The overwhelming majority of women with PCOS who undertake a paleo diet see great, quick results. The paleo diet helps them achieve greater weight loss, insulin sensitivity, and reproductive function. Paleo reduces inflammation and meets nutritional requirements, as well as balances hormones. When enacted properly, a paleo-type diet completely eliminates toxic foods from a woman’s body. Of course she is going to get better.
Unfortunately, I also know of a fair number of women who only begin showing symptoms of PCOS when they begin eating a paleo-type diet. Others have see their symptoms worsen. In response, I always wonder if these women have had some sort of underlying problem for a long time, perhaps via exposure to phytoestrogens or endocrine disruptors. The fact remains that a paleo diet sometimes exacerbates PCOS problems. What gives?
First, the biggest player in this problem is probably weight loss. As I mentioned in my post on PCOS etiology, shifting fat mass levels can alter the amount of estrogen in a woman’s system. If a woman was overweight as a child, if she began her period early, if she had a lot of leptin in her system as a child from eating a high carbohydrate diet, she may have trouble ovulating later in life at a lower, “healthier” BMI. The opposite is also true. This is unfair, especially in a world in which women are expected to look a certain way in order to be beautiful.
Secondly, many assert that weight lifting shifts the body towards great androgen production. Greater muscle mass = more testosterone? According to weight lifting gurus at least, yes. This means that the whole “strong is the new skinny” mantra may shift women’s hormone profiles farther than they can handle (especially with respect to the point I made above that a woman’s hormone levels are established early in life.) Additionally, an obsession with exercise may push a woman into an energy deficit, such that her ability to signal fertility from her fat cells to her hypothalamus is impaired. I covered this extensively when I talked about exercise-induced hypothalamic amenorrhea.
Third, paleo typically decreases leptin levels for a variety of reasons: 1) women eating a paleo diet often thin out naturally, 2) appetite is decreased so women eat less frequently, and 3) most people on paleo diets eat fewer carbohydrates. With less leptin in a woman’s body,signalling to the hypothalamus and to the pituitary glands is hampered. Sometimes it decreases enough to cause hypothalamic amenorrhea, which I treat at length.
Fourth, different kinds of paleo diets influence hormone profiles in different ways. For example, a diet heavy in nuts delivers to a woman’s system both excess phytoestrogens as well as a lot of omega 6 poly-unsaturated fats. These PUFA fats actually increase systemic inflammation rather than decrease it, and phytoestrogens throw off a woman’s estrogen production. Another example: dairy is testosterogenic. Many people give up dairy on a paleo diet, but others end up eating a lot of dairy, particularly butter. Butter, and its purified form, ghee, have been touted as a solution to the problem of food allergies by being free of casein and lactose, the typical proteins that cause digestive problems. Yet all dairy, regardless of the type remains testosterogenic: pregnant cows produce a protein that inhibits normal testosterone blocking procedures in a human body. This fact is why many people experience acne when they eat dairy.
Fifth, many people on paleo diets eat high protein diets. This is not optimal for longevity, nor for reducing cysts on the ovaries. Protein is a building block molecule, and if the body has already used enough bricks, it will redirect the remaining bricks to unnecessary locations. Cysts are one such example of this. Tumors are another. Another reason a high protein diet may not be ideal is that high protein diets increase levels of Insulin-like Growth Factor-1 in the blood. IGF-1 decreases Sex Hormone Binding Globulin levels in the blood, and SHBG is responsible for finding free testosterone. Most women with high androgen levels have correspondingly low SHBG levels. I recommend .5 grams of protein per pound of lean body weight each day. This means that a 100 pound woman would eat 50 grams of protein each day. She can go as high as 100 grams if she likes, especially if she exercises a lot (in that case it should be increased), but that may not be optimal.
Sixth, low carbohydrate diets can contribute to PCOS, though this is a complicated issue since all of the women with PCOS have such different etiologies. For example, overweight women with PCOS almost always see great benefits with a low carbohydrate (specifically fructose) diet. Yet for thin women with PCOS, low carbohydrate diets are problematic. Glucose is required for the conversion of T4 into T3 in the liver. Without glucose, T3 is not produced. Worse still, reverse T3 is produced instead, and reverse T3 acts as a T3 antagonist. So without carbohydrates, a woman’s thyroid activity can drop off dramatically. Hypothyroidism is one of the biggest causes of cystic ovaries, as well as general female malaise. Additionally, SHBG levels increase with an increase in thyroid hormone.
Finally, women on paleo diets are often perfectionists. They are sometimes orthorexic, and they stress out about their food, exercise, and bodies more than they ever have a right or reason to. Stress inhibits pituitary function, and in a very big way.
All that said, these are some of the ways in which a paleo diet and life style can contribute to PCOS. Much of it is related, in what I consider a “perfect storm” of endocrine problems. Yet without taking the diet to these extremes, and especially stressful extremes, eliminating toxins, eating natural foods, and living a stress-minimizing life almost always does nothing but wonders for women.
For more information on PCOS, why you have it, and how to overcome it, check out PCOS Unlocked: The Manual, the multi-media resource I created in order to share all the PCOS information and experience I’ve amassed in my brain, and apply it to solving the unique case of your PCOS.