Paleo Pepper

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?:

So you’ve done it.  You ate more than you wanted to.  Or you ate foods you think are unhealthful.  You feel overly full, perhaps, and maybe are slammed with a sugar rush, and you are (wrongly) feeling shitty and guilty about the whole thing.  What do you do?  I get asked about post-binge/ post-sugar behavior a lot.  I don’t have all the answers.  But I do have some.

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What happens to our bodies when we binge?

Mostly, we get flooded.  Our hormones get right down to work, and do their assigned jobs with absolute vigor.  We’ve consumed lots of carbohydrate, so our blood glucose and our insulin levels spike.  The blood glucose eventually crashes, so we feel lethargic and perhaps dizzy in the end, but in the beginning we feel high and charged.  Often, I think, we feel good enough that we try to maintain this high, and therefore keep on eating.  This is a strong motivator both for bingeing and for grazing behaviors.

Another strong motivator is dopamine, which gets released in the brain when we eat.  Those of us who have experience with overeating know this phenomenon well.  The more conditioned a response–that is, the more of a habit this behavior is for us–the stronger the desire for dopamine, and the more relieving it feels to finally eat.  This relief and this pleasure is so strong that it keeps us eating.

So sugar and fat are processed in the intestines and in the liver and then getting stored as fat.  Protein is much more difficult to convert and to store, so its likely that if protein has been a part of our binge, it is being sent to become molecular backbones for a whole range of cell types, particularly muscles.  If we ate” too much” protein (more than 1 g/day/lb of body weight, generally), our body will convert it to glucose in the liver, and it will be handled by insulin like the rest of the glucose already in our bloodstreams.

The food in our systems is all the while triggering the release of satiation hormones.  The biological need to eat has passed.   Ghrelin, the “appetite” hormone produced primarily in the stomach, decreases after food has entered the stomach.  Insulin acts on the hypothalamus and tells our brains we’ve had enough.   Cholecystokinin, glucagon-like peptide 1, and peptide y are all produced by the gut and signal satiation.   Lots and lots is going on here.  But: “I don’t know what it feels like to be ‘satiated’!” you cry.  Amen.  It’s… I don’t know.  Difficult.  Really, really fucking difficult. Those of us who binge, or who graze, or who have some sort of unhealthful relationship with food often have dysregulated appetite signalling.  Or we’ve got it just fine but don’t know what to do it with.  So we binge.   We never feel satiated, and we don’t know how to stop.  But we employ certain strategies and eat certain foods and think certain ways… and in the end we find progress.  Over time.  And perhaps get better and better at hearing the signals of our hormones.

In any case.  We’ve now flooded our systems with food and with the appropriate hormones and we’re each wondering… how the hell do I get back on track?  Is it hopeless?  Is it futile?  Can I still be healthy?  Can I still be me?

Absolutely.

How do you recover?

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First, you fast.  Easier said than done, I know.  But hear me out:

Fasting is great for your system, metabolically.  It triggers autophagy–a sort of cellular clean up–increases insulin sensitivity, and generally allows your body to clean up shop, get efficient, and perform damage control.  If the idea of a fast doesn’t scare you, doesn’t further dis-regulate your eating, and won’t be further stressing out your adrenal system, consider waiting a while before you eat.  Determine the proper time period for you.  Is it the following morning?  Afternoon?  Evening?  Or another great idea: wait until you feel absolutely, certainly physically hungry before you eat again.  That way, you’ll know that you’ve maximized the calories and benefit you can get from the foods you binged on, and your body is now hormonally and physically primed to resume eating.  This will help you feel positive about your self, affirmed about your actions, and physically much better all at the same time.

You may also, of course, exercise during that time.  (!)

And what foods do you eat?  Whether you’re coming off of a fast or not, what helps your body and your mind the most?

Eat protein. Protein is a vital part of every cell.  Therefore, when we consume protein, a lot of it is going to go directly to cell maintenance and repair, and will not be stored as fat.  Protein, when digested, also comes with a thermal effect, which means, in essence, that it creates some excess energy (re: heat) when digested.  It’s “harder” to digest than carbohydrates or fat, so our body expends more energy (that heat) when digesting it.  Bottom line: metabolically, you work the hardest to break it down, so if you’re looking for a low-impact, highly satiating food, protein is your star.

Some great proteins to eat would be eggs, which are high in protein, important vitamins and minerals, and saturated fat.  Also: fish, which is high in protein, high in omega 3s, and low in just about every other kind of fat.  It is also relatively low in density, and fairly low calorie, if that is a concern of yours.  Also: beef, lamb, or pork.  Ruminants have awesome protein, vitamins, saturated fat contents, and pretty good omega 3/6 ratios.  Eat a lean portion if you just want the high protein content, but fat is great for satiation, so go ahead and eat up as much of the fat as you like.

Eat fat.  Animal fat. Re: eggs, fish, and meat, as stated above.  Bacon. Fat gets you all kinds of wonderful satiation hormone activity, so eat up!  Try eating in small quantities at first.  Since you’re coming right off of a binge, you don’t actually need all that many calories to maintain your weight and your health.  What you’re looking for in this meal is a regulator, something to take the place of a meal, and something healthy and filling that can get you back on track.  Perhaps have a few eggs fried in butter, one hamburger patty, or one half filet of salmon.  These foods are hugely nutritious and hugely satisfying, even when we have somewhat messy relationships with feelings of fullness.

If you feel the need to keep eating, however, or perhaps to fill up your stomach with more stuff, supplement your animal foods with some nice, fibrous veggies.   Sometimes when I come off of a period of overeating I feel the need to ramp down slowly.  So I might do a whole head of cabbage for lunch one day, and then have a protein/fat heavy meal for dinner.

The point here is to think about your favorite healthful (PALEO) food, to get as much satiation from it as possible, and to make sure you get as much satisfaction out of this time period as possible. You want to be healthy, and to “stay on track” but you never want to create feelings of deprivation.  One negative eating episode won’t derail you (IT WON’T), so just fast a  bit and eat your favorite paleo foods and continue to revel in how awesome you treat yourself and your body.

You also need to think about you. How do you react to certain foods?  What made you binge in the first place?  Is that trigger removed from your life?  What foods will help you get back on track as soon as possible?

And you need to think about your psychological response. Despair is a big NO.  Self hate is a big NO.  Disordered eating is a monster and you are amazing for resisting it as often and as well as you do.  The fact that it got you this time is OK, and natural, and, in fact, inevitable.  So forgive yourself for bingeing, and consider it a natural part of your healing process.  Use the binge as a learning episode and continue your paleo lifestyles as healthfully and happily as you had been before.  If you really, really can’t resist the pull of sugar, phase it out of your life gradually.  The next day, have some sweet potatoes and enjoy them and consider it a wonderful and healthy paleo way to ease back into excellence.  Recall that your body is in fact a temple and you are going to continue treating it with as much love as you were previously.  And in the days following your binge you will eat the best paleo foods for your body and for your particular soul, and it will feel good and satiating and all will settle with time.

Since there’s very little human data out there, I’ve been doing a bit of digging on differences in bingeing behavior between carbohydrate- and fat- fed rats.  What I’ve managed to unearth is fairly striking.  Rats appear eager to binge on any kind of diet, but this frightening fact is offset by the fact that only high carbohydrate diets induce addiction-like symptoms.

Rats are made binge eaters by offering them highly palatable foods for only short periods of time (approximately two hours) throughout the day.  Regular lab chow is available for consumption the rest of the time.   What we find is that rats binge on three kinds of foods: high sugar chow, high fat (vegetable oil) chow, or a combination of both sugar and fat in the chow.  Rats that binge solely on sugar or solely on fat manage to maintain average body composition.  Here, rats self-restrict and normalize after their bingeing periods, simply by eating less of the normal chow. However, rats with daily access to a sweet-fat mixture gain weight.  This is what we witness with human beings.  It lines up with our knowledge of insulin release and fat storage.  Combining sugar and fat is the most insidious obesity-inducer of all.

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High sugar rats:

Rats are made sugar addicts by being provided with laboratory chow 100 percent of the time, but for a short period of time, approximately 2-4 hours, provided access to sucrose solutions.  When that sucrose window is removed from the rats’ daily routine, they demonstrate symptoms of opiate withdrawal.  These include horrific behaviors such as paw tremor and violent head shaking.   What worse, their symptoms and their frantic lever-pressing increases the longer they’ve gone without sugar.   They also, when forced to abstain from sugar, demonstrate a 9 percent increase in alcohol intake, demonstrating cross-links in substance abuse.  Sugar addiction can induce alcoholism.  Fascinating and scary, huh?

High fat rats:

Some literature suggests, moreover, that similar patterns emerge with high fat binges.  Teegarden and Bale demonstrated in one study that rats on both high fat, high carbohydrate, and mixed binge diets for 4 weeks, when removed from the diets, demonstrate severe anxiety and endure aversive environments to reach their preferred foods.   They conclude that dietary withdraw and changed habits induces the rats’ stress state, which in turn induces “dietary relapse.”  This data indicates that a stark change in eating habits, rather than the macronutrient ratios of the diet, is responsible for the extreme stress the rats display.   Neurochemically, this makes sense as well.  Both fat and sugar have strong effects on dopamine release, such that withdraw from a conditioned, pleasurable diet negatively effects the rats.

What we ultimately find, however, is that rats love fat, and do in fact binge on fat, but never experience symptoms of addiction or withdraw on a high fat diet. This lines up with my own experiences bingeing, and with those with whom I’ve conversed about fat binges.  It is in fact totally possible, and totally satisfying, but not quite as demonic as sugar.  The rats in this study were fed high fat diets, removed from the opportunity to binge, and then observed for addict-like behavior.  None emerged.  (!)  They also showed no sign of opiate dependency.   Moreover, most remarkable part, in my opinion, is that rats fed both a 100 percent fat diet and a 45 percent fat diet demonstrated no signs of addiction or withdraw. What we learn here is that fat has a neurochemical stabilizing effect on the brain.  While definitely pleasurable to binge on fat, it is not what induces addiction symptoms.  In rats.  In humans, too, I’d bet.  Loads.

Why do signs of opiate-like withdrawal emerge with sugar but not fat bingeing?
The relative lack of opiate-like withdrawal behavior after fat bingeing demonstrates the importance of opioid systems in differenetiating sugars and fats and their subsequent effects on behavior.  Both sugar and fat effect dopamine signalling in similar ways, but opioids are another question entirely.  You can read more about it here, but in brief: based on some recent data and neurochemical processes, it seems as though the lack of opiate-like withdrawal signs in fate-bingeing rats may be caused by fat-induced peptide activation, which can inhibit opioid transmission.  In essence, fat likely interferes with opioid processes and effects in the brain.

The authors of this study conclude with the same caveat that I do.  “Although we have not noted signs of opiate-like withdrawal in fat-bingeing rats, that does not mean that excessive fat intake cannot produce addictive-like behaviors.  Withdrawal is not a necessary criterion for drug craving, just as food deprivation is not necessary for food craving.”

Sugar is the big demon here, but fat is not well understood, and it can still be a part of an unhealthy diet or disordered eating style.  I have personally binged on just fat before (ever had 1000 plus calories of coconut?  Pork Rinds? Macademia nuts?  Bad. News. Bears.)   I do know, and I do feel, the satiating effects of fat.  I think about food far, far less when there is fat in my diet, and honestly, the types of cravings I feel now are orders of magnitude less than the cravings I felt on my 100 percent carbohydrate diet (can you believe I did that?  Oh my god.)   What’s more, keeping the carbs away, even ones as innocuous as vegetables, helps, too.  Recall that the rats experienced the same phenomenon.  Mixing sugar and fat was the worst combination for them, inducing both weight gain and symptoms of withdrawal.

It’s really nice to have this rat model, and to see our physiological responses validated.  As complicated as our decisions and our lives are, we have comrades in mere rats, and we are all victims here.  Cheer up, compadre!  Eat some avocado and fuck the lollipops and we’re on the road!   We’re not all the way there, to this destination of perfect mental and physical health, but we’re certainly walking and enjoying the stroll, which is all we could possibly ask for. 

Huzzah!