One of the more esoteric but much beloved tools in the paleo dieter’s tool-kit is intermittent fasting.
What is intermittent fasting? I.F. is the practice of maintaining overall caloric intake while consuming those calories in fewer meals or in reduced time windows throughout the day. The goal is to create conditions of fasting in the body, but not for extreme lengths of time.
Some examples of intermittent fast strategies include 10, 8, or 5 hour eating windows throughout the day, or perhaps eating just two meals each day: one in the morning, and one at night. The evolutionary premise — the argument that proponents of intermittent fasting make — is that humans evolved to optimize their health under less-than-optimal conditions. Intermittent fasting, they say, is a natural and perhaps even necessary part of being human.
The modern-day scientific correlate appears promising, too:
Most people are nowadays aware that a calorie-restricted diet has the ability not just to decrease body weight but also to lengthen a human life. Emerging research is beginning to show, however, that intermittent fasting is just as effective as calorie restriction in ensuring these health benefits! Amazingly enough, this happens without any of the psychological crippling side effects of cravings and food obsession that practictioners of calorie-restriction often experience.
Intermittent fasting, proponents say, also may benefit the fight against cancer, diabetes, and autoimmunity. Here is an excellent, up-to-date review of the “benefits” of fasting. It is wholly understandable that fasting is all the rage these days.
Intermittent fasting women is a specific interest of mine because of what I have witnessed both in myself and in working with literally thousands of women in the PfW community.
Many women report to me (read more about that in this awesome book) that intermittent fasting causes sleeplessness, anxiety, and irregular periods, among many other symptoms hormone imbalance, such as cystic acne.
I have also personally experienced metabolic distress as a result of fasting, which is evidenced by my interest in hypocretin neurons. Hypocretin neurons have the ability to incite energetic wakefulness, and to prevent a person from falling asleep, in reaction to the body detecting a “starved” state. Hypocretin neurons are one way in which intermittent fasting may dysregulate a woman’s normal hormonal function.
After my own bad experience with IF, I decided to investigate intermittent fasting. I looked into both a) the fasting literature that paleo fasting advocates refer to, and b) the literature that exists out in the metabolic and reproductive research archives.
Intermittent Fasting Women: Problems in the Paleosphere
What I found is that the research articles cited by Mark’s Daily Apple (and others), focus on health benefits such as cancer-fighting properties, insulin sensitivity, and immune function.
However. I was struck by what seemed like an egregious sex-based oversight in that MDA post I linked to above. MDA cites this article as a “great overview” of the health benefits of intermittent fasting. This startled me because the article MDA cited was for me one of the strongest proponents of sex-specific differences in response to fasting.
Sex differences were relevant in two striking areas:
1) women in studies covered by the review did not experience increased insulin sensitivity with IF regimes and
2) intermittent fasting women actually experienced a decrease in glucose tolerance.
These two phenomena mean that women’s metabolisms suffered from IF. The men’s metabolisms on the other hand improved with IF across the board. Recall that the review was reported by MDA as “a great overview of benefits [of IF].”
Secondly, in another fasting post at MDA, of which there are many, the health benefits of fasting are listed and reviewed, but the sex-specific aspects of the hormonal response go unmentioned, and reproduction/fertility/menstrual health isn’t mentioned at all.
This is not to say that Mark is not attentive to who should and who should not be fasting. He knows very well and cautions people against the dangers of fasting while stressed. Still, the mere fact of being more sensitive to fasting simply by being a woman is, I would assert, pretty important for a woman who is contemplating or already practicing IF.
This goes nearly unmentioned in the blogosphere.
Intermittent Fasting Women: Problems in the Literature
Beyond reporting biases in the blogosphere, there remains an even greater problem of a significant testing bias in the fasting literature. Searching “men” + “intermittent fasting” in a Harvard article database yields 71 peer-reviewed articles. Searching “intermittent fasting women” yields 13, none of which are a) solely about women b) controlled studies or c) about more than body weight or cardiovascular benefits.
The animal studies are more equitable, but also a bit less applicable to human studies.
It is well-known in both the research and the nutritional communities that caloric restriction is horrible for female reproductive health. This is not news. There is an infertility condition – called hypothalamic amenorrhea – that millions of women suffer from due to being overly restrictive. But what of fasting?
Intermittent Fasting Women: Should we Fast?
The few studies that exist point towards no.
It is not definitive, since the literature is so sparse, and it necessarily differs for women who are overweight versus normal weight (and who have different genetic makeups), but when it comes to hormones, women of reproductive age may do well to err on the side of caution with fasting.
What follows first is a brief review of what can be gleaned in sex-specific responses to fasting in animal studies. Afterwards I talk about what has been concluded by the few relevant human studies.
Mice & Rats
First up is a study that demonstrates the hippocampal changes of calorie restriction and intermittent fasting for both male and female rats. In this study, they do alternate day fasting, which entails free eating on one day and a fast day on the next.
The study found that brain states while fasting were different for male and female rats. For male rats the change in hippocampus size, hippocampal gene expression, and ambulatory behavior was the same no matter what kind of restricted diet they were on – but for female rats, the degree of change in brain chemistry and in behavior was directly proportional to degree of calorie intake, demonstrating the unique sensitivity of female rats to the starvation response.
” The organization of the females’ response to the energy restricted diets is suggestive of some underlying mechanism that may allow for an organized, pre-programmed, response to enhance survival in times of food scarcity. Comparatively, the males’ genetic response was less specific, suggesting that the males respond to a general stressor but they seem to lack the ability to discriminate between a high energy and low energy stressor.”
Moreover, “IF down-regulated many gene pathways in males including those involved in protein degradation and apoptosis, but up-regulated many gene pathways in females including those involved in cellular energy metabolism (glycolysis, gluconeogenesis, pentose phosphate pathway, electron transport and PGC1-α), cell cycle regulation and protein deacetylation.” In this study, both male and female rats gained small amounts of weight on IF diets.
For female rats, even in the most innocuous form of restriction–intermittent fasting–significant physiological changes take place. Male rats do not experience as dramatic hippocampal and general brain chemistry change as female rats do, and their behaviors, specifically their cognition and their dirunal and nocturnal activity, do not change.
Female rats, on the other hand, “masculinize.” They stop ovulating and menstruating. They become hyper-alert, have better memories, and are more energetic during the periods in which they are supposed to be sleep. Theoretically, according to these researchers, this is an adaptive response to starvation. The more the female rats need calories– or at least the more their bodies detect a “starvation” state– the more they develop traits that will help them find food. They get smart, they get energetic, they get active, and they stop sleeping.
In a follow-up study conducted by the same researchers who explored the masculinzation of female rats, the researchers analyzed the gonadal transcription of male and female rats subjected to IF regimes.
This study found that male reproductivity up-regulates in response to metabolic stress. Female reproductivity down-regulates.
Completely opposite to the female rats becoming infertile while fasting, male rats become more fertile. In the researchers’ own words: “our data show that at the level of gonadal gene responses, the male rats on the IF regime adapt to their environment in a manner that is expected to increase the probability of eventual fertilization of females that the males predict are likely to be sub-fertile due to their perception of a food deficient environment.”
In the final relevant IF rat study I could find, researchers subjected rats to the same diets– to 20 and 40 percent Calorie-Restricted (CR) diets, as well as to alternate-day fasting diets, and monitored them over the long term for hormonal responses. The results were striking. Below is the abstract in full because it’s so powerful:
Females and males typically play different roles in survival of the species and would be expected to respond differently to food scarcity or excess. To elucidate the physiological basis of sex differences in responses to energy intake, we maintained groups of male and female rats for 6 months on diets with usual, reduced [20% and 40% caloric restriction (CR), and intermittent fasting (IF)], or elevated (high-fat/high-glucose) energy levels and measured multiple physiological variables related to reproduction, energy metabolism, and behavior.
In response to 40% CR, females became emaciated, ceased cycling, underwent endocrine masculinization, exhibited a heightened stress response, increased their spontaneous activity, improved their learning and memory, and maintained elevated levels of circulating brain-derived neurotrophic factor. In contrast, males on 40% CR maintained a higher body weight than the 40% CR females and did not change their activity levels as significantly as the 40% CR females. Additionally, there was no significant change in the cognitive ability of the males on the 40% CR diet.
Males and females exhibited similar responses of circulating lipids (cholesterols/triglycerides) and energy-regulating hormones (insulin, leptin, adiponectin, ghrelin) to energy restriction, with the changes being quantitatively greater in males. The high-fat/high-glucose diet had no significant effects on most variables measured but adversely affected the reproductive cycle in females. Heightened cognition and motor activity, combined with reproductive shutdown, in females may maximize the probability of their survival during periods of energy scarcity and may be an evolutionary basis for the vulnerability of women to anorexia nervosa.
They also found this:
The weight of the adrenal gland was similar in rats on all diets; however, when normalized to body weight CR and IF diets caused a relative increase in adrenal size, the magnitude of which was greater in females, compared with males.
The testicular weight was unaffected by any of the diets. In contrast, both CR diets and the IF diet caused a decrease in the size of the ovaries.
And this, bearing in mind that “daytime” for nocturnal rats is “nighttime” for humans:
The daytime activity of females was doubled in response to IF, whereas the IF diet did not affect the activity level of males. Nighttime activity levels of males and females were unaffected by dietary energy restriction.
Uterine activity was monitored daily with vaginal smear tests; cyclicity was scored as regular, irregular, or absent. The mild energy-restriction diets (20% CR and IF) significantly increased the proportion of animals displaying irregular cycling patterns, whereas the 40% CR animals displayed an almost complete loss of estrous cyclicity.
In males, corticosterone levels were elevated only in response to the 40% CR diet, whereas in females corticosterone levels were significantly elevated in response to all three energy-restriction diets, suggesting a relative hyperactivation in females of the adrenal stress response to reduced energy availability.
For lipids, all the rats did well: “Collectively, these data suggest that atherogenic profiles of both males and females are improved by dietary energy restriction.” Interestingly, too, as they pointed out in the abstract, human females also perform cognitively much “better” (memory and alertness) on CR and IF diets than on normal feeding schedules.
There are of course some caveats to this study: A) They are rats. B) They are somewhat “metabolically morbid” rats, which may make them more susceptible to disease. C) The rats were allowed to eat ad libitum on the IF days, but they simply did not meet their caloric requirements this way. So while it is a somewhat natural form of IF, it is still calorically reduced, such that that must be taken into account when gasping in horror at the hormonal responses of IF-ing female rats.
The Few Human Studies
I mentioned above that through the same review that MDA used as a “great overview” of IF benefits for all sexes, I found harmful metabolic effects for women subjected to alternate-day fasting regimes.
This is the study:
Heilbronn et al found that with IF, insulin sensitivity improved in men (21 participants) but not in women (20 participants): after three weeks of alternate day fasting, insulin response to a test meal was reduced in men. Women experienced no significant change. “It is interesting that this effect on insulin sensitivity occurred only in male subjects,” they report.
With respect to other health markers female health actually declined, specifically with respect to glucose tolerance:
“Another diabetes risk factor that has shown a sex-specific effect is glucose tolerance. After 3 weeks of ADF, women but not men had an increase in the area under the glucose curve. This unfavorable effect on glucose tolerance in women, accompanied by an apparent lack of an effect on insulin sensitivity, suggests that short-term ADF may be more beneficial in men than in women in reducing type 2 diabetes risk. ” The opening line of their discussion reads: “Alternate day fasting may adversely affect glucose tolerance in nonobese women but not in nonobese men.”
In a follow up study, Heibron et. al studied the effects of alternate-day fasting on cardiovascular risk. When human subjects fasted on alternate days for another three week period, circulating concentrations of HDL cholesterol increased, whereas triacylglycerol concentrations decreased. This is a good thing. However, the shifts in lipid concentrations were shown to be sex specific: ie, only the women had an increase in HDL-cholesterol concentrations, and only the men had a decrease in triacylglycerol concentrations.
The most recent review of IF agrees with my conclusion: sex-specific differences in metabolism exist and need to be studied further.
This study of alternate day fasting included 12 women and 4 men. In eight weeks, body weight decreased by about 10 pounds, and body fat percentage decreased from 45 to 42. Blood pressure decreased, total cholesterol, LDL cholesterol, and traicylglycerol decreased. These people were significantly obese, which limits the results of this study to an obese population. However, “perimenopausal women were excluded from the study, and postmenopausal women (absence of menses for >2 y) were required to maintain their current hormone replacement therapy regimen for the duration of the study.” (Their words, my emphasis)
The one, big study of intermittent fasting conducted on men and women looked at differences between isocaloric feeding schedules: 3 meals/day feeding versus 1 meal/day.
The study focused on body weight composition, blood pressure, and body temperature in subjects. Subjects were fed isocalorically either one meal each day or three meals each day. All subjects were between 40 and 50 years old (excluding women of reproductive age), and between BMIs of 18 and 25. They ate, so far as I can tell, a healthy diet with 35 percent fat, PUFA < MUFA < SFA. Only 15 of the original 69 completed the study (which goes to show just how fun everyone thought fasting was). As for the results,
“Systolic and diastolic blood pressures were significantly lowered by ≈6% during the period when subjects were consuming 3 meals/d than when they were consuming 1 meal/d. No significant differences in heart rate and body temperature were observed between the 2 diet regimens. Hunger was enormously larger in the one meal/day than in the three meals/day group. “The 1 meal/d diet was significantly higher for hunger (P = 0.003), desire to eat (P = 0.004), and prospective consumption (P = 0.006) than was the 3 meals/d diet. Feelings of fullness were significantly (P = 0.001) lower in the 1 meal/d than in the 3 meals/diet.” Body weight dropped only four pounds after several months. Cortisol dropped, but Total, LDL, and HDL cholesterol were 11.7%, 16.8%, and 8.4% higher, respectively, in subjects consuming 1 meal/d than in those consuming 3 meals/d.
In sum: patients on the one meal/day regiment were unhappy, hungry, lost a little bit of weight, increased cholesterol. This was a small sample, included somewhat menopausal women, and all people of normal body weight.
Intermittent Fasting Women: In Conclusion
All that being said, that’s it. That’s all that exists! Women don’t have much to go on.
There are a few rodent studies. They found that when alternate-day fasting,female rats and found significant negative hormonal changes occurring in the females.
There are even fewer human studies. Human studies on alternate day fasting have not been conducted on women of reproductive age at all, nor have any studies analyzed reproductive responses to fasting.
Moreover, the few studies that have been conducted on non-obese women have demonstrated that their metabolic responses are not nearly as robust as those of men, and may in fact be antagonistic to their health.
This post has focused on sex-specific responses to fasting, specifically intermittent fasting women. Another important distinction to make is between different body weights. Overweight and obese patients appear to experience significant improvements with IF regimes, but normal weight patients do not show the same across-the-board benefits. For women this may be a particularly sensitive issue. Overweight women may experience metabolic benefits, whereas normal weight women do not. I suspect that that may roughly be the case, but who knows. Honestly, no one at this point.
The practical solution, then, I believe, is to look at options, to be honest about priorities, and to listen to one’s body with awareness and love.
Is fasting worth trying if a woman is overweight and trying to improve her metabolic markers, and so far hasn’t had much success? Perhaps. Should it be undertaken if a woman is of normal weight? What if she is a light sleeper? What if her periods begin to dysregulate? Or stop? What if she starts getting acne, getting a stronger appetite, or losing her appetite altogether? These things happen, and I see them in women who fast and contact me time and time again.
We women (people!) should be honest with ourselves about our priorities, and act constantly with our mental and physical health foremost in our minds. All women are different. But the literature is so sparse in this area that we cannot make any real statements or predictions about the effects of fasting, other than that we just don’t know, and that we should continue to emphasize the centrality of awareness, caution, and loving nourishment in moving forward.
IF is one realm in which the female body has unique characteristics and needs that demand attention. There are boatloads of others. If you’re interested in reading about the collective set of them and learning how to optimize female skin, weight loss, and hormone balance, for a few examples, you could do worse than my best-selling book, Sexy by Nature, here.
And that’s a wrap! What do you think?
If you’ve done any searching on my website you have probably learned a lot about your PCOS and how to try to heal its many underlying causes and symptoms.
You may have even purchased my helpful e-book, PCOS Unlocked (find it here).
But I have a fear for you, my readers, that I feel its important to point out.
You need a doctor.
Here me out, because I know that in the natural health world, it’s pretty common practice to think you’ve got all the tools at your fingertips, that food is your medicine, and you don’t need anything else.
That given time, your body will heal itself.
I don’t mean to be pessimistic, of course. I DO believe that food is medicine and that there is much that can be done for PCOS with nutrition and lifestyle alone.
But that doesn’t mean that those who follow those nutritional rules to the letter will succeed in eliminating the condition.
And MOST importantly, that doesn’t mean you don’t need to be followed by a medical professional.
This has been on my mind lately with the diagnosis of endometrial cancer in a friend.
She did everything right, watched her diet, did her exercise, went off birth control pills.
But her periods didn’t normalize and she didn’t see a doctor and eventually, because she was not ovulating, the lining of her uterus became too thick, turned into complex hyperplasia with atypia and eventually developed into early stage cancer.
It’s rare, it’s absolutely uncommon in a woman her age, but according to many doctors, it’s becoming more and more common.
Endometrial cancer used to be considered a cancer of older women, something that would occur during menopause.
But more and more women with PCOS are suffering from it.
There is no ideal situation here. It sucks any way you look at it.
Because what she should have done is gone to her doctor when she didn’t menstruate and the doctor would have prescribed a progesterone pill to induce her to menstruate.
There’s potential issues with those progesterone pills, sure, just like with anything prescribed.
It would have prevented cancer.
So I’m asking you ladies, you know who you are, the ones who are sick of ill-informed doctors and being told to go on birth control.
The ones who are tired of being judged for their weight.
The ones who are sick of the old advice to just lose “10%”.
The ones who are looking to natural health to fill the void of medicine.
I’m asking you to please keep them both.
Do the natural thing, absolutely.
But don’t neglect those important screenings- vaginal ultrasounds and sometimes, endometrial biopsies, that are vital to knowing the state of one’s health.
No matter what we do with our diet, some of us are just going to be facing a higher wall than others and we have to be cautious and careful in that climb.
Here’s some of the things that make that wall so high:
- Having to eat conventional meat with antibiotics and hormones. If you can afford to do so, we recommend meat from Butcher Box (find more info here), or any grass-fed, pastured meat because it is healthier. At the very least, go organic if you can.
- BPA in the environment, the water, and basically everywhere. You can cut some of the BPA you take in by using BPA free products like these, but you can never eliminate it all.
- Being more prone to craving sweets and sugar, even though they are much worse for your health when you have insulin issues and having hyperinsulinemia, which most women with PCOS do, in which you produce excessive insulin in relation to the food you eat. There are several supplements that can increase insulin sensitivity like L-carnitine (find more information here), inositol (find it here), and others, but none can fully solve the underlying problem.
- Being overweight and inflamed or being normal weight and inflamed. Carrying excess weight in the stomach produces inflammation, no way around it, and that inflammation harms the whole body.
- Having poor gut health, bowel irregularities, or digestive illness. Here’s my post about having a healthy gut.
That means trying our best, but also listening to the advice of a good doctor. It’s a TEAM effort.
My friend found a wonderful OBGYN who is super knowledgeable and informed, but there are great reproductive endocrinologists and even primary care providers out there.
By all means, shop around! Find a doctor that stays up to date on PCOS research, that specializes in PCOS, or at least one who recognizes the important role diet plays in insulin sensitivity.
Find a doctor you are comfortable with, who doesn’t think all supplements and nutrition advice is quack science, and who supports your goals.
But find a doctor.
And see them regularly.
And face your PCOS head on.
The last thing you want to do is bury your head in the sand by eating paleo and thinking everything will just work itself out.
That may happen, but please, don’t take the risk.
Have you learned this valuable lesson? I’d love to hear your stories.
We already know how important the gut is to the health and functioning of the body. (Find my article A Healthy Gut in 4 Steps: This Week In Paleo here)
But did you know that the gut doesn’t just determine the health of our digestion or immune system but even the health of our brains and our offspring?
In fact, evidence is mounting that the microbiome (that collection of bacteria, fungi, and other creatures who colonize the colon, skin, etc) may determine whether you suffer from anxiety, depression, and may play a role in the development of autism in young children, among other things.
If you are pregnant, thinking of becoming pregnant, or have a young child, these are important things you should know.
The Microbiome and Pregnancy
Before birth, the mother’s microbiome actually changes to produce extra lactobacillus (which helps the baby digest milk) as well as several other bacteria that give the infant an important start in the world, helping with their immune systems and digestion, as well as several other things.
These bacteria coat the vaginal wall in preparation for the infant’s trip through the birth canal.
However, some mothers are placed on antibiotics while pregnant. They are sometimes important but these broad spectrum antibiotics destroy both negative and positive bacteria, meaning fewer bacteria overall for the baby.
It is wise to seek a doctor with a well-rounded view and respect for the microbiome, one who is careful with prescriptions of antibiotics, especially during pregnancy.
The Journey of Birth
When it comes time to give birth, the journey through the birth canal is one of the most important moments for the microbiological quantity and quality of an infant.
That trip through the birth canal is vitally important for a new baby. The microbiome of the vaginal wall infiltrates the babies mouth, eyes, ears, and gets into every mucous membrane, rapidly providing the important first colonization.
However, many babies are now born via cesarean section and therefore are not colonized by the bacteria on the vaginal wall, but rather by the skin of whoever they first spend time touching. This is significant because the microbiota of the skin is different than what is present in a healthy gut.
If C-sections are necessary (and they often are, though the medical community is beginning to admit they have historically been overused for many reasons) then many women are requesting or performing vaginal swabs to the mucous membranes of infants just after birth so that the infants can be colonized by the mother’s microbiome.
It might sound weird, but this could prove to be a vitally important procedure for the health, immune system, and psychology of children.
Since pregnant women spend nine months building this special colony for their baby, it’s a shame not to be able to pass it on, and may one day be shown to be quite damaging to the infant.
The first three years of life are vitally important for development of a child, especially their microbiome but many children experience ear infections early in life, or other issues which may be prescribed antibiotics.
Studies on rats have shown that those kept sterile or “germ-free” develop social anxiety, even autistic-like features, as well as a penchant towards obesity and other diseases.
Not only that, but with animals from conventional farms being fed antibiotics to both prevent illness and promote fat storage, we are all are inadvertently consuming antibiotics through food when we eat conventional meat.
Though there are times when antibiotics are necessary and can be lifesaving, it is generally agreed upon that they have been historically overused, often with little to no benefit and, it is being discovered, more and more detriment. In many cases, the condition would go away in time and may not even be a bacterial infection.
According to many medical professionals, it is often difficult to discern whether an issue is bacterial or a virus. Because many doctors receive pressure from patients for relief or are determined to “cover their bases”, antibiotics have been overprescribed. Pair that with the overuse of germ-killing products like hand sanitizer and it’s clear why there has been such a rise in antibiotic resistant bacteria, which can be deadly.
Most of us were probably placed on antibiotics at some point which threw our microbiome out of whack.
And it’s important for us to work with the best information and knowledge we have to try to put a healthy gut back together.
As adults, early childhood issues of the microbiome promote a range of conditions including obesity, diabetes, and associated illnesses, as well as diseases of the gut like Chron’s, and autoimmune conditions, allergies, and the like.
Psychologically there is growing evidence that an affected microbiome can stimulate anxiety, depression, and other mental health issues.
In several studies, as well as my work anecdotally, probiotics do seem to help many people improve mood, digestion, and symptoms of illnesses and conditions like irritable bowl syndrome.
For those with depression and anxiety, I think it makes sense to take a probiotic and for anyone- children and adults- who have had to use rounds of antibiotics, I think it is valuable to take a probiotic.
The probiotics used in most supplements are those with heavy research backing their efficacy. It’s hard to know just how much bacteria actually gets through the stomach acid with these probiotics, but several have special coatings to hopefully help them reach the colon intact.
I particularly like this probiotic for adults (find it here). Though it has fewer colonies, it is supposed to be more effective, remaining intact through the stomach and small intestine so that it can reach the colon.
This is a probiotic recommended for children (find it here). As with anything with kids, please make sure you get your doctor’s OK before giving these to your child.
Remember that a healthy diet is vital for the health of the gut as well. As much as I’d love it, we can’t just take a supplement and be done with it.
If you’ve had success with probiotic therapy, I’d love to hear from you! Which ones have worked for you? Which haven’t? And what have you done to improve your microbiome?
If you have PCOS, you’ve probably tried a number of things to help your health, and you probably have a number of concerns.
Women with PCOS are more likely to be overweight or obese, more likely to suffer metabolic disorders and insulin-related conditions, and, alongside the extra facial hair, irregular periods, and infertility, it’s a lot to take.
I care deeply about this condition and have worked in my own way to help those who have it for many years (see my PCOS program: PCOS Unlocked)
But the more prevalent PCOS becomes, the more research is done, and new things are coming out all the time!
I’m so excited to bring you this information on L-carnitine, a very special amino acid that can help women with PCOS lose weight naturally and feel more energetic.
L-carnitine is a nootropic amino acid found typically in meat products and milk.
Nootropics are types of supplements (like adaptogens) that work with the brain to increase it’s efficiency.
L-carnitine helps alleviate the effects of aging and disease on mitochondria, while increasing the mitochondria’s potential to burn fat.
For most people (i.e. those without PCOS) it is not a nutrient of concern and they synthesize an ample amount internally and from lysine and methionine in foods. However, it has been found that women with PCOS are often deficient in L-carnitine, regardless of their diets.
L-carnitine improves insulin sensitivity and helps lower blood glucose, which is valuable for women with PCOS who are usually insulin resistant.
This ability, plus the fact that PCOS women are often deficient in L-carnitine seem to make l-carnitine effective in promoting natural weight loss.
It is also known to increase energy, lower ammonia, enhance energy during cancer treatment, improve exercise tolerance and energy in those with conditions like angina and congestive heart failure, and enhance sperm morphology, in case you were curious!
Although studies regarding weight loss with l-carnitine in general seem to find mixed benefit, studies which look at those deficient in l-carnitine or those with insulin resistance and metabolic syndrome find it does help.
In fact, a recent study of PCOS only women found that compared to placebo, statistically significant weight loss occurred over 12 weeks with supplementation.
This is excellent news since it is no secret that PCOS women, with their hormone imbalances and insulin resistance typically struggle to maintain a healthy weight.
Adverse effects are rare but can include gastrointestinal disturbance, body odor, and seizures. I’ve heard from some women that it causes a “fishy” odor in the urine, which can be unpleasant. It may possibly interact with anticoagulants and certain thyroid medications so, like with any supplement or diet, you should get the okay from your doctor.
Typical doses in the studies that showed weight loss benefits ranged from 500-2,000 mg a day, with 2,000 mg. a day being what was used with PCOS women.
Though the evidence for this supplement in PCOS are somewhat new, there’s enough promise that I find it interesting for PCOS ladies looking for weight loss help.
It’s not a magic pill, and a focus on healthy dietary habits is absolutely still vital for women the PCOS.
But, one of the cool things about L-carnitine is that it is best deposited into muscles in hyperinsulinemic states, or during times when insulin is high (which is almost all the time for most PCOS women).
That means those with insulin resistant conditions would see the most benefit from supplementation.
If you’re interested in trying L-carnintine, give it at least 12 weeks of supplementation. This is one (find l-carnitine on amazon here) I particularly like because the pills are in 1000 mg amounts so you can just take 2 a day, with meals.
Find L-carnitine on Amazon here.
Do you take l-carnitine and has it helped you? What supplements are part of your PCOS routine?
(Here’s the citation for that study, in case you want to check it out-
Samimi, M., Jamilian, M., Afshar Ebrahimi, F., Rahimi, M., Tajbakhsh, B., & Asemi, Z. (2016). Oral carnitine supplementation reduces body weight and insulin resistance in women with polycystic ovary syndrome: a randomized, double‐blind, placebo‐controlled trial. Clinical endocrinology.)
When we think about our hormonal health, it’s easy to think of it as a factor in and of itself.
But just like every other process in the body, hormonal health is intricately connected with the other processes of the body, and many of the other organs.
The liver in particular plays an important role in the maintenance of hormonal health and to properly balance our hormone’s we can’t neglect this important organ.
How the Liver Balances Hormones
The liver is where things go to be filtered. Anything circulating that is in excess (like too much estrogen or testosterone, for example), anything that is toxic, and waste products are processed through the liver and excreted from the body.
In a healthy liver, this means that the onslaughts of daily life in the form of toxins and old hormones get processed out and everything functions in balance.
But sometimes, other conditions like PCOS mean that for myriad reasons too many hormones are cycling around the body.
If the liver can’t process them because it’s already overwhelmed with toxin load or poor diet, these excess hormones can reak havoc and cause things like estrogen dominance or exacerbate PCOS symptoms.
Other negative things can occur if the liver get overloaded, including the production of free radicals that the liver can’t then contain and excrete.
(See my article on estrogen dominance here. For help with PCOS, check out my PCOS Unlocked program here.)
That’s why it’s so important to not only think about balancing our hormones, but about supporting our liver.
Supporting the Liver
A properly supported liver can make the difference between chronic hormonal imbalance and the ability to heal.
The liver goes through 2 stages of detoxification , called Phase I and Phase II which are each equally important. Several processes happen during these two phases that break down waste products into less harmful or weaker versions of themselves and eventually excrete them through urine or fecal matter.
If any of these processes gets thwarted along the way, it can cause any of the problems mentioned above.
(If digestion is too slow (constipation) or the gut flora balance is off, it’s possible for some hormones to be re-absorbed. That’s why it’s also important to work to improve our digestion, making sure to drink enough water and eat enough fiber as well as improve gut health. Fortunately, many of the steps to take to support the liver are also great for digestion!)
The most important thing to do to support the liver is to avoid foods and toxins that burden the liver.
Don’t tax the liver with toxic substances like alcohol. As much as it’s fun to have a drink now and then, alcohol is a poison which primarily burdens the liver. Alcohol in particular steals glutathione which increases estrogen levels in the blood.
Other things to avoid include:
To support the liver, several foods should be a major part of the diet. These foods include the following:
- Leafy greens like spinach and kale
- Cruciferous and sufur containing vegetables like brocolli and onions
- Grass-fed organic meats, especially red meat, and eggs
- Pure, filtered water
If you struggle already with a slugglish liver or have a condition like estrogen dominance or PCOS, the following supplements help support the liver through Phase I and Phase II detoxification and can be really helpful:
- Methylated forms of B12 (find it here), B6 (find it here), and Folic Acid (find it here): important for the passing of methyl groups which helps with the excretion of hormones like estrogen and is sometimes difficult in women with PCOS.
- DIM (I like this one): contains the strongest components of cruciferous vegetables known to help break down excess hormones.
- Calcium D Glucarate (I like this brand) supports the glucuronidation of the liver and prevents excess estrogen from being re-absorbed in the bowels.
- Glutathione (find it here): important for the detoxification of alcohol. Smoking, chronic stress, and infections or inflammatory disorders also deplete this important nutrient.
Doing a liver “detox” that you might find on Pinterest of drinking some kind of miserable lemon-water concoction for 3 days with no solid food is not necessary.
If you’re curious how to do a liver detox properly as well as read the more scientific descriptions of Phase I and Phase II liver detox, read my article here.
How do you like to support the liver?
Poly Cystic Ovarian Syndome (PCOS) is a fertility condition that affects between 10 and 15 percent of women in the Western world.
All of these women suffer from at least some of the symptoms of PCOS: irregular menstrual cycles, weight gain, difficulty with weight loss, low libido, facial hair growth, balding, and, perhaps most popular of all, acne.
PCOS and acne are inextricably linked. Why? Because PCOS is caused by an underlying hormone imbalance. The very same underlying hormone imbalance causes acne. It is possible to have PCOS without acne, and possible to have this kind of acne without PCOS. But quite frequently they occur together.
Here in this post I explain the hormone imbalance that causes PCOS, and the ways in which it also causes acne.
Also, and importantly: after figuring out how to overcome my own PCOS and acne, I wrote a manual on overcoming PCOS. It’s PCOS Unlocked: The Manual, and you can read all about it here.
PCOS and acne: the underlying hormone imbalance
Most medical professionals understand the hormone problem that underlies PCOS to be quite simple: elevated insulin levels cause the ovaries to produce excess testosterone, which throws a wrench in the menstrual cycle and causes irregularity, cysts on the ovaries, and infertility.
This does indeed happen to be the case for many women with PCOS. Testosterone is their biggest problem. In my PCOS manual, I call this “type I PCOS”.
Yet there are other types of PCOS.
Low female sex hormone levels are another cause of PCOS.
Why? Because–even though most medical professionals don’t understand this–PCOS is not just about high testosterone, but is rather about a fundamental imbalance between testosterone and the female sex hormones.
When estrogen and progesterone levels fall, they get out of fundamental balance with testosterone, which also throws a wrench in the menstrual cycle.
Estrogen and progesterone levels fall for any number of reasons, though by far the most popular reasons have to do with stress and with starvation.
The thing about the female body is that it is highly sensitive to any conditions that may impair it’s ability to healthfully bear children. If you imagine life millions of years ago back on the savannah, it would be quite common for natural disasters or tribal conflict to create stressful times that could hinder a healthy pregnancy. It would also be quite common to come into a period of famine, in which case pregnant women would not be able to get enough food to sustain their pregnancies.
In periods of stress and starvation, pregnant women die more easily.
In order to prevent this from happening, the female body shuts down hormone production when it detects the slightest bit of stress or starvation. Shutting down hormone production prevents the body from becoming pregnant, which would have saved an ancestral woman’s life in the long run.
Our bodies do the same thing.
If we count calories, resrict food intake, limit carbohydrates or fat too much, yo-yo diet, or excercise excessively, our sex hormone levels fall, and our estrogen and progesterone levels become too low both for a healthy menstrual cycle and for clear skin.
You can read more about the female body and psychological stress in this post: psychological stress and hypothalamaic amenorrhea, and more about the female body and starvation-type stress in this post: metabolic distress and hypothalamic amenorrhea.
There is yet one more popular hormone problem that causes PCOS. It’s what happens when DHEA-S levels rise.
Elevated levels of DHEA-S contribute to PCOS because DHEA-S is also an androgen, or male sex hormone.
DHEA-S and testosterone act very similarly in the female body. The primary difference is that testosterone is produced by the ovaries, and DHEA-S is produced by the adrenal glands.
DHEA-S levels rise in response to stress. Whenever you feel stressed out, your body has a choice to make: it can continue to direct it’s hormonal resources toward sex hormone production, or it can divert those resources toward stress hormone production.
This process is often called “pregnenolone steal.” The reason we call it a “steal” is that hormonal resources are literally stolen by the adrenal glands and used for sex hormone production.
Thus you end up with lower hormone levels (like estrogen, progesterone, and the pituitary signalling hormones LH and FSH), as well as elevated DHEA-S levels, which can cause testosterone-like symptoms in the body: PCOS, infertility, facial hair growth, and acne.
So in sum, there are several hormonal factors that may be at play in PCOS:
Testosterone levels may be too high largely due to insulinemia
Estrogen and/or progesterone levels may be too low due to psychological and physical stress
DHEA-S levels may be too high due to psychological stress
Causes of PCOS and causes of acne
So in a very brief, very simplified nutshell: PCOS is caused by and large by an imbalance between male sex hormones and female sex hormones. If testosterone or DHEA-S is elevated, PCOS may result. If estrogen or progesterone is low, PCOS may result. Any of these things can happen at the same time, and often do.
(For more on the details of how all this happens, check out the PCOS manual here.)
This hormone imbalance is also one of the primary causes of acne.
How hormones and acne work
There are three separate layers to the skin, and pores traverse these layers. In order to adequately protect your body and keep toxins on the outside, the outer layer of the skin has to be hydrated and strong.
Pores deliver oil to the out layers from the bottom up. In healthy skin, oil comes up through the pores and oozes onto the surface, lubricating the skin and making it look soft and glowy. Think of it like a well, or a hot spring, or an oil rig.
In acne-prone skin, debris from the surface clogs pores, bacteria clog pores, and oil coming up from the bottom clogs pores. Then all this oil oxidizes and bacteria go on a feeding frenzy – which makes the pores become infected and inflamed.
The problem for women with PCOS is that male sex hormones increase oil production.
Estrogen performs an opposite function, and helps sooth the skin.
When estrogen levels are low, and when oil production increases from elevated testosterone or DHEA-S, acne is often the result.
The kind of acne that usually accompanies PCOS is around the chin, the mouth, and the jaw. It can spread to other areas of the face and the body, particularly the shoulders, buttocks, and back of the thighs, because these are the areas where the skin has the most testosterone receptors. If you have acne in these places there is quite a decent chance that your hormones are at least a bit out of balance, PCOS or no.
For more on hormones and acne, check out this post: cystic acne and hormones: everything you need to know.
PCOS and acne: what to do about it
So what do you do about your acne and PCOS?
For one, tackling PCOS should be a priority.
You can do so by utilizing the manual for overcoming PCOS I’ve mentioned a few times that I’ve used with thousands of women, which you can read all about here.
You can also read some other posts I have on PCOS:
What is PCOS?
The PCOS Diet
5 Things I wish I knew when I was diagnosed with PCOS
PCOS and hypothalamic amenorrhea: What’s wrong with the contemporary understanding and how you can have both
You may also wish to consider tackling your acne from more than one angle. PCOS and underlying hormone problems are in all likelihood a significant factor in your acne, yet there are probably other factors at play. To that end you may wish to check out the posts:
The ultimate hormonal acne treatment plan
Acne: thinking beyond hormones
And, most of all, I highly recommend the remarkable acne program by my favorite thinker on the topic of acne, Seppo Puusa. I have learned so much of what I know about acne from Seppo. You can read all about his work, his program, and what he has to offer HERE.
And that’s it! Please let me know your thoughts, your problems, your experiences in the comments! I and everyone else in our community would be honored to learn through your life and wisdom 🙂