Paleo Pepper

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.

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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.

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What you can do to treat your PCOS

Please refer to my previous post for a description of PCOS pathologies.  What follows is a brief layout of different treatments.   Going through them all, and experimenting and finding what works best, and talking to your doctor and doing your own research is all critical.   This is just what I have found, both on the web and in my body.   Note that the section on diet does not stand alone.  There is more information on the role different foods play in PCOS is in the post to which I just linked.  Below is the Rock to get us started.  Woop!

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Diet

If you are an overweight PCOS patient, I recommend that you eat low carbohydrate (specifically fructose) to decrease insulin and testosterone levels.  Try and stick to glucose and safe starches when you do eat carbohydrates.  These include potatoes, sweet potatoes, yams, and white rice.  Fixing the metabolic syndrome that may be the causative root of your PCOS is a bit more complicated than this, but people seem to have success with this method across the board.  Low carbohydrate diets tend to mitigate insulin signalling problems, which in turn helps with PCOS.

If you are an overweight PCOS patient, also, try fasting.  Fasting, especially for people with overburdened metabolisms who are trying to lose weight, increases insulin sensitivity and helps the weight slide off.

If you are a thin PCOS patient, eat high carbohydrate.  Carbohydrates elicit a greater leptin response than fat.  Leptin is responsible for telling your hypothalamus that you are well fed.  If you are someone who often feels hungry or who recently lost weight, you may want to seriously consider this idea.  If your body thinks it is starving, it will not perform reproductive functions.

Similarly, if you are a thin PCOS patient, do not fast.  Fasting decreases leptin levels.

If you are a hypothyroid PCOS patient, eat a high carbohydrate diet, at least 50 percent of calories, a la Ray Peat, Chris Kresser and PHD.  This is because glucose is necessary for the conversion of T4 into T3 in the liver.  Without glucose, less T3 is synthesized, such that many cellular functions, such as reproduction, slow down.

Don’t eat fructose.  For overweight PCOS patients, fructose can inhibit leptin signalling and make you hungrier.  Fructose is significantly, insidiously implicated in weight gain.  For thin PCOS patients, fructose directly inhibits the reception of leptin in the hypothalamus.  This is another factor that makes it difficult for the body to perceive whether or not it is being fed.

Don’t eat soy.  Soy is the most potent phytoestrogen.  Not only does soy beget PCOS by hindering the production of true estrogen, but it is also implicated in reproductive cancers.

Don’t eat legumes, which also contain phytoestrogens.  This means all forms of beans and peas.

Don’t eat dairy.  It’s androgenic.   Having too many androgens in the bloodstream is one of the primary drivers of PCOS.

Lower the amount of cruciferous vegetables you eat (if you eat them a lot).  Brassica plants activate an enzyme (cytochrome P450) in the liver which clears estrogen out of the body.  Additionally, if cruciferous vegetables are consumed often in the raw form, they act as goitrogens and can decrease thyroid function.

Eat plenty of fat.  Fat is crucial for the production of hormones.   And cholesterol.  Cholesterol is one of the root molecules in endocrine production.  Good fats to focus on are the monosaturated fats–olive oil, avocado, and macadamia oil–and saturated fat in the form of coconut oil or organic animal products.

Steer clear of Omega 6 PUFAs.  Omega 6 fats are associated with increased testosterone levels in both women and men, in addition to causing excessive inflammation.  This means limiting soy, canola, rapeseed, vegetable, and corn oils.  Nuts in their natural form should also be avoided because they are primarily omega 6 fats, and also because they contain phytoestrogens.

Eat grapefruit.  Grapefruit inhibits the cytochrome P450 I mentioned above that clears estrogen out of the body.  This is a nice trick to increase estrogen levels, but note also that it is not a permanent fix, and that the activity of cytochrome P450 is still crucial for your health.

Eat magnesium rich foods to increase insulin sensitivity.

Eat beta carotene containing foods to increase progesterone levels.  The corpus luteum has the highest concentration of beta-carotene of any organ in the body, suggesting that this nutrient plays an important role in reproductive processes.

Eat foods good for the liver.  The best are high in choline, such as eggs and organs.

Eat organic meat or wild game, not factory farmed meat, as often as possible.  The hormone levels are guaranteed to be natural and to disrupt your system as little as possible.

Drink spearmint tea.  It’s fairly highly regarded as a testosterone blocker.

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Supplement

Honestly, in my personal experience, I have rarely witnessed benefits from supplements.   In fact, the biggest changes I experience are usually negative and from overdoses, probably because I eat a rich enough diet already.  So if you eat a range of vegetable and animal products, supplementation should not be too much of an issue.    If you want to supplement for general health, I recommend checking out the Jaminet’s list of supplementation in their book, or which can be figured out over at their blog.   Please use the organic (that is, carbon-based), chelated forms of any mineral supplements you take.  Magnesium oxide, for example, is something you do not want to take because it’s basically eating crunched up metals.  Instead, take a form of magnesium that is “bio-available,” or “chelated,” which means that it is a part of a molecule your body can actually use.

Supplementation to correct specific deficiencies, however, can be very helpful.  If you’re worried specifically about your ovaries and your fertility, here is a list of supplements I have witnessed being efficacious:

Iodine
On his podcast, Robb Wolf  recommends that women with PCOS or androgen-dominant type symptoms try to boost their thyroid functioning with iodine supplementation.  His clients are apparently satisfied and ‘healed’ by taking iodine.  If you really suspect your thyroid in your pathology, however, I recommend getting your blood tested for levels of TSH, T3, and T4 at least before proceeding.   Iodine can help with hypothyroid, especially if its an iodine deficiency causing the problem, but iodine can also hinder thyroid functioning in clinical hypothyroid cases, especially if the underlying problem is the autoimmune disease Hashimoto’s thyroiditis rather than a simple iodine deficiency.

Chromium 
Chromium helps to encourage the formation of glucose tolerance factor which is a substance released by the liver and which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  Because of this, it is the most widely researched mineral used in the treatment of overweight.

Selenium
Selenium is crucial for thyroid functioning.  Try eating one or two brazil nuts each day– they are supposed to be better supplements than the pills themselves.

B vitamins
Vitamins B2, B3, B5 and B6 are particularly useful for controlling weight, and here’s why: Vitamin B2 helps to turn fat, sugar and protein into energy. B3 is a component of the glucose tolerance factor (GTF), which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss because it helps to control fat metabolism. B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid hormone production. Any deficiencies in these vitamins can affect thyroid function and consequently affect the metabolism.

The B vitamins are also essential for the liver to convert your ‘old’ hormones into harmless substances which can then be excreted from the body.

Zinc
Unfortunately, because our soil has been depleted by overfarming, there is very little natural zinc found in our food. Furthermore, processing and refining strip out what little might be remaining. So no matter how good your diet, you may not be getting anywhere near the levels of zinc that you need. There are two approaches to this: you can eat whole organic food, which has much more rigorous controls on farming methods, or you can add a zinc supplement to your diet. But why is it so important?

Zinc is an important mineral for appetite control and a deficiency can cause a loss of taste and smell, creating a need for stronger-tasting foods.  Zinc is necessary for the correct action of many hormones, including insulin, so it is extremely important in balancing blood sugar. It also functions together with vitamins A and E in the manufacture of thyroid hormone.

Magnesium
Magnesium levels have been found to be low in people with diabetes and there is a strong link between magnesium deficiency and insulin resistance.

Co-Enzyme Q10
This is a vitamin-like substance that is contained in nearly every cell of your body. It is important for energy production and normal carbohydrate metabolism.  Co-Q10 has also been proved useful in controlling blood sugar levels.

Boron?
Word of mouth recommends taking boron, or eating apples, which contain boron, to boost estrogen levels, but I can’t find any scientific research endorsing this is a solid idea.

Herbs 

Agnus castus (Vitex/chastetree berry)
Chasteberry anecdotally helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH and FSH, which signal the menstrual cycle.

Saw Palmetto (Serenoa repens) 
Saw palmetto is an herb that is traditionally considered in light of its success in treating prostate problems caused by an imbalance of hormones (including excess testosterone). It is a small palm tree found in North America and the berries of the tree are used in tinctures or capsule form.  Research has shown that saw palmetto works as an anti-androgen, which can be very helpful given the high levels of testosterone in PCOS.

Milk Thistle (Silybum marianum)
This is one of the key herbs for the liver. It helps to protect your liver cells against damage and to promote the healing of damaged cells, so improving the general functioning of the liver and all its detoxifying properties.

Spearmint tea also counts.  The mechanism is unknown, but spearmint tea has been shown to significantly reduce circulating free testosterone levels in women with hyperandrogenism.

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Exercise

Exercise is an excellent way to increase insulin sensitivity and promote metabolic fitness.

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Sleep

A great deal of healing and hormone production takes place.  During the night, when cortisol levels are low, and when the body is recharging, enables the hypothalamus and pituitary glands to send their signals to reproductive tissues uninterrupted.

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Optimize thyroid function

If you have hypothyroid, or even subclinical hypothyroid, try addressing this issue before getting on different PCOS medications.  Hypo- or subclinical hypo- thyroidism os often the underlying cause of reproductive failure.  To understand more about hypothyroid and PCOS, see my recent post on PCOS pathology.   

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Blood sugar medication: Metformin

Metformin is for many people a wonder drug.  Most everyone on the standard American diet I believe could take the drug and see an improvement in metabolism.  Metformin prevents the uptake of sugars in the gut, and it improves the efficiency of the insulin response, thereby creating greater insulin sensitivity and reduced testosterone levels.  Metformin is great for overweight women with PCOS who also tend to be insulin resistant.  Metformin is usually used to treat diabetes.

Metformin has also been shown to decrease testosterone levels even in PCOS patients who don’t test positive for insulin resistance.  Metformin may directly impede the production of testosterone in the ovaries.   Personally, I am a lean woman who doesn’t test positive for insulin resistance.  I took metformin for six days and ovulated for the first time in a year.

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Birth control pills

Yaz, Yasmin, and Ortho-try-cyclen are popular choices.  But there’s a lot out there on birth control and I will write about the various options and implications of them all as soon as I can.  Birth control is effective in “treating” PCOS by increasing either estrogen or progesterone levels, though usually both.  However, birth control doesn’t solve the underlying issue.  In fact, many women experience even greater dysfunction in their cycles once they go off the pill.   As one popular example, some women began taking birth control as teenagers.  They continued taking it until they want to have babies, yet once they got off the pill, they found themselves breaking out for the first time in decades and unable to conceive.    Birth control pills are great for mitigating PCOS symptoms, but they will never make you more fertile, and they rarely restore hormonal balance.

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Progesterone

Women who don’t menstruate are proscribed progesterone medications by their doctors in order to induce menstruation.   How it works is that these women take progesterone pills for ten day.  A week later, as the progesterone levels fall, estrogen levels rise, and the pituitary and ovaries read this as a signal to shed the corpus luteum.

Because amenorrhea increases the risk for endometrial cancer, amenorrheic women are advised to induce menstruation every few months.   Some go years without ill effects, and this depends on each individual’s PCOS pathology and hormone levels.  Progesterone also might help jumpstart your system back into more normal health, such that you can take it for a while and then afterwards have achieved enough of a cycle to continue functioning without progesterone. This is a good thing to do if you are trying to balance your  hormones via a more natural method, such as eliminating soy from your diet or losing weight.

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Antiandrogens

 These are my favorite medications, mostly because they have served as a great crutch while I work on the rest of my issues.  Metformin is technically one of these, but other good options are spironolactone and flutamide.  Spironolactone is the safer and more efficacious of the two, so almost everyone pursues this option first.

Antiandrogens act to block or inhibit testosterone activity in the body.  For this reason, they are often proscribed for acne or hirsutism, helping women cope with these nasty issues while they try to sort out the rest of their endocrine health.

Spirionolactone, in particular, is interesting.  It is normally proscribed for high blood pressure, but it is proscribed off label to help women reduce their testosterone levels.  Spiro is shaped very similarly to testosterone, so it sits in receptor sites and blocks activity.  This is why it’s so effective against acne.  Additionally, it helps prevent testosterone production itself by inhibiting 17α-hydroxylase and 17,20-desmolase, which are enzymes in the testosterone biosynthesis pathway.

With Spiro, estrogen levels increase via enhancing the peripheral conversion of testosterone to estradiol and by displacing estradiol from sex hormone-binding globulin (SHBG).  Spiro actually decreases serum testosterone and increases serum estrogen levels.  I really can’t speak more highly of it.  The one great issue is that it creates birth defects, since testosterone is completely blocked, so Spiro absolutely cannot be taken during pregnancy.

Perhaps most importantly, Spiro has an excellent success rate with getting women to ovulate.   In this study, 11 out of 13 women began ovulating after a few months of treatment.

Spiro decreases testosterone activity in the body.  For this reason, it is an excellent treatment for hyperandrogenic symptoms such as hair loss and hormonal acne.

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Ovarian Drilling

        Ovarian drilling is exactly what it sounds like—in this course of treatment, a woman lays on a table and a doctor inserts a microdrill through her abdomen and into the ovaries, creating tiny holes.  These holes puncture the thick endometrium of amenorrheic women and reduce testosterone production.  Ovarian drilling to me seems like a great option, but the complications if something goes wrong include permanent infertility.  For this reason, many people leave this option as a last resort.

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For more information on PCOS, I would direct you first to Pubmed, to the Journal of Endocrinology, and also to some PCOS support forums such as soulcysters.net or www.hormonehelpny.com.

A final relevant point is that OB/GYNs are decent doctors for PCOS, but the best specialist to see is a reproductive endocrinologist.   This is my personal area of expertise, but I cannot provide you with the full range of testing that certified reproductive endocrinologists can.

I’ve read a lot about PCOS, but not everything, and this is really a summary of everything, more or less, that I’ve discovered.  In any case, my hope is you’ll hop on google and figure out how to tailor my starting points to your own needs.  That has been my greatest lesson with PCOS.    It’s all about experimentation, your own body, diligence, and patience.   

What causes PCOS?

Many of the PCOS “experts” out there do not understand the connection between the endocrine system and the reproductive system.  Because of this, they miss a very important link between metabolic syndrome and PCOS.  I have read maybe a dozen books about PCOS that recommend nothing but taking birth control pills in response.  This puts a patch on a problem that is, in the authors’ views, a simple result of genetics. Some idiots go so far as to recommend a low fat, low carbohydrate, moderate protein diet.  WTF is left?

Others—the real doctors, not the one’s publishing books—understand that PCOS is a disorder of the endocrine system.  It is not just an ovarian problem, but is rather a problem of hormone signaling to and within the ovaries.  This means that ovarian hormone production, pituitary action, and even hypothalamic action are all crucial for proper reproductive health.  Check out the Journal of Endocrinology’s 681 articles on PCOS if you want to know more about that.

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What makes PCOS so hard for doctors to figure out is not just 1) the grab bag of symptoms but also 2) the heterogeneity of its population.  There are two primary groups of PCOS patients.  In the first group are about 60 percent of the patients, all of whom are overweight.  More importantly, they are insulin resistant.  High levels of insulin in these patients shift hormonal balances away from estrogen and towards testosterone.  Insulin directly stimulates testosterone production.  It’s pretty clear to endocrinologists how to fix this problem.  Lose weight, and create better insulin sensitivity.  Low carb (specifically low fructose!) diets, exercise, and intermittent fasting are all excellent means by which to do this.  The issue is much more complicated than this–really, it is, and many overweight women still have some issues when they lose weight–but it can more or less be boiled down to these steps.  On the other hand, the problem is a fair bit more complicated for the other 40 percent, the “thin cysters.”   If it’s not overt insulin resistance causing their issue, what is it?

It’s a lot.  I’m a thin cyster, and, by gods, have I tried everything to shake this damn condition or what.  For the last couple of years I have spent the majority of my free time researching PCOS.  This was mostly because I wanted to get rid of my acne, but infertility, insulin resistance, diabetes, heart disease, and ovarian and endometrial cancer aren’t risks to laugh at, either.  Up to this point I have learned a shit ton about the endocrine system (but certainly not everything and I am NO expert), and I want to share with you as much as I can.

Things that give people PCOS and why

 Overweight, metabolic derangement and/or insulin resistance

        Like I just mentioned, metabolic derangement is the single greatest cause of reproductive derangement in women.  Insulin makes ovaries produce testosterone.  This is bad news.  We all need testosterone—it’s the crucial hormone for generating sensation in the clitoris!—but too much can entirely derail that.

Dramatic weight loss

        Fat cells are major players in endocrine systems.  This means that any kind of weight fluctuation can significantly disrupt endocrine function.  Primarily, this is an estrogen problem.   Estrogen is produced in fat cells.  When people gain weight, their estrogen levels increase (obese PCOS patients might have elevated testosterone AND estrogen).  When they lose weight, they decrease.  I have discussed androgenicity a lot so far, and it is the most universal element in diagnosing PCOS, but estrogen levels are crucial for proper reproductive signalling with the pituitary gland.  Moreover, higher levels of estrogen can “block” harmful effects of androgens, such as acne.  For these reasons,  it may be more important to have proper balance between testosterone and estrogen rather than having good absolute value of both hormones.  For example, when I was first tested for PCOS, my testosterone was slightly elevated and my estrogen was slightly depressed.  These weren’t alarming numbers in either case, but combined they spelled serious issues.

The jury is still out on the long term impact of weight loss.  Can someone lose weight slowly and maintain reproductive health?  Does the speed with which she loses weight matter?  If someone loses a significant amount of weight, will her ovaries ever “learn” to make up for the estrogenic load her fat cells used to give her?

From what I can tell from my own experience and talking with others, the answer to each of those questions is “sort of.”  I used to be at a BMI of 25 (5’2, 130 pounds).  In three months I dropped to approximately 18 (105 pounds) and today sit around a BMI of 20, perhaps, 113ish pounds.  I prefer not to know.  In any case, I am not malnourished and I certainly look healthy—much more so than I did before when I was supermodel thin–but this has not increased my estrogen levels at all.  In fact, they have continued to drop.  This is probably due to some other factors, which I’ll get to later, but putting on weight hasn’t been the answer.   If it were, I would have seen a bit of normalization with my increase from 105 to 115 pounds.   In this time period, my estrogen has dropped but my testosterone dropped, too, which is good, and LH and FSH remained normal.  Moreover, I have been experiencing irregular periods and symptoms of low estrogen such as insomnia and hot flashes since I was a young girl, and I have also been amenhorreic at 137 pounds.  Clearly my issue goes deeper than simple weight loss and weight gain.    Weight fluctuations trigger the surfacing of some my problems, but it is not what planted them there.

Excessive exercise or super low body fat– or maybe even just weight loss in sensitive individuals

        This issue is virtually the same as the one above, except the literature on it is more extensive, and it relies less on the actual production of estrogen in fat cells and more on being in starvation mode.  When you burn calories at a high rate, and when you consume a low calorie diet (and also if you’re consuming too much fructose!) your leptin response is restricted.  This means that less satiety is reaching your hypothalamus.  The hypothalamus is in charge of telling the rest of the body how nourished it is, and whether or not it should be running on “conserve” mode and shutting down peripheral systems such as reproduction.  To do this, it releases Gonadotropin Releasing Hormone, which signals to the Pituitary to release FS and LSH, the hormones that tell the ovaries to produce sex hormones.  Without leptin, GRH is impeded, and the entire neuronal cascade is impeded.  No proper balance of pituitary hormones is produced.

It is absolutely crucial to convince the body that it is not starving in order to mitigate PCOS.  The problem comes with how exactly to do that.  There’s no formula.  Exercise less, eat more.  Eat different foods.  Not fruit.  Seems as though other carbohydrates — glucose — have the highest of all leptin responses.  I’m not sure, and I’ve spent a hell of a lot of time trying to figure it out.  It has been my experience that a higher carbohydrate diet, even though it makes me want to eat more and puff up a little bit, increases my sex drive and vaginal lubrication (both indicators of estrogen production).  As I mention below in the diet section, this result cannot be truly trusted, however, since legumes (containing phytoestrogens) were included in my high carbohydrate diet experiments.

Stress

        Sex hormones are produced in our bodies via two axes: the first is the specifically reproductive axis which includes the pituitary gland and the ovaries, and the second is the adrenal system.  If a body has fatigued adrenals in any significant fashion, it’s hormone cascade can be seriously disrupted.  Cushing’s disease, an adrenal disorder that causes abnormal cortisol production, often causes PCOS in its patients.

Literature seems to show, however, interestingly, that cortisol hinders testosterone function.    When women present to evolutionary medicine folks (and regular medicine folks) with symptoms of estrogen dominance, such as PMS or abdominal fat, they are advised to reduce stress.  So then: should you stress yourself out because you want your testosterone to decrease?  No, Crazies.  What is ideal is hormonal balance, and the endocrine system is so complicated and our understanding of it so limited that reducing stress should be the number one on everyone’s health agenda, period.

Metabolic derangement during puberty

        Check out the book Ancient Bodies, Modern Lives by Wenda Trevathan for an excellent book on fertility in general.  It’s where I first read this theory, that whatever physiological state a girl is in in when she begins menstruating can affect her cycle for the rest of her life.  Trevathan proposes that conditions of famine and bounty are determined by this metabolic state, such that deviating from the start-of-puberty norm triggers famine or bounty responses in a woman’s body.  For example, many rail thin women in the world, particularly in developing countries, menstruate their entire lives.  But when someone who has a BMI of 25 loses 15 pounds, or maybe has less of certain micronutrients in her system, and also has some metabolic derangement from other sources, her hypothalamus might think this is a period of starvation and turn off her reproductive response.

A lot of evidence in the pathogenesis of PCOS, specifically in thin women, points to problems during puberty, childhood, and even the womb (if someone’s mother’s hormones are messed up, hers will be, too.)  Menstruation is kicking into gear earlier and earlier in young girls.  The middle teen (~14-16 years old) menarche that used to be the norm is now considered “late,” and the average age of menarche in American girls is 11 years old.  Evolutionarily, this is quite young.  This is partly because young girls are heavier than they used to be.  Menstruation starts when a certain estrogen level is reached in the body, and estrogen is not just produced in the ovaries but also in fat cells.  The problem therefore is that the ovaries sometimes start out with a handicap, as I touched on above.  They are dependent on the fat cells.  So any time weight fluctuates, ovaries necessarily have to adjust, and often do so poorly.

Another factor is related: childhood insulin resistance.  Having high testosterone levels at a young age primes the body to always act in that fashion.  This spells trouble for the entire endocrine system.  Please feed your children real food.

Hypothyroidism

        I explored the link between hypothyroid and PCOS for a while last year, and I wrote about it here.  I abandoned my quest when I didn’t see much improvement and may have overdosed on iodine, unknowingly taking upwards of 2000 percent of the daily allowance for a significant amount of time, but I have remained aware of how important the thyroid hormone is for reproductive function.  If you want to really learn about thyroid functioning, visit www.chriskresser.com.  His work is brilliant and thorough.

Thyroid hormone is made in the thyroid gland.  First, however, thyroid stimulating hormone, TSH, is produced by the pituitary (after being signaled by the hypothalamus) and sent to the thyroid gland.  This instructs it to make T4.  T4, though it accounts for 99 percent of the thyroid hormone in the bloodstream, is inactive, and rather just floats around in until the body needs more of it.  T4 is converted to T3, which is then used by every cell in the body.  In this way, T3 is the hormone of primary interest.  Things can go wrong at any step in this process.  TSH can be underproduced, and either or both of thyroid hormones can go missing.  T4 can be underconverted to T3.  Someone can be dealing with an inflamed system, menopause, or Hashimoto’s thyroiditis (accounting for approximately 90 percent of hypothyroid cases), and in each case the functioning of every cell in the entire body is impaired.  T3 is as crucial for cellular function perhaps as ATP, so you had best have your thyroid health in mind no matter what your presenting condition.  This can be bolstered by proper iodine intake, high dose iodine in the form of iodoral, or supplementation with T3 or T4.  Whichever step one takes depends on where her endocrinologist sees the problem occurring.

Because every cell is dependent on T3, and because bodies try to optimize its T3 resources, peripheral systems such as reproduction can be shut down in favor of protecting other systems.  If the thyroid is malfunctioning, the hypothalamus may reduce signalling to the pituitary gland in order to protect the thyroid system as much as possible.  This is analogous to the phenomena of starvation.   Another possible point at which hypothyroidism influences PCOS is at the level of cellular functioning.  If there isn’t enough thyroid hormone in a cell, it will shut down or become sluggish independently.  Reproductive tissues, such as those in the ovaries, might therefore not have enough energy or resources to produce estrogen at the proper rates.

PCOS patients who present with subclinical levels of thyroid hormone begin ovulating once regular thyroid functioning is achieved.  One of my favorite articles (because it gives me hope) reports that thyroid hormone replacement therapy achieves a “significant reduction in total as well as free testosterone,” and also states that “ovarian volumes of patients with hypothyroidism were significantly great compared with controls, and their magnitudes diminished significantly during thyroid hormone replacement therapy.”

BPA, environmental toxins, and endocrine disruptors

        I mentioned before that thin women with PCOS present with greater gland and endocrine dysfunction than overweight women.    What is the root of this malfunction?

One plausible answer is environmental toxins. The primary ones about which we should be concerned are pesticides and BPA.  Almost all fruits and vegetables are covered in chemicals that act as phytoestrogens in the body, and over time, specifically when young, these can have a major impact on reproductive physiology.  Some foods are worse than others.   This information is easily accessed via google.  The way to mitigate this is to eat organic, to peel your vegetables, or to wash them.  A great way to wash them to make sure the endocrine disruptors get mitigated is by soaking them in vinegar for several minutes.  Vinegar binds with some of these toxins and will help chelate them off of the skin of your vegetables.

A second endocrine disruptor, perhaps the most prevalent one in American lives today, is BPA.  BPA is a polymer leached from plastics that disrupts endocrine function in a way not entirely yet understood, but appears to have “estrogenic” effects.

When rats are exposed to BPA, their male offspring have decreased fertility, and only after exposure to small doses.  Of the male rats, one study concludes:

“The BPA exposed males had a suite of reproductive deficiencies that collectively created subfertility in the rats. Some of these included lower sperm counts, poor sperm motility and cellular defects within the testes. Circulating levels of testosterone, estrogen and other reproductive hormones were also significantly lower.

The BPA exposed males were also significantly heavier than unexposed controls.

Mating behavior was also negatively impacted. The BPA-exposed males took longer to copulate with females and a few failed to copulate at all. These observations suggest that the males had lower sexual motivation.

Potentially most concerning, is that the sons and grandsons of the exposed males were also subfertile, indicating that the germ line itself was damaged by the initial exposure to BPA. The mechanism for this transgenerational effect is unclear.”

Female rats are affected just as strongly, if not worse.  THEY GET PCOS.    Not only do they present with cystic ovaries, but they have increased testosterone and estrogen levels, and also decreased progesterone.  Recall that progesterone is THE crucial hormone for menstruation.   They also have lowered fertility and higher BMIs than non-exposed rats.

If that doesn’t convince you BPA is bad, note that this result has also been reported in human females.  A high correlation has also been shown between mothers with high levels of BPA having children with mood, behavior, and personality disorders.

Moreover, women with PCOS, both lean and overweight women, have 40 percent higher levels of BPA in their blood than those without.  However, the levels are even more markedly increased in thin women with PCOS.  In thin women, PCOS patients had 1.6 times ordinary BPA levels, and in overweight women the ratio was just 1.3.  Some researchers speculate that this is because BPA is being stored in fat cells, while other posit that BPA causes brain-related hormone signaling dysfunction, which could explain why thin people end up having PCOS at all.  The question of causation rather than just correlation remains, however: does BPA cause increased testosterone levels or do increased testosterone levels inhibits the body’s ability to clear BPA out of its system?  Erring on the side of caution, I decided to eliminate all of my consumption of BPA-touching foods, and specifically to stop drinking (and microwaving!) ALL OF MY WATER out of a plastic mug.  Idiocy, I know.  The result?  One week later the bumpy acne on my forehead disappeared, after having been persistent for years.  While other factors are always at play, I didn’t change anything else.  It was as controlled an experiment as I was going to get.

All that said,

Hard plastics, the polycarbonate plastics such as #7, are worse than soft plastics.  Plastics 1, 2, and 4 seem to be BPA free.  Heated plastics leach at much higher rates than cold ones (such that buying frozen vegetables is not as scary as one might originally imagine.)   However, just because a plastic is free of BPA does NOT mean it is free of estrogenic activity.  All plastics have EA–Estrogenic Activity–just from different chemicals and in different amounts, with not any of them yet measured significantly.  Finally, research has shown that BPA gets into bodies in even higher doses from eating out of aluminum cans than out of plastic.  Cans are lined with BPA on the inside, so viritually everything you eat out of a can is swimming in BPA.   Here’s a  list of consumer tips if you’re interested:  http://www.ewg.org/bisphenol-a-info.

Another source of environmental estrogens is body applications.  Parabens are phytoestrogens and are one of the most common elements in lotions and soaps.  Consume organic here, or check labels, or, even better, stop washing altogether.  I promise I don’t smell.  Also importantly, there’s a fuckton of BPA in receipts. I know!  So if you’re a cashier, seriously, you can ask your boss to let you wear gloves and she had best say okay.

Liver dysfunction

        Glands get hormones pupming into the bloodstream, but the liver filters them.  I’ll talk more about what one can do with a liver below.

Pituitary or hippocampal tumors

        This speaks for itself.  If your LH, FSH, TSH, or Gonadotropin Releasing Hormone levels are significantly impaired, tell your doctor you want an fMRI.

Diet

1)        Limit insulin responses, especially if you are overweight or insulin resistant.  Lowering insulin decreases testosterone production.  How to do this is really complicated, though fasting and low carbohydrate diets seem to do the trick.  Be careful, however:  Notably for paleo and low carb dieters: low carbohydrate diets can reduce the conversion of T4 to T3 in the liver, inducing hypothyroidism.  Look out for this if you’ve been low carb for a significant period of time, if you have a low body temperature, and/or if you are a thin PCOS patient.

2)        DON’T EAT SOY.   Soy is a phytoestrogen.  Phytoestrogens resemble– but are NOT THE SAME as– estrogen in the body.  This leads to confusion in the endocrine system (and, significantly, breast cancer.)   Remarkably, soy may play a greater role in endocrine disruption than BPA.  Phytoestrogens can help mitigate some side effects of low estrogen levels such as hot flashes, but they cannot perform the proper signaling functions of true estrogen.  This means that exposure to BPA results in a body totally devoid of proper estrogen.  When the body detects “estrogen” in its bloodstream, it stops producing it on its own.  In this way, phytoestrogen consumption decrease estrogen levels at the time of ingestion.  Perhaps more importantly, however, it might also impair the body’s ability to produce estrogen, since the ovaries essentially get out of practice.  This is similar to the issue of gaining or losing weight.  Soy, like excess weight, is a “crutch” for the ovaries.  But it goes beyond that simple role in that it is a malfunctioning crutch, only working in certain circumstances.

One study done measured phytoestrogen levels of different foods, and while some vegetables had an order of magnitude greater than others, soy itself has 10,000 units per gram, rather than 4 or 5 hundred like other potent vegetables.  (I just spent a half hour looking– I know it’s on ScienceDirect– I’m sorry!)  Soy is the number one food you want to avoid if you have PCOS.

3)        Legumes, nuts, and seeds also act as phytoestrogens.

4)        Don’t eat dairy.   Pregnant cows produce a protein that inhibits testosterone blocking within our own systems, such that dairy is the most androgenic food out there.  Don’t eat dairy if you have PCOS or if you are worried about your androgen levels at all, especially if you want to decrease your acne.  I mean it.  Dairy also has a significant insulin response, which can irritate acne and PCOS.

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Other foods have less dramatic impacts but may be important to consider for hypersensitive PCOS patients.  My hormone levels probably wouldn’t be all that different if I ate a more varied diet, but because I am so careful to avoid androgenic and phytoestrogenic foods, I have managed to get my acne under pretty good control while I begin playing with clinical methods of treating my PCOS.   I seem to be quite sensitive, so it’s definitely worth a shot if you think you are.

5)        Factory farmed meat is injected with Bovine Growth Hormone, which can increase insulin-like growth factor 1 in humans.  This is bad.  Other hormones such as estrogen and testosterone are approved by the FDA for injection into the animals via an earpiece each animal is implanted with at birth.  The FDA claims that even with supplementation the animal’s hormonal profile falls within normal ranges, but I’m skeptical.   Aside from noticing that my acne gets worse whenever I eat meat, chicken, or any other farmed animal (not fish), I also noticed that while in Taiwan I rarely got new cysts, except for one day I ate hamburger meat from Costco.  I don’t know if they put anything nefarious in the meat, but I had volcanoes all over my face the next morning.  It’s also possible that natural levels of hormones in all meat affect me just as much as the factory-farmed sort.  I haven’t done any experiments to check.

6)        Cruciferous vegetables.  These veggies not only act as goitrogens and can decrease thyroid functioning when eaten raw, but they also promote the activity of cytochrome P450 enzyme CYP1A2.  This enzyme resides mostly in the liver and is responsible for clearing estrogen out of the system.  People often say that “excessive consumption” of cruciferous vegetables should be avoided, but that didn’t stop me from eating a pound or two raw per day.  It was hard not too, considering how limited my own diet is  (I eat primarily vegetables and fish, and wild game when I can get my hands on it).  In any case, my estrogen levels have continued to plummet over the last year, despite putting on a bit of weight, and I think this might have something to do with it.

The one food that has been found to reverse this “on” effect on cytochrome P450 enzyme CYP1A2 of cruciferous vegetables in the liver is grapefruit.  This is well documented in the medical literature.  Grapefruit is the only food that promotes estrogenic activity without acting as a phytoestrogen, so far as I can tell.   Be careful since this enzyme also inhibits the processing of a wide variety of drugs, but if you’re low on estrogen, don’t eat soy, eat grapefruit.

7)  Experiment with low carbohydrate (fructose!) and high carbohydrate diets.   Carbohydrate elicits a greater leptin response than fat.  Leptin is the hormone responsible for signalling to the hypothalamus that the body is sufficiently fed.  Without leptin, the body feels very hungry and might think it is living in a time of starvation.  This is one of the primary causes of amenorrhea and PCOS, presumably, as I described above.  That said, if you are a thin PCOS patient and are not insulin resistant, you might want to try eating a high carbohydrate (Safe starch!  Potato, taro, sweet potato, yam, white rice!) diet.  If you are an overweight PCOS patient, you probably want to eat a lower carbohydrate (again, most importantly, fructose) diet to limit insulin in your body as much as possible.

This past fall I experimented with higher carbohydrate diets.  I experienced greater vaginal discharge and sex drive when I ate a higher carbohydrate diet.  However, there were legumes involved in this diet, so there are too many variables to draw proper conclusions.  I remember one night in particular in which I ate a lot of potatoes, and I felt great,  wanting-to-skip-down-the-hall-to-my-room-every-thirty-minutes aroused, hah, for the rest of the next day.  But that’s all I’ve got so far as anecdotes go.

Experiment with fasting.  Fasting decreases leptin levels.  If you are overweight, intermittent fasting can really help you increase your insulin sensitivity and lose weight.  It can help you decrease testosterone.  Yet if you are thin, fasting might further convince your body that you are starving.  I really love to fast, but I have begun experimenting with addressing my hunger immediately.  Unfortunately I have nothing concrete to report on this point: it’s too soon to tell.

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What can somebody with PCOS eat?  Whatever they want, I suppose.  EXCEPT FOR SOY AND DAIRY AND SUGAR, holy crap it’s just not worth it.  In any case, it entirely depends on the patient, how much of a perfectionist she is, and how she reacts to certain foods.  It depends on her medication, her doctor, and her choices.  Experimentation is key. It’s taken me ages to figure out what I can eat to minimize my acne and to maximize the function of my ovaries.  With the drugs I’ve started taking, I imagine I’ll be able to start integrating in other foods such as cruciferous veggies, meat, and maybe even a bit of dairy in a few months.  This is a part of why PCOS treatment is important.  It enables you to eat a diet rich in all of the nutrients.  In the next post I’ll expound a bit more on food and on the different treatment options for PCOS.

What is PCOS?  Other than “shitty but not the worst thing in the world”?

PCOS stands for Polycystic Ovarian Syndrome.  Though it’s hard to define because none of the patients present with exactly the same symptoms, roughly four percent of women still have it worldwide. It is the leading cause of infertility in the Western world.

PCOS is a disorder of the endocrine system.   It is characterized by the appearance of multiple small cysts on the ovaries, which is almost always accompanied by elevated male sex hormone levels and decreased female sex hormone levels.   The male sex hormones, called androgens, are testosterone, the many varieties of testosterone, and DHEA-S.  The female sex hormones are all of the varieties of estrogen and progesterone.   This imbalance results in a number of problems.  These include :

-Oligo- and anovulation

-Irregular or absent menstruation

-Infertility

-Increased risk for metabolic symdrome, diabetes, heart disease, and ovarian and endometrial cancers

-Male pattern hair growth (hirsutism)

-Male pattern hair loss (alopecia)

-Weight gain and increased difficulty in losing weight

-Adult acne.

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In order to understand how menstrual dysfunction occurs, it is important first to review normal menstruation:

The first day of a menstrual cycle is the first day of bleeding.  During this period, the lining of the uterus is shed.  This bleeding constitutes the first 3-8 days of the first half of the menstrual cycle, which lasts about two weeks and is called the follicular phase.  During the follicular phase, levels of estrogen rise and make the lining of the uterus grow and thicken.

Detecting elevated estrogen levels, the pituitary gland increases its production of follicle-stimulating hormone throughout the follicular phase.  This hormone stimulates the growth of 3 to 30 follicles.  Each follicle contains an egg.  With time, the levels of FSH decrease, so only one of the follicles continues to grow.  It produces estrogen, and other stimulated follicles break down.

Detecting this shift, the pituitary now releases luteinizing hormone.  This makes the follicle bulge and rupture, releasing its egg.  This is ovulation.  During ovulation, testosterone, that is otherwise constantly produced at low levels by the ovaries, surges, and estrogen drops.  Estrogen is required for serotonin production, which is why many women might experience depression during this time.

After ovulation comes the luteal phase.  Here the ruptured follicle closes and forms the corpus luteum.  This makes the endometrium thicken, which produces progesterone.  Estrogen is on the rise again, too, after ovulation.  But if the egg is not fertilized within about two weeks, progesterone levels fall, which triggers shedding and bleeding.  Here the cycle begins again.  Cycles are generally “known” to be 28 days long, but the length of a regular, healthy cycle can vary from ~20 to ~35 days.

Doctors are not sure where the problem enters into the picture with PCOS, but it probably varies.   Some options are as follows:

-Low levels of the hormone sex-hormone binding globulin, a “result” of PCOS, decreases the rate of conversion from testosterone to estrogen.  This might make estrogen too low to send the proper signals to the pituitary.

-High androgen levels coming right from the ovary or from the adrenal glands can block estrogen and progesterone activity.

-Insufficient pituitary signaling with LH or FSH could be the primary problem.  In PCOS, the ratio of LH to FSH is typically around 2:1, instead of the more normal 1:2.  This is presumably because the PCOS patient’s pituitary gland wants her to menstruate but she simply is not.

-Finally, the one hormone that is absolutely crucial for menstruation is progesterone.  When looking at all of these issues, it is a break in the line towards progesterone production that is the likely cause of disordered menstruation.   Without progesterone, the corpus luteum never “knows” when to shed.

In all cases, it’s all very complicated.  The question is a tricky one.  Therefore, it’s important to test testosterone, DHEA-S (the testosterone precursor, an androgen), estrogen, progesterone, LH and FSH at the very least when trying to figure out an endocrine problem.  A liver panel, fasting glucose levels, thyroid tests, micronutrient levels, and adrenal hormone such as cortisol are all important for background endocrine understanding.

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Some people in the world of evolutionary medicine posit that PCOS is present in the world today because it was evolutionarily advantageous in a hunter-gatherer environment.  This hypothesis falls in line with the “thrifty gene” hypothesis, which states that those humans who are best at conserving energy are the best at reproducing.  In this instance, an obese woman, or a woman with PCOS, would be able to always have babies during a famine because she is so good at storing and using fat.  The “famine” stage for her makes her fertile.  The times of plenty, on the other hand, would make her infertile.  This hypothesis might work with overweight PCOS patients, but it doesn’t account for the million PCOS patients who aren’t overweight.

And most importantly, just like with diabetes, solely because PCOS may have provided an advantage in evolutionary times does not mean we do not want to treat it as a medical problem in contemporary society.

In the next post, I’ll cover the apparent causes of and influences on PCOS.

How much is on the web?  Too much?

When you’re looking for advice, or for specific information, sometimes it’s really hard to find what you’re looking for.  That’s why I try–but it really is so hard–to be as comprehensive as possible with my posts and my pages.  I want to support healthy thinking and disordered eaters as well as contribute to the Paleo Zeitgeist, and, perhaps most importantly, help my friends and family and other newcomers get going with new nutrition and new diets.   This is a huge goal and a diverse set of desires, which is why it’s so impossible to be comprehensively awesome.

Because I so desperately want to provide good information to my readers, I have begun compiling an archive of relevant posts.  It’s almost impossible to google what you want to know about nutrition and find a good answer these days.  Almost always Paleo Hacks comes up for the first ten results, and then some other advice forums.   I’ve started automatically typing -”paleo hacks” into every search bar for this very reason.  It helps, some.   But still I am often stymied.  This is because what I am really looking for is the Good Stuff.  And what I hope I am giving to you, here, is exactly that.  I should have done this sooner.  I should have started years ago.  But better late than never, I am certain.

I decided to finally get started on this because I want to open up my readers  to the vast wealth of research going on out there.  Yes, it’s about cutting grains.  Yes, you should cut sugar.  Yes, you should balance your omega 3 and omega 6 consumption.  But why?  How many different ways does that impact your health?  How many different body functions and micronutrients does your nutrition impact?   How many different opinions are there?  Almost countless amounts.  What I touch on in my blog is nothing. Nothing!  It truly is.   What I even touch on in this post is nothing.  The tippiest, tippiest point of the iceberg.   Stars of the paleo movement are day in day out out there on a rowboat next to the iceberg, chipping away at science, digging through academic journals and staying up to date on the latest research, and I want to help you find and navigate them.  For a number of reasons, I am not one of these stars.  Instead, I filter through their material and sometimes read the academic stuff, and do my best to live  and eat and recommend eating habits accordingly.   If you know me personally, you will not be surprised to learn that I have read each of these blogs in their entirety (along with the rest of the blogs in my blogroll on the right) at least once.  I think they all deserve that deep of attention and analysis.  It is unfortunate that I only have a handful of posts from each blogger on here.  All the more reason, however, to follow the link and see what you can learn.

What follows is a collection of articles by various scientists, doctors, nutritionists, and paleo lifestyle-ers on a variety of health topics.    This is so far away from comprehensive it’s ridiculous.   However, I do not want to overwhelm my new readers.   Instead,  my hope is to provide what I think is both healthy blog diversity and perhaps the best investigation on each topic. Some topics I miss and some I know I don’t do justice to– such as intermittent fasting, and also, weight loss– but 120 is, I think, a good enough starting point.  I have been working on this for many days, and it’s time for me to start going to school again.

So what’s out there that I think you should be reading, and why?  What follows are some specific articles and also general recommendations.

For the updated archives (250+), please see this post or this page.

I’ve been wanting to give you an update on my PCOS for a while now, but I kept saying, “just wait until X,” or “once Y happens.”  This was stupid.  Health progresses very slowly, and I might end up waiting to write about PCOS forever if I decide to wait for everything to be perfect.

Here is my original post on PCOS.  To summarize:

PCOS is the condition of having cystic ovaries, which is caused by a hormone imbalance.   When women have too many androgen (male) sex hormones, and not enough estrogen, we do not ovulate properly.  We develop cysts on our ovaries, and often exhibit other symptoms: we might stop menstruating, become infertile, have irregular periods, or exhibit testosterone dominant characteristics such as male-pattern facial hair, loss of head hair, and acne.  Gross.  Most PCOS patients are overweight and tend towards insulin resistance.  Testosterone is high in these patients for this reason, and even conventional medicine prescribes low carbohydrate diets for remediation.  However, there exists a minority of PCOS patients who have a bit of an opposite problem: that when they lose weight, or are perfectly fit, they mysteriously struggle with the same imbalance.  I am one of these.  Doctors are having a difficult time figuring out why.

I stopped menstruating about a year and a half ago now.  I don’t want to get to the punch line too early, but I also want to let you down slowly, so know in advance: I do not have an absolute victory to share with you.  I am not menstruating yet.  But I have hope that I will begin some time soon.  (!)

When I became period-free, I had recently lost a lot of weight.  I have maintained, more or less, that body size since then.  My doctor’s hypothesis for why I have PCOS is, therefore, as follows: since estrogen is produced in fat cells, when I lost fat, my body, which had become dependent on fat cells for estrogen supply, stopped having enough estrogen to menstruate properly.  Make sense?  Sure.   But I have also tested low on thyroid, and around 40 percent of PCOS patients also have hypothyroidism.  A high percentage of hypothyroid patients, in turn, (up near 80 or 90, according to Chris Kesser) have Hashimoto’s Thyroidism, an autoimmune condition.  So it is possible that this is the underlying cause of my PCOS.  I have yet to be tested for it since I am living in Taiwan, but I intend to find out once I return state-side.

That October 2009 was when I stopped menstruating.  I was on a zero fat vegetarian diet, and had in fact been doing that for three years, though it was only in the final months of 2009 that I ever “got really serious” and lost weight.   I wonder if this had anything to do with losing my periods, but, again, I don’t know anything for certain.  In March of 2010, still around 19 percent body fat, I switched to lacto-paleo.   My ovaries remained the same.  I had no periods, no vaginal discharge–which I used to have in spades–and no sex drive. Life can be really hard sometimes.

In August of 2010, acne emerged.  And not just acne, but, like, acne. I don’t have any photos from the time period because it was too horrific to even contemplate.  At one point I had 37 active cysts around my mouth.  Yikes.  I do, however, have one photo from after I had recovered a little bit, and I’m going to post it below.  We can pretty definitively attribute this acne to the high testosterone levels, since this is where testosterone-heavy people (such as steroid abusers) always break out.  I really panicked about it being due to food allergies, however, which made my diet an absolute mess.  My new hypothesis is that certain foods exacerbate the acne, but testosterone is the underlying cause.

Ugh, gross.  At this point, I decided to give up dairy.  It didn’t really help.  I was eating a lot of vegetables (including a shit ton of goitrogenic cabbage), eggs, fish, and industrial meat.  I noticed then when I took a lot of fish oil it seemed to improve, and also that whenever I put on weight it seemed to improve.  When I lost weight again after putting it on over the holidays, my face was a fiery nightmare.  Recall that estrogen is produced in fat cells, and helps mitigate the hormone imbalance.  Putting on weight, then, was at least moderately effective.

The first time I saw any significant improvement was when I took progesterone pills for three weeks.  This also made me put on about ten pounds in that three week time period, so I stopped taking it.  It made me a little suicidal anyway.

In any case, because of this, I have always sort of used my face as a metric for my PCOS.  The general trend seems to be that with a better hormone balance in my system, my face gets better.  The state of the acne is also, I believe, related to my diet.  There are two specific ways:  1)  I notice that if I have some sugary drinks while out on a weekend, I get a small break out.  This might be why dairy was so problematic for me, too.  (I think I noticed that the worst food instigator for me was store bought blue cheese dressing: dairy and low-fat additives and omega 6 dressing: Gods, could I have been putting anything worse in my body?)  So insulin is related.  Note that insulin’s role in all of this is probably due to how strongly it stimulates testosterone production.  2) I think that my diet, despite my best efforts, was still high in omega 6s while at home.  I also think I have a lot of inflammation left over in my body from my previous lifestyle and diets, so I need to really watch my omega 3s and 6s.  That “meat” that I was consuming a lot of including high quantities of chicken.  So perhaps it was never enough to balance the salmon filets I ate a couple of times per week.  I don’t know.  In Taiwan, I have been eating a whole hell of a lot of fish, which I think definitely helps.

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Ok.  So my skin is bad and my vagina is as dry as Oscar Wilde, and I depart for Taiwan at the end of January 2011.

Within a week I see mild improvement.  Wtf?  What changed?

Honestly, I’m not sure.  There have been lots of variables at play already, and in Taiwan there are even more.  I stop eating chicken, and I eschew dairy 100 percent.  I also start eating seaweed.  I notice that this helps, I think, considerably.  This makes me wonder: is my low thyroid being fixed by iodine consumption, and is that in turn helping my PCOS?  Iodine is known to support ovarian and mammarian tissue health, so basic nutrient supplementation could be the key, I think.  When I discover this, I decide to eat seaweed daily.   I also decide to really pay attention to my omega 3s and omega 6s.  I eat as few vegetable oils as possible (though that is incredibly difficult in Taiwan), so I also eat fish twice per day.   This means that I am decently balanced, omega 3 to 6 (though I really have no idea, and I don’t take fish oil), and also that I am getting more than sufficient iodine.  More than sufficient, since seaweed and seafood are the most rich natural sources. I am also eating some pork, getting sufficient protein, avoiding sweets, and even adding some carbohydrate back into my diet.  I have yet to really test whether the carbohydrate is important, or not, probably not, but there we go.

I see my skin improve with time. It’s slow, at first.  Quite slow.  I troubleshoot and figure I need more seaweed and omega 3s.  I also stop eating sugar-free gum.  I start consistently sleeping seven hours a night.  I no longer live with my enormously stressful father.  I have put on five pounds.  I don’t know what is working, but something is.   After about six weeks in Taiwan, my vaginal discharge returns.  At this point, I’m pretty hopeful.

This is what I look like in early April:

From April through May, something really amazing happens.  I don’t know what.  But my skin advances like a warrior.  Every day I see it clear up.  Today, May 12, 2011, I have no acne.  Only scars.  I just sit back, and eat as carefully as possible, and watch the scars heal over time.

It’s also pretty fascinating, however, because in April I start getting violently ill once in a while.  I get incredibly nauseated and have disturbingly thorough diarrhea.  The first time this happens to me it is so severe that I am hospitalized for dehydration and shitting mucus and blood.  Yikes.  This meant that I end up eating a lot of sweet potatoes and occasionally squeezing in pork and eggs, and also carrots.  For a while I drink soy milk and even eat some granola, simply because those are the only things that feel good in my stomach (but I worry about the insulin for my face!).  This also means that, still, I am worried about my health.  Am I doing something wrong?  What is making me so ill? I don’t know.  Honest.  With my expert medical opinion, I have narrowed the causes down to: hyperthyroid activity, whether from an autoimmune condition or the vast amounts of iodine I was consuming, food poisoning, a duodenal ulcer, a parasite the hospital missed, or, my favorite candidate right now: iodine poisoning.   I think I overdosed on iodine.  Iodine can be corrosive in the stomach, and for a while I was exceeding the upper limit on iodine by a few thousand percent each day.  I didn’t know I had been eating that much.  In any case, my intestinal lining is upset and ulcerated, and this may be due to iodine consumption.  Therefore: I have dropped my seafood and seaweed consumption to about zero recently (boy I miss omega 3s), and I have been doing okay.  Skin still looks good, I feel great otherwise, my vaginal discharge is now not just present but constant, and my sex drive is back in full force. That is unfortunate, since I liked the mental clarity I had as an asexual for a year and a half, but Zeus hates me so what can I do?

This means that, I think, my periods will come back.  I have no real evidence for what is working and what isn’t.  The answer could simply be that my body needed time to adjust to the new body weight.  Or it could be as complicated as having low thyroid from iodine deficiency, or low thyroid from an autoimmune condition, recovering from inflammation, needing omega 3s and more iodine for my PCOS, living a relaxed lifestyle, eschewing dairy, getting more nutrients in my body, drinking more water, drinking less (herbal) tea, or keeping insulin low.   Another very important factor is that I’m about 5 pounds heavier than I was in September 2010.  That’s not very significant for someone who weights 200 pounds, but the difference between 110 and 115, or 115 and 120, is pretty profound.  I think it is a mix of a lot of things.  In any case, I am no longer ashamed of going out in public–of inflicting my face on people, I used to think–and I have a sex drive and I was kidding above it’s fucking (pun intended) incredible, and I may in fact regain my fertility in the near future.

When I first started getting vaginal discharge a few months ago I thought my periods would start right away. Now I know better.  Just like it took a long time for my acne to develop, cysts to show up, and menstruation to stop (perhaps that was a result of my long-term vegetarian low fat lifestyle), it is going to take a while for my body to find new balance and reap all of the benefits from increased nutrients on the paleo diet.  I need to keep moving forward slowly, and to experiment with different foods ideas, and to be as smart and safe as possible.  I think it’s going to come in time.  I don’t have a triumphant success story for you yet, but trust me, when I begin menstruating, you may in fact be the first to know.

This weekend.  A bit of foundation, hints of scars on the left side of the photo, but otherwise, well, free.  Not bad, eh?: