It’s possible (probable) that I have my statistics all wrong, but I think there’s a bit of a link between Paleo and PCOS. Some women, such as Peggy the Primal Parent, come to paleo eating because they are trying to mitigate PCOS, and this is awesome. A lot of overweight PCOS patients fall into this category. I think the paleo diet helps them achieve greater weight loss, insulin sensitivity, and reproductive function. Time and time again we hear about how insanely fertile women become on the paleo diet.. This has a lot to do with reducing inflammation and meeting nutritional requirements, as well as with balancing hormones. I cannot ignore that. Paleo is apparently bomb diggity for making babies.
But I also know of a fair number of people who only began showing symptoms of PCOS once they went paleo. Or that their symptoms worsened. I would argue that these women have had some sort of underlying problem for a long time, perhaps via exposure to phytoestrogens or endocrine disruptors, but the fact remains that paleo exacerbates their PCOS problems. What gives?
First, I think this is because of weight loss. As a mentioned in my post on PCOS etiology, shifting fat mass levels can alter the amount of estrogen in a woman’s system. If she is overweight, or at least at a higher BMI at the time when she begins her period, she may have trouble ovulating later in life at a lower BMI. This is royally unfair and doesn’t even really make sense with the literature. This is because it is usually only endurance athletes and anorexic women who make headlines in this way. But perhaps this one effect of the paleo diet, the weight loss, is just one part of many that disrupt the hormone balance in women.
Secondly, I have read many assertions that weight lifting shifts the body towards great androgen production. Greater muscle mass = more testosterone? According to weight lifting gurus at least, yes. Additionally, overtraining decreases testosterone levels. A lot of paleo dieters are careful not to overtrain. I know this is silly– I’m not telling you to train yourself into the ground– but it’s interesting. The typical paleo kinds of exercise are testosterone friendly. Lift heavy things occasionally and spend the rest of your time recovering.
Third, stress decreases testosterone levels. Related to the point above with overtraining, paleo people often do their best to mitigate stress. AND YOU SHOULD. TESTOSTERONE IS NOT BAD. But an array of different influences can converge on your body in negative ways. When thinking about stress, consider this: if you have been stressed for a lot of your life, you might have just handicapped all of your hormone production. If you work hard to reduce stress now, that balance is going to shift. I am sure it shifts for the better, but still, if you have problematic ovaries, etc, it can be a rocky transition.
Relatedly, drinking and poor sleep both inhibit testosterone production. If you are abstaining from alcohol and sleeping well, you will see more of this hormonal shift.
Fourth, paleo tends to decrease leptin levels just because the people on it thin out, maybe eat less frequently, and maybe eat fewer carbohydrates. With less leptin in your system, you can disrupt hypothalamic signalling to your pituitary gland, which I do not recommend.
Fifth, different kinds of paleo diets can influences your hormonal profile in different ways. For example, a diet heavy in nuts will give you both excess phytoestrogens as well as a lot of omega 6. This can actually increase your systemic inflammation rather than decrease it. More strikingly, dairy is phenomenally testosterogenic. I know personally that I stopped menstruation in November after losing weight on a crash diet, went paleo in March and saw no improvement, and in June, when I started eating a lot of cheese, finally starting breaking out a lot. Later I put back on some weight, stopped eating dairy and all phytoestrogenic foods, and still did not have any success inducing ovulation. Clearly I had a number of issues going on. But the dairy was an exacerbator, no questions about it. BUTTER was problematic, too. Many people on paleo eat butter but not other forms of dairy because butter doesn’t contain casein or lactose. It doesn’t matter; it still has hormonal effects. If you’re going to eat a paleo diet, especially as a woman, be wary of the way different foods can influence your body chemistry.
Sixth, paleo foods, specifically the animal-source foods and high-fat foods, in and of themselves can exacerbate problems in women with PCOS. There are several reasons.
Here’s one: fats are used to synthesize DHEA-S. DHEA-S is technically an androgen, but it is also generally regarded as the precursor sex hormone. All hormones derive from DHEA-S, including estrogen. Women with PCOS often have elevated DHEA-S levels and lower estrogen levels. This seems to imply that there is a problem with conversion between DHEA-S and estrogen. If there is in fact an issue with conversion, then when the woman in question eats DHEA-S-stimulated foods, she will continually elevate her DHEA-S while not having success converting it to estrogen. The result is a worsening of PCOS symptoms.
However, there are many different hormone profiles for PCOS. If a PCOS patient has low hormone levels across the board, she should try to increase her DHEA-S.
Here’s another: sex-hormone binding globulin (SHBG) binds with androgens in the blood. If you have high SHBG levels, your androgen level is likely low, and vice versa. (Know also that if you have high androgen levels, it is probable that you have low SHBG. There is a direct correlation.) High levels of insulin-like growth factor 1 decrease SHBG (thereby increasing testosterone levels). The jury is definitively still out on this, but many researchers have published papers such as this one arguing that a high protein diet increases levels of IGF-1 in the blood. If you are eating a super high diet like I have for much of the last couple of years, and you are worried about your SHBG levels, consider lowering the protein content of your diet.
*Sidenote: you can increase SHBG by increasing thyroid hormone levels. (!) (!)
Personally, I think a low-ish protein diet is important not just for adrenal but also for general health. Lower protein diets are associated with increased life span. I have argued in many places that protein is necessary both for your health and your satiety, and god damnit of course it is, but don’t go wild. .5 g/lb of lean body weight for someone who doesn’t exercise excessively is, imho, ideal. Relatedly, anecdotally, I have also noticed that the satiating effects of protein–again, while crucial–really hit a ceiling. I can have ten bites and feel full-ish, or I can eat a hundred bites and feel the same way.
Finally, low carbohydrate diets decrease the conversion of T4 to T3 in the liver. If you eat a low carb paleo diet, you may become hypothyroid over time, depending on the rest of your hormonal profile. Really, really bad news.
All this said, paleo is of course awesome for health in general and works wonders for a lot of people. It’s also a great way to treat PCOS, as Peggy has shown. BUT for those of us who have different issues, who perhaps over-eat certain foods like dairy or nuts, or who are looking for new ways to play with food and our hormones since what we have already done with a paleo diet has not worked, these are some ideas at least worth throwing around.