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paleo and pcos by stefani

Paleo and PCOS

A lot of women who have PCOS try the paleo diet to help them overcome the PCOS. The majority of them see great, quick results. Paleo helps them achieve greater weight loss, improve their insulin sensitivity, and regain their fertility. Paleo also reduces inflammation, enhances the nutrient content of the diet, and helps balance hormones. Paleo is a great strategy for women looking to overcome PCOS.

Unfortunately, sometimes women do not get better with paleo. Sometimes they even get worse. 

What gives?

What is the relationship between paleo and PCOS? Why does it heal some women so well? Why do symptoms get worse sometimes for others?

Paleo and PCOS: the benefits

First and foremost – paleo is an incredibly nourishing diet. It is rich in healthy EPA and DHA fats (which may in fact best be obtained from fermented cod liver oil if you cannot get wild-caught fish), B-vitamin rich organ meats (or dessicated organ capsules if you don’t like the taste), vitamin C and E rich fruits and vegetables, and calcium, magnesium, zinc, iodine (kelp capsules if you do not regularly eat seaweed), and the crucial fat soluble vitamins A, D, and K (also great to get in fermented cod liver oil).

On paleo, women often become better nourished than they have ever been. After having eliminated processed foods, seed oils, and grains, their bodies are all the healthier and more efficient.

This is one reason that women improve. This can (and usually does) happy to everybody to some extent.

It can energize you, improve the quality of your sleep, clear your skin, rev up your libido, heal your gut, boost your immune system, reduce inflammation, and improve neurotransmitter function.

One major way in which one particular subset of the PCOS population improves is by sharpening insulin sensitivity. Through gut healing and managing carbohydrate intake, the paleo diet often helps women who have insulin problems achieve healthier insulin levels.

Excess insulin is one of the primary causes of PCOS (check out this post for more on the various causes of PCOS) – so women who get insulin under control with paleo often get their PCOS under control.

Another major way in which a subset of the PCOS population improves is by helping with hypothyroidism. Through gut healing, autoimmune healing, stress reduction and a higher nutrient content, paleo often helps women overcome hypothyroidism, which itself often plays a role in causing PCOS.

Paleo and PCOS: where it can go wrong

Unfortunately, even while paleo can be great for PCOS, some women still do fall through the cracks. Here are the most common roadblocks I have seen women run into with paleo and PCOS throughout my years in the field:

1) Weight loss.

I know it may sound counter-intuitive, but sometimes weight loss can cause problems. This is because fat mass is highly hormonal, so any shifts in fat mass can cause hormone imbalance. Usually this imbalance is temporary, though sometimes it is not.

When you lose weight, the toxins that were stored in the fat cells get released into the bloostream. One of these “toxins” is estrogen and other hormones. Sometimes this causes hormonal upset, but should be temporary.

When you lose weight, you also lose a supply of estrogen, since estrogen is produced by fat cells. If your fat mass dips below the amount that your body thinks is optimal, then you may end up with less estrogen than your body thinks is optimal. This can cause an imbalance between testosterone and estrogen, which is a common way for women to develop PCOS. This kind of hormone imbalance may be permanent if you really have lost too much weight.

2) Exercise without refueling properly

Lots of women start to exercise while on paleo. This is awesome! Unfortunately if you do not do it right then it can cause hormone imbalance.

When you work out, your body secrets cortisol and testosterone, along with other muscle-building hormones.

After your workout, if you do not eat carbohydrates and protein, then your testosterone levels will stay elevated. High testosterone can cause symptoms of PCOS. Read this post to learn about how to refuel properly after a workout.


3) Exercising too much.

If you get into paleo and start to exercise, but haven’t exercised much before and really are exercising a lot now, this can cause energetic stress to a woman’s body. This kind of stress causes the body to shut down hormone production – I covered this extensively when I talked about exercise-induced hypothalamic amenorrhea and the causes of hypothalamic amenorrhea.


4) Personal variations in paleo dieting

This topic could comprise a book instead of a few paragraphs. It is important to bear in mind that different foods have different effects, and if your diet is high in any particular subset of food then you may be more influenced by them then you know. Here are a few examples:

A) 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.

B) Another example: dairy is androgenic (male sex hormone stimulating). 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.

5) Very high protein diets.

Many people on paleo diets eat a lot of protein.

A high protein diet is not terrible for your health. However, it is not necessarily optimal, either. 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 may be another.

High protein diets also 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 binding free testosterone.  Most women with high androgen levels have low SHBG levels.


Additionally, a significant number of PCOS patients (I’d guess somewhere around 50%, but that is a total guess, as there are no studies on this) have the MTHFR gene mutation. People with MTHFR have a defect in the body’s detox processes that elevate homocysteine levels in the blood. Homocysteine is extremely unhealthy to have in high levels and high levels have been associated with PCOS.

Protein metabolism elevates homocysteine levels. Women with PCOS should therefore eat a moderate amount, but probably not much above that, of protein in their diets. I recommend .5-.75 grams of protein per pound of lean body weight each day.

6) Low carbohydrate diets

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 diet. Yet for thin women with PCOS, low carbohydrate diets are problematic. Glucose is required for proper thyroid function. It’s also necessary for assuring the pituitary gland that it has been properly fed, so that it will go ahead and make hormones as abundantly as it should.

7) Increase in saturated fat intake

While saturated fat is a healthy part of any natural diet, undertaking a big shift in the fat content of your diet (all fat, though especially saturated fat) can cause hormone imbalance.

This is because hormones are made out of fat. If you ate a low fat diet for a long time then added fat back into your diet, your body may over-produce hormones. If you have an inkling toward hormone imbalance on top of that, your body may over-produce imbalanced hormones.

The best way to deal with this is not to give up on fat entirely! It is, instead, to gradually increase the fat content of your diet. Scale back a bit from what you are doing now and see if that helps (again, especially saturated fat from animal products). Then add fat back in over the course of months, slowly. That should help your body adjust to new hormone levels. Also be sure to do whatever healing you can for other health problems, so that your hormones can be as balanced as possible.

8) Perfectionism

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. It is incredibly important to keep stress as low as possible, and to treat yourself lovingly and gently 100% of the time.

Paleo and PCOS: in summary

This is not an exhaustive list. Every woman is an individual, and therefore needs to treat her PCOS and her symptoms like an individual. Nevertheless I hope these theories that I have crafted and things I have witnessed in my time with paleo can be helpful sign posts for you.

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. Much of it has to do with stress. Much of it has to do with dieting to extremity in one way or another.

Troubleshoot as best you can. The trick to naturally overcoming health problems is to be as educated as possible, and to have the patience and fortitude necessary for experimenting with your body and your diet over time.

PCOS can be tricky to overcome, I most certainly know that.

Paleo is an excellent tool for PCOS for every woman. Yet the real trick to PCOS is to figure out the specific cause of your own PCOS (since many things cause PCOS), and then working on overcoming that specific cause.

You can read more about the causes of PCOS, why you have it, and how to overcome it, in PCOS Unlocked: The Manual, the multi-media resource I created in order to solve the unique case of your PCOS.




So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

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


  1. Oh my god. Answers. Thank you. Too bad I just ate a huge handful of nuts. Well now I know! Are seeds the same? Do you have any thoughts on ketosis? Thank you so much for all this.

  2. Just a few questions for clarification. How thin is too thin? BMI is a poor measure of health and well-being and weight also seems a poor indicator. How does being of a lower weight when entering puberty/entering puberty late relate to ideal weight for fertility? For example, I was very small and much older than my peers in comparision when puberty hit, probably weighing in at less than 105 lbs and being 14 or so. How does all of this relate to my ideal size/shape for health now. I’m sure you get plenty of questions like this, and it’s not a vanity thing, avoiding type 2 diabeties and being able to have children are my two biggest health goals in life! Thank you.

    • Too thin is too thin if it is causing you health problems. If you do not menstruate, for example, and have had certain blood tests done, and see that you have low estrogen and progesterone, and possibly low lh and fsh, then that is possibly/probably an indicator of being too thin. That is probably the greatest problem with being thin– that of fertility. If you have both good health markers and are also fertile, I don’t see why you’d have any reason to worry– not about being under, or even about being over, weight. That should help?

      • Thank you. That helps clarify. I’ll have my yearly check-up soon, so I’ll have an idea of all my levels very soon. The length of my cycle has gotten longer over the last few months, but that might be related to my Mirena IUD, which I’m thinking of having removed. As long as my cycle doesn’t disappear I won’t stress for now and focus on staying healthy with Paleo and Crossfit! Thanks again.

      • I am so confused by this article. So what am I suppose to eat? I haven’t had a menstrual in 4 yrs. I don’t like to take prescription medications, I have ovarian cysts, I’ve tried eliminating sugars at times and dairy. That actually helped with hot flashes. But now, I’m losing my hair in the crown area. I use to get really bad ingrown hairs on my limbs. I’m now working out with weights and exercising more after losing weight from HCG diet because I gained 60 lbs. What kind of blood tests do I do and what am I looking for in a blood test? what do I eat? I’m 42 and may still want to have children. Please help

        • HI Jerra,
          Perhaps your weight loss and exercise has stressed out your body, hence the hair loss. That would be my best guess. Eliminating sugars and dairy is a big help, but you also want to make sure you don’t cut carbs too far if stress is an issue for you.
          I’d look at your thyroid levels, so TSH, t3, t4, and also testosterone, DHEAS, estrogen, progesterone, lh and fsh. Those should help you understand where your hormone levels are getting imbalanced. Your doctor can help you with that. If not, come back and I’ll explain it to you. PCOS Unlocked should also be helpful, I think. 🙂

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  4. Thank you for this amazing blog and the valuable information and empowerment that you provide. I stumbled across this website today and having only quickly browsed through, I can already tell that it will assist me a great deal in leading a healthier life and managing PCOS/hormone imbalance. I’ve been seeing an endocrinologist and have so far had one consultation with a doctor specialising in hormonal imbalances. While they are helpful, much of what I’ve read here so far resonates with me a great deal more.

  5. I agree with the other ladies here. This article is so helpful. I was diagnosed with PCOS at 16 yrs old. I’ve become very frustrated and disillusioned by the treatment (or rather, lack of) that I’ve been getting from my physician and endocrinologist. At this point, I want to make some real positive changes in my lifestyle and take the control of my health into my own hands. I’m 32 now and still hoping that someday I can be a mother. Now is the time to make these changes! Thanks again!!!

  6. Hi,

    I was reading your article and wondering what i was going to eat. I am 34 – i was diagnosed with PCOS at age 15 and am on the lean side. I also have been dealing with adrenal fatigue in the past year after 4 moves and two children. I noticed when i go too low carb i end up with vomiting bouts and severe anxiety. I have no idea what to eat as i don’t do well on grains, gluten or dairy which doesn’t leave too much else. I find myself being so hungry and not knowing what to eat throughout the day. I find the info about reverse T3 really interesting as that is my problem – too high reverse T3 since all the stress hit a year ago. What kind of carbs would you suggest to reach a happy medium?

  7. Hi,

    I’m interested in trying this diet as I was diagnosed with PCOS a few months ago. I’m trying to do everything the natural way, well as natural as possible. The only thing that seems to worry me about the article is the second paragraph when you say it could make symptoms worsen. Could you be more clear, in which case would that happen? I am 5’3, 150 pounds. I work out at least 2 days a week and try to keep fit but the depression part with PCOS makes it really hard to stay motivated.

  8. You also can’t ignore the quality of the protein eaten when going Paleo. A lot of people still eat feed-lot, grain-fed beef, etc. Even I did that when I first started and my PCOS tortured me something awful. When I switched to grass-fed… no symptoms. Back to crap meat… instant pain. It’s not enough to just switch to Paelo foods. It has to be quality Paleo foods. Same with veggies…

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  10. Hi, I know it’s a long shot, but if you could offer me any advice, I would greatly appreciate it. I have recurring miscarriages and after further testing, have found that I have lean PCOS and a clotting problem that can occur with it PAI-1, the clotting problem can lead to recurring miscarriages. I also have endometriosis. My Dr. has prescribed Metformin to help the PAI-1 once I’m pregnant and also to bring on ovulation. It makes me incredibly sick. I’m already hypoglycemic and it’s really hard to keep my sugar up on the medicine. I quit taking it and was planning to start the Paleo diet before starting again. I have very limited information on the diet itself and would really appreciate any tips or suggestions you could give me. We want a baby more than words can express and I’m willing to do anything I can to better prepare my body. Thank you

    • Hi there, I was diagnosed with PCOS when I was 15, and was put on Metformin. That is the WORST drug you can be on! Besides feeling like your sugars are always low, constant diarrhea, and stomach upset, this drug can hurt your organs, mainly your pancreas!

      I am trying the Paleo diet, in search of an all natural way to heal my body from PCOS.

      • Er, do you have a source for Metformin being any source of harm to the pancreas? There is nothing to confirm this.

        Additionally, Metformin helps regulate blood sugar, not lower it. If you’re hypoglycemic, that is likely the foods you are eating and not the medication. Finally, the stomach distress goes away as you get used to your dose. Please try not to spread misinformation!

  11. Dear Stephanie,
    I am hoping that you can help me decide if going on the paleo diet is the right thing for me, or it will throw me into another tail spin. I’m 37 yrs old 5’2″ 148 lbs. diagnosed with pcos at age 28.

    About two years ago, something went haywire with me and I got really sick. I lost the hair next to my ears, I lost 20 lbs almost over night, crazy insomnia, my heart was racing, I’d get these weird sores all over my body, I was so scared, and anxious. I took an adrenal supplement before all of tis happened, but I have no clue if it was that or something else. I went to lots of doctors and they all though it might be hyperthyroid, but all tests were normal – though my tsh was.66 – which was the lowest id ever seen it. My estrogn was completely bottomed out . I had also limited my gluten intake. So after giving up on traditional medical doctors I went to see an acupuncturist. She seemed to help the most. But because I’m so sensitive she didn’t give me any herbs. Just lots of bone broths because my system was so depleted of minerals.

    Fast forward 2 years and now I am gaining weight like crazy – belly and back side. I have tons of extra hair. No acne. I exercise 3 times a week. I am sleeping better now, but have occasional set back.

    Do you think that paleo will be good for me?

    • YES! And what you’re talking about– it seems as though your thyroid is doing some wacky things, which can be helped enormously by a paleo diet that striclty eliminates grains, dairy, and legumes.

  12. Blood test from doctor back when I sent you the original message in October 2012 results were T3 2.71 T4was 1.13 And thyroid stim hormone was 1.39
    Postmenopausal range said 15.9-54.0,luteinizing hormone 20 .3 mIU/ml
    Follicle-stimulating hormone was 32.4. Normal follicular phase I’m told was 4 to 13 is the range postmenopausal females is 20 to 138
    Thanks for the response. I’ll try the paleo diet see if anything changes. I can’t imagine that I’ve been perimenopausal since I was 37 or 38 yrs. I think that would be extremely early

    • My testosterone was 30ng/dal at the time

  13. About 8 months ago I underwent extensive test with my doctor because I am having a really hard time losing weight. My doctor told me that my lh/fsh levels are at 2/1, and that puts me on the doorstep of PCOS, I guess 3/1 is a standard diagnosable level. My husband and I recently started on the Paleo diet and a new workout routine to shake things up. I guess my question is, how concerned should I be about PCOS going forward? I also tested as pre-diabetic, which is a huge concern for me and a factor in choosing Paleo.

  14. I started the paleo diet two weeks ago. I have been feeling great but I have been spotting and having allot of cramps. Do you think it is making my PCOS worse? Or do you think my body is just trying o regulate and adjust to my new way of eating? Thanks for your help!

    • Adjusting! But that also totally depends on WHAT you are eating on paleo and what sort of changes you have made. 🙂

  15. Hi,

    I’m 5’2″, 115 lbs, some minor acne (more like clogged pores) and no hair issues, diagnosed with PCOS 6 months ago after I went off bc and (after a first good 6 months of 28-32 day cycles) didn’t have a period for 8 months (this was also during a time of extreme stress). My bloodwork showed slightly elevated LH, but that was it. I had no cysts, only a number of follices on an ultrasound. A few months ago, I started working out 4-5 times a week and cut out all grains and processed sugar — still eat legumes but am careful about fruit and never drink juice. I FEEL a lot better (more energy, less irritable, etc.) but my somewhat regular 7 week cycles just changed this past cycle to a 9+week, with pain that feels like a cyst (I never used to actually have cysts, so hard to say) and spotting. Is my diet making symptoms worse, or is this a normal process to recovery? If a low-carb diet probably isn’t right for me, what is?

  16. I have PCOS and was able to relieve some/most of the symptoms on a low carb diet however could not lose weight while consuming dairy and artificial sweeteners. Through a low carb lifestyle my periods have become regular, blood sugar levels have normalized and cholesterol looks great. Now I’m switching to paleo. Starting out with the whole30 in hopes that I lose the weight and figure out what’s keeping me from the weight loss. Good luck to all you ladies. We can beat this. Just need to find the right combination of food and exercise to do so.

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  18. Hoo boy. I’m not sure what’s left to eat now for PCOS ladies – there are so many conflicting suggestions coming from all sides!

    If you’re doing low carb yet should be avoiding protein, nuts, seeds, most fruits, and dairy, how do you keep from going hungry? If someone needs to maintain weight loss, turning to more fats and cholesterols seems counterintuitive. And many fats come along with a fair amount of protein, too.

    I’ve heard praises sung for so many things that someone else claims is harmful, it’s hard to know where to turn (for example, I’ve read a number of studies and articles promoting phytoestrogens for PCOS). Ironically all of this information flying around is pretty stressful – something everything says to avoid. Easier said than done, I guess!

    With my new lower carb diet, I’ve let go of so much I enjoyed – I feel like I can only pick so many battles! Greek yogurt, cruciferous veggies, almonds/nuts, more protein, flaxseed…if they’re really as detrimental as you say, I might just need to compromise and weigh the risks against the benefits. 🙁

    Thanks for the read, however. I can see this is complicated stuff.

    • Agreed! I am about to the point where I am going to throw in the towel and go on the medicine my doctor has recommended (or even do replacement hormones.) Everything I’ve read basically says that ‘if paleo isn’t working you’re doing something wrong.’ Like I’m some sort of idiot or something… I have several family members that specialize in this stuff, and they agree that it doesn’t always work for everyone. It is unrealistic to think that. And this is telling me to cut back on working out..ect and all the FOOD I’m supposed to cut out. Really? So lower protein, no nuts, no dairy(already doing no dairy), and no fruits. Hm….Sounds like I get a chicken breast per day. Super realistic. I’m sorry for being rude, but it is just upsetting that all you seem to get when you go in search of how to go about treating PCOS the natural way is a bunch of guilt or misguided information when an approach doesn’t work. Bottom line: Paleo might not treat your PCOS, but it is STILL incredibly healthy for your body. (As long as you aren’t having bad side effects with it.) So I am gonna stick with it for a while longer to see if it improves my PCOS. If not I will just stick with it to be healthier. Hope that helps. You’re not alone!! 😀

      • “it is just upsetting that all you seem to get when you go in search of how to go about treating PCOS the natural way is a bunch of guilt or misguided information when an approach doesn’t work. ”

        OMG – yes, this!! plus, 99% of the time there’s no real evidence that something is truly good or bad either way, but someone will pick a side, vilify the opposition, and ultimately just kinda…scare people.

        For now I’ve decided to just do what works for me, which seems to be lower carb/lower sugar, and metformin (which I’ve been on for a long time). I still enjoy some dairy, limited fruits, etc etc…I can only make so many changes and pick so many battles at a time, you know? I really need to stop doing google searches that land me on posts like these.

        Either way, thanks for the moral support, Ashley! I got your back too if you need it. ;D

        • More power to you, ladies!

  19. I am 32, recently found out that I have had at least two strokes and that I have PCOS. I was diagnosed with both of these health problems in the same week and I have been struggling to make the right health choices. I apparently can’t be on birth control to regulate my PCOS symptoms which are acne, lack of menstruation, and over all exhaustion as well as insulin intolerance. I exercise every day and I eat well. I am 5’2 and 130 which is big for me. I am usually 120-123. I would love any insight anyone has to my unique case. I am thinking about taking the risk and getting back on orthotricyclene because my symptoms are intolerable. Please help! My doctors are being very nonchalant bout all of it and I am at the end of my rope.

    • 5’2 130 is my size, too! And this so happens to be as heavy as I need to be in order to menstruate, not have acne, and many of my other hormone problems. This may not be the case for you as you are obviously a different strand of DNA aand also have experience with the pill… so I say this only to encourage you to consider reconciling yourself to a higher weight if you find that it alleviates symptoms. Stress is a big factor, I think, and I think over time as you heal and your stress levels drop then you will no longer feel the need for BC to regulate symptoms. I know its a hard and long road, but trust me when I tell you that there is always progress

  20. Thank you so much for this article! My “idiopathic” hirsutism started after I was on the candida diet when I was 19, I started off at 60kg at 5’8″ and then dropped to 53kg very quickly. Unfortunately the hirstuism slowly got worse over the years despite eating normally and putting weight back on (I never got back to 60kg though). Just this month I had a new hair sprout above my belly button where there wasn’t hair before and it’s made me really helpless and depressed.

    One thing that happened after that diet was very interesting though; before I went on it I was a total bread addict – now I have to force myself to eat any starches and it makes it harder to put weight back on.

    This is the first time I’ve seen someone acknowledge that a diet purported to help PCOS can jumpstart the symptoms in some women. I’d really like to know more about it, but there just isn’t enough interest research-wise 🙁

  21. What irritates me most about your article is the lack of support that you have for a Paleo Diet. I have been eating Paleo for 2 years now combined with crossfit. I was diagnosed with PCOS several years ago and was overweight. I lost 40 lbs and kept it off and feel way better. The paleo diet helped me tremendously. People do not have to go strict paleo. It’s honestly about moderation and carbs such as bread and grain just desolve into sugar. I feel as if the carb load did not help improve PCOS symptoms at all. I think ultimately it is different for every individual and we have to be completely honest with ourselves and get a healthy dose of exercise 3-5x a week alongside a natural diet. A natural diet will always help improve PCOS and weight issues. Have you personally tried Paleo and Crossfit combined or had any issues with PCOS? Thanks for the article though. It’s interesting to see different points of view and different women’s responses.

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  24. Ok, what kind of exercises are the best for PCOS?
    Walking? Dancing? Yoga?
    What if I don’t like it? Well, ok I practise yoga, I’ve just started salsa course but I miss something more.
    I was a runner but it’s too stressing for me.
    HIIT is to much for me lately.
    I lift heavy weights thinking it’s healthy and save for me and know I’ve just read that it may increase testosterone… Damn… My testosterone was ok but I have very low estrogen… And I don’t know how to increase it.

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