Why I now believe phytoestrogens may be good for you

Why I now believe phytoestrogens may be good for you

I write and talk about phytoestrogens on this blog a lot.

Phytoestrogens are estrogen-like compounds that come from plants, and are found in particularly high quantities in soy and flax seeds. Lower quantities of phytoestrogens can be found in all legumes and nuts, such that women with sensitive hormonal systems may find themselves reacting to chick peas, black beans, or macadamia nuts (all foods that I personally react to).

Most paleo authors are hard-liners on the issue of whether we should consume phytoestrogenic foods: the answer is “no.”

Why? Their concern is that the hyper-estrogenic character of the phytoestrogens in the Standard American Diet contributes to inflammation, to the feminization of the male body (such as development of breasts, which is true), and to cancer. These are all considerable risks and I take them very seriously.

When I first began writing in the paleo blogosphere I considered it my duty as “the female paleo expert” to get to the bottom of the phytoestrogen issue fairly and come to the right conclusion about them. Yet after diving deep into the literature I found more questions than I did answers.

There are many several different types of phytoestrogens and they all have different chemical characteristics. There are also different types of estrogen receptors in the body. These different phytoestrogens interact with the estrogen receptors in different and complex ways, and different tissues in the body have different kinds of estrogen receptors…

You can see why it’s so complex.

Looking at data from studies on women and from collecting my own data working with women, I developed my own beliefs about phytoestrogens and what to do about them. As far as I could best tell, phytoestrogens would increase estrogenic activity in many respects for women with low estrogen levels but also perhaps decrease it in other respects. As for women who have high estrogen levels, phytoestrogens may help decrease this excess, since they take up space on estrogen receptors but  are not as potent as the body’s own estrogen stores.

Usually, I end up concluding: “you won’t know how phytoestrogens affect you until you try, so eliminate them for a few weeks, then add them for a few weeks, and see what happens.”

That seems to satisfy people well enough, and it really is the most truthful recommendation I can make.

Today I am able to augment that recommendation since I have discovered a bit more clarity about the issue and. Here is, in a nutshell, what I’ve learned:

The body has two types of estrogen receptors

As I have mentioned, the body has two types of estrogen receptors: alpha and beta.

What  I did not know previously, however, is that estrogen receptor beta activity to some extent inhibits estrogen receptor alpha activity.

When estrogen receptor alpha is dominant, estrogenic activities in the body get carried out.

When estrogen receptor beta is dominant, on the other hand, estrogenic activities in the body are suppressed.

Now, as I mentioned before, different tissues in the body have different amounts of the two receptors. And, very importantly, different environmental conditions can contribute to the success of one over the other. Having a robust gut flora population, for example, supports estrogen receptor beta activity. The gut flora have a lot of different impacts on hormone levels (healthy gut flora will help break down old hormones and excrete them, for one, or can selectively reabsorb estrogen back into the bloodstream). In this particular case, they help estrogen receptor beta keep a lid on runaway estrogenic activity in the gut and at the gut-bloodstream barrier.

So then what happens when we consume phytoestrogens?

Phytoestrogens, by and large, enhance estrogen receptor beta

Phytoestrogens are estrogen receptor beta agonists (here). This means that they increase the activity of estrogen receptor beta, which you’ll remember inhibits excessive estrogenic activity.

Now of course, different phytoestrogens will do this to different extents, though lignans, some of the most common phytoestrogens and those found in soy, do have this ER-beta enhancing effect.

As a quick aside and demonstration of how this might work in an individual, some of you may remember that I struggle with acne. I noticed that when I consumed phytoestrogens the quality of my skin got worse, despite the fact that estrogen is supposed to help with skin quality. Skin cells have a plethora of estrogen receptors beta, however. So even while I was consuming a plant-based estrogen and even while some estrogen recpetors alpha were certainly active in other parts of my body, my skin quality suffered because the phytoestrogens actually decreased the estrogenic activity in my skin.

This may also be important for particular cancers, specifically the female cancers like breast and ovarian cancer, and also gastroenterological cancers like colon cancer.  Like this article demonstrates, “the ER alpha/beta balance seems to have a relevant influence on colorectal carcinogenesis and ER beta appears to parallel apoptosis, thus exerting an anti-carcinogenic effect.” Increasing phytoestrogen consumption may promote ER beta activity, which can lower estrogenic potency in the body as a whole, thereby decreasing the risk for certain cancers.

Of course, there are still very many studies to be done for any of this to be certain, though most professionals in the medical field are interested in the possibilities for phytoestrogens to play a (small) role in cancer prevention and remediation.

Estrogen replacement therapy and the birth control pill on the other hand…

Plant estrogens increase the activity of ER beta and can therefore reduce estrogen dominance, risk of certain cancers, leaky gut, inflammation in the gut, and more.

Estrogens that are synthesized in the laboratory, however, have a much more potent estrogenic effect. For what I can tell of perusing the literature, these estrogens do not have the same bias for ER beta. They activate both ER alpha and ER beta, and therefore do not limit estrogenic potency in the body, but instead may simply directly increase it. They also appear to increase inflammation and risk of disease in the gut, as illustrated by this study.

The body has many mechanisms in place to help modulate estrogen levels in the blood: the liver filters out excess, “old” hormones for example, and the pituitary gland produces less estrogen of its own if its detects higher levels of circulating estrogen in the bloodstream.

But those may not be sufficient to handle the extra estrogen load that comes from the birth control pill and high levels of hormone replacement therapy. From what I can tell, any time you signficant reduce pure estrogen levels above what is “normal” or “healthy” you increase your risk for a lot of things, including inflammation, mood swings, ulcerative colotis, colorectal cancer, breast cancer, ovarian cancer and uterine cancer.

What to do about it

First and foremost, I think the best thing to do for  women who eat a paleo diet is “not all that much different.”

I think it may be wise to re-consider our ban against soy and other phytoestrogenic foods, particularly for  women who are estrogen dominant. In fact, I recommend at very least that estrogen dominant women experiment with a very small serving of soy or flax, or a moderate serving of chick peas or other beans, daily for two weeks to see if positive changes happen.

I think women who are going through menopause may wish to seriously consider consuming phytoestrogens to see if it helps alleviate symptoms. This can help with some menopausal symptoms by increasing ER alpha activity to some extent, but will most likely prevent increasing the risk of cancer by the complementary increase in ER beta. There is a chance phytoestrogens will simply make your own symptoms worse, but there is enough evidence out there to suggest  it is worth a shot.

The potential risk of elevated estrogen levels from supplementation does not mean I am necessarily against using pharmacological estrogen for various conditions: sometimes it is entirely appropriate to take estrogen supplements. For example, when going through menopause, small doses of hormones may be more helpful than harmful, as a low dose of estrogen will most likely not overwhelm estrogen receptors alpha and beta. This can be a great way to alleviate symptoms, especially in the short term, though as I mentioned above the phytoestrogenic route may be preferable. For  another example, low dose estrogen therapy may be crucial for women with chronically low estrogen levels to help boost bone health, for example. For a final example, if a low enough dose and in good balance with progesterone, birth control pills may be an acceptable method of family planning.

Nevertheless, most data on the relationship between HRT and cancer seems to indicate that there is something worrying there that needs further investigation. My preference for women who are in menopause or otherwise have low estrogen levels is to try to fix things with a nourishing, relaxing paleo approach first, to try playing with phytoestrogens second, and then as a last resort go on a low dose therapy.

…And this, then, is why I now believe phytoestrogens may help reduce the risk of certain diseases and cancers for women, particularly those of us who are estrogen dominant.

Every body is different, but this may be an important piece of information that helps you figure out what the best path forward is for you! As I always say, I am a big fan of personal experimentation.

If you’ve personally done studies on yourself or noticed effects that different phytoestrogens have, please chime in! This is a hugely complex area of health and research… I need all the help and wisdom I can get!





10 Paleo secrets for preventing osteoporosis

10 Paleo secrets for preventing osteoporosis

Osteoporosis is when bone becomes more porous and thus more brittle as you age. Osteopenia is the precursor to osteoporosis, and while osteoporosis normally only occurs in elderly people, osteopenia is common among young women, too. Osteomalcia is another problem, this time due to soften bones, and is primarily due to vitamin D deficiency.

Combining all three of three problems, approximately one in two women and one in four men over the age of fifty suffer at least one broken bone as a result. That’s 50% of women and 25% of men!

Unfortunately, osteoporosis is poorly understood by conventional wisdom and the public at large. Most people think it is simply a problem of not getting enough calcium in the diet. They try to make up for this by taking calcium supplements.

But this is misguided. There is much, much more complexity that goes into how healthy bones are made. Fortunately, the paleo diet is excellent for helping us understand and nourish this complexity.

Below I list the ten most crucial insights into osteoporosis and how to prevent it.

Paleo and osteoporosis: 1. Calcium

Conventional wisdom is right that calcium is necessary for healthy bones. How much however is a question up for debate. The US governments recommends that adults get between 1000 to 1300 mg of calcium daily, though in reality only about 800 mg may truly be necessary.

Laura Schoenfeld made a great table for calcium values of different foods in this post:


Try to hit the 800 mg mark with just food every day, and that’ll go a long way toward protecting you against osteoporosis. You can also try to do so with supplements, my favorite of which is this one.

Paleo and osteoporosis 2: Magnesium

Few people know that magneisum is also crucial for healthy bones.

Adequate magnesium is essential for absorbing and storing calcium in bones. Magnesium and calcium often work hand in hand in the body, and in the bones is no exception. Any time calcium needs to get into a cell, magnesium is necessary for opening the channel in the cell membrane for it to pass through.

There are not very many foods high in magnesium in the paleo diet. Dark leafy greens may be your best bet. Nuts and legumes have decent amounts of magnesium in them. Dark chocolate is relatively high in magnesium, too. Avocadoes, bananas, and yogurt also have decent amounts of magnesium in them.

Since magnesium is so important for health and for bones, I often recommend that women take a magnesium supplement. It’s one of the very few supplements I recommend on a regular basis. For anyone who may be concerned about  bone health, an excellent supplement that meets both of these needs is Osteocalm. Osteocalm which is a delicious, fizzy powder that contains bioavailable amounts of calcium and magnesium in good balance.

Paleo and osteoporosis 3: Good gut health

Having good gut health is crucial for preventing osteoporosis, because without a healthy gut, the body won’t be able to absorb the calcium, magneisum, and other important nutrients the body needs.

Unfortunately, assuring that you have a healthy gut is far more complex an issue than I can address as a small item contained within this post, though I can generally recommend that you work through any gastrointestinal symptoms you may have with a functional medicine doctor or gastroenterologist, that you regularly consume probiotic foods like kimchi, sauerkraut, kefir, or (coconut) yogurt (soooo good), that you consider taking a high quality probiotic supplement, and that you avoid potential gut irritating foods like grains and dairy.

Paleo and osteoporosis 4: Minimize anti-nutrients (no grains or legumes)

Not only do grains irritate the gut  and potentially cause leaky gut  issues, but they also contain high amounts of anti-nutrients.

Anti-nutrients are molecules that are found in high quantities in grains (though also in fairly high quantities in legumes and nuts, and even in some vegetables), that bind with regular nutrients in the gut. Phytonutrients are too big to pass through the intenstinal wall into the bloodstream, so they get excreted out of the colon, and take the good nutrients with them.

A diet based on grains, legumes, and other high Anti-nutrient foods may be a serious health concern, since so many nutrients are flushed right out of the gut. To keep your nutrient absorption rates high and help protect your bones, you may wish to minimize your consumption of Anti-nutrient-heavy foods.

Paleo and osteoporosis 5: Vitamin D

Vitamin D is second probably only to calcium in it’s importance for bone health. Vitamin D, much like magnesium, is necessary for absorbing calcium into your bones.

Sunlight is the most natural and effective way to get vitamin D. Someone with relatively fair skin may get enough vitamin D by getting 40% of their body exposed to the sun for about 20 minutes of noontime sun every day. Someone with darker skin will need more time, since lighter skin in part evolved in the first place to help the body absorb more rays from the sun as people migrated further away from the equator.

If you cannot get this kind of sun exposure, you may wish to consider taking a vitamin D supplement. I currently take about 1000 IUs of vitamin D a day, though most people opt for more like 5000 IUs. It is important not to get too much vitamin D, however, so if taking more than a minimal dose, consider getting some bloodwork done and consulting with your doctor. I recommend a supplement like this one.

Paleo and osteoporosis 6: Vitamins A and especially K

Vitamin D is only ever really effective if in proper balance with vitamins A and K.

Moreover, vitamin K2 (there are forms K1 and K2) itself is important in the knitting together of strong bones.

Vitamin A is best obtained from egg yolks, from liver (you can try desiccated liver supplements if you don’t like eating liver), or from cod liver oil supplementation. Cod liver oil also provides vitamins D and K2, which makes it a great way to meet all three of these vitamin needs. You can also get vitamin A from foods that contain beta-carotene like carrots, mangoes, and sweet potatoes, but this is a less assured way of getting vitamin A since that relies on having a particular strain of bacteria in your gut to convert the beta carotene to vitamin A.

Vitamin K1 is best obtained from leafy greens. Vitamin K2 can be made out of K1 but  the process is incredibly inefficient and it is best to make sure to get K2 in the diet as well. The best sources of K2 are grass-fed butter (or ghee), grass-fed liver (it must be grass-fed to have K2 in it – here’s that desiccated liver supplement again), or fermented cod liver oil.

Paleo and osteoporosis 7: Keep estrogen levels up while young

Estrogen is also crucial for stitching together calcium to make strong bones. This is why women suffer from osteoporosis at twice the rate of men. Hormones levels fluctuate and may drop due to some health conditions throughout life, which reduces bone strength.

It is incredibly important for women to have strong bones when they are young, particularly in their teen years and their twenties. Bone growth is just finishing up at this time, and during their 20s women’s bones are in the process of solidifying and strengthening (as much as they can) for the rest of adulthood.

Unfortunately, this is a time at which women are at particularly high risk for decreasing their estrogen levels. Any sort of restrictive eating, starvation-type behavior, low carbohydrate diets, low fat diets, vegetarian diets, or excessive exercising can make a young woman’s estrogen levels drop precipitously (like mine did). This can lead almost immediately to osteopenia, which, if not corrected for, will endure and cause sigificant bone problems later on in life.

The best way to make sure your estrogen stores stay strong while young is to steer clear from restrictive food behaviors. Eat when hungry and stop when full. Don’t count calories. And if an athlete, make sure to always refuel after exercising.

It is also important to keep stress levels as low as possible, since high and/or chronic stress can also cause the female body to stop producing hormones, and estrogen in particular.

To read more about low estrogen, starvation signals in the body, and female health, check out this post on hypothalamic amenorrhea, or this one on the physical symptoms of starvation signals.

Paleo and osteoporosis 8: Maintain estrogen balance while aging

It may be easier said than done, but keeping estrogen levels in balance with other hormones while going through adulthood, perimenopause, and menopause cacn be extremely helpful for preventing osteoporosis.

Some women choose to take Hormone Replacement Therapy during menopause, which can alleviate menopause symptoms like insomnia and low libido while simultaneously support bone health. Yet there is an unclear relationship between HRT and certain female cancers, so many women choose to abstain from HRT.

If you can minimize inflammation in your body, keep your blood sugar and insulin levels in control, sleep as well as possible, and minimize stress throughout menopause, you should be able to keep your estrogen levels high enough to maintain sufficient bone health (presuming that you kept your bones strong and healthy throughout your younger adulthood).

You may also wish to experiment with phytoestrogen intake–that is, with soy, flax, or chia seeds–to see if that helps boost your estrogen levels. (You can read more about my menopause and phytoestrogen recommendations in this post on hot flashes).

However, even while keeping estrogen levels elevated throughout menopause can certainly help, I cannot stress enough how important healthy estrogen levels throughout the earlier reproductive years are for bone health.

Paleo and osteoporosis 9: Collagen

Around 25-30% of the weight of bones is made of collagen proteins. This makes collagen an incredibly important element in bone health. Collagen is both produced by the body by a matrix of amino acids from protein, and can be utilized if consumed from food or supplemental form.

High quality complete protein is thus a must. Fortunately, all proteins that come from animal sources are “complete,” so anyone who eats a paleo diet is safe in that regard. Be sure to consume at minimum 50 grams of animal protein a day, and bump that up to about 75 for a minimum if you are significantly atheltically active.

You can consume collagen directly by eating bones, joints, tendons, and skin from animals. How? You can make bone broth, you can actually eat joints, tendons, and skin, or you can consume gelatin (here’s a good one) by adding it to soups, jellos, yogurts, salads, or whatever you like. I would recommend doing this at least once a week if you are concerned about your bone health.

Paleo and osteoporosis 10: Minimize inflammation

Conventional wisdom is also ignorant about the important role inflammation plays in bone health.

Several different inflammatory cytokines have been implicated in the development of osteoporosis. Chronic inflammation is considered a risk factor for the disease.

Unfortunately, like “good gut health,” writing up inflammation is impossible to do with just a few short paragraphs.

Inflammation has many causes and many possible ways to remediate it. The most important causes of inflammation in the diet to eliminate are omega 6 seed oils such as vegetable oil, canola oil, soybean oil, rapeseed oil, sunflower oil, and the like. These should really only be consumed at a very minimal level. They need to be in balance with omega 3 fatty acids, which can be obatined from that cod liver oil supplement I referred to earlier. Refined sugar is also inflammatory, so processed desserts, sodas, and the like should be avoided. Cereal grains and dairy are also fairly inflammatory, so should be avoided if inflammation is a concern.

A paleo, natural-foods diet rich in vegetables and fruits, healthy fats like olive oil, coconut oil, ghee and other animal fats, and healthy protein sources like grass-fed beef and wild caught fish is an excellent way to combat inflammation. This does wonders for osteoporosis, and wonders for the rest of the diseases of civilization like heart disease, diabetes, stroke, cancer, alzheimer’s, and the like.


And with inflammation, I wrap up my list of paleo secrets to help with osteoporosis. What do you think? Different opinion? Different experience? More resources to recommend? I’d love to know!!


Female Hormones and Insomnia: One Thing You Need to Know

Female Hormones and Insomnia: One Thing You Need to Know

Of all the things in the body that hormones affect, sleep is one of the most important.

Without quality sleep, it is difficult to regulate appetite, to burn fat, to feel good, and to be happy and calm. Poor sleep can cause inflammation, poor blood sugar control, depression, anxiety, and a whole host of other issues.

Women suffer from insomnia at nearly twice the rate of men. This may in part be due to social and psychological factors, but it is also no doubt also due to the physiology of female hormones.

Fortunately, even though it’s nearly impossible to find great information about female hormones and insomnia on the web, the basics of are actually quite simple. Here is what you need to know about female hormones and insomnia.

Female hormones and insomnia: low estrogen levels cause insomnia

Low estrogen levels cause insomnia. Why? Because estrogen helps move magnesium into tissues. Magnesium is crucial for catalyzing more than 300 reactions in the body, the synthesis of important sleep neurotransmitters and the sleep hormone melatonin included.

When this happens, it is both harder to fall asleep as well as harder to stay asleep throughout the night.

Female hormones and insomnia: when estrogen levels get low

Estrogen levels can fall for a number of reasons. Here are the most common:

Female hormones and insomnia: psychological stress

High amounts of psychological stress can cause the female body to shut down reproductive function. This happens because the body would prefer to wait until less stressful time before becoming pregnant. It is much easier to become ill or die while pregnant if you are in a stressful environment.

You can read more about psychology and how it can affect sex hormone function in this post: psychological stress and hypothalamic amenorrhea.

Female hormones and insomnia: metabolic stress

High amounts of physical stress like under-eating, over-exercising, low fat or low carb diets,  intermittent fasting, dramatic weight loss or low body fat percentage can all  cause estrogen levels to drop precipitously.

It is super important for the female body to feel relaxed and fed. If it does not feel fed, it will think that it is starving. And if it thinks that it is starving, it will stop producing reproductive hormones, so as to stop you from becoming pregnant at a time in which it may be dangerous.

All sorts of activities that involve undereating of some sort – whether from calorie counting or chornic dieting – thus become a threat to your ability to sleep, especially if they are a chronic problem.

You can read more about the threat of starvation to female sex hormones in this post: metabolic stress and hypothalamic amenorrhea.

Female hormones and insomnia: fluctations with the menstrual cycle

Women of reproductive age often experience fluctations in their ability to sleep on a monthly basis. I know that I certainly do.


Most women report most difficulty sleeping in the day or two before menstruation, and during the first days of menstruation.

This is because these are the days in which estrogen levels are the lowest.

On day 1, the day of bleeding, all sex hormone levels are very low. Over the course of the next two weeks, before ovulation, estrogen levels rise. After ovulation, estrogen and progesterone levels fluctuate. Sometimes during this phase, progesterone levels may be elevated enough in order to off set any benefits from the estrogen, but usually the estrogen is strong enough to enable you to sleep.

At the end of the cycle leading up to the days of bleeding, however, most hormone levels are back down very low, including estrogen, making sleep difficult during these days and in the days that follow.

Female hormones and insomnia: menopause

Menopause is infamous for causing insomnia. Hot flashes often play a role in this, but even without hot flashes many women and toss and turn for years.

Menopause causes insomnia because the ovaries stop producing estrogen and progesterone at this time. Very often, after menopause the body readjusts to low estrogen levels and more easily picks up on a light estrogen signal. But it can take a significant amount of time for that to happen, which can be super problematic if you enjoy sleeping.

One solution to this problem is to try hormone replacement therapy. I am not an expert in pharmaceutical solutions to menopause, however – so I cannot in good conscience recommend particular brands or dosages. I will say that I think a low dose for a short period of time is probably okay and will not cause any problems, though HRT can cause symptoms such as breakthrough bleeding and is also under investigation for being linked to incidences of female cancers such as breast cancer.

One more natural solution is to experiment with phytoestrogens like legumes (chick peas, black beans), nuts (macademia nuts, cashews), small amounts of soy or flax in your diet, or even moderate alcohol consumption. These foods act like estrogen in the body and may be able to help give your sleep the estrogenic edge you need. Each woman’s body is different so you won’t know how these affect you until you give them a shot.

I recommend starting with one bowl of chickpeas a day if you are coming from a ‘clean’ paleo diet, and with something a bit more robust, like a tablespoon of flax, a day if you are coming from a Standard American Diet. The reason there is a difference in those recommendations is that women who have been ‘clean paleo’ will be more sensitive to phytoestrogens than ones who regularly consume them as a part of the SAD.

You will also want to make sure you are eating at least 40 grams of fat a day so your body has all the fat it needs to make estrogen, as well as at least 50 grams of carbohydrate (100 for women who are still of reproductive age), to keep your metabolism, thyroid, and reproductive hormones burning strong.

For more on some recommendations I make for menopause, check out this post on menopause and hot flashes.


Other hormones, systems, and insomnia

Of course, there are other hormone problems that can cause insomnia. Disorders of testosterone production, growth hormone production, and thyroid hormone – especially if hyperthyroid – can all have a negative effect on your ability to sleep.

Plus of course there are many other causes of insomnia beyond hormones. Neurotransmitter imbalances, electrolyte imbalances, stimulating substances like caffeine or MSG, blood sugar spikes, stress, anxiety, and dysregulated circadian rhythms can all be significant problems. I have suffered from each of these in my own journey with insomnia.

Nevertheless, the menstrual cycle, menopause, and the sensitivity of the female body to stress are all very common reasons that women lose sleep. And it all boils down to one thing: estrogen.

Estrogen, estrogen, estrogen.

Working on correcting or taking care of the estrogen-lowering issues discussed above can and will go a long way towards soothing your insomnia needs.



And, as ever, I am super curious as to what you think! Do you have experience with female hormones and insomnia? What things have worked for your insomnia?


Menopause and Hot Flashes: The Paleo Solution

Menopause and Hot Flashes: The Paleo Solution

Menopause and hot flashes have a very unfortunately relationship: that is, nearly every woman going through menopause experiences hot flashes at some point. Many women suffer them on a regular basis.

And it’s not just about feeling hot… hot flashes can be extraordinarily uncomfortable. They can upset social situations. And perhaps worst of all, they can rob you of a good night’s sleep.

Most of the advice out there for hot flashes is vague and unhelpful, and doesn’t really address the root of the problem.

But with a keen eye towards the underlying physiology of hot flashes, you can use your brain, your diet, and some lifestyle changes to manage menopause and hot flashes like a pro.

Menopause and hot flashes: What are hot flashes

Hot flashes are an uncomfortable surge of a  “too hot” feeling that can occur at random times, and are known to occur increasingly during perimenopause and menopause, in nearly 75% of women.

There is intense warmth, sometimes flushing, sometimes sweating, and maybe a tingling feeling all across the skin over the body. Sometimes they occur at night while you are sleeping, and you can wake up an intensely hot, sweaty mess.

Menopause and hot flashes: Standard internet and medical advice

Most of the articles you read on the internet about menopause and hot flashes will tell you that hot flashes are a result of “changing hormone levels.”

While true – hot flashes are caused (though not solely) by hormonal changes – this is not exactly a helpful response. How do you treat a problem that no one can give you a precise description of?

Most websites then advise you….

1) that Estrogen Replacement Therapy and Estrogen/Progesterone  Hormone Replacement Therapy have been helpful for treating women’s symptoms,

2) that a variety of practices like sleeping in a cool room and avoiding caffeine could help

and 3) that you could perhaps take some supplements thought to regulate hormones like black cohosh to help with the hot flashes. Maybe.

I am here to give you more answers, and better advice.

Menopause and hot flashes: What causes hot flashes?

It is true – the exact cause of hot flashes is not nailed down by science.

But  digging into the literature a little bit at least gives us some good clues.

So far as I can best tell, hot flashes are the result of sharp changes to blood vessel dilation. Sometimes people experience this just in the head (along with some other factors), and it can cause headaches. But a hot flash occurs when blood vessels all over the body expand in sharp, punctuated periods of time.

Now of course, blood vessels constrict and dilate in the body all of the time. This happens differently in menopause however because estrogen plays a key role in blood vessel management. When estrogen levels are low, blood vessels become somewhat more sensitive to other factors that may influence them.

One such factor, and the one which I believe is the primary one, is adrenaline release. When adrenaline is released in a period of consistently low estrogen levels, blood vessels dilate excessively and rapidly – more than they normally would, causing a hot flash. Adrenaline release can be triggered by caffeine, by sleep deprivation, by blood sugar fluctations, by inflammation, or by stress, to name a few examples.

Menopause and hot flashes: Estrogen and blood vessels

Estrogen receptors are found all over the body in tissues that you would never expect to find estrogen in, like the skeletal structure, the gut, the skin, and, very importantly, blood vessels.

Estrogen helps dilate blood vessels. How? It stimulates the synthesis of nitric oxide (as well as reduces concentrations of LDL!) which causes coronary dilation. Like so:



So we find that estrogen helps maintain flexible, free-flowing blood vessels. In women of reproductive age with relatively stable estrogen levels, blood vessels stay nice and relaxed all the time.

In women who are undergoing menopause, blood vessels become more constricted generally, and more sensitive to vasodilators and other stimulants.

We also find that estrogen has a general cooling effect on the female body. Estrogen lowers the temperature ‘set point,’ in part because it has a tendency to increase blood flow to the skin and decreases heat production. We can see this effect in the normal menstrual cycle –  body temperature rises during ovulation and high progesterone periods, and it decreases estrogen-high periods.

Both of these facts help keep the skin relatively cool.

Estrogen, other hormones, and hot flashes

Estrogen can also affect hot flashes via it’s effect on other hormones.

When estrogen levels fall, one of the body’s first  instinctive responses is to secrete the hormones LH and FSH. These are pituitary hormones that help trigger ovulation. When levels of these hormone rise, body temperature also rises.

So if estrogen falls in a quick drop on some random day during perimenopause or menopause, a flood of LH or FSH could cause core body temperatures to rise, at least to some degree. This probably does not happen on a regular basis for most women, but it can be a factor occasionally.

Estrogen, neurotransmitters, and hot flashes

Estrogen causes hot flashes indirectly via one more mechanism –  via its effect on neurotransmitters:

Estrogen influences levels of epinephrine and norepinephrine levels in the brain. It tends to increase them. It also tends to increase levels of serotonin and dopamine, come to think of it. (As a quick and important side note, this fact may explain part of why certain anti-depressants have been shown to have a positive effect on hot flash management.)

Norepinephrine and epinephrine (adrenaline) are vasodilators. They dilate blood vessels. When maintained at a somewhat consistent level their effect on blood vessels is not extreme, but constant. This helps keep blood vessels open and smoothly flowing in women of reproductive age. However, when estrogen levels fall during menopause epinephrine and norepinephrine levels may also fall to a lower baseline level – leaving blood vessels more susceptible to spikes of adrenaline and other stimulants.

Over time, blood vessels appear to adjust to lower baseline levels of estrogen and quite possibly serotonin, dopamine, and adrenaline, too, but perimenopause and menopause require patience while the body adjusts.

What about progesterone? Progesterone and hot flashes…

What about progesterone?

Progesterone and hot flashes

For many decades, estrogen was seen as the cure all for hot flashes. It was the only hormone that anyone ever studied for managing hot flashes, despite the fact that progesterone is also a critical player in menopause and women’s health generally.

Estrogen Replacement Therapy has been demonstrated to help with hot flashes and menopausal symptoms  greatly – but it has also come under fire because it has a questionable relationship with female cancers like breat cancer and endometrial cancer. Does it increase the risk of them? The medical community has yet to come to a consensus on that question.

Fortunately for them a different solution has presented itself.

Enter progesterone.

In the last couple of decades researchers have looked into progesterone for hot flashes, and have found that progesterone supplementation alone can help mitigate hot flashes. Many women take both estrogen and progesterone supplements, which may be the most certain way to help alleviate symptoms, yet progesterone itself does appear to have hot flash-mitigating effects.

The question, however, remains as to why. 

Progesterone does not have the same cardio-protective effects as estrogen. Estrogen strengthens and dilates blood vessels. Progesterone does dilate blood vessels, but it can also constrict them. The physiology of it all is complicated though if you’d like to read more in this article please be my guest.

My best hypothesis at this point is that progesterone supplementation simply helps keep everything stable. If body temperature is elevated slightly from progesterone, then a hot flash won’t occur… you are already hot on the inside! Moreover, progesterone  supplementation helps stabilize estrogen levels, because estrogen and progesterone act as balances to one another in the blood stream. So even if estrogen levels are not high during menopause, they may at least be more stable.

Progesterone also may help reign in the production of stress hormones epinephrine and norepinephrine, which would prevent the blood vessels from dilating and constricting so abruptly and causing hot flashes to occur.

And, of course, the most effective supplementation for managing all menopause symptoms including hot flashes has been shown to be both estrogen and progesterone combined… though you must not forget that the long-term health effects of continued HRT are questionable.

Menopause and hot flashes: Summary takeaway points

-Sudden blood vessel dilation is probably the main culprit in hot flashes

-Low levels of estrogen and drops in estrogen can cause hot flashes due to their effect on blood vessels

-Spikes in sympathetic (fight or flight) nervous sytstem activity and stress hormones like cortisol and adrenaline can cause hot flashes

-Hot flashes have been shown to improve with estrogen replacement therapy

-Hot flashes have been shown to improve with progesterone replacement therapy

-Hot flashes have been shown to improve best with both estrogen and progesterone replacement therapy

Hot flashes and menopause: paleo for women solutions

What to do now with this information? There is actually plenty! Here are some options for you:

1) Consider estrogen replacement therapy or combined estrogen/progesterone replacement therapy.

I mention this one first just to get it out of the way. It is of course an option. It might not be the best one but it is definitely an option.

So far as the medical literature is concerned, short-term use for management of menopause symptoms (say, several months to a couple years) is not a significant health threat.

These options have been shown to help with symptoms, and may even help protect against cardiac events, which are both great things. But estrogen therapy may be associated with an increased risk of breast and uterine cancers.

If you choose to experiment with these options, consider taking very low dose pills, or taking some time off from your supplementation like a week or two every few months in order to give your body a chance to detox excess estrogen.

2) Consider experimenting with phytoestrogen intake

Phytoestrogens are molecules in plants that resemble but are not identical to human estrogen, and which are a perfectly natural part of the diet that everyone consumes on a regular basis.

Some plants have more estrogens than others. Broccoli, for example, has some estrogen, but very, very little.

Most other vegetables and fruits are about the same.

Foods that do contain significant amounts of phytoestrogens are legumes and nuts. For most people on a Standard American Diet, the phytoestrogenic effect of these foods is probably negligible, because the SAD contains high amount of phytoestrogens all over the place, largely due to its reliance on soybean oil.

Yet if you have been legume, bean, pea, and nut free on the paleo diet for quite some time, adding some of these foods back into your diet may have a greater effect for you than they do for other women, because you are more sensitive to them now.

Even more powerful than legumes, beans, peas, and nuts are soybeans (and all soy products), chia seeds, and flaxseeds, which contain significant amounts of phytoestrogens. Whether you experiment with these or not is completely up to you and to the specifications of your own history and body. If you think you will not be sensitive to the legumes and nuts, experimenting with these is a perfectly viable option.

I recommend experimenting with phytoestrogens instead of pharmaceutical Hormone Replacement Therapy. These are natural methods, and the foods are extremely low dose compared to HRT.

I would start, personally, with a small bowl of chickpeas per day… coming from a paleo diet, and with a very sensitive body. If you have a less sensitive body you may wish to try a serving of edamame (soybeans) a day instead.

Phytoestrogens have also been studied for their effects on female cancers. The jury is still out on these guys, too. Do they increase the risk of female cancers? It is much less likely that plant estrogens in doses like the ones I just suggested will be problematic for you than pharmaceutical replacement therapy.

The physiological effect of phyestogestrogens is different on each women. It is possible they will have a negative effect on you and your symptom management. It could  change your estrogen levels in a way that actually exacerbates your systems. Though if you are low in estrogen then it is more likely they will have a positive effect. They may also alleviate some symptoms – like hot flashes – but exacerbate others – like mood swings. There is no way to know unless you try!

3) Avoid stimulants and stress!

Stimulants like caffeine, cigarettes, alcohol, spicy food, and heat cause secretion of stress hormones which can cause hot flashes.

Any other stimulating event can also cause a hot flash.

4) Reduce stress!

Stress causes stress hormones to be released, which can cause hot flashes.

5) Stabilize blood sugar

Blood sugar spikes will cause stress hormones to be released and therefore may cause hot flashes, especially in the middle of the night.

Stabilize blood sugar by improving gut health, for one. You can do this by avoiding potentially gut-threatening foods like grains and dairy, and by experimenting with FODMAP intake or SIBO management, and finally by supplementing with probiotics like my favorite here at Amazon or by regularly consuming fermented foods like my favorites you can get online listed here.

You can also help stabilize blood sugar by making sure to eat a diet rich in whole foods without processed sugars. A diet with moderate amounts of fat (40-60 grams a day), healthy carbs like vegetables, sweet potatoes, and fruits (75-200 grams a day) will also help.

If you are looking for a good supplement to stabilize blood sugar, I recommend magneisum. You may also wish to try zinc.

6) Exercise regularly

Good, regular exercise will help keep levels of important neurotransmitters like serotonin and dopamine as high as possible, as well as keep blood sugar and insulin levels low.

Aim for 3-4 hard (get your heart pumping) work outs every week.

Be sure not to over do it, however, because excessive exercise can cause significant stress to the body (and therefore hot flashes!). Make sure to listen to your body and only to exercise when you feel like you have the energy and strength to do it. I generally recommend women do no more than four hard, heart-thumping workouts per week.

7) Consider vitamin E

Vitamin E is rumored to help the body produce progesterone. Get good vitamin E from almonds, avocadoes, or dark leafy greens like kale or chard.

If you don’t think you get enough of those, you could try a supplement like this one.

8) Reduce inflammation as much as possible

Inflammation is a high risk factor for cardiovascular disease and poor blood vessel health. You can tell that from the image below:



Reducing inflammation may be easier said than done. Nevertheless some of the things you can do are:

-Avoid potentially inflammatory foods including ALL processed foods, omega 6 seed oils (Vegetable oils like corn oil, soybean oil, safflower oil, and the like), and perhaps grains and dairy,

-Consume a nutrient-rich diet full of varied, organic vegetables and fruits,

-Consume organ meats once or twice a month (here’s a supplement in case you do not like to eat liver)

-Consume eggs

-Eat fermented foods daily (here are my favorites)

-Get some sunlight everyday on your skin without SPF or consider taking a vitamin D supplement

-Eat wild-caught, fatty fish like salmon or sardines once a week and

-Consider taking the rockstar superfood cod liver oil which is rich in fat-soluble vitamins A and D as well as the crucial anti-inflammatory molecules EPA and DHA.

9) Booze up!

Alcohol increases estrogen levels in women, partly because it increases the aromatization from testosterone into estrogen.

Post-menopausal women who consume 3-6 drinks per week have been shown to reduce the risk of cardiovascular disease – while maintaining the same level of risk for osteoporosis or fatty liver disease. Whether alcohol, and how much of it, increases the risk of breast cancer remains to be seen.

10) And consider the practical tips

Many people recommend certain practical tips for managing hot flashes, such as

-deep breathing meditation, especially before bed

-sleeping in a cool room with light blankets

-avoiding spicy foods, caffeine, alcohol, and cigarette smoke

-avoiding hot environments

-try using a chill pillow (here’s a good one designed for hot flashes!) to stay cool at night

And… that’s a wrap for paleo, my theories (?!), hot flashes, and what to do about them. Since I have not gone through menopause I do not  have first hand knowledge of any of this, nor  have I been able to experiment with any of these ideas on my own body.

Check back with me in 25 years or so. 🙂

What do you think?! Especially if you have gone through menopause I am just dying to learn from your experiences!

(Image source: MonkeyBusinessImages)

How to know if you have low testosterone

How to know if you have low testosterone

The relationship between women and testosterone is poorly understood.

Testosterone is commonly blamed for libido problems… but that’s all anyone ever really talks about.

There is however a lot more to testosterone than meets the eye! Sufficient testosterone is important for mood, for energy, for cognitive function, and for overall health. Without testosterone, your energy and happiness can really suffer. How to know if you have low testosterone?

Most women are not in danger of insufficient testosterone levels. But you altogether might be, depending on your age and the type of health conditions and stressors you have endured over the years. This blog is a great starting place to learn about testosterone, and to help you identify if you suffer from low testosterone.

(And for even more on this topic, check out this book by Dr Sarah Gottfried, one of my favorites that addresses hormones and menopause.)

What testosterone does for YOU

Testosterone is important for your health because it plays a key role in reproductive function, in mood, and in physical fitness. Here are some of the things testosterone does, and why having low testosterone is a real problem. Testosterone:

-Enables female athletes to make greater increases in both lean mass and power. This study demonstrated gains in lean mass, chest-press power, and loaded sair-clibmer power in 71 women who had low testosterone due to menopause and/or hysterectomy.

-Increases sex drive, as shown by just about every study on menopausal sex drive. The measurements shown to improve are one measure of sexual fuction called the composite Brief Index of Sexual Functioning for Women, reported thoughts/desire, reported feelings of arousal, and frequency of sexual activity.

-Supports bone health. Even while estrogen is well known as the ‘bone mineral density’ hormone, studies like this one have shown that adding sufficient testosterone to the mix vastly increases success with bone strength, osteopenia and osteoporosis.

-Helps manage pain. At least we think. Rodent studies demonstrate that newborn female rats injected with testosterone experience better pain management than those that do not. But we are not quite sure if this effect extends to humans and how well.

-Manages mood and mental focus. Testosterone appears to help women feel motivated and upbeat. Depression, mood swings, and other unexplained emotional symptoms can be caused by decreased testosterone levels. Women with low testosterone also report failing to enjoy activities they once loved.

Testosterone production

So how does your body do these things? Where does testosterone come from?

Testosterone is produced in part by the ovaries, and in part by the adrenal (stress) glands.

Both of these organs take their cue from the pituitary gland, so any sort of pituitary malfunction – whether due to a common problem like stress, or to something less common like a tumor – will hinder testosterone production.

The pituitary gland usually functions healthfully in adolescents and women of reproductive age. Once a woman enters menopause, however, it stops sending signals to the ovaries. (This is natural, it’s supposed to happen!)

Nevertheless, menopause can cause some problems and symptoms. In menopause, because hormones are no longer being produced by the ovaries, the bulk of hormone production is left up to other glands, like the adrenals. Sometimes this isn’t sufficient, and testosterone (and estrogen and progesterone) levels suffer.

Average testosterone levels

The standard healthy range for testosterone levels for adult women is 15-70 ng/dl.

Unfortunately this is a fairly large range. This means that you may experience some level of dysfunction – whether your levels are too high or too low – without actually falling outside of the normal ranges.

Testosterone levels rise throughout puberty (along with the rest of the sex hormones), and they stay relatively stable throughout young adulthood and middle age. During menopause testosterone levels drop significantly, as I just mentioned, due to the Retirement of the ovaries.

(Personally my ovaries will be retiring to Key West.)

Signs your testosterone levels may be low

There are many signs that you may wish to investigate your testosterone levels. They are:

-Osteoporosis, osteopenia or low bone mineral density (most likely coupled with low estrogen)

-Poor memory and brain fog

-Low mood, lack of motivation, no goals, and no competitive spirit

-Low libido

-Poor pain tolerance

-No evidence of ovulation (which would include spiked libido, increase in vaginal discharge, spike in body temperature)

Causes of low testosterone

Many things may contribute to low testosterone levels. Far and away, the most common cause of low testosterone in women is menopause. Second to that is an ovariectomy. In addiction to these two landmark cases, there are also:

-Stress, since stress can decrease reproductive function and divert your body’s resources away from sex hormone production and toward stress hormone production

-Sedentary lifestyle, since testosterone production is supported by exercise

-A very low fat diet (less than 30 grams of fat/day), since fat is necessary for producing hormones

Estrogen dominance – you may experience symptoms of testosterone insufficiency if your estrogen levels are too high, since estrogen causes testosterone to become bound and inactive in the bloodstream (thus why they must always be in proper balance)

-A pituitary tumor. This is rare but not impossible! Doctor’s can screen for it with an MRI.

What to do about it

1) Overcome estrogen dominance.

Sometimes you just need testosterone alone. This would be the case if you are estrogen or progseterone dominant, regardless of your age. In that case you may wish to take a very small dose of a bioidentical testosterone hormone. My preferred method however would be to overcome the estrogen dominance via the methods I describe here.

Doing weight lifting exercises like these and some HIIT exercising can also be an extraordinary help.

2) Boost hormone production generally

Other times what women need is to increase all of their sex hormone levels. This often happens with hypothalamic amenorrhea, stress-based health problems, ovariectomies, and menopause. You can do this by:

-Increasing the fat content of your diet to at least 45 grams a day (or 25% of calories)

-Being sure to eat at least 75 grams of protein every day

-Eat carbohydrate with at least two meals a day

-Boost thyroid hormone health via the many complex ways that can be done, such as described here in my favorite thyroid resources (here for Hashimoto’s, here for general hypothyroid)

So in summary…

Most women of reproductive age are not at risk of low testosterone. But you may be if you’ve suffered from hypothalamic amneorrhea, any sort of HPA axis disruption, or the detrimental effects of a very low, vegetarian style, restrictive diet. You could also experience symptoms of low testosterone if your estrogen levels are too high.

The best thing you can do for this is to overcome estrogen dominance, as well as to boost hormone production. If in menopause, you may wish to consider bioidentical hormone therapy, but a more natural route would be to balance your hormones with diet and exercise.

Your libido, your lovers, your brain clarity, and your goal-driven, competitive edge may thank you. 🙂



For some further reading –

I really like what Sarah Gottfried has to say about menopause and hormone balance in her best-seller here.

And here’s a great tongue-in-cheek and insightful look at testosterone and human societies: The Trouble with Testosterone, which I love so much. Plus it’s SO PALEO!


What do you think? Do you have LOW T? What have you done about it?


How to Know if You Have Low Testosterone

The Invisible Demographic: Important, Respectable AND Sexy At Every Age?

The Invisible Demographic: Important, Respectable AND Sexy At Every Age?


When I first started writing this blog, I did so because I perceived a dearth in both the medical and the popular literature on women’s health, particularly with respect to evolutionary perspectives.  We might talk all day along about insulin and obesity and heart disease.  But what about ovaries?  50 percent of the population has them.  Or what about depression, anxiety, acne, and gut dysbiosis, all conditions that affect women at much higher rates than men?   What about the enormous burden and joy and giving birth?   3 million 999 thousand women in the United States do so every year.  That’s 12,000 every day.  We needed to talk about women, and we needed to do so fast.


compared to women above the age of 45, reproductive women are virtually living in the limelight.

Much as I’ll malign contemporary health dialogues for neglecting the needs of reproductive women, post-reproductive women receive even less attention.   But dealing with menopause — that’s even nastier for many women than dealing with PMS.  Why do we give attention to one, but not to the other?

The answer is simple: women might be a pain in the ass, but at least the young ones are sexy.  That’s what society would have us believe, anyway.   Far more than we would like or that we would ever admit to, we reserve an enormous amount of a woman’s value based on her sex appeal.   Squirm your own way out of it however you want.  But it’s there, deep in your brain, I’d be willing to bet.  We can’t help it — this is the product of hundreds of years of conditioning and billions of dollars in advertising every year.   The value of a woman is skewed largely by her physicality (helllooo President Obama).  It is skewed largely, then, by her youth.  Largely by her reproductive fitness.  Largely by her virginity, her potential, her sexual wiles.

This is evidenced most obviously by the film industry.  From the Huffington Post:

study released by USC’s Annenberg School for Communication & Journalism took a survey of the 4,342 characters in the top 100 grossing films of 2009 and compared it to results from the top films of 2007 and 2008. For women, nothing much has changed — in these top films, 33 percent of actors are female and 67 are male.

This means there are twice as many men in movies as women.  

Only 17 percent of films are gender balanced, even though females make up half of the ticket-buying population.

Adding fuel to the fire, women are much more frequently sexualized when they appear on screen. They’re more likely to be seen in sexy clothing than men (25.8 percent to 4.7 percent — five times as much) and four times more likely to be partially naked (23.6 percent to 7.4 percent).

And then the proof, lying naking in the pudding:  Teen girls feature in movies the most of all age groups.  Women ages 21-39 are to be shown as sexy, or partially naked. Older women, aged 40-64, are a) less likely to be shown as attractive (3.8 percent) and b)  less likely to be shown at all.  Only 24 percent of all characters over the age of 40 are female.


All of which is to say: I don’t have an easy answer.

How do we give older women the respect and love and attention they deserve?  How do we convince the rest of society to do the same?

De-objectifying women is the most important thing we can do in this case.  It will be the biggest help, if the most entrenched battle.  The more valuable women are for skills and personality, the less we will rank women based on physical appearance and sex appeal.   The more these non-physical values are emphasized, the more and more older women will find definition, liberation, and empowerment in all of the non-physical valuable traits they contribute to the world.  Right?  This is how it is supposed to work for all of us, in any case.

Someday we’ll get there.  We’re getting there.

I think film is a wonderful way to help us think about this issue and to identify the problems in our own brains.  Why are there virtually no films about or featuring older women?  Why are there films about older men?  How might we be able to combine and blur those lines?  If older roles are usually reserved for executives, mob bosses, and the like — well, women can do that every bit as well as men, can they not?


Another aspect of it is the expansion of sex appeal.   Don’t get me wrong — I don’t want any woman to be an object.  In fact, I don’t want any people to be objects.  Period.  Ever.  Obviously.  But I also want all people to be embodied and empowered in their own sex appeal.   Just because a woman has wrinkles does not mean she is not sexy, people!  What the hell!   Certainly, she may be out of fantasy range for most young adult males and females.  But that does not mean that she is a desexualized, de-feminized being.

Get the hell out of here.  The idea is unreal.  But we do it, don’t we?  We see and enable men living into sexual roles well into older age — we do it all of the time.  I’d leap into bed with George Clooney at the drop of a hat — who wouldn’t?  But what of Meryl Streep?  Helen Mirren?  The idea is less automatically appealing.  The sexuality of older women is egregiously overlooked and discouraged.  I shall not stand for it!

Huzzah!  This is a part of the revolution we can do ourselves.  As a community of women of all ages, we can reinvigorate our own sexuality however we see fit.  We can live into it.  We can be natural women — not sexy because we have botox and the ridiculous like — but sexy because we are precisely our menopausal age and yes I have hot flashes sometimes and no my vagina does not unleash a daily cascade of lubrication, but I have been a woman for a damn long time and I know exactly how to own my natral body and to live in it and to love it and to use it for physical pleasure.*

And we can be more than sexual beings at all times of our lives!  We always have value — enormous value.  We are smart and productive and empathetic and talented and all of that other fancy crap.

Rawr, ladies.  Rawr!


*At least I imagine these are ideas that helpful to think, 40 years down the road.  Please share your thoughts and tell me what feels good for you.  I’m rather guessing, here, and acknowledge that openly.  The whole point being — let us not forget the embodied, sexual power nor the inherent asexual dignity of women at all ages.