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paleo and pcos by stefani

Paleo and PCOS

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The overwhelming majority of women with PCOS who undertake a paleo diet see great, quick results.  The paleo diet helps them achieve greater weight loss, insulin sensitivity, and reproductive function.  Paleo reduces inflammation and meets nutritional requirements, as well as balances hormones.   When enacted properly, a paleo-type diet completely eliminates toxic foods from a woman’s body.  Of course she is going to get better.

Unfortunately, I also know of a fair number of women who only begin showing symptoms of PCOS when they begin eating a paleo-type diet.  Others have see their symptoms worsen.   In response, I always wonder if these women have had some sort of underlying problem for a long time, perhaps via exposure to phytoestrogens or endocrine disruptors.  The fact remains that a paleo diet sometimes exacerbates PCOS problems.  What gives?

First, the biggest player in this problem is probably weight loss.   As I mentioned in my post on PCOS etiology, shifting fat mass levels can alter the amount of estrogen in a woman’s system.  If a woman was overweight as a child, if she began her period early, if she had a lot of leptin in her system as a child from eating a high carbohydrate diet, she may have trouble ovulating later in life at a lower, “healthier” BMI.   The opposite is also true.  This is unfair, especially in a world in which women are expected to look a certain way in order to be beautiful.

Secondly, many assert that weight lifting shifts the body towards great androgen production.  Greater muscle mass = more testosterone?  According to weight lifting gurus at least, yes.     This means that the whole “strong is the new skinny” mantra may shift women’s hormone profiles farther than they can handle (especially with respect to the point I made above that a woman’s hormone levels are established early in life.)    Additionally, an obsession with exercise may push a woman into an energy deficit, such that her ability to signal fertility from her fat cells to her hypothalamus is impaired.  I covered this extensively when I talked about exercise-induced hypothalamic amenorrhea.

Third, paleo typically decreases leptin levels for a variety of reasons: 1) women eating a paleo diet often thin out naturally, 2) appetite is decreased so women eat less frequently, and 3) most people on paleo diets eat fewer carbohydrates.  With less leptin in a woman’s body,signalling to the hypothalamus and to the pituitary glands is hampered.  Sometimes it decreases enough to cause hypothalamic amenorrhea, which I treat at length.

Fourth, different kinds of paleo diets influence hormone profiles in different ways.  For example, a diet heavy in nuts delivers to a woman’s system both excess phytoestrogens as well as a lot of omega 6 poly-unsaturated fats.  These PUFA fats actually increase systemic inflammation rather than decrease it, and phytoestrogens throw off a woman’s estrogen production.   Another example: dairy is testosterogenic.   Many people give up dairy on a paleo diet, but others end up eating a lot of dairy, particularly butter.  Butter, and its purified form, ghee, have been touted as a solution to the problem of food allergies by being free of casein and lactose, the typical proteins that cause digestive problems.   Yet all dairy, regardless of the type remains testosterogenic: pregnant cows produce a protein that inhibits normal testosterone blocking procedures in a human body.    This fact is why many people experience acne when they eat dairy.

Fifth, many people on paleo diets eat high protein diets.  This is not optimal for longevity, nor for reducing cysts on the ovaries.  Protein is a building block molecule, and if the body has already used enough bricks, it will redirect the remaining bricks to unnecessary locations.  Cysts are one such example of this.  Tumors are another.   Another reason a high protein diet may not be ideal is that high protein diets increase levels of Insulin-like Growth Factor-1 in the blood.  IGF-1 decreases Sex Hormone Binding Globulin levels in the blood, and SHBG is responsible for finding free testosterone.  Most women with high androgen levels have correspondingly low SHBG levels.  I recommend .5 grams of protein per pound of lean body weight each day.  This means that a 100 pound woman would eat 50 grams of protein each day.  She can go as high as 100 grams if she likes, especially if she exercises a lot (in that case it should be increased), but that may not be optimal.

Sixth, low carbohydrate diets can contribute to PCOS, though this is a complicated issue since all of the women with PCOS have such different etiologies.  For example, overweight women with PCOS almost always see great benefits with a low carbohydrate (specifically fructose) diet.  Yet for thin women with PCOS, low carbohydrate diets are problematic.  Glucose is required for the conversion of T4 into T3 in the liver.  Without glucose, T3 is not produced.  Worse still, reverse T3 is produced instead, and reverse T3 acts as a T3 antagonist.  So without carbohydrates, a woman’s thyroid activity can drop off dramatically.  Hypothyroidism is one of the biggest causes of cystic ovaries, as well as general female malaise.   Additionally, SHBG  levels increase with an increase in thyroid hormone.

Finally, women on paleo diets are often perfectionists.  They are sometimes orthorexic, and they stress out about their food, exercise, and bodies more than they ever have a right or reason to.  Stress inhibits pituitary function, and in a very big way.

All that said, these are some of the ways in which a paleo diet and life style can contribute to PCOS.  Much of it is related, in what I consider a “perfect storm” of endocrine problems.   Yet without taking the diet to these extremes, and especially stressful extremes, eliminating toxins, eating natural foods, and living a stress-minimizing life almost always does nothing but wonders for women.

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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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Managing director of Paleo for Women and author of Sexy by Nature.

34 Comments

  1. Oh my god. Answers. Thank you. Too bad I just ate a huge handful of nuts. Well now I know! Are seeds the same? Do you have any thoughts on ketosis? Thank you so much for all this.

  2. Just a few questions for clarification. How thin is too thin? BMI is a poor measure of health and well-being and weight also seems a poor indicator. How does being of a lower weight when entering puberty/entering puberty late relate to ideal weight for fertility? For example, I was very small and much older than my peers in comparision when puberty hit, probably weighing in at less than 105 lbs and being 14 or so. How does all of this relate to my ideal size/shape for health now. I’m sure you get plenty of questions like this, and it’s not a vanity thing, avoiding type 2 diabeties and being able to have children are my two biggest health goals in life! Thank you.

    • Too thin is too thin if it is causing you health problems. If you do not menstruate, for example, and have had certain blood tests done, and see that you have low estrogen and progesterone, and possibly low lh and fsh, then that is possibly/probably an indicator of being too thin. That is probably the greatest problem with being thin– that of fertility. If you have both good health markers and are also fertile, I don’t see why you’d have any reason to worry– not about being under, or even about being over, weight. That should help?

      • Thank you. That helps clarify. I’ll have my yearly check-up soon, so I’ll have an idea of all my levels very soon. The length of my cycle has gotten longer over the last few months, but that might be related to my Mirena IUD, which I’m thinking of having removed. As long as my cycle doesn’t disappear I won’t stress for now and focus on staying healthy with Paleo and Crossfit! Thanks again.

      • I am so confused by this article. So what am I suppose to eat? I haven’t had a menstrual in 4 yrs. I don’t like to take prescription medications, I have ovarian cysts, I’ve tried eliminating sugars at times and dairy. That actually helped with hot flashes. But now, I’m losing my hair in the crown area. I use to get really bad ingrown hairs on my limbs. I’m now working out with weights and exercising more after losing weight from HCG diet because I gained 60 lbs. What kind of blood tests do I do and what am I looking for in a blood test? what do I eat? I’m 42 and may still want to have children. Please help

        • HI Jerra,
          Perhaps your weight loss and exercise has stressed out your body, hence the hair loss. That would be my best guess. Eliminating sugars and dairy is a big help, but you also want to make sure you don’t cut carbs too far if stress is an issue for you.
          I’d look at your thyroid levels, so TSH, t3, t4, and also testosterone, DHEAS, estrogen, progesterone, lh and fsh. Those should help you understand where your hormone levels are getting imbalanced. Your doctor can help you with that. If not, come back and I’ll explain it to you. PCOS Unlocked should also be helpful, I think. :)

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  4. Thank you for this amazing blog and the valuable information and empowerment that you provide. I stumbled across this website today and having only quickly browsed through, I can already tell that it will assist me a great deal in leading a healthier life and managing PCOS/hormone imbalance. I’ve been seeing an endocrinologist and have so far had one consultation with a doctor specialising in hormonal imbalances. While they are helpful, much of what I’ve read here so far resonates with me a great deal more.

  5. I agree with the other ladies here. This article is so helpful. I was diagnosed with PCOS at 16 yrs old. I’ve become very frustrated and disillusioned by the treatment (or rather, lack of) that I’ve been getting from my physician and endocrinologist. At this point, I want to make some real positive changes in my lifestyle and take the control of my health into my own hands. I’m 32 now and still hoping that someday I can be a mother. Now is the time to make these changes! Thanks again!!!

  6. Hi,

    I was reading your article and wondering what i was going to eat. I am 34 – i was diagnosed with PCOS at age 15 and am on the lean side. I also have been dealing with adrenal fatigue in the past year after 4 moves and two children. I noticed when i go too low carb i end up with vomiting bouts and severe anxiety. I have no idea what to eat as i don’t do well on grains, gluten or dairy which doesn’t leave too much else. I find myself being so hungry and not knowing what to eat throughout the day. I find the info about reverse T3 really interesting as that is my problem – too high reverse T3 since all the stress hit a year ago. What kind of carbs would you suggest to reach a happy medium?

  7. Hi,

    I’m interested in trying this diet as I was diagnosed with PCOS a few months ago. I’m trying to do everything the natural way, well as natural as possible. The only thing that seems to worry me about the article is the second paragraph when you say it could make symptoms worsen. Could you be more clear, in which case would that happen? I am 5’3, 150 pounds. I work out at least 2 days a week and try to keep fit but the depression part with PCOS makes it really hard to stay motivated.

  8. You also can’t ignore the quality of the protein eaten when going Paleo. A lot of people still eat feed-lot, grain-fed beef, etc. Even I did that when I first started and my PCOS tortured me something awful. When I switched to grass-fed… no symptoms. Back to crap meat… instant pain. It’s not enough to just switch to Paelo foods. It has to be quality Paleo foods. Same with veggies…

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  10. Hi, I know it’s a long shot, but if you could offer me any advice, I would greatly appreciate it. I have recurring miscarriages and after further testing, have found that I have lean PCOS and a clotting problem that can occur with it PAI-1, the clotting problem can lead to recurring miscarriages. I also have endometriosis. My Dr. has prescribed Metformin to help the PAI-1 once I’m pregnant and also to bring on ovulation. It makes me incredibly sick. I’m already hypoglycemic and it’s really hard to keep my sugar up on the medicine. I quit taking it and was planning to start the Paleo diet before starting again. I have very limited information on the diet itself and would really appreciate any tips or suggestions you could give me. We want a baby more than words can express and I’m willing to do anything I can to better prepare my body. Thank you

    • Hi there, I was diagnosed with PCOS when I was 15, and was put on Metformin. That is the WORST drug you can be on! Besides feeling like your sugars are always low, constant diarrhea, and stomach upset, this drug can hurt your organs, mainly your pancreas!

      I am trying the Paleo diet, in search of an all natural way to heal my body from PCOS.

      • Er, do you have a source for Metformin being any source of harm to the pancreas? There is nothing to confirm this.

        Additionally, Metformin helps regulate blood sugar, not lower it. If you’re hypoglycemic, that is likely the foods you are eating and not the medication. Finally, the stomach distress goes away as you get used to your dose. Please try not to spread misinformation!

  11. Dear Stephanie,
    I am hoping that you can help me decide if going on the paleo diet is the right thing for me, or it will throw me into another tail spin. I’m 37 yrs old 5’2″ 148 lbs. diagnosed with pcos at age 28.

    About two years ago, something went haywire with me and I got really sick. I lost the hair next to my ears, I lost 20 lbs almost over night, crazy insomnia, my heart was racing, I’d get these weird sores all over my body, I was so scared, and anxious. I took an adrenal supplement before all of tis happened, but I have no clue if it was that or something else. I went to lots of doctors and they all though it might be hyperthyroid, but all tests were normal – though my tsh was.66 – which was the lowest id ever seen it. My estrogn was completely bottomed out . I had also limited my gluten intake. So after giving up on traditional medical doctors I went to see an acupuncturist. She seemed to help the most. But because I’m so sensitive she didn’t give me any herbs. Just lots of bone broths because my system was so depleted of minerals.

    Fast forward 2 years and now I am gaining weight like crazy – belly and back side. I have tons of extra hair. No acne. I exercise 3 times a week. I am sleeping better now, but have occasional set back.

    Do you think that paleo will be good for me?

    • YES! And what you’re talking about– it seems as though your thyroid is doing some wacky things, which can be helped enormously by a paleo diet that striclty eliminates grains, dairy, and legumes.

  12. Blood test from doctor back when I sent you the original message in October 2012 results were T3 2.71 T4was 1.13 And thyroid stim hormone was 1.39
    Postmenopausal range said 15.9-54.0,luteinizing hormone 20 .3 mIU/ml
    Follicle-stimulating hormone was 32.4. Normal follicular phase I’m told was 4 to 13 is the range postmenopausal females is 20 to 138
    Thanks for the response. I’ll try the paleo diet see if anything changes. I can’t imagine that I’ve been perimenopausal since I was 37 or 38 yrs. I think that would be extremely early

    • My testosterone was 30ng/dal at the time

  13. About 8 months ago I underwent extensive test with my doctor because I am having a really hard time losing weight. My doctor told me that my lh/fsh levels are at 2/1, and that puts me on the doorstep of PCOS, I guess 3/1 is a standard diagnosable level. My husband and I recently started on the Paleo diet and a new workout routine to shake things up. I guess my question is, how concerned should I be about PCOS going forward? I also tested as pre-diabetic, which is a huge concern for me and a factor in choosing Paleo.

  14. I started the paleo diet two weeks ago. I have been feeling great but I have been spotting and having allot of cramps. Do you think it is making my PCOS worse? Or do you think my body is just trying o regulate and adjust to my new way of eating? Thanks for your help!

    • Adjusting! But that also totally depends on WHAT you are eating on paleo and what sort of changes you have made. :)

  15. Hi,

    I’m 5’2″, 115 lbs, some minor acne (more like clogged pores) and no hair issues, diagnosed with PCOS 6 months ago after I went off bc and (after a first good 6 months of 28-32 day cycles) didn’t have a period for 8 months (this was also during a time of extreme stress). My bloodwork showed slightly elevated LH, but that was it. I had no cysts, only a number of follices on an ultrasound. A few months ago, I started working out 4-5 times a week and cut out all grains and processed sugar — still eat legumes but am careful about fruit and never drink juice. I FEEL a lot better (more energy, less irritable, etc.) but my somewhat regular 7 week cycles just changed this past cycle to a 9+week, with pain that feels like a cyst (I never used to actually have cysts, so hard to say) and spotting. Is my diet making symptoms worse, or is this a normal process to recovery? If a low-carb diet probably isn’t right for me, what is?

  16. I have PCOS and was able to relieve some/most of the symptoms on a low carb diet however could not lose weight while consuming dairy and artificial sweeteners. Through a low carb lifestyle my periods have become regular, blood sugar levels have normalized and cholesterol looks great. Now I’m switching to paleo. Starting out with the whole30 in hopes that I lose the weight and figure out what’s keeping me from the weight loss. Good luck to all you ladies. We can beat this. Just need to find the right combination of food and exercise to do so.

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  18. Hoo boy. I’m not sure what’s left to eat now for PCOS ladies – there are so many conflicting suggestions coming from all sides!

    If you’re doing low carb yet should be avoiding protein, nuts, seeds, most fruits, and dairy, how do you keep from going hungry? If someone needs to maintain weight loss, turning to more fats and cholesterols seems counterintuitive. And many fats come along with a fair amount of protein, too.

    I’ve heard praises sung for so many things that someone else claims is harmful, it’s hard to know where to turn (for example, I’ve read a number of studies and articles promoting phytoestrogens for PCOS). Ironically all of this information flying around is pretty stressful – something everything says to avoid. Easier said than done, I guess!

    With my new lower carb diet, I’ve let go of so much I enjoyed – I feel like I can only pick so many battles! Greek yogurt, cruciferous veggies, almonds/nuts, more protein, flaxseed…if they’re really as detrimental as you say, I might just need to compromise and weigh the risks against the benefits. :(

    Thanks for the read, however. I can see this is complicated stuff.

    • Agreed! I am about to the point where I am going to throw in the towel and go on the medicine my doctor has recommended (or even do replacement hormones.) Everything I’ve read basically says that ‘if paleo isn’t working you’re doing something wrong.’ Like I’m some sort of idiot or something… I have several family members that specialize in this stuff, and they agree that it doesn’t always work for everyone. It is unrealistic to think that. And this is telling me to cut back on working out..ect and all the FOOD I’m supposed to cut out. Really? So lower protein, no nuts, no dairy(already doing no dairy), and no fruits. Hm….Sounds like I get a chicken breast per day. Super realistic. I’m sorry for being rude, but it is just upsetting that all you seem to get when you go in search of how to go about treating PCOS the natural way is a bunch of guilt or misguided information when an approach doesn’t work. Bottom line: Paleo might not treat your PCOS, but it is STILL incredibly healthy for your body. (As long as you aren’t having bad side effects with it.) So I am gonna stick with it for a while longer to see if it improves my PCOS. If not I will just stick with it to be healthier. Hope that helps. You’re not alone!! :D

      • “it is just upsetting that all you seem to get when you go in search of how to go about treating PCOS the natural way is a bunch of guilt or misguided information when an approach doesn’t work. ”

        OMG – yes, this!! plus, 99% of the time there’s no real evidence that something is truly good or bad either way, but someone will pick a side, vilify the opposition, and ultimately just kinda…scare people.

        For now I’ve decided to just do what works for me, which seems to be lower carb/lower sugar, and metformin (which I’ve been on for a long time). I still enjoy some dairy, limited fruits, etc etc…I can only make so many changes and pick so many battles at a time, you know? I really need to stop doing google searches that land me on posts like these.

        Either way, thanks for the moral support, Ashley! I got your back too if you need it. ;D

        • More power to you, ladies!

  19. I am 32, recently found out that I have had at least two strokes and that I have PCOS. I was diagnosed with both of these health problems in the same week and I have been struggling to make the right health choices. I apparently can’t be on birth control to regulate my PCOS symptoms which are acne, lack of menstruation, and over all exhaustion as well as insulin intolerance. I exercise every day and I eat well. I am 5’2 and 130 which is big for me. I am usually 120-123. I would love any insight anyone has to my unique case. I am thinking about taking the risk and getting back on orthotricyclene because my symptoms are intolerable. Please help! My doctors are being very nonchalant bout all of it and I am at the end of my rope.

    • 5’2 130 is my size, too! And this so happens to be as heavy as I need to be in order to menstruate, not have acne, and many of my other hormone problems. This may not be the case for you as you are obviously a different strand of DNA aand also have experience with the pill… so I say this only to encourage you to consider reconciling yourself to a higher weight if you find that it alleviates symptoms. Stress is a big factor, I think, and I think over time as you heal and your stress levels drop then you will no longer feel the need for BC to regulate symptoms. I know its a hard and long road, but trust me when I tell you that there is always progress

  20. Thank you so much for this article! My “idiopathic” hirsutism started after I was on the candida diet when I was 19, I started off at 60kg at 5’8″ and then dropped to 53kg very quickly. Unfortunately the hirstuism slowly got worse over the years despite eating normally and putting weight back on (I never got back to 60kg though). Just this month I had a new hair sprout above my belly button where there wasn’t hair before and it’s made me really helpless and depressed.

    One thing that happened after that diet was very interesting though; before I went on it I was a total bread addict – now I have to force myself to eat any starches and it makes it harder to put weight back on.

    This is the first time I’ve seen someone acknowledge that a diet purported to help PCOS can jumpstart the symptoms in some women. I’d really like to know more about it, but there just isn’t enough interest research-wise :(

  21. What irritates me most about your article is the lack of support that you have for a Paleo Diet. I have been eating Paleo for 2 years now combined with crossfit. I was diagnosed with PCOS several years ago and was overweight. I lost 40 lbs and kept it off and feel way better. The paleo diet helped me tremendously. People do not have to go strict paleo. It’s honestly about moderation and carbs such as bread and grain just desolve into sugar. I feel as if the carb load did not help improve PCOS symptoms at all. I think ultimately it is different for every individual and we have to be completely honest with ourselves and get a healthy dose of exercise 3-5x a week alongside a natural diet. A natural diet will always help improve PCOS and weight issues. Have you personally tried Paleo and Crossfit combined or had any issues with PCOS? Thanks for the article though. It’s interesting to see different points of view and different women’s responses.

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