, and particularly women’s hormonal health.  This is manifested in a wide array of problems, but also most predominantly these days in the condition PCOS, or Poly Cystic Ovarian Syndrome.

You can read more about stress and it’s interplay with cysts, as well as how to overcome it all,  in my forthcoming guide, PCOS Unlocked: The Manual.   Coming to this website on 10.17.12, ONE WEEK FROM TODAY.

 

 

 

 

 

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PCOS and Hypothalamic Amenorrhea: what’s wrong with the contemporary understanding, and how women can have both

Posted by on Jul 3, 2012 in Blog, HPA axis, Hypothalamic Amenorrhea, PCOS | 62 comments

PCOS and Hypothalamic Amenorrhea: what’s wrong with the contemporary understanding, and how women can have both

PCOS is complicated.  It’s an easy diagnosis, but the causes of it are rarely understood.  This is because cysts crop up under a wide variety of hormonal circumstances.   We might think that this would mean that the medical community recognizes the need for diverse treatment among PCOS patients, but actually it does not.   Instead of considering the wide variety of PCOS needs, many doctors (especially those who are not endocrinologists) use blanket diagnoses and treatments for all of their PCOS patients.   This is not wholly unreasonable.  There is  a majority PCOS condition, and the biochemistry of this condition is both simple and compelling.  However, there remain other causes and problems.  Failing to address them means that thousands of women end up falling through the cracks.

The current understanding of PCOS is flawed in two major ways.   First is what I just described above, the fact that the wide array of different hormonal issues that might cause PCOS has not really been explored or emphasized.  Instead, PCOS is broadly regarded as a direct effect of being insulin resistant and overweight.  However, this only accounts for between 60-80 percent of PCOS patients.  The second flaw is a corollary of that nearsightedness: most members of the medical community (though there is a real debate getting off the ground) believe that it is impossible to have both PCOS and hypothalamic amenorrhea at the same time.

I disagree.

The belief in problem number two, ie, that HA and PCOS are incompatible, derives from the first problem, ie– the lack of a nuanced understanding of PCOS.  PCOS is widely regarded as a problem of insulin resistance and being overweight.  These are two significant factors that generate cystic ovaries.  But they are not the only ones.  Only 60 percent of PCOS patients are overweight.  Some normal weight PCOS patients are also insulin resistant.  Yet others still are not.  What causes normal weight women to develop cystic ovaries?  And what about insulin-sensitive women?

Recommendations for overcoming PCOS are directed at this insulin-resistant.    PCOS patients are advised by the National Institute of Health to “drop 5 percent of their body weight” in order to become fertile.  This is, again, great for the majority of PCOS patients, who usually do well and recover reproductive function with the simple implementation of an insulin-sensitized lifestyle.  This is why the paleo diet kicks ass for overweight women with PCOS.   When they exercise, eat low-ish carbohydrate diets and eliminate refined foods…. these women correct their insulin resistance, reduce their testosterone load, and as such watch their hormone balance fall elegantly in line.  It is worth noting that there are different nuances within this population– that some of them have vastly different estrogen and progesterone levels and varying degrees of hormonal imbalance.   This is another reason that a nuanced understanding of PCOS is necessary for the health of each women.  Nonetheless, however, overweight PCOS patients generally recover well on weight-loss and insulin-sensitizing programs.

This does not really do the trick, however, for the rest of the women out there with PCOS.

Below, I discuss the typical and some atypical causes of PCOS, which will hopefully shed light on a) the variety of ways in which hormones can be disrupted, but also in particular b) how hypothalamic amenorrhea (and hypothyroidism) can play a powerful role in causing cystic ovaries.

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There are three characteristics necessary for a PCOS diagnosis for all women:

-Cystic ovaries, as detected via ultrasound

-Elevated androgen (male sex hormone) levels

-Irregular or absent menstruation

Overweight and insulin resistance are two important ways these characteristics can be brought about, yet other ways are equally powerful.   The thing is– having cystic ovaries means that the process of menstruation is not completed properly.   It does not mean necessarily that one universal step (such as insulin resistance) goes wrong.  Instead, it means that at some point along the chain throughout the four menstrual weeks, one or more factors misfires.  A signal is missed, one hormone floods the rest of them, or one hormone isn’t properly produced, for example.   Androgens usually end up at dominating the reproductive scene, and cysts usually develop.  But the mechanisms by which this occurs are not as simple as many PCOS practitioners would have us believe.

The dominant pathway by which women develop poly cystic ovaries is, again, that of the overweight woman.  It is a fairly simple process:

1) insulin stimulates testosterone production in the ovary, and

2) testosterone production throws off estrogen levels and inhibits estrogen signalling.

In PCOS, testosterone and estrogen become improperly balanced, and the rest of the menstrual cycle, which takes its cues from the rise and fall of estrogen levels, suffers.  LH and FSH, two pituitary hormones that tell the ovaries what to do and when, are of particular concern. LH and FSH levels become dysregulated with dysregulated estrogen because they take their cue from blood estrogen concentrations.  This is why the vast majority of PCOS patients have a reversed and high LH and FSH ratio compared to healthy women.   The pituitary gland keeps trying to make the body ovulate, but it does not read estrogen signals properly, and the ovaries do not hear the pituitary properly.   So these are the markers of the typical PCOS diagnosis: inverted LH and FSH, insulin resistance, overweight, and elevated testosterone levels.

Yet there are other means by which a woman’s hormonal profile can create cysts.

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First is a simple case, and this one is thankfully recognized by many in the medical community: that of hypothyroidism.   Having low T3 (the active form of thyroid hormone) in the blood is strongly correlated with cystic ovaries.  When women with subclinical hypothyroidism correct their condition (this is normally done in medical studies by taking T3 pills), the majority of cases begin menstruating again.  This is presumably because low T3 levels decrease the activity of cells and hormonal signalling, which means that the menstrual cycle proceeds with fits and starts, rather than powerful, holistic health.   Three common causes of lower thyroid function are poor sleep, restricted calorie intake, and a long-term carbohydrate limited diet (since glucose is necessary for the conversion of T4 to T3 in the liver).

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Second is the important and powerful case of hypothalamic amneorrhea.  HA is known by many to be exactly the opposite of PCOS.  In PCOS, hormone levels often skyrocket.  High testosterone, high and uneven LH to FSH ratio, high estrogen levels (though not always).  In HA, hormone levels plummet.  Low LH, low FSH, low estrogen, low testosterone.  PCOS is a problem of being overweight; HA is a problem of being underweight.  In PCOS, women over-produce hormones.  In HA, women under-produce hormones.

Or so the story goes.  However, women can present with cystic ovaries and still have low levels of hormones.  The problem– the real, truly universal problem that creates cysts–is a hormone imbalance.   Absolute levels of the hormones are important, but even more important is the balance between testosterone, estrogen, progesterone, and leptin, even.  The other factors– insulin resistance, LH and FSH inversion, and being overweight– they are not the only thing that can create an androgen-dominant cystic profile.

Hypothalamic amenorrhea is a problem of being too stressed, eating too few calories, exercising too much, and having too little body fat.  In essence, it is a condition caused by hypothalamic stress and down-regulation.  Hence the name.

The ways in which these four problems typically classed under a diagnosis of hypothalamic amenorrhea– the eating, the exercising, the stress, and the body fat– can cause cysts and/or co-occur with more classically PCOS-type symptoms are vast.  Here are a couple of examples:

-A woman is really stressed out by work and life.  While most of her hormone production plummets, her DHEA-S production (the top-of-the-food-chain hormone produced by the adrenal gland) skyrockets in response to HPA axis dysregulation.  DHEA-S is an androgen, and it influences the development of cystic ovaries if estrogen levels are not equally as high.

-A woman is fairly healthy but has slept poorly throughout her entire life.  This pushes her towards insulin resistance, but more than that it dys- and up-regulates her cortisol production.  Cortisol signals to the HPA axis to decrease pituitary activity, and it does so.   Her hormone levels all decrease.  This woman’s predisposition to insulin resistance coupled with adrenally-induced fluctuations triggers the development of ovarian cysts.

-A woman is stressed out via the typical HA pathways–caloric restriction, excess exercise, and stress–so her pituitary hormones decrease in potency.  Testosterone and estrogen levels are low but okay, and the woman is probably thin but may also be larger, depending on the degree of stress.  Nevertheless, this time it is progesterone that takes the largest hit from the stress (taking it’s cue from both estrogen and LH), and menstruation can never occur without sufficient progesterone levels.

-A woman has a tendency towards insulin resistance, and is overweight, and then loses weight.  While this corrects the insulin problem, the drop in estrogen levels she experiences from the weight loss (since estrogen is produced in fat cells) causes an imbalance in her predisposed-to-testosterone-production ovaries.

- Or a similar phenomenon occurs with leptin: In this case, a woman may be a bit insulin resistant, and therefore have a predisposition to testosterone production, but she does not test into a “dangerous”  testosterone zone.  Instead, her problem lies in the fact that she lost weight, and with it, she lost the potency of her leptin stores.   During puberty, each woman’s body adapts to whatever levels of estrogen and leptin she has circulating in her blood at the time (creating a bit of a leptin “set point”).  Later in life, one of these women loses weight.   As she loses weight, and, significantly, if she is restricting calories or exercising excessively, her leptin (and estrogen) levels drop.  The hypothalamus perceives this drop as an indication of a time of famine, and initiates a starvation response, primarily by decreasing the production of sex hormones.  In this woman’s case, therefore, estrogen is low, and testosterone may be low to high, depending on the degree of insulin resistance and ovarian malfunction, but LH and FSH are both also low.  She does not present with typical PCOS.  She is not over-producing hormones, but is, instead, under-producing.

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All that said, these are some examples of how typical HA problems can cause the cystic condition that is typically associated solely with PCOS.   Stress, excess exercise, restricted macronutrient intake, restricted calories, and weight fluctuation can all contribute to cyst development.   Many of these situations can co-occur, and that totally depends on a woman’s genetics, epigenetics, lifestyle, and diet.

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The problem with having a poorly-nuanced understanding of PCOS lies in the way in which blanket recommendations are made for women with PCOS or HA.  As a result of this mindset, I have been criticized for recommending that thin women with PCOS eat carbohdyrates.  This is because those who are criticizing me believe that PCOS is solely a result of insulin resistance.  I do not believe so.  I believe that many women with PCOS do not necessarily have a problem with insulin resistance, and even if they do, it can be compounded by factors that lie outside of that typical diagnosis.

I would, then, tentatively recommend that women who are overweight and insulin resistant follow the typical PCOS protocol and under-take insulin sensitizing steps.   On the other hand, I would tentatively recommend that potentially under-weight and overly-stressed women with PCOS consider eating more, possibly upping their carbohydrate intake, and exercising less.   Women with low thyroid would do well to correct that problem however they see fit.  This is, however, particular to the individual, so please do not take my musings about PCOS etiology and treatment as prescriptions.  At all.

The real recommendation, therefore, is to get a blood test (!), and to have discussions with your doctor about all of the possibilities that could be affecting your hormone levels.   With PCOS it is crucial to order blood tests.  While it is a near certainty that androgen levels are elevated relative to the rest of the hormones, that is not the case 100 percent of the time.  All of the hormone levels– testosterone, estrogen, progesterone, LH, FSH, and T3 levels may be all over the map and still cause a woman to present with PCOS.   An adequate picture of what is happening in the body is crucial for moving forward.  This then enables women to undertake dietary and lifestyle changes appropriate to their own holistic health and well-being needs.

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For more information on PCOS, why you have it, and how to overcome it, check out PCOS Unlocked: The Manual, the multi-media resource I created in order to share all the PCOS information and experience I’ve amassed in my brain, and apply it to solving the unique case of your PCOS.

Here!

 

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Carbohydrates for Fertility and Health

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

Carbohydrates for Fertility and Health

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

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

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

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

Here’s why:

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

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

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

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

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

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

Carbohydrates to eat:

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

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

Of course, grain-based carbohydrates are a no.

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

This means that I recommend eating:

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

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

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

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

How much to eat: 

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

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

Carbohydrates elsewhere in the paleo blogosphere:

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

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

Jamie Scott: A Week of It

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

Cheeseslave: Why I ditched low carb

Beth Mazur: Why I don’t eat low carb

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

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

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

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

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

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

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

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

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

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

What happens in the body when it stops menstruating

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

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

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

Hormone malfunctions that cause amenorrhea

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

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

-Increased testosterone production interferes with estrogen levels.

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

Cause 1: Weight loss

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

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

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

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

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

Cause 2: Exercise

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

Cause 3: Low Calorie Diet

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

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

Cause 4: Low Carbohydrate Diet

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

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

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

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

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

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

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

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

Cause 6: Altered Phytoestrogen and Hormone-Ingestion Profile

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

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

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

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

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

Cause 7: Stress

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

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