When I google tips for how to enhance female libido, I get a lot of answers like “take a ginseng supplement” or “eat oysters four hours before intimacy.” While these tips might be effective in the short term, they are not effective in the long-term.
The ultimate solution (physically, anyway) to female libido is hormone balance.
The relationship between hormones and female libido could not be more clear:
The better your hormones are balanced and the more rich your supply, the more robust your libido will be.
The female body is highly sensitive to hormone fluctuations. This is in large part because the female body needs to be absolutely certain that it is healthy and in a safe enough environment in order to have sex and be pregnant. Why? If it is not healthy enough or in a safe enough environment and you conceive, then you could actually die from the physical stress of it all.
Fortunately you have all the tools you need to balance and boost hormone production. Here are the most efficient and effective steps you can take to get your libido robust and roaring.
1. Hormones and Female Libido: Address underlying hormone conditions
Do you have an underlying hormone condition?
This is a very important question to ask yourself. If you have an underlying health or hormone condition that is blocking healthy hormone production, then you will never be able to boost your libido no matter how hard you try.
The most common types of hormone conditions are:
PCOS affects around 15 percent of American woman, making it the leading cause of infertility in the Western world. Symptoms of PCOS include irregular menstrual cycles, acne, low libido, difficulty losing weight, male pattern hair growth (facial hair), and male pattern hair loss (balding). If you have PCOS, this is definitely a roadblock to a robust libido. You can figure out if you have PCOS, and learn all about what to do about it, in the guide I wrote on the topic, here, or a blog post I wrote on the topic, here.
2) Hypothalamic amenorrhea.
Hypothalamic amenorrhea is the fancy way of saying that the body is too stressed out in order to have healthy hormone production.
Emotional stress – such as mortgage payments – and physical stress – such as exercising too much and eating too little – are both big components of HA.
You may have HA if your menstrual cycles are absent, light, or irregular, if you have acne, if you have lost a lot of weight or dieted a lot in your life, and if you are stressed out. Here is a comprehensive post I wrote about Hypothalamic amenorrhea symptoms – and here is one about treatment.
You can also have HA and PCOS at the same time, despite what most doctors will tell you. I wrote a post debunking this myth and telling you what to do about it here.
3) Estrogen dominance.
Estrogen dominance occurs when estrogen levels get too high and throw off hormone balance relative to progesterone, testosterone, and other hormones. If estrogen levels are too high libido will plummet (though estrogen is generally good for libido! Just not too much).
Estrogen dominance can be caused by being overweight, not exercising enough, low liver functionality, inflammation, birth control pill use, and a diet rich in processed foods. You can read all about estrogen dominance and how to overcome it in this post.
You can read all about how to lose weight healthfully in my fat burning and accelerating guide Weight Loss Unlocked, here.
4) Early or unoptimized menopause.
Menopause is one major hormonal cause of low libido. Unfortunately this problem is harder to fix than the others, because hormone levels naturally drop. Fortunately with an anti-inflammatory, nutrient dense diet rich in healthy carbs and fat like a paleo diet (read my take on paleo here), hormone balance is often supported and restored in menopause. You may also wish to consider bioidentical hormone replacement therapy, but you really do not have to, as a supremely healthy diet should normally be enough to help. Sometimes patience is really helpful too, as hormone levels fluctuate for a long time and then often settle into a more balanced place.
2. Hormones and female libido: get off the pill, or get on the right one
The birth control pill is another huge factor in female libido. Admittedly, sometimes it can help with libido, but more often than not it squashes it.
One solution for this is to find a variety of the pill that works well for you. If you are on a progesterone-only pill, you may wish to consider getting a formulation that also has estrogen in it. High doses of progesterone have been found to decrease libido when compared to estrogen. Switching kinds of progesterone can also help enhance your libido.
Another option is to ditch hormonal birth control altogether and instead opt for a hormone-free version like the copper IUD or fertility awareness. You can read all about these natural options, as well as the hormonal options, and what to do about them in my quick guide to birth control.
3. Hormones and female libido: Minimize inflammation
Systemic inflammation and other underlying health conditions like auotimmune diseases can often get in the way of healthy hormone production. When the immune system is in hyperdrive, testosterone levels can rise, stress hormones can rise, and other reproductive hormone levels can fall.
Reduce inflammation by eliminating foods that are potentially inflammatory and which can block good nutrient absorption. The three major major culprits here are omega 6 vegetable oils (vegetable oil, soybean oil, corn oil, canola oil, wheatgerm oil, sunflower oil, safflower oil and the like), processed or added sugar, and grain products.
Focusing on fresh fruits and vegetables, wild-caught and grass-fed animal products, and healthy fats like olive oil and coconut oil is an excellent place to start. Organ meats are great for reducing inflammation, (here’s a supplement in case you do not like to eat liver), as are eggs, fermented foods (here are my favorites) and the rockstar super-suppelment that boosts the hell out of libido fermented cod liver oil.
4. Hormones and female libido: Get the building blocks you need
Sometimes women don’t have robust libidos because they don’t give their bodies the building blocks they need for robust hormone production.
In order to optimally produce hormones, you should consume:
-At very minimum 50 grams of animal protein a day (and up to 100). This is the equivalent of two cans of tuna, or two palm-sized portions of protein.
-At very minimum, 30 grams of fat each day. This is equivalent to about three tablespoons of oil. If you struggle with libido, I recommend increasing this to 45 grams a day to see if that helps. Fats are absolutely essential for healthy hormone production…. hormones are made out of fat, after all!
-At very minimum, 100 grams of carbohydrate every day. Many women go on low carbohydrate diets and are then puzzled about why they have lost their libidos. Low carbohydrate diets can reduce thyroid function – which is necessary for a robust libido – and can also cause the pituitary gland to slow down its activity. Be sure to eat at least 100 grams – so about four pieces of fruit or two bowls of rice – of carbohydrate every day. If you are an athlete, be sure to eat even more, and to always refuel after a workout.
You can fill in the rest of your diet with whatever macronutrients you like. Yet these minimums must be met in order to assure you get the building blocks you need.
5. Hormones and female libido: Eliminate or manipulate estrogenic foods
Many foods contain estrogenic compounds. Soy and flax are the worst offenders (don’t forget that soybean oil and soy lecithin are in almost all processed foods!), and are very potent phytoestrogens. Other foods that also perform estrogenic functions but are less powerful are nuts, beans, peas, and all other legumes.
For some women these foods are problematic and cause estrogen dominance symptoms. If you suspect that you have estrogen dominance, or if you consume a lot of these foods, consider eliminating them to see if that helps.
If you have low estrogen levels, such as if you have hypothalamic amenorrhea or are in menopause, you may wish to experiment with adding these foods to your diet to see if they help. I know that I personally notice a big spike in my sex drive when I eat these foods. You need robust estrogen levels in order to have a healthy sex drive, and these foods, while not permanent fixes, can definitely help boost your libido in the short-term.
6. Hormones and female libido: Reduce stress!
This last and final recommendation you cannot do, unfortunately, with diet. And it is perhaps the hardest one. But it is the most important.
Stress is a big physical problem for the body. Stress causes inflammation, it causes the thyroid and pituitary glands to shut down, and it causes hormone production to be shunted away from reproductive hormones and instead toward stress hormones, which do nothing other than elevate your heartbeat and make you feel wired.
So stress has a physiological impact on your body that must be eliminated for libido.
Though of course the psychological component of stress is also hugely important. It may in fact be the most important thing you can do for your libido.
I mentioned earlier that the female body is highly attuned to stress. This is true. The female body does not want you to have sex if you are stressed out, because it wants you to wait to be pregnant and care for an infant for a time when you are relaxed and the environment is safe.
Work, relationship trouble, self-doubt, self-consciousness, depression and anxiety are all big, stressful reasons that your libido can be crushed. And I can tell you, I can absolutely promise you, that you can be the healthiest eater in the world. But if you don’t take care of your heart and your brain and reduce stress, you will never have a robust libido.
I talk a fair bit about my own personal stress reduction techniques in this post. While not directly related to libido, it might be helpful for you. I also talk about the psychosocial aspects of female libido (and how to feel awesome about your lady parts) in this other post on libido.
My favorite books to help you think about sex healthfully are The Guide to Getting it On (a great intro to sex and great sex advice with emotional maturity and cultural awareness), Sex at Dawn (an exploration of the evolutionary origins of human sexuality and what that means for our modern lives) and She Comes First (a guide to pleasuring women!).
Hormones and Female Libido: In Sum
All in all, female libido is complicated in many ways. This is because hormones can be tricky to balance. But armed with knowledge of the ways in which hormones can go awry, and with the dependable help of a female health expert like myself (! 🙂 ), you can absolutely boost your libido again.
Grab a plate of oysters and ginseng in the meantime. But know that in the long-term, the plan that I have laid out here is the most effective.
It has worked for me! (I solved my own PCOS – read about how you can too here). And it works for my clients…. nothing will support your libido better or more permanently than by giving your body the fuel it needs to burn, baby, burn.
What works for you? Do you think my thoughts on hormones and female libido are accurate? What do you recommend?!
There are a lot of myths in Western culture that make me furious. Here is one I’ve been thinking about a lot recently:
Women orgasm less than men because NATURE SAYS SO.
According to one large-scale survey of American adults, women have about one orgasm for every three that men have. That is thirty percent. Women orgasm thirty three percent as often as men do.
How do we account for this difference?
The standard means by which Americans explain this difference by suggesting that women’s bodies are simply bad at orgasms. “It’s complicated!” we say. “Women are delicate flowers!” “Sometimes women orgasm and sometimes they don’t.”
Because NATURE. (Here’s what I have to say about a woman’s nature!)
Where does the idea that it’s a biological imperative that women orgasm infrequently come from?
1) Sigmund Freud. Freud famously argued that an orgasm without vaginal penetration was an “immature” orgasm. The idea that women could orgasm without (GASP!) a male organ inside of her was terrifying for the man. This theory has of course been seriously disproven. Masters and Johnson later showed that stimulating the clitoris on the outside of the body and the vagina on the inside is two different ways of stimulating… get this… the clitoris, because it’s actually a pretty big body part that exists both inside and outside the body. It’s the whole pleasure experience of the woman, period. So. There’s no such thing as an “immature” orgasm. They’re all on the same organ.
All the poor women who think there’s something wrong with them because they don’t orgasm from penetration alone – well. They (YOU) definitely need to know this. It’s all the same organ. And, in fact, more than 75% of women need some sort of external stimulation to orgasm.
Anyway. Freud said that the clitoris was bad and should be ignored. People (men) really liked how much easier this made their lives. It rationalized what they were already thinking anyway. So the idea stuck, and stuck hard.
(For a radically alternative view to Freud, see the electrifyingly awesome book on sex in human history, here.)
2) Accidental ignorance
30% of women and 25% of men don’t know where the clitoris is.
A lot of people, I believe, are accidentally ignorant. Whether its because of a lack of good sex ed or because of the misogynistic culture in which we live (see points below), they simply can’t make heads or tails of female anatomy. It’s not really their fault – and I’m not mad at anyone for accidental ignorance. We are all victims of negativity in our culture in one way or another, and this is simply one of them.
One of my favorite books on this topic is She Comes First: The Thinking Man’s Guide To Pleasuring a Woman by Ian Kerner! It does a FANTASTIC job of explaining where the clitoris is, how to find it, and what it wants!
3) “What you need is what I need.”
Even for a lot of people who do know where the clitoris is and who are interested in female pleasure, they simply go about it all wrong. Here is something that almost all people do subconsciously:
We treat other people the way we’d like to be treated.
At least in the bedroom, anyway.
So this is what sex ends up looking like: Women act a bit like a tease with men, touch them gently, don’t go right for the male organ right away. (Very, very generally speaking.) Because women generally tend to be more gentle and patient and appreciative of suspense in the bedroom.
On the other hand, men tend to go right for the goods. (At least, this is what Men are from Mars Women are from Venus tells me.) And when they want to increase pleasure, they go harder and faster. Because men generally enjoy it when things are harder and faster.
So let it be known, lads and ladies. You’re doing each other backwards. Think about the psychology of the human being you are with. Don’t assume that they like the style you like. Generally speaking, pleasure tends to be a bit complementary, with women’s bodies responding more positively to lighter touches and men’s to firmer. And if not – well. The right thing to do is ask.
(Here is my favorite book on pleasure for both partners, including psychological stuff. Here’s my favorite for women alone. Here’s my favorite for pleasing guys.)
“I know women can receive pleasure, but I’m afraid I’ll look stupid if I let anyone know I need help.”
We live in a world in which men are expected to be perfect and manly and not need help. Plus, people are generally very fearful of vulnerability. Sex is already a profoundly vulnerable act. But what if you go into it and say openly “I don’t know what I”m doing!” That is perhaps the most vulnerable act of all. Of course – in that act there is a LOT of strength. It takes a lot of strength to confess ignorance. But it is a highly vulnerable and potentially volatile situation.
We can work to overcome by this developing our skills for acceptance, patience, and open communication. Men are cultured to be incommunicative. We tell them from day one that they should be strong, silent, unemotional types. But that’s just… that’s not right. If we can help make our culture one in which vulnerability and communication are highly prized values, then we can more easily navigate intimate spaces like the bedroom.
Obviously, this is the worst one, and the one at which I concentrate my fury. It says:
“I know women can receive pleasure, but I really can’t be bothered to do it.”
That’s what The Men think.
This is what The Women think:
“I like orgasms, but I really want my partner to think I’m sexy and like me. I feel terribly self-conscious. I am going to please him first and not ask for my own.”
Six months ago, I met a man who was totally lovely and charming and kind. We went up to his hotel room. He pushed me on the bed and put his penis in me and intercourse-d me for maybe ten minutes, saying conquesting things like “this *ss is mine tonight.” He had an orgasm, and then “we” were done having sex.
Stefani was never a part of that sex. Afterward, I just laid there and sort of looked at him. I knew I should have had some fiery feminist thing to say, but I still couldn’t believe that that was it, he wasn’t going to invest in my pleasure at all, I thought surely there must be more coming. But there wasn’t. That was it.
When I say we live in a misogynistic culture that denies female pleasure, this is what I’m talking about. Of course this was a singular situation, but there are so many similar situations that happen on a day to day basis, I don’t even know where to start.
Misogyny — that is, this culture we live in that prioritizes men’s needs over women’s, and which tends to dehumanize and objectify women — makes us (both women and men) think a lot of bad things.
Misogyny makes us think the male orgasm is more important than the female.
It makes us think guys are lusty fellows, and that women are lusty objects.
It makes us think guys enjoy sex but women enjoy the mushy emotional things like cuddling.
It makes us think women are dirty and immoral if they act on sexual desire.
It makes us think, as was the case with my mystery hotel man, that sex is an acceptable form of conquest.
Come to think of it, it makes men want to conquer women in the first place.
It makes us think men have a valid sexual need, and that women are obligated to fulfill that need (see The Man’s Rights Movement or GamerGate or that punk on the shooting spree or any other incidents from 2014).
It makes us think men are sexual and women are sexy.
It makes us think the male orgasm is what makes sex successful and fulfilling.
It makes us think the male orgasm is the END OF SEX. (Hey guys, you have HANDS AND A FACE, I’m just saying.)
To demonstrate that what I’m saying isn’t crazy, I’d like to pull some quotes from an academic article by Elizabeth Armstrong and her colleagues, in the context of another article posted at Alternet.
Elizabeth Armstrong and her colleagues conclude that women’s orgasm rates are strongly related to her evolving relationship with her partner, the activities they include, and his investment in her pleasure. The more times a woman is with a man, the more she orgasms. Women in relationships in fact orgasm up to seven times as frequently as single women do.
Qualitative research on men’s motivations confirm the last piece. “I’m all about making her orgasm,” said a man interviewed for their study. “The general her or like the specific her?” he was asked. “Girlfriend her,” he responded, “In a hookup her, I don’t give a shit.”
Women know the difference. Said one: “When I… meet somebody and I’m gonna have a random hookup… from what I have seen, they’re not even trying to, you know, make it a mutual thing.”
Expecting an orgasm from a male hookup partner is even seen as demanding and rude. One woman explained how she felt like she didn’t have the “right” to ask for an orgasm: “I didn’t feel comfortable I guess. I don’t know. I think I felt kind of guilty almost, like I felt like I was kind of subjecting [guys] to something they didn’t want to do and I felt bad about it.”
Out of nerves, insecurity, or a lack of entitlement, women often prioritize men’s pleasure too. Speaking of hookups, one woman insists: “I will do everything in my power to, like whoever I’m with, to get [him] off.” My own research confirms that college women often fully accept that hookups usually don’t include orgasms for women. “Even if I was in charge,” said one, “I did not make sure I was being pleased.” “The guy kind of expects to get off,” said another, “while the girl doesn’t expect anything.”
The bottom line is this: women orgasm less than men do for many complicated, interwoven factors. But they are all social factors.
When you remove social barriers to orgasm, women in fact far outstrip men in orgasmic performance.
Not only do women match men in potential number of orgasms biologically, but in fact we do it more.
How do we know this?
Well. Women who sleep with women have many more orgasms than heterosexual women. Women also have no problem experiencing orgasm through masturbation. The same women who frequently have orgasms during masturbation report many fewer orgasms when they’re with a partner.
Even the idea that women simply “take longer” than men is a myth. It takes women the same amount of time to orgasm during masturbation as it takes men, on average, to have an orgasm through intercourse: four minutes.
So here’s the bottom line of the bottom line:
Women orgasm less than men do because of the social forces of our culture, that live in both the brains of both men and women.
And then we come up with this idea, that no, it’s not our culture’s fault, it’s actually our biology’s fault.
And then we have a seriously powerful rationalization for ignoring female pleasure on our hands.
Saying that the female body is bad at orgasms gives guys (and gals) a free pass.
It is simply easier to go on thinking that female pleasure is “complicated.” One one side of the coin, it lets guys be lazy and feel properly accomplished in the sack. On the other side, it lets us women avoid having to stand up for ourselves and explore and demand equal attention.
So I challenge men to overcome fear and ignorance and help us. Even more importantly, I challenge us women to become better communicators about this. I challenge us to explore our own bodies and sexuality, and to learn what we like and dislike. I challenge us to tell men. I challenge us to be unapologetically sexual. I challenge us to own the real sexual power of our natural bodies – the biological bodies that have the potential to sustain multiple orgasms in quick succession. I challenge us to do this not only for the sake of a quick high between the sheets… but more importantly for the sake of consideration, empathy, and respect, and equality between the sexes.
For my favorite books on the subject, check out (all amazon links):
Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships
The Guide to Getting it On: A Book about the Wonders of Sex
The Red Queen: Sex and the Evolution of Human Nature
She Comes First: The Thinking Man’s Guide to Pleasuring a Woman
Passionista: The Empowered Woman’s Guide to Pleasuring a Man
The Male Brain: A Breakthrough Understanding of How Men and Boys Think
And of course, don’t forget my own book Sexy By Nature that covers all things women’s health!
I’ve told my story about my experience with anxiety and insomnia a few times here on the blog (and here’s a post describing my favorite resources for overcoming it)… but I’ve never told it completely, in full. Plus, I keep learning more about what happened to me, so I keep developing a better picture of what’s going on.
Below is more of my story. I am sharing it with you mostly because I want you to know that health is not easy for any of us, health bloggers included. I also want you to know that you are not alone in whatever struggles you face. And also I want to give you hope, because I had no hope. I never thought things would get better. But then they did. They really, I still can hardly believe it, did. They’re not perfect these days, but god, they’re so, so sweetly better.
Here it is, my life on a plate:
After I spent a summer in Italy living off of almost nothing but cheese and being incredibly skinny, I developed a serious case of acne.
For years afterward the acne was nearly impossible to manage. Some days I didn’t even leave my room, because I didn’t want to inflict my appearance on people. I was doing them a service, I was convinced. I did my best to fix the acne (I even ate paleo!), yet nothing appeared to make much of a dent at all.
(If you are struggling with acne, I have an awesome FREE guide on clearer skin in 7 days, all you have to do is sign up for my newsletter!)
Deep down, I knew that I had to gain weight to be healthier and to clear up my skin. But I didn’t want to. “Please don’t make me get fat, please don’t make me get fat” I’d chant over and over again in my head sometimes while going to sleep. I had the “ideal” body. There was no way I was going to give that up, come hell or high water.
In January of 2012, I was desperate enough to stay thin and clear my skin that I tried prescription meds for the acne.
So then came the hell, and the high water.
The drug I took is called “spironolactone.” Spiro was not originally designed to treat hormonal acne. It is, in fact, a blood-pressure medication. It also just so happens to have a dampening effect on male sex hormone production, so it is often prescribed off-label to women with acne.
WebMD lists spiro’s potential side effects as dizziness, drowsiness, lightheadedness, stomach upset, nausea, or headache. Not too bad, right? BUT it also warns that spironolactone can cause potassium levels to build up in the blood. If this happens, muscle weakness and heart failure may occur.
To prevent this disastrous possibility from killing off wide swaths of the female population, doctors usually insist on getting blood potassium levels tested before prescribing spironolactone.
I got my blood tested a few weeks after going on spiro, and my potassium levels checked out “fine.”
In February of 2012, I stopped sleeping well. In fact, I almost stopped sleeping completely. To be fair, I have always been a poor sleeper, having to wait several hours some nights to fall asleep. But this February brought, for the first time in my life, entire nights without sleep. I will never forget my 8:00 am seminars every Wednesday morning on one hour of sleep. Nor will I forget the terrified and confused tears that came later in the afternoons. Nor will I forget the morning I had to take the GRE on 25 minutes of sleep. Nor will I forget the tears of exhausted frustration I wept for days after. (Still aced it, btw!) These are tears that I still, to this day, experience after a poor night’s rest.
I also developed a severe case of anxiety. To be fair, again, I have always been a bit neurotic. But this February, for the first time in my life, I laid awake in bed at 3am and felt the ceiling collapsing down on me, suffocating me, with my heart racing, desperate and afraid. Afraid doesn’t cut it. Panicked. Terrified. I’d call my mother sobbing. “I don’t know what’s wrong, I don’t know what’s wrong, I don’t know what’s wrong,” I’d gasp. She’d talk to me and tell me everything was okay for hours, sometimes until the sun came up. At which point she would leave the house for her full-time job.
My mother is a saint.
I stopped taking thyroid meds. I guess that helped. My potassium levels continued to check out fine. Plus, for all the thousands of reviews of spironolactone available online, .02 % (there are more than 1000 of them, and I found 2) of them mention anxiety as a side effect. None mention insomnia. It seemed it had to be something else.
Yet finally in June I was at my wits end. Even though I was scared shitless to go off of Spiro because my acne would come roaring back, I went back to my mother’s home in Michigan, hid my face in my bedroom, and did the experiment. I went off the spiro.
The anxiety calmed. The sleeplessness abated. Somewhat. I breathed. For the first time in four months, I breathed. Relief was on the horizon.
Then, on the evening of June 20, I did not sleep.
Nor did I on June 21.
Or June 22.
I crawled into my mother’s bed, crying. I got a few hours of fitfull sleep.
I had to come back to Boston. I didn’t want to. But work called. My life called. I wasn’t about to let my insanity destroy my life.
From there things got nothing but worse. I would lay on the sofa with my heart beating like a jackhammer against my rib cage. I felt claustrophobic and trapped. I’d keep the front door wide open, and I’d lay there and just hate how few windows there were in the living room. I felt overexposed. I’d go outside, and I’d hate how open the sky was.
I couldn’t win. Nothing felt good.
I’d try to pick a shirt to wear before work in the mornings, and was it blue or red? 20 minutes and a panic attack later, I’d hyperventilate my way out the door in one color or the other… of course it didn’t matter, in the end.
I don’t know how to explain the intensity of anxiety to people who have never experienced it. I wouldn’t wish it on my worst enemies. Perhaps this’ll put it in perspective: Sometimes I suffer debilitating migraines – the ones that make you throw up and kind of wish you were dead they hurt so bad. Today, I don’t know if I’d rather have the migraines or the anxiety.
What anxiety does to a brain like mine is astounding. I am a human being who weighs every pro and con and implication before making a decision. I see and I know very many things. Already my neurons are a web of highly nuanced, carefully chosen concerns. The horror of anxiety is that it sets them on fire.
Thoughts race in a million directions. Every question makes more questions arise, and the most horrible of them rocket to the surface and drag you cartwheeling down their own sinister nightmares before you can take just one breath. It is relentless. And hopeless. And endless.
You know that feeling where you’re nervous, and your heart starts to beat like a bass drum on speed, and you can feel it in your chest and maybe even sometimes in your ears? My anxiety’s partner in crime is a heart on a murderous rampage. The palpitations never go away. My heart’s its own monster, it’s own hell. It really beats so hard. At least it used to. These days it doesn’t happen too often. And yet again – it is nothing compared to the anxiety that rides wild on its back.
With these kinds of health issues, it’s nearly impossible to make a decision without being paralyzed by fear. It’s nearly impossible to calm the body enough to sleep. It’s nearly impossible to see anything but relentless terror in the future. I think I’ve probably made this point clear.
Which is why, in August of 2012, riding my bike down Massachusetts Avenue to an acupuncture appointment, of all things, I very, 100 percent sincerely, for the only time in my life, genuinely wanted to stop living.
This was the first time prescription drugs almost killed me.
The second was perhaps a week later. I finally re-connected the dots. I looked at the symptoms of high potassium levels — heart palpitations, shortness of breath, muscle weakness — and thought, “holy hell, I’ve still got it.”
I checked myself into the ER. They took me right in. My pulse, they said, was shockingly hard and fast.
Yet in the ER, my blood tests came back fine. My EKG came back fine. Everything came back fine. I snatched my test results out of my attending physician’s hands and knew right away that my electrolyte levels were fishy, despite his insistance that they were fine.
I gave up sodium for a day or two and felt a bit better. Every once in a while I’d do that and feel a bit better. But nothing improved.
10 months of chronic anxiety, panic, heart irregularity, and sleepless nights later, I realized that my symptoms lined up perfectly with those listed for magnesium deficiency, right down to insensitivity to noise. (That morning, I had laid in bed crying because I could hear my roommate’s air conditioner running.) One teaspoon of magnesium later (this is my favorite, by the way), and I felt miraculously better. Really, it felt like a miracle. Thump..thump…..thump… my heart slowed. Through the darkness peeked genuine hope for the first time in months.
“Just kidding!” said life. I had been wrong. I supplemented the hell out of magnesium for months but the anxiety, insomnia, and heart racing never really went away.
It was not until another year later, in February of 2014, when I ate an avocado (a high potassium food) and my heart started pounding, that I connected the dots on what had actually happened:
My kidneys started sparing potassium back in January 2012, and, even though I stopped taking spironolactone six months later, the potassium sparing never stopped.
High potassium causes irregular heartbeat, muscle weakness, insomnia, anxiety. Blood tests and doctors and discussion boards all said I was okay on the spiro. But I wasn’t. They said I would definitely be fine coming off of it, but I wasn’t. Yesterday, I ate an avocado. I won’t dare eat one today. Finally, now in the fall of 2014, I know specifically how much potassium I can consume without making my heart race. It’s not much.
I also now know, after doing extensive research, that the precise effect spironolactone has on the kidneys actually up-regulates excitatory activity in the brain. It increases glutamate and decreases GABA. This causes anxiety. I figured this out and almost solved my health problems for good when I began supplementing with GABA and my migraines and anxiety abated…for the first time in years. (This is on of the GABA supplements I like) The whole story and it’s horrible villain is now crystal clear: spironolactone stole my peace of mind, and maybe even my sanity, at least a little bit, for years.
Spironolactone has been the primary influence on the quality of my life for the last 34 months. Throughout that time, it never won the war. I wrote a few books. I got a degree. I had my willingness to keep pushing forward in life bolstered by my discovery of partner dancing, which truly was, as my mother continues to insist, what really saved my life. Today, I can happily say that I am at peace, and relatively carefree, and excited about the future, and maybe even genuinely happy, most of the time. I figured it out. I really did. It took me so long, and it was so hard, but I made it. I figured it out. My health problem had a cause… I just had to stay committed to recovery and doing everything I could to find the cure I needed.
But I will say that the spiro won way more of the battles than I’d like. My life during those two and half years was at times unbearably difficult. I don’t know how long my heart will be prone to beating like this. I still sleep extraordinarily poorly. I don’t eat like a normal person, nor do I make plans or schedule my life like a normal person. Yet perhaps worst of all is that spiro stole my innocence. Spiro took me to the dark side of what a human mind can feel and do. I am incapable of forgetting just how terribly, insidiously dark that is.
This is the story of the drug that killed me.
(For help with anxiety – well, I’m writing a book on it now, but I also highly recommend this book — it is the go-to anxiety-manager for psychologists who know their stuff. The Mood Cure and The Anti-Anxiety Food Solution are all fantastic reads as well. And if you’re interested: GABA and Magnesium both can help with anxiety. Find GABA supplement here. Find magnesium here. )
Somewhere in the neighborhood of 40 percent of women report having “sexual dysfunction.”
This was, for me, on first encounter, an astounding statistic. That’s practically half of us women!
Upon further reflection, however, the statistic makes perfect sense to me. To be honest, I’m surprised the number isn’t higher. With such high rates of negative body image, obesity, eating disorders, depression, anxiety, and stress in female lives in America, not to mention all the sexual objectification and denigration that happens in culture at large… it seems as though almost none of us should be getting by unscathed.
There are plenty of physiological reasons libido can be off, and plenty of ways to troubleshoot that with diet and lifestyle changes . You can also read my book “Sexy by Nature”which addresses all of this and my thoughts on it here.
Perhaps even more important than that, however, are psychological problems. Psychological problems, ranging from doubts about your body’s appearance to lack of trust in your partner, cause undue worry in the female brain during sex. If your brain is anything other than 100 percent relaxed and “in the moment,” it’s going to be much harder to enjoy yourself and orgasm is going to be approximately 1500000% harder to achieve than otherwise. This is a simple fact of female physiology.
These are these psychological roadblocks to satisfying sexual activity I see most often in my friends and clients (and please note, before reading ahead, that I use explicit language and talk about explicit sexual things, so if that isn’t your cup of tea, feel free to stop now, no hard feelings. 🙂 ):
1) Thinking your lady parts are “gross”
I remember being twelve years old on the way to dance practice in the back of my mother’s SUV being told by my “cool” friend that I needed to shave my pubic hair if I wanted to be sexy.
I also remember experiencing feelings of disdain for this friend, since I obviously already knew that.
I also remember making jokes about vaginas smelling badly, and tasting badly, and being all around just horribly unpleasant.
This made me never want to inflict my body on anyone. If my vulva were so gross, how could I possibly expect any man or woman to enjoy it? If they insisted on pleasuring me anyway, how could I be sure it was because they really wanted to? What if they were grossed out the whole time?
Okay, ladies. This is the most important lesson about our sexual selves I think we could ever learn:
There is no valuative difference between a penis and a vulva. No smell, taste, sight, or feel of one is better than the other. Neither are “gross.” Any person or any media like a movie (or porn) that leads you to believe so is not just wrong but possibly evil.
If you want to read what our partners (and men in particular) REALLY think about the vulva, its taste, its smell, and what they are really thinking, you’ve got to read “She Comes First” by Ian Kerner. It will open your eyes!
And if your partner is one of those evil doers, it’s time to have a conversation about what’s going on, or to show them the door. This is not a joke. Your body is straight up awesome. It has the ability to give both you and your partners pleasure (here for male pleasure, here for female!). It is a wonderland. No one has the right to take that away from you.
You are not gross. Society’s double standards about the impurity of female bodies has only made you feel that way.
2) Feeling self-conscious about the way your body looks
If you’re laying in bed and trying to think of sex positions that can hide your rolls rather than enjoying the ride, that’s a giant road block to both connection with your partner and also physical pleasure.
Nothing kills a libido like self-doubt.
Fortunately, there’s a fantastic remedy to this problem. It’s remembering three simple facts:
1) The sexiest woman alive to any person having sex is the one right there in the bedroom with them. Sure, Jennifer Lawrence may be a physical specimen, and Giselle Bundchen may have “perfect” proportions, but neither of them are a real person with your real partner in a real room.
2) Nobody will get into bed with you if they find you unattractive. Period. Initiating or consenting to the sexual act means that this person wants to be there. So get out of your own head. Stop worrying about the way that you look. This person finds you sexually appealing for one reason or another – there’s absolutely no way to ignore this fact.
3) The last thing any person you’re sleeping with wants you to be doing is worrying. That’s ridiculous. What they want is for you to be thinking about them and having a good time. So do those things. Don’t disrespect yourself or your partner by being self-conscious. Trust your partner’s desire, own every inch if who you are, and let yourself move comfortably in your own skin.
I know letting go of self-consciousness in the bedroom is easier said than done, but it’s incredibly empowering. Plus, once you begin doing it, you can’t stop. Self-love is powerful, and infectious.
3) Feeling ashamed of sexual desire and activity
As women in American society, we are taught (if subconsciously) that we are dirty and immoral if we have sexual desires. We are told that our bodies are primarily objects of sexual desire. Men want us, but we don’t want them. Men lust for us, but we don’t lust for them. Men always have orgasms, women sometimes do. Men’s sexual desires are supposed to be robust and lusty – marking them as strong “men.” Women’s sexual desires are supposed to be shrouded in burkas and locked away beneath chastity belts.
Mark my words, however:
this is bullshit.
Women have every right to be sexual, just as much as a man. Women are free to have desires – even non-monogamous ones! – and to have them be pleased. (My FAVORITE book on that topic is this one, you’ve got to read it!)
I cannot tell you how many women I’ve spoken to who have never had an orgasm in bed because it just “wasn’t her place.” So many women are focused on pleasing their partners, and keep quiet about their own needs.
In American culture as a whole, we tend to radically favor the male orgasm in bed, and to deny the importance of female pleasure.
But this is wrong. Your needs are normal. They should be met as equally – whatever they are! – as your partners are. You should be in the bedroom to take care of and entertain each other, not for you to be a subservient, unfulfilled sex toy.
So – if your sex life is unbalanced, consider if that’s because of your partner’s attitude, or your own. Consider why you neglect your own pleasure. Challenge yourself to accept this part of yourself. Challenge yourself to be in conversation with your partners about this. You will never get to experience pleasure if you do not welcome it into your heart.
4) Not having a safe space in which and partner with which to be sexual
This almost goes without saying. If you don’t trust your partner, like your partner, or have pleasant sexual experiences with your partner, you will never feel comfortable in bed with your partner.
If you do not feel comfortable, you will not have an easy time experiencing physical or psychological pleasure.
The solution to this problem is entirely contingent on your own particular situation. Perhaps you need couple’s therapy. Perhaps you need to have a conversation about each other’s doubts and desires. Perhaps you’re in an irredeemable relationship that you need to get out of. Perhaps you pick up random strangers who don’t always treat you very well. Perhaps you and your partner simply need to remember how to laugh with and love each other.
5) Worry about your sexual skills
Lots of people spend all of their time in bed worried that they’re not doing it “right.”
The only way to know if you are or not, however, is to ask. Every person is different, and every person has different tastes and desires. You’ll never know if what you’re up to is good for your partner if you do not communicate about it.
Moreover – the most important aspect of “skill” in the bedroom is the willingness to experiment, to listen, and to give and receive feedback. It’s not about how many partners you’ve had or how many sutras you’ve practiced. It’s about your desire to give pleasure and experience connection, and to communicate. Don’t worry about your performance. Simply be, and talk, and ask questions if you want answers.
There are two books that I really like that can also help with the concrete skills of sexual performance as well. Find them here and here.
6) Being too stressed to think about sex
Any thought that takes you away from your partner is going to diminish the quality of your sexual experience. This is true for all people, but it is especially true for women. Your body craves sexual activity only if it perceives a great enough state of safety in your life to enjoy it.
Stress makes you dwell on problems and prevents you from delighting in the blessings in your life.
The best way to mitigate this problem is to reduce the amount of stress in your life. This liberates your day dreams to wander into the realm of the explicit and the naughty, and it makes your heart free to reflect on love. If you absolutely cannot eliminate certain stressors, do your best to set aside time for sexual activity. When you do so, check your worries at the door.
Give yourself the time and space you need to be fully present – not locked in the past nor anxious about the future – and the depth of connection and pleasure you and your partner both experience will skyrocket.
But what does any of this have to do with paleo?
As I’ve argued many times before, there is the paleo diet, on one hand, and then the paleo perspective on the other.
Paleo provides us with a lens with which we can examine our lives. At least this is how I like to look at it. Paleo asks us to question social norms, and to think deeply about where our beliefs and habits come from. Just about everything we think, say, and do is cultured by the world in which we grow up. It is helpful for us to analyze those things (I do a lot of that in my book!), so that we can do away with the unhealthy ones.
Thinking a woman’s body “gross,” for example, is one of those things.
Paleo also asks us to think about what is “natural.” Is it natural to have sexual desire? Natural to have an imperfect body? Natural to receive pleasure without feeling guilty? The answer is yes to all of these things. Thinking about humanity in evolutionary terms helps us see that. Many groups – such as the evangelical Christian sects that promote purity vows in young girls – don’t think much of evolution, and this ends up being a significant hindrance to healthy and happy sexual activity.
(My favorite book on the naturalness of sexuality and questioning social norms [not my own!] is this one.)
Sexuality is an important part of relationships and life. There are physical aspects of that – which the paleo diet certainly helps, as I’ve discussed at length here – and there are psychological aspects of that which are also fun and important to look at with an evolutionary lens.
Whether or not birth control causes weight gain is a topic of gigantic controversy in the health literature. More than 50 percent of women think that it does, and up to 20 percent change their pill or go off of the pill because of this belief (here, here, here, here, here, here, here and here.).
Yet most researchers don’t believe these women!!
Really, they don’t. It is possible that they are right to do so. Most studies indicate there isn’t much of a statistical effect on weight maintenance in the long term at all.
Nonetheless, even if there is not a statisitcal significance for the population as a whole, individual women can and often do suffer from weight gain when on the pill. Whilemany call weight gain a “myth,” I do not. I simply know too much about the biochemical theory and have talked to too many women about their experiences to do so.
My book “Birth Control Unlocked” can help you find a form of birth control that will work best for your body and my book “Weight Loss Unlocked” can help you healthfully bring your weight back into balance.
The means by which weight gain happens, I believe, are multi-fold, and I’ll go through all of them below. First, a quick primer on birth control will get us set up to understand how it all fits together.
How birth control works
Almost all forms of birth control contain hormones. There are a few that do not. Prophylactics such as condoms are obvious exceptions, as are the methods of tubal ligation — getting your “tubes tied” — and the Fertility Awareness Method, which basically helps you chart your fertility cycle so you know when to avoid unprotected sex in order to avoid pregnancy. The final and most popular form of non-hormonal birth control is the copper IUD. The copper IUD is expensive, however, and it comes with risks of copper toxicity as well as side effects of cramping and heavy bleeding.
Most women therefore end up on hormonal birth control. The way that it works is quite simple: the body cannot ovulate if there is progesterone in the bloodstream. Therefore, all hormonal birth control options contain some form of synthetic progesterone. Some of them have estrogen added into the mix because some women need it in order to achieve the best possible hormone balance. These options are most popular in pill form, but can they also be found in the form of a patch, an injection, an implant, a vaginal insert, or an IUD.
Why weight gain is not quite as much of a problem as it used to be
Back when the birth control pill was first invented in the 1960s, there was nearly 1000 times as much progesterone and estrogen in the pills as there are now. This is an extraordinary comparison. Back then, all of the side effects including weight gain were much more severe and much more common, simply because the amount of hormones were that much higher.
Moreover, many women today experience a “normalization” after starting on the pill. There may be an initial period of weight gain, but after three months of use the symptoms lessen. Biochemically, this makes some sense, as the pituitary gland learns to accomodate the exogenous hormones.
Finally, as I stated before, even though most women think birth control causes weight gain, statistically, it doesn’t really seem to. Meta-analyses of dozens of investigations have concluded that hormonal birth control does not significantly affect body weight or composition, at least not without statistical significance (here).
Why weight gain is still a concern today
Even while most women do not experience weight gain while on the pill – and especially if they find the “right fit” for them – some still do. Moreover, certain formulations of birth control may be more antagonistic to maintaining a healthy weight than others. For example, in one study, Depo-Provera users gained ten pounds on average over the course of 18 months.
So far as I can tell, there are three ways exogenous (exo = “from the outside”) hormones can influence your weight:
1) By increasing appetite,
2) By causing water retention, and
3) By increasing the rate of fat deposition
What does science have to say about each of these categories?
1) Appetite increase
Contrary to what you might otherwise guess – and to that which is broadly opined on the internet – estrogen is an appetite suppressant. How is not totally understood, though it is widely thought that estrogen spontaneously decreases calorie intake by increasing the potency of the satiating actions of some gut peptides, especially cholecystokinin. The more cholescytokinin produced by the gut, the more full the brain feels. Moreover, estradiol stimulates anorexigenic (stop eating) POMC/CART activity and inhibits orexigenic (keep eating) NPY/AgRP neurons.
Estrogen appears to boost all of of these things, in both rodents and humans. Rats that have had their ovaries removed, for example, spontaneously eat more and gain weight. When injected with estradiol, their normal feeding and weight behaviors are restored.
Progesterone on the other hand appears to stimulate appetite. This is the case with rodents as well as with humans. First it blocks estrogen’s satiating effects, since estrogen and progesterone often act as counter-balances to the body. It also stimulates appetite all its own. This could be why you want ALL THE DESSERT as it gets close to your period.
For the record, testosterone increases appetite, too – which is relevant for women who have PCOS or elevated testosterone levels. It also tends to promote fat storage in the abdomen rather than in “female fat” areas like the hips and thighs. Minimizing testosterone levels by minimizing stress and overcoming insulin resistance is a great way to help lose weight and regulate food cravings.
Hirschberg, 2012. Click to zoom.
2) Water retention
Formulations of the pill that have high quantities of estrogen and progesterone or that are especially high in estrogen may cause water retention.
Estrogen causes tissues to reabsorb sodium, which increases sodium levels in the body’s fluids. Elevated sodium causes water weight, because the body balances the extra sodium with extra water. The more sodium you have floating around in intercellular space, the more water your body is going to send to that space.
Estrogen can puff you up a whole pant size based on water weight alone.
- Progesterone, on the other hand, also causes sodium retention, but it doesn’t store it in the same free-floating space as estrogen it does. Instead, it tends to work more on regulating other important hormones in this process, which down the line causes extra excretion of fluid rather than retention. Thus, progesterone is somewhat of a diuretic.
- A low-dose, well-balanced pill should not cause water retention. High-dose and especially high estrogen pills can.
3) Fat deposition
THIS IS WHERE THE WHOLE ISSUE GETS INTERESTING.
Again, estrogen is commonly blamed for the birth control problem. This is somewhat fair. Estrogen promotes fat storage, and particularly in the female areas of the buttocks, hips, thighs, and breasts.
However – the true villain in this story is a certain class of progesterone.
Not all hormones are created equal. One major component of this whole discussion I’ve so far glossed over is the fact that the “hormones” in birth control pills are not actually natural female hormones. They are synthesizsed in laboratories, normally out of plant proteins. Yams are a favored estrogenic contributor to birth control pills, used to synthesize the most popular form of estrogen, “ethinyl estradiol.”
So hormones are synthesized in labs, and not all of them are created equal. There are eight classes of “progestins.” They can be broken down into three broad categories: progestational, estrogenic, and androgenic. Those which act more like male hormones in the body are androgenic.
Research suggests that older varieties of the pill that used more androgenic progestins caused the greatest weight gain. Newer formulations with less androgenic progestins may cause less weight gain according to several studies, such as here, here, here,here and here.
Some more androgenic varieties – ones you might want to avoid, are levonorgestrel and norgestrel. It’s worth noting that levonorgestrel is the most commonly proscribed progestin worldwide.
The three least androgenic forms of progestin and the ones you may want to keep an eye out for if weight gain is a problem are norgestimate, desogestrel, and drospirenone. (But drospirenone has its own risks – read about them here and how they almost killed me here.)
Androgenic progestins like levonorgestrel are still in use for a few reasons. One is that they simply are not a problem for weight gain for the majority of people. Another is that these specific progestins are better at mitigating the risks of estrogen-containing pills than other progestins. They provide better balance. Better balance appears to decrease the risk for vascular thromboembolism and stroke – which is why androgenic progestins are the progestin of choice in most countries. Whichever kind of progestin is right for you is your and your doctor’s own decision.
To sum up my research:
-Pills high in progesterone – or that do not have estrogen at all – may increase appetite and therefore cause weight gain at least in the short term
-High quantity pills may cause water retention
-Pills high in “androgenic” progestins appears to cause more weight gain than others (norgestimate, desogestrel, and drospirenone)
So does the birth control pill cause weight gain?
In the majority of women, the birth control pill does not cause weight gain, especially if she is on the pill for more than three months. However, studies are conducted on hundreds if not thousands or tens of thousands of women at a time, so even if the average experience is to maintain a steady weight, there will be women who are not average and who do not maintain a steady weight.
Weight gain is listed as a side effect for birth control for a reason. It doesn’t happen to everyone but it does happen to some. Androgenic pills may cause the most weight gain, and water weight and appetite can also come into play. In order to best navigate these options and minimize the side effects you experience on the pill, aside from purchasing my book on the topic, continue reading on this topic in the next installment, How to go on birth control without gaining weight.
More on weight loss for women!
This kind of insight and information is super rare to find online. Rarely do websites that talk about hormones go this in depth into personal experiences and deal with the possibilities of side effects and how to mitigate them (Women to women, or webmd, anyone?). Fortunately, I am one of the few researchers interested in them, and from a paleo perspective!
And many kickass paleo authors are, too!
As luck would have it, 20+ of my favorite paleo weight loss revolutionaries… Diane Sanfilippo, Chris Kresser, Dr Sara Gottfried, me… are getting together for the next three weeks and sharing all their new tricks and tips and their own particular insights (I give a talk on birth control that contains information much like this!)… in a series of FREE talks.
While the event is going on, it’s 100% free. It’s a summit on weight loss, for women only.
Check it out and find more sweet info like this, if you’re into this sort of thing, @ http://forwomenonly2014.com.
And if you’re interested in a great resource that you can read and benefit from today, check out my excellent book on women’s weight loss “Weight Loss Unlocked” here.
What follows today is a hell of a monster of a behemoth of a post. It’s nine single-spaced pages in Microsoft word. This bulk amounts to around 5000 words. This is not a number to sneeze at. In fact, it is regarded as a number that screams “don’t go there! You’ll lose all your readers!” to any blogger who knows just about anything about just about anything.
Nonetheless it is one of the best blog posts I have ever read (because I certainly did not write it). I thought I’d roll my eyes a paragraph in, click the little red X in the corner, and be on my happily scheduled productive way. Instead I was sucked in by line 2 and read every single word, a torrent of emotion and insight and stunningly beautiful prose.
I could go on, but I’ll let you see for yourself.
This is the story of Elissa Washuta and her body. It is full of so much love and hate and love and hate and fear and hope. Few stories can show us better (and have shown me better) the visceral truth of what it means to be a human animal in a concrete word.
Stab Wounds: Killing My Gallbladder, Wounding My Brain
An Essay by Elissa Washuta
I was twenty when the nausea came to stay. The feeling coiled around my stomach one morning when I woke up beside my boyfriend, picked my way across our fallen textbooks, and dry-heaved in his moldy bathroom. Every week, as directed, I had pressed a fresh birth control patch onto a blank expanse of skin. We wanted so badly to draw on the patch, but the prescribing instructions had forbidden it, so we sharpied beside it, around it, and all over each other’s torsos. No fetuses, he wrote on me, and drew a tadpole with a line through it. Ever since I was old enough to cover my scrapbooks in stickers of Mr. Yuk and unicorns, I was compelled to coat my life in adhesive badges.
As I sat on the grimy toilet and a phantom python tried to force all intruders out of my empty gut, I worried, transdermal ethinyl estradiol and norelgestromin notwithstanding, that the linty-edged sticker on my ass was no more magical than the neon Lisa Frank teddy bears that covered my fifth grade diary.
Hours before the roommates woke to shuffle off to class, my boyfriend drove me to the pharmacy. I bought three pregnancy tests for good measure. I peed out a negative. The attacks of nausea persisted, soon leading to pains that would break open my right side with an invisible shiv, then swiftly retreat. Over the following weeks, I lost my ability to stomach frozen pizza and box-mix brownies, and my diet moved toward hard liquor and liquid sugar. I was not pregnant, but I felt something inside me alive and howling.
This was 2005, and as a college sophomore and a hypochondriac since puberty, I learned to take my visits to Dr. Google to the next level. Swinging between starving and nauseated, I haunted WebMd and PubMed until my symptoms and family history locked into perfect alignment. Nothing sounded more elegant than porcelain gallbladder. I said cholecystitis over and over, as though a hidden door would slide open and show me a new world of hurt that was a cold, clinical alternate dimension. My own world had flipped from bright to hostile halfway through sophomore year, when my campus turned from brochure-bright to haunted. My bones felt rocked by the constant thuds of big university life: basketball-inspired couch-burning, rabid chants of obscenities upon every Maryland win or loss to Duke, and rows of Mid-Atlantic brick behind unwelcoming white columns. Rage, joy, and thirst seemed to have been written into the college’s charter. There was a time when I saw none of that—when my school was a place for learning.
My mother, a nurse at the county hospital back home, made the arrangements I requested while I kept my focus, as usual, on my grade point average. I traveled home to New Jersey to visit a surgeon. I told him my guts were tangled. By his order, a radiologist shot me up. When I asked about what I was going to feel, she told me, you may experience the same discomfort that brought you to your physician.
Cholecystokinin, meant to send my gallbladder into a panic, spread everywhere, from the crook of my elbow to my eyeballs. A radioactive tracer chemical collected in my liver to light up my hepatobiliary system under the gaze of the gamma camera. Will this stuff make me a superhero? I wanted to know. I needed protective powers of all kinds—self-defense and then some. She wouldn’t answer. Soon enough, I only wanted to save my own gut, empty my veins onto the gray floor. As my gallbladder seized, wrapped by the atomic-radiated python, clenching with ten times its normal strength, I implored the snake, Kill me, kill me here.
I knew the flesh was dead inside me before I had to be told. The surgeon summoned me back to his den. He said that I had no stones, but the organ had ceased to function. He gave it to me in brief, wasting no words: the gallbladder’s job was to release bile into the duodenum as food passed by, emulsifying lipids, but it had gone kaput. He could take it out, the liver’s bile ducts would enlarge, the liver would take over the gallbladder’s job, and everything would be beautiful. There was almost no chance that open surgery would be needed, as the whole shebang would be laparoscopic. There was a ten percent chance it wouldn’t work out. Meaning, what?—my mom wanted to know. I don’t remember what he said—something abstract, I think, about the bile ducts being unable to enlarge to compensate for the loss. I only know that his words weren’t gruesome enough to stop me from telling him that I needed him to cut it out of me.
While I waited to be opened at the end of 2005, some of my college friends mused that nobody really needs a gallbladder anyway. Others asked if I could get a transplant.
Things I don’t need: my kitchen; my eyeglasses; my hands; my lips. I puked thin green chemical spills. I convinced myself that I could live like the saints I venerated throughout my Catholic upbringing: the self-flagellators, the hairshirt enthusiasts, the starvation devotees. I ate nothing but Cheerios and soy milk, read every food label, consumed no fat for weeks. Kill me, kill me here.
As finals week approached, students began leaving their customary offerings to Testudo the terrapin, the bronze idol of our mascot that lives on a pedestal outside the library. The gifts have become more elaborate in recent years, but back then, standard offerings were coins, flowers, votive candles, pints of booze, to-go coffee. I left nothing. I wouldn’t even rub his nose for luck when I passed, the standard turtle greeting. I didn’t want luck, a purposeless force shaping my life without my control. I wanted to put my hands into my own works, broken by the unknown forces of illness and the known force of another person’s venom, and finally set myself right.
The person close to me who had no gallbladder told me not to go through with the surgery. “If I had to do it all over again, I don’t know if I would,” he said. I don’t even remember what else he said, because I couldn’t listen: all I wanted was to be sliced open so that the thing rotting deep inside me could be snipped out. I wanted my innards to be scrubbed clean with antimicrobials. I wanted the team to give me a brand new body. I wanted to tear open the cellophane and start over on my life. I must have told him that I was going to go through with it, because I did.
Right after Christmas, at age twenty-one, I put on a gown, asked for an IV in the back of my fist instead of my perpetually bruised fencing arm, and faced the knife. Nobody told me, in dramatic cinematic fashion, that I could back out anytime. I was Hibiclens-clean, properly foodless, and eager. The dream team was ready for the minor abdominal surgery that would be easier to my surgeon than an application of eyeliner was for me. Right before I went out, as I entered the bright operating theater, I thought, They will take off these clothes they gave me, and then they will open me, and I won’t even know if I die naked.
The women watching over me in the post-op recovery room wanted numbers. Seven, I yelled. Seven, again. I’m sorry, I cried. Seven. They said they’d hit the morphine ceiling. I had no eyeglasses. They silenced me with Demerol. Finally, my frontal lobe had been overtaken.
In the bed they said was mine, I was more nauseous than I knew I could be. My gut looked like an alien pregnancy, big but not happy, marked by four tiny cuts. The nurse called them stab wounds: a hole for the camera, a hole for inflation, a hole for snipping, a hole for yanking out the thing. She said that when they were trying to get the gallbladder out of that tiny hole, my belly would have been stretched so far away from my body it was like a cartoon.
The nurse said I could only leave after peeing, which took half the day. My mom sat with me in the bathroom while I tried to get empty. I went two drops and Mom made the announcement.
I was told not to fence for a month. While the morphine nausea persisted, Mom read me short stories and I hid from the light; after the drug wore off and I beat at the throbbing with vicodin, I busted the stitches on one of my stab wounds as I slipped off the couch after a fallen saltine while watching a 24-hour marathon of 24.
I thought about the flaws in my fencing game, picturing my broken body vertical, functional, flexible. I thought about my sweet boyfriend back in College Park, waiting for me to come back and play house. I spent a lot of time with my laptop sitting hot on my stab wounds as I Googled words I’d been afraid to look at for a year: post traumatic stress rape trauma date rape acquaintance rape college rape statistics denial. My stab wounds began closing over, starting with the smallest one, while the two longer lines refused to swallow their stitches. I couldn’t eat without feeling my insides sloughing off. Was it normal to hand in nausea and receive the runs in return? The photocopies from the hospital said nothing about it—I had been instructed not to make any important business or personal decisions for 24 hours following surgery, not to engage in sports until my physician gave permission. In bold capital letters, I had been told to make arrangements for someone to stay with me for the first night. I had not been told about the achy sojourns between toilet and couch, my incisions screaming. Creeping my way up the stairs, I worried that wide gashes would be torn across my punctured abdominals. At my destination, I’d remember that my wounds were buried deep: my liver sobbed over its loss.
My surgeon was inaccessible during an extended European vacation, so I saw the primary care doctor who had told me, before I left for college, to be careful with my virginity—what would my future children think about a mom who had slept with a bunch of guys? Now, she told me my only recourse was Imodium AD. Until when? I wanted to know. This wasn’t a cure, she told me. This was a treatment: two with food, as long as symptoms persist. How long would symptoms persist? Well—how long did I expect to be gallbladderless?
What’s worse: nausea or the shits? Going to work or being bedridden? Having an organ never work again or never getting it back? A heart full of fear of the imagined first time having sex or a head wracked by memory of the known experience?
Here comes the Ow.
After three weeks on the couch, I went back to school. No surgeon was around to tell me not to fence, so I took up my epee a month after surgery; I traveled to a regional tournament, got wasted on Smirnoff Ice in the hotel room, woke up still drunk, stuffed my bloated body into my stiff white knickers and jacket, and fenced all day. By evening, I had my first fencing medal, and my topmost stab wound was losing the ends of its stitches as my overworked abdominals groaned. I accepted my shiny disc, dosed myself with vicodin, and curled up among the gear against the wall. During the dark bus ride back to Maryland, my teammates played “Never have I ever,” increasingly scandalous secrets about sexual dalliances coming out at every turn, while I sanded down my brain with pills and told them nothing.
I didn’t notice that my brain was spoiling. It just started getting mean.
I was standing on the subway platform one day, commuting home from work, when I realized that I had been raped that year before, by that boy who had first penetrated me. My heart was a train and it plowed through my head.
I called the campus peer counseling and crisis line and a grown man answered. I told him I thought I had been raped approximately one year ago, by a boy I was just beginning to date, and he said that in his professional experience, women who are raped or sexually assaulted are usually beaten within an inch of their lives, usually have their clothes torn off, usually they’re in pretty bad and bloody shape. I hung up and tried to eat my own mouth so it wouldn’t tell anyone else what I’d divulged.
I began showering at least twice a day. I showered whenever my insides shed while I cried on porcelain, begging kill me, kill me now, a secret held more deeply than any other, because no college student can ever tell the authorities that she wants to die, even if it’s not a true wish to die, but a wish to be physically reborn with new guts, new skin, new hymen stretched like a tarp, like a whip.
I don’t know what lobe of my brain said it, but someone inside my head told my boyfriend, “I need to know what it’s like to be with other people,” and he said he didn’t want to lose me. At the moment of crisis, my boyfriend coming in through the window and my heart flaccid, I knew that, despite the sad scene I had set up so I might rewrite my memory, another boy’s small hand was not the body part I was missing.
I developed a fixation upon a slightly younger boy who had no intention of dating me, preferred World of Warcraft over sex, and hadn’t dropped his baby fat. I left the boyfriend with whom I had psychic conversations and built love forts. I still didn’t eat. My back was the back of my bony fist and I wanted to curl up and bloody the face of the world.
I sat down with my surgeon and told him about the runs. He told me he wished I would’ve come in sooner. This thing had a name, postcholecystectomy syndrome, and if he could name it, he could smite it. He prescribed packets of Questran, a bile acid sequestrant once used to treat hypercholesterolemia, for my bile acid malabsoroption. How long will I have to take this? I asked. It’s cheap, he said. Mixed in some water, you can barely taste it.
Postcholecystectomy syndrome is the name for a bundle of symptoms after surgery, either a continuation of the pre-operative symptoms or the development of new ones. The problems are caused by changes in bile flow into the GI tract.
PCS is found in 5-30% of patients, with 10-15% being the most reasonable range. [. . .]
If the procedure is performed for stones, 10-25% of patients develop PCS. If no stones are present, 29% of patients develop PCS. [. . .]
Freud found age and sex differences.Patients aged 20-29 years had an incidence of 43%; those aged 30-39 years, 27%; 40-49 years, 21%; 50-59 years, 26%; and, 60-69 years, 31%. Patients older than 70 years did not develop PCS. Females had a 28% incidence of PCS, and males had a 15% incidence. [. . .]
Note that half of patients with a preoperative psychiatric disorder have an organic cause of PCS, whereas only 23% of patients without a psychiatric disorder have an organic cause. [SOURCE]
I became certain that I was addicted to love, or romance, or attention, or crushes, or being around magnetic people, or not going to work. My boss at my part-time federal government job said, “You had a major organ taken out. That’s a big adjustment for your brain.” I used all my sick days. I quit the job. I started working all night at the 24-hour service desk in the apartment lobby and then went home and drank alone.
One day, walking in my high heels to the liquor store in the suspended sweat of a Maryland summer, I realized that I might be one of those girls in the glossy magazines—not the ones with concave bellies and hips like dolphin backs, but the ones whose brains are horror stories, cautionary tales about the brinkwomanship of pressing against the edge of institutionalization.
I cut off all my hair. Then I did it again and again and again, daring someone to want me without it.
Until my boss mentioned the connection between my gallbladder and brain, I hadn’t thought they were related. Bipolar disorder may be associated with immune system dysfunction and pro-inflammatory cytokines, though results in individual studies are conflicted, according to a recent meta-analysis. Cholecystectomy has been found to result in cytokine release. I’m not a scientist; I’m a writer. I can’t prove that, when my surgeon cut into my gut, a phantom twin scalpel scored my brain. But the connection between the gut and the brain is coming into clear focus, and I know that when the surgeon took my gallbladder, he performed a lobotomy of the belly.
At the beginning of senior year, in 2006, I saw a psychiatrist at the university health center. According to my questionnaire responses, he found me depressed and prescribed Lexapro. Over the next few months, I would get all the drugs whose names had titillated me as a straight-edge kid in New Jersey: Wellbutrin, Ritalin, Ativan, lithium, and others I’d never heard of. I would break out in a rash signaling a potentially fatal reaction. I would get so depressed my doctor would write notes requesting assignment extensions. I would get so manic I would leap on my bed and think my ribs were god’s xylophone. Almost every day, I drank beer or Grey Goose screwdrivers. When the scale reported the number that was, by BMI, underweight for my height, I jumped up and down.
I gained forty pounds after moving to Seattle and going on a new antipsychotic drug. I would’ve tried to yank all my flesh off my body if the mania hadn’t been sanded down by the Seroquel and the depression by the intense endorphins of all the avocado-hummus-provolone sandwiches I was eating. Seroquel is thought to cause insulin resistance. My new doctor didn’t tell me that; she told me it would be a good drug, and it has been. Years later, she added Topamax, and twenty pounds dropped off. I figured out, through paleo—thank you, Level 4 CrossFit Seattle and Dave Werner—that I had celiac disease, and once I cut out gluten, the diarrhea stopped. Just like that.
The crazy never stopped. I found the right medication cocktail and got better at letting my hair grow out, but I’ll always be bipolar. I’ve seen practitioners who suggest I consider going off my meds. I think about the old days when I’d sit on a pile of high heels in my closet, wondering if I could get away with never coming out again, hoping if I starved for long enough my exhausted hepatobiliary system might reset and sprout new buds, wishing I could tweeze the pain from my skull. None of that happened. I spent seven medicated years writing a book about my body and my brain, and the regular wringing-out mechanism wore out every nerve until the shock of my brain’s tangle had worn off. I wrote the word rape, once as off-limits as a secret password, until it didn’t look like a word anymore, and rebuilt it as something I could begin to understand.
The only thing to do is find the wound and rub in the salve.
There’s a lot of talk in the paleo community about the over-prescription of psych drugs, but my meds keep me functional. Maybe I wasn’t born broken, but I’ve been broken into, and someone walked away with my treasures. There is too much at stake to try to disavow the chemicals that have patched my world back together. I hear, too often, that we should all be able to mend ourselves with the right food, the right movement, and sunshine. It’s easy to tell people they don’t need drugs when you don’t know what it’s like to need drugs, to wander around all night hoping you’ll find the end of the earth, to pummel the floor with another panic attack, to self-medicate with another handle of vodka because the right medication still hasn’t appeared. Maybe I could find the right combination of foods and movements that could replace the meds, but I could lose my mind while searching. This much is irreversible: I needed to get some dense nodule of hurt out of me, and so I agreed to that surgeon’s swift medicine and made wreckage of myself. I am no longer the intact human who arrived on this earth in 1984. I will do what I need to keep my brain from taking me down.
My moods are fairly stable now, the bipolar peaks and valleys having been evened out by medication and good practices. I still have a fat gut on my skinny, flamingo-legged frame. I still have keratosis pilaris—chicken skin—on my upper arms and thighs, signaling possible nutrient absorption problems. A couple of years into paleo, I developed dramatic cystic acne that comes and goes, seemingly related to a mysterious family of food intolerances (possibly, it seems, as broad as all salicylates). I have other symptoms. I still have a gut feeling that I am a destruction site, and now, it’s informed by too much knowledge: bad choices, genetic mutations. Regularly, I take 5-MTHF, fermented cod liver oil, offal, chicken foot broth, gelatin, butyrate, l-glutamine, ox bile, and so many other talismans to charm the snakes inside me. The most terrifying part is that nobody really seems to know how to make my snakes sleep—I try and I err and I eliminate foods until almost nothing remains. Humans are resilient, but we are not unbreakable, and the mending process is consuming me.
Almost ten years have passed since I was raped in my campus apartment by a boy who had my consent for kissing, for more than kissing, but not for the breaking of an emotional seal I feared more than anything: first-time sex. I suppose I could say I have “healed” in that I no longer act out in direct response to my tangled emotions. But it’s hard to say I’ll ever really get over being raped when I know I had my gut mutilated because I wanted to scalpel out my own crawling brain, my own dark heart. I thought I loved my illness, once it arrived. But in truth, I loved that it gave me the power to point to a part of myself and order its execution.
Last week, my friends and I went to the mystical bookstore. I don’t usually go for the new age stuff, being an actual Native person, but I like a good field trip. I went right for the table covered in stones: pink stones, green stones, crystals, stones with high polish. While Claire examined the pendulums, Catherine read from a book about the stones that could give me power, the stones that could heal me. I found a strand for my left wrist, a strand for my right, and a ring. This stone provides energy and protects from bad vibrations; this stone makes one invincible in battle. I know, in truth, as I put my hands into these stones, that they move nothing but my mind. Maybe, now, I need to stop shunning luck, start rubbing the terrapin’s nose and asking for intercession. I am tired. Keep my tissues untouched. Give me no other cure.
Elissa Washuta is a member of the Cowlitz Indian Tribe.