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paleo and cramps by stefani

Paleo and Menstrual Cramps

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Ever think that menstrual cramps are just a fact of life?  That every woman has them?  And even if they don’t, that you are just one of the unlucky ones?   I call BS!  Cramps are actually a symptom of an underlying problem.  They can be cured.  The only thing that is required for that is to look at the underlying causes.  Once those are taken care of, the cramps almost always go away, or at least are eased considerably.

An important side note before getting started is that the same problems that cause cramping are the ones that cause a heavy menstrual flow.  Managing to cure one almost definitely cures the other (presuming that what is being handled is primary dysmenorrhea, not a form of  secondary dysmenorrhea caused by an underlying physiological abnormality).  This would be helpful for a lot of women.  Heavy blood flow reduces iron levels and can make women weak, woozy, and anemic.   What’s worse, a heavy period is arguably the biggest pain in the ass on the planet.

There are three respects in which a natural, paleo approach can ease the pain of and even cure menstrual cramps.  They are curing micronutrient deficiencies, cooling inflammation, and restoring hormonal balance.

Micronutrient deficiencies, cramping, and a paleo diet

Micronutrient deficiencies are a problem for menstrual cramping because micronutrients are key components in the contraction and relaxation of muscle tissue.  Electrolytes in particular, which would be potassium, calcium, sodium, and magnesium, all have well known muscle-relaxing effects.  In fact, deficiencies in any of these nutrients is the primary cause of muscle cramping elsewhere in the body.   Magnesium especially.   With adequate intake of each of these nutrients, as well as the whole slew of micronutrients and vitamins that are enriched on a paleo diet, the intense pain of abdominal muscle cramping can be eased.

A paleo diet maximizes micronutrient intake by the simple fact of keeping a woman’s diet within the range of whole foods.   This helps first by eliminating sources of empty calories.  Empty calories include all desserts, breads, baked goods, sodas, and wheat products.  They contain almost nothing of nutritional value, except for perhaps some B vitamins and a bit of these micronutrients, but all of these nutrients can be obtained from animal and other plant products in much higher quantities.

Moreover, empty calories, particularly wheat-based calories, have downright negative effects on nutrient absorption.  Wheat foods contain proteins called lectins, which bind with micronutrients strongly enough that they prevent normal digestive chemicals from being able to absorb the micronutrients themselves.   For this reason, empty calorie foods such as bread can actually make an individual’s micronutrients pass right through her.  When a woman replaces these empty, or even micronutrient-stealing calories with vegetables and animal products, she naturally increases her intake of just about every vitamin and mineral.  Foods that are particularly rich in magnesium include nuts, cruciferous vegetables, and halibut.  Foods rich in calcium include sardines, dairy products, cruciferous vegetables, and meats.  Foods richest in potassium are bananas, avocadoes, tomatoes, cruciferous greens, and salmon.    Organic vegetables have higher proportions of nutrients than inorganic ones.

Vitamin E has been shown by itself to reduce the pain of menstrual cramping.   Good sources of vitamin E are cruciferous vegetables such as spinach, turnip greens, broccoli, and chard, almonds, peppers, asparagus, tomatoes, and carrots.  Vitamin E is also available in high amounts in meat products.  Most importantly for paleo dieters, vitamin E is four times as concentrated in grass fed meat than feed lot meat.

Inflammation, cramping, and a paleo diet

A paleo diet is inherently anti-inflammatory.  Inflammatory agents include gluten, other wheat proteins, sugar, particularly fructose, and omega-6 PUFAs which are found in almost all vegetable oils.   A paleo diet is absent of these.  As a matter of fact, calling a paleo diet an “anti-inflammatory” diet is spot on.  The whole point of adopting a paleo diet is to reduce the inflammation that comes from eating toxins.  Yet the benefit of a paleo diet is not just in toxin removal; it is also in the addition of helpful molecules.  Paleo diets active include anti-inflammatory foods such as grass-fed ruminants, seafood, and vitamin- and anti-oxidant- rich plant products.

Reducing inflammation reduces the body’s hyper-reactivity to uterine physiology.   With a calmed immune system, a woman’s body will not leap into inflammatory hyper-drive.

The most important molecule to focus on in a discussion of muscle contractions and menstruation is prostaglandin.  Prostaglandin is an inflammatory eicosanoid, and it’s responsible for the contraction of muscles around the uterus at the time of menstruation.

The precursor to prostaglandin is arachidonic acid, an omega-6 fatty acid.   Arachidonic acid has positive effects in the body, since the inflammatory process is necessary for homeostasis and maintaining optimal health, but when consumed in excess, it provides ample material for the body to mount inflammatory processes.  Arachidonic acid is found naturally in animal products, particularly meat and egg yolks.  This has caused many conventional nutritionists to demonize meat and egg yolks.  Yet AA is also derived from the consumption of linoleic acid, another fatty acid, and linoleic acid is found in great amounts in soy, corn, and vegetable oils.   A natural level of consumption of AA is optimal, and should be ingested in the natural, animal forms.   With this kind of diet, the ratio of omega 6 fats to omega 3 fats is ~ 3:1 or 2:1, which is considered by most researchers today to be the optimal ratio.   When vegetable oils are regularly consumed, the ratio of omega 6 to omega 3 fats can spike to average American levels, ~ 20:1.  That incites the painful, inflammatory response.  No questions about it.

Hormone balance, estrogen dominance, stress, and a paleo diet

The final and most important piece of the puzzle is hormone balance.  When hormones get out of balance, which is really easy for women today, many things can go wrong.  A woman’s reproductive system is not to be messed with.

What goes wrong with menstrual cramping is that the uterine lining becomes too thick.  With a larger lining, more tissue exists to produce prostaglandin.  Moreover, more tissue needs to be shed, so more and more material needs to be squeezed through a smaller space (women with narrow cervixes are more prone to menstrual cramping).   This also, as I hinted at above, means that the exorcised material will be heavier, and the period will last longer.

Estrogen is responsible for the thickening uterus.  Therefore, estrogen dominance is the primary problem that most women with menstrual cramps suffer from.  Estrogen causes their reproductive organs to go into productive hyper-drive, and their abdominal muscles suffer the results.  If estrogen can be brought back down, a woman’s menstrual problems often cease.

Estrogen dominance is caused primarily by two factors: it is caused 1) by the consumption of phytoestrogens, and 2) it is caused by stress.

Phytoestrogens are naturally occurring plant chemicals that resemble, but are not identitcal to, a woman’s natural estrogen.  What this means is that phytoestrogens enter a woman’s body through her diet and act as estrogen in her body.  In some ways this phenomenon enhances normal estrogen functioning, and in other ways it inhibits the activity and signalling of true estrogen, since it confuses the body’s normal accounting mechanisms.  With both phytoestrogens and true estrogens in the blood, the reproductive organs and hypothalamic receptors do not know how much estrogen to produce.  Sometimes the pituitary will detect the phytoestrogens in the blood and go ahead and decrease it’s production of estrogen, such that a relative balance between estrogen-like chemicals and the rest of a female’s hormones is maintained in the bloodstream, yet other times the pituitary does not detect the phytoestrogens, and it goes on pumping out as much estrogen as it had previously.  In this case, way too much estrogen is floating around in a woman’s bloodstream, and it’s causing all sort of reproductive havoc.  This results in menstrual cramping.  It is also a factor in PMS, PMDD, mood disorders, endometriosis, uterine fibroids, and breast cancer.

Foods that contain phytoestrogens are legumes, nuts, and seeds.  These should be avoided by all women.   The worst of all of them, however, is soy, and is should be avoided at all costs by all women.  Sometimes soy and other phytoestrogens are recommended to women during menopause to mitigate their symptoms, and this does sometimes help with hot flashes and the like.  However, almost always soy leads to decreased ovulation, irregular menstruation, and impaired fertility.   Phytoestrogens may resemble estrogen, but they are not estrogen, and that confusion has plagued the medical establishment and struggling women alike for decades.

A paleo diet eschews soy, legumes, and goes light on nuts and seeds.  For this reason, it is helpful in restoring hormonal imbalance.  A paleo diet also eliminates the toxins I mentioned above which contribute to systemic inflammation, which in turn can incite estrogen production, so in this way it helps restores balance.  And finally, a paleo diet emphasizes natural, grass-fed animal consumption against feed-lot consumption, which minimizes the amount of foreign hormones and foreign hormone disruptors that are often injected into or fed to feed-lot livestock.

A paleo diet also emphasizes organic vegetables, or at the very least washing and peeling vegetables.  Conventionally-grown vegetables are often coated in fertilizers and such that contain potent endocrine disruptors.  It is important, especially during a person’s developmental years, to be as removed from these toxins as possible.

A second cause of estrogen dominance is stress.  Physiological stress from consumption of modern toxins as well as emotional stress from modern living results in a decrease in progseterone production and an increase in estrogen production.  The term “estrogen dominance” was first coined by Dr. Lee, and what it means is that estrogen is higher than the other hormones in the body.  In his book, he talks mostly about how much faster progesterone production falls off in menopause than estrogen production does (by 120 times!).   Estrogen levels may rise in response to stress, but it’s also important to note that estrogen dominance can also mean that estrogen levels stay the same while progesterone and testosterone levels fall.   The only way to insure that progesterone secretion does not stop is to have the healthiest possible functioning HPA axis.  This means reducing stress, both of the emotional kind and the physiological kind.

This being the case, a paleo diet is the optimal course of action.  It markedly reduces all kinds of stress: it eliminates toxins, for example, but it also restores blood sugar balance by eliminating sugar from the diet, which improves mood, and it optimizes dopamine, serotonin, and GABA functioning, all of which are necessary for being in a good mood and having a healthy HPA axis, too.

A caveat: the female response to stress is complicated, and it does not always result in estrogen dominance.  It can, for example, result instead in adrenal fatigue, or in stress-induced hypothalamic amenorrhea.   In both of these cases, hormonal disruption does not lead to estrogen dominance.  Yet in women with menstrual cramps, it is almost certain that this is the case, since excess estrogen is what causes uterine excess.

As a final note on hormone balance, being overweight contributes to estrogen dominance.    Almost all human cells carry an enzyme called aromatase.  What aromatase does is convert testosterone into estrogen.   This means that if aromatase activity has increased in a woman, her estrogen levels will spike, but her progesterone levels will remain the same.   The reason this happens in overweight women is because aromatase is highly active in fat cells.  Worse than that, however, is the fact that aromatase activity begets more aromatase activity, such that being overweight can create a vicious cycle of fat gain and estrogen production.  Many overweight women exist in a state of constant aromatization and estrogen production.  One way to mitigate this problem is to stop consuming aromatase-exciting foods such as soy, and to instead eat foods such as cruciferous vegetables which activate enzymes in the liver responsible for clearing excess estrogen out of a woman’s body.   Another way to mitigate this problem is with natural, non-restrictive weight loss.  A paleo diet provides just such a template.


One final way to restore hormonal balance and alleviate menstrual pain is with exercise.  Exercise boosts serotonin levels, and serotonin helps with the pain response.  Moreover, moderate exercise improves mood and mental clarity, improves glucose sensitivity, and better prepares the body to handle other stressors that come its way.

All that said…

hormone balance takes time.   Sometimes results can be seen immediately, but sometimes the body needs months to heal and to readjust the sensitivity of its hormone receptors.  For this reason, all of these steps help with menstrual pain, but patience and stress-reduction are possibly the most crucial steps of all.

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Managing director of Paleo for Women and author of Sexy by Nature.


  1. I have found a combination of paleo diet / anit-inflammatory diet (gluten free is highly linked to a decrease in symptoms in many anecdotes), omega 3 (which reduces production of the prostaglandins related to cramps), vitamin D (interesting study done recently on vit D and cramps) and magnesium, plus exercise all add up to a significant reduction if not elimination of cramps in most women.

    • Excellent point on the vitamin D! Any chance you could direct me to that study?

  2. http://www.medpagetoday.com/OBGYN/GeneralOBGYN/31388

    Links to studies are at the bottom of the article

  3. This is the only study on gluten and cramps in pubmed. Lots of anecdotes though. I have a collection!

  4. vey thorough article…i’m glad that the word is finally getting out about estrogen dominance and the link to painful periods. thanks for writing this post!

  5. I did a Google search on this very topic and this was the first thing that came up. This article really gave me food for thought, but I’m on the fence about it. I have had horrible, and I do mean horrible, cramps since the very first day I got my period (I tend to have a light flow). I’ve been on birth control for most of my life to control the pain, but I went on a vegan diet a few years ago because of an article I read that said red meat and dairy tend to exacerbate the pain, and my cramps went away. The vegan diet was great, but I have a family history of diabetes and after reading Gary Taubes book Why We Get Fat, I started exploring a Paleo diet. I started eating more red meat and dairy and my cramps came back. I’m not really sure what to do. It seems like eating Paleo is a much healthier way of eating and it raised my energy levels, but I absolutely can’t deal with painful periods anymore and I want to get off birth control. I would love to get your feedback. Thanks.

    • Hi Trenia,
      I see that you are grouping red meat and dairy together. You might want to try separating them. There are a couple of issues with dairy that make me think it is your main problem. the first is that it significantly alters hormone levels. It’s the most androgenic food out there, which is the primary reason it gives a lot of people acne. It also contains inflammatory proteins that many people have issues with. If diary really is upregulating your body’s expression of inflammation, then it is going to make your inflammatory response to menstrual cramps all the greater. I’d try that first.
      All that being said, just because you seem to have problems with dairy and or red meat does not mean that you should be eating toxins that vegans sometimes eat (ie, omega 6 oils, lots of sugar, etc). I would argue that you’re health is probalby maximized on a paleo diet, but it can also be quite good on a vegetarian/vegan type diet, so long as it is done properly and with whole, nourishing foods.

      • Trenia and Stefani, It could be the birth control causing the cramps since bc creates a hormone imbalance. I’ve been doing paleo almost a year, take vit D, E, and magnesium and never did get rid of the cramps. I am recently off the birth control (menopausal) and look forward to not having those cramps. Doctor reported my hormones are perfectly balanced.
        If you have painful cramps with bc and without bc, your doctor needs to help you find the balance.
        Don’t be afraid to try different kinds and methods.

    • Interesting! I actually found the opposite happened to me, though at the time I didn’t put 2 and 2 together because I thought my vegan diet was the healthiest way to eat since I believed all the vegan propaganda.

      I was vegetarian for many years then became more and more vegan and my cramps got worse and worse. Adding flax oil helped them be a lot less awful (manageable with advil whereas before waiting for the advil to kick in was TORTURE!). But then when I went paleo they got even better. Not gone completely though. I’m still wondering what I can do to make them go away altogether. But I think a part of it may be that I need time to heal. I was vegetarian/vegan for so many years that I figure I can’t expect things to be perfect right away.

  6. Thanks for the information, Stefani. I’ll start with the dairy and see if that works.

  7. Excellent article (I’m so glad I found your blog)! I see that you wrote moderate exercise is helpful. If you ever got around to it, I would love to read a post by you on what you consider moderate exercise and how to know when you are over exercising/over training and no longer helping yourself. Thanks and awesome work!

    • In all honesty I can’t really say, since each individual has a unique set of genes and a unique story. Nonetheless, I am working on it… :)

  8. I’ve reduced my cramping greatly by taking high doses of Carlson’s Fish oil, magnesium (cal/zinc), and DIM for clearing up some of the estrogen, which gave me a few extra days each cycle from 26-28 to 30-32.

    I would be curious if any one has any info on how to reduce the bloating sensations that occur. Paleo hasn’t seemed to keep that symptom of the cycle at bay. Any word on this would be greatly appreciated.

  9. I have been paleo for over a year, but lately my periods have been very heavy. I don’t get the bloating or cramps i used to get but this massive flow is difficult to deal with.
    It seems to have coincided with when i began eating a homemade Paleo muesli for breakfast. It contains nuts, seeds and coconut oil. Is this a likely cause?
    I’m shocked if it can make this much difference as before the muesli my periods were very light.

    • A likely cause? Definitely something worth experimenting with. A lot of people handle phytoestrogens just fine– but personally, even a few cups of peas will give me a noticeable hormonal difference.

  10. Great Article Stefani and very enlightening. I am very glad I found your site. My daughter’s period very extremely painful and heavy. I started ger on vit d and other micro nutrients not knowing all this. Now she does not get any cramps and her periods are more towards normal but her cycle has changed from 30-32 days to 38-40 days. Should I be concerned. Thanks so much

    • I do not think so, no, but you would definitely want a professional opinion on that one, especially considering I have no idea what her blood hormone levels are like or anything.


  11. Pingback: Menstruation and Paleo - Page 2 | Mark's Daily Apple Health and Fitness Forum page 2

  12. Great article, Stefani!

    Another cause of estrogen dominance is exposure to xenoestrogens. I write about them in this blog post:


  13. Interesting. I have a whole host of problems with my cycle, but most of my issues have been resolved by taking Vitex/Chaste berry herb supplement. I wonder if it actually fixes some of these underlying problems or masks them?

    I’m trying to read through most of your blog. I’m still trying to get enough discipline to go primal. I wish it didn’t involve a withdrawal period. A few years ago when I drastically cut down on breads and cereals I’ve felt amazingly better. But I can’t seem to completely eliminate them without feeling crappy. Its hard to forego when the rewards aren’t immediate, and really the immediate sucks. :S

  14. Wow. What a great post with so much helpful information to ponder. As a woman entering menopause, I wonder how all you discuss here relates to menopause symptoms like hot flashes (immune reaction?). I’ve been eating Paleo for 1.5 years, my peri-menopause period. My periods have stopped but I’ve had no hot flashes or any other negative symptoms.

    Also I wonder if any of these issues relate to the development of fibroids.

    Thanks for your work!

  15. My horrible cramps, insane breast pain, and the heavy flow all disappeared after I did a series of DIY fecal transplants. This was not a result I had even thought to hope for in my strange treatment. I had 6 completely painless cycles this month I did have a painful fist day missed work and I have had increased GI stuff. I would love to tell you my story and get your feed back

    • To get rid of menstrual cramps, period cramps, period pain, this natural herbal period pain relief pad can help.

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  16. I noticed a few years back (after being really busy one day and forgetting to eat!) that my cramps were a lot less painful. Overtime I realized I could eat salad and fruit (and sometimes a very light meal if I REALLY wanted to) and the pain would be greatly reduced. What do you think of this? I was actually thinking about this today and decided to search online to see what the science behind this phenomenon is- that’s how I came across your website. Also, I agree, dairy makes me feel really sick. I can eat small amounts from time to time, but I have to avoid it completely when I’m on my period. Anyway, for me, if I stick to eating salad/fruit the first day or two of my period, then I don’t have any pain!

  17. Thank you! This is wonderful information. I am new to Paleo, but finding things out about myself along the journey. I added back in dairy a week ago and am now having PMS symptoms (severely) with no cycle to start.

  18. I am over 40 years old and have been getting painful periods since I was 13. I experience severe pain in my lower abdomen and lower back, vomiting, nausea, diarrhea and have almost fainted a few times. Last year, I had to visit the emergency room 3 times. I’ve tried Premenstrual Tension from BrainSync Technology and I saw that if I listen to this for about 3-4 days before the strike I am more present more able to handle myself… and this helped immensely. Give it a try http://www.brainsynctechnology.com/shop/premenstrual-tension/ This has helped a lot.

  19. Wonderful article that gets to the cause of cramps, but I’ve been on SCD/Paleo for three months (from a vegan/vegetarian for 3 years) and my flow is VERY different. I’m eating all wild and grass fed meats. My cycle has moved from 28 days to 30 days apart, and the flow from 5 days tops to now 7 – 8 days. Also, I used to have cramps for 1 to 2 days, and now I’m getting cramps from 4-5 days into the period. I’m 41 so I may be perimenupausal. So it looks like I’m still stuck with cramps and for longer, but I can’t take any pain killers due to the starch in them. Do you have any suggestions for pain control that will actually work for intense cramps that doesn’t involve an NSAID?

  20. Thank you for this! I am having a light and pain free period this month. I was a bit freaked out but after reading this it all makes sense. I am certainly pleased. I suffer from very heavy and painful periods. So glad to know Paleo is helping my body in so many ways.

  21. Hi and thank you for the research! I’ve been paleo for all of 2013, and was mostly paleo in 2011 and 2012. My cramps have definitely been much worse since going Paleo. They are now 24 days instead of 28 apart, and last 7-8 days instead of 4-5. Any theories on why this might be?

  22. I think a few important things would be helpful to include. First, all plant foods have phytoestrogens. Healthy cruciferous veggies are some of the highest, so we would not want to miss those. A list including just legumes, nuts, seeds, and soy is very limited.

    As well, many herbal and other supplements are high in estrogen. For people who have trouble clearing estrogen faster than it is taken in, they can definitely lead to estrogen dominance. Dandelion root and evening primrose oil are quite high.

    Also, animal products all have naturally occurring hormones, even if they are grass-fed,, free of added hormones, and some of the best you can get. While very healthy, if we’re talking about estrogen dominance and hormonal balance, those cannot be considered neutral foods.

    Finally, dietary fat leads to higher estrogen production. Again, it is very necessary and healthy to have fat and the very last thing we want to do is return to the low-fat, high carb “Bagels are health food” days! But, if we’re talking about reducing estrogen, women should be aware that higher fat will lead to higher estrogen.

    To maintain a diet that includes the above, one can focus on liver-clearing methods (the liver clears estrogen) and supplements like calcium-d-glucarate that help clear it.

  23. Since going paleo 3 months ago, my menstrual cramps have COMPLETELY disappeared. I was stunned by this, since I have had painful periods for over 30 years, even on birth control pills, with an IUD, and early on I took prescription pain relievers. What a wonderful benefit to switching away from eating grains, sugar, and a lot of carbs!

  24. Wheat-based empty calories? Give me a break.

  25. Like a couple others, I too have abominable cramps that keep me in bed for at least 1-2 days a month AND have a very light flow.

    Had no cramps the 4 years I was strictly organic vegan 2000-2004.

    Went primal, no GMO in 2005 and had cramps that were manageable with NSAiDS and lasted maybe a day.

    Since going paleo and no GMO in 2012 my periods are the worst ever. I know my nutrition is better now. Why are my periods worse?

    • Liz, please can you explain me what is the difference between primal and paleo? I read a book recently on Primal and liked it in different aspects but mainly as it exludes all sugar definatelly. Besides that point, as I cant find much information on primal in the website I feel confuesed. Will be very grateful for your help.

      • I’m an “expert” in the field and even I don’t get the distinction. Some people like to think there is one but there isn’t (if anything its a simple distinction between Mark Sisson’s beliefs and everyone elses.) In my opinion, any way of eating that focuses on ancestral, natural foods is paleo! There’s flexibility witihin the paleo world but more or less there’s lots of variety and they all fit the bill!

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  28. Pingback: Paleo for Women | The Two Major Causes of PMS, Plus 11 Ways to Fix It (More or Less)

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  30. I’ve had the worst 2 cycles since being on paleo (started 1/2014). After reading this article I figured out what the problem was..well I don’t normally eat nuts (found out I was allergic after starting paleo) I did enjoy some macadamien nuts as a late night snack with my husband. Oh so good…like a solid piece of movie popcorn butter! Anyway, I have been layed up for 4 of the 6 days I’m on this mess. It has been very painful. It felt like labor pains. The nuts were the only new thing I’ve added from the other months. So I think I just gotta stay away from it. Otherwise I was getting lighter periods and no cramping. Which was blessing from above. I never thought I could live w/o Advil.

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