Even though many dermatologists would deny it, hormonal acne is a real and serious problem for women.
Gut health and inflammation are both major players in acne. (read more about causes of acne other than hormones in this post, or my brand new acne program, for 50% off this week!).
Yet hormones can be the biggest problem for women.
In today’s post I discuss all the variations of hormonal acne, where it comes from, and what to do about it.
Hormonal Acne: When and how it shows up
Hormonal acne for many women presents at certain times of the month. Popular times include 1) at ovulation, which occurs almost precisely smack in the middle of the cycle, two weeks after the first day of bleeding (read about how to pinpoint ovulation in this post), 2) the few days before a period, and 3) at the start of a woman’s period.
Hormonal acne can also be present all of the time. For women with hormonal problems such as PCOS (read here to start figuring out if you have PCOS) and Hypothalamic Amenorrhea (read here to figure out if you have HA), this is unfortunately the case.
When I had both PCOS and HA at the same time, I had terrible acne every day for three years.
Hormonal acne usually occurs in the form of cysts. Cysts are those lovely, pus-filled, painful and inflamed red bumps. They often culminate in a peak of white pus.
Hormonal acne also appears as more mild forms called comedones. These are those whitehead “bumps” that never break the surface.
Hormonal acne can even show up just as smaller lesions. These are not quite as angry and painful as full out cysts, and may appear more rash-like or just smaller than typical acne. Below is a photo of my own cysts (on a “good” day) back in 2011.
These are cysts, classified as “stage 3” acne by dermatologists. There are 4 stages of cysts in hormonal acne
Hormonal acne occurs first and foremost around the mouth. It shows up on the chin, below the nose, around the sides of the mouth, and sometimes up the jawline.
As hormonal acne worsens, however, it spreads to the cheeks and the forehead.
Other body parts can be affected, too. This usually includes the shoulders, back, and buttocks–where the body’s testosterone receptors are most prominent.
The physiological mechanism of hormonal acne
Hormonal acne is caused by increased oil production beneath the skin. Think of it like a river. Ordinarily there is a healthy flow of oil to the surface. This is important because it lubricates the skin.
But when there is too much oil – and when it combines with the normal skin cells and other debris on the surface of the skin – it can clog the pores.
When oil clogs pores, bacteria go on a feeding frenzy. This causes inflammation.
The worse inflammation is, the more irritated the oil gland can become, and thus the more red, and the more painful.
Yet it is important to remember that hormonal acne does not occur unless there is an oil problem.
This is the reason no amount of washing will ever completely eliminate hormonal acne. Admittedly, it can be helped by antioxidant cleansers, serums, or creams.
But it will never go away completely without curing the hormonal acne from underneath. The only way to fix it is from the inside out.
Hormonal Acne: Causes of increased oil secretion
The primary causes of oil secretion are male sex hormones, also called androgens. Testosterone is the primary culprit. Another androgen, called DHEA-S, is also very important. They both increase oil secretion.
This effect is worsened when female sex hormone levels – particularly of estrogen – fall. Estrogen balances male sex hormones in the skin. Without a healthy balance, problems occur.
1. The most prominent androgen is testosterone.
Testosterone causes oil production in the skin.
Why might you have high testosterone?
You might have it if you have PCOS.
(Acne is one of the clearest indicators of PCOS.)
You may also have high testosterone if you have diabetes or insulin resistance, because when the body produces insulin, the ovaries produce testosterone. It’s a very simple yet very damaging process.
When might you show hormonal acne from high testosterone?
If you still have a menstrual cycle, you may find that you break out around ovulation. This is the middle of your cycle. It is also when your testosterone levels are the highest.
But if you have a hormone condition like PCOS – you will probably have hormonal acne most of the time.
(If you struggle with PCOS or think that you may have it, you may want to check out my handy guide on overcoming PCOS.)
2. Another androgen, called DHEA-S, causes oil production as well.
Yet unlike testosterone, which is a sex hormone, DHEA-S is a stress hormone.
It is produced primarily in the adrenal (stress) glands. Whenever a woman is under any degree of stress, her body faces a choice: it has to decide if it wants to produce normal sex hormones like progesterone and estrogen, or if it wants to produce stress hormones like DHEA-S.
For this reason, Hypothalamic-Pituitary-Adrenal (HPA) Axis dysregulation is usually the first place to look to as the origin of DHEA-S problems. Women with a lot of stress – whether from emotions, poor sleep, or under-feeding – have higher levels of DHEA-S levels.
3. Estrogen fights acne.
Estrogen helps promote clear skin. It does this in a number of ways.
First, it has the power to off-set high testosterone levels in the blood. Estrogen increases levels of sex-hormone-binding-globulin (SHBG), which in turn binds testosterone and makes it impotent.
Second, the skin has many estrogen receptors in it, so estrogen directly performs a balancing and soothing function at the site of acne.
For women with chronically low estrogen, hormonal acne is often a consistent problem. They have acne 100% of the time.
In women with relatively healthy hormone systems, low estrogen can still be a problem. This is because estrogen levels fall at the end of each menstrual cycle, and are low at the beginning. Having such low estrogen levels during this time can lead to monthly breakouts.
Because hypothalamic amenorrhea is characterized by low hormone, and particularly low estrogen levels, boosting estrogen is one of the main and most helpful ways women with hypothalamic amenorrhea cure their acne.
Because menopause significantly decreases estrogen levels–almost to zero–this is also the primary reason women in menopause can see a re-emergence of hormonal acne after decades of clear skin.
4. Finally, progesterone can also play a role in acne. Progesterone, in high doses, acts as an inflammatory agent, and can cause acne to flare up. Progesterone levels are highest during the days leading up to menstruation, which explains why many women experience outbreaks at this time.
Synthetic progesterone, such as that found in birth control pills, can also cause acne.
Whether a certain variety of the pill causes acne for you or not, however, is entirely dependent upon your own body chemistry and how your body reacts to external hormones. Know only that if you noticed a change in your skin while experimenting with birth control methods, this is most likely why. You may want to consider a birth control method that has a different kind of progesterone in it, or one that has a different progesterone-estrogen balance, to see if it helps relieve your acne.
(I discuss hormonal causes of acne with more complexity and depth in the program I just published, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.)
Aggravators of hormonal acne
There are many factors other than hormones that can worsen hormonal acne. Here is a list of the most common:
Stress: Stress plays an important role. It acts as an inflammatory agent, especially if cortisol levels remain high for a long time. Stress also decreases production of healthy, skin-supporting hormones like estrogen, and increases production of acne-causing stress hormones like DHEA-S. Stress is not necessarily the cause of hormonal acne, but does exacerbate it, and prevent proper healing.
Heat. Heat is inflammatory, and also causes sweat, which can clog pores.
UV Rays. The sun’s rays are some of the most potent acne inflamers out there. Protect the skin on your face with at least an SPF of 20, or consider wearing a hat in the summer months.
Inflammatory foods: grains, dairy, nuts, and omega 6 vegetable oils can all contribute to poor gut health and inflammation.
Dairy: While already mentioned for being inflammatory, dairy deserves special mention because it is a highly hormonal food. Pregnant cows produce several hormones designed for growth. Growth hormones can both cause androgen levels to rise as well as promote production activities that lead to acne.
I have seen enormous success with women with hormonal acne eliminating dairy for their skin. Many people at least anecdotally least respond to dairy with acne more strongly than any other food.
Phytoestrogens: soy and flax are the primary phytoestrogens to be concerned about, with legumes and nuts coming in a distant second place. Phytoestrogens (“phyto estrogen” is greek for “plant estrogen”) have the power to act as estrogens in the body. This may sound like a good thing for acne, but this role is ambivalent and should be treated with caution, especially with the skin. Different estrogen receptors read different kinds of phytoestrogens differently, such that phytoestrogens usually perform estrogen-lowering effects in skin tissue despite what they do in other locations.
Low carbohydrate diets: Having sufficient glucose stores is important for skin healing, and can speed the recovery of acne lesions. Glucose is also helpful for preventing hypothyroidism. Find out 8 of the most important signs you need to eat more carbohydrate here.
Poor sleep: Sleep both enables healing and promotes healthy hormonal production.
Hypothyroidism: Without sufficient levels of T3, the active form of thyroid hormone, in the blood, a woman’s skin cells lack the ability to heal properly. Many women who suffer hypothyroidism suffer chronic acne.
Dealing with hormonal acne
The best thing you can do for hormonal acne is get blood work done and figure out precisely what your underlying problem is. That way you can target the problem and treat it effectively.
Unfortunately not all of us can afford this, so it’s okay to guess. Nevertheless, the better an idea you have of what is going on in your body, the more specific you can be about what to do to fix it.
In general, hormone dysregulation that leads to acne can be broken down into a few broad categories:
1) high testosterone from PCOS (specifically the overweight and insulin resistant type of PCOS),
2) low estrogen from low body fat levels, chronic restriction, or living in an energy deficit,
3) low estrogen from menopause,
4) high progesterone from general hormone imbalance, possibly related to PMS,
5) any of these conditions worsened by stress or hypothyroidism, and
6) any combination therein.
The ultimate hormonal acne solution
The solution to all of these problems is to correct the hormone imbalance. I have discussed methods of doing so above and elsewhere.
So to get rid of hormonal acne for good, check out my manual that has now helped several thousand women overcome their PCOS, or some of my work on hypothalamic amenorrhea.
For women with menopause, it may just “take time” or perhaps medical interventions are appropriate, depending on the severity of the problem.
Medication for hormonal acne?
There are drugs designed to help with hormonal acne. Spironolactone and flutamide are the two primary ones that come to mind (though I don’t recommend taking either of them), as well as birth control.
The reason birth control pills are helpful for acne is because they enforce hormone regularity on a woman’s system. The precise pill that is helpful for each woman varies by her particular condition– but in general, BCPs are comprised of estrogen and of progesterone. BCPs can for that reason 1) raise estrogen levels–which either corrects an estrogen deficiency or helps balance the activity of runaway testosterone–and they can also 2) restore proper balance between estrogen and progesterone, which is important for keeping progesterone levels within their proper parameters.
Some BCPs also contain anti-androgenic substances, such as drospirenone, which is an added benefit for women who are living with androgen excess (but poses some health risks). In all cases, I do not generally recommend that women get on BCP, as it can cause worse hormonal dysregulation in the long run (sort of like handicapping a delicate hormonal system), and does not solve the underlying problem.
Flutamide acts in a similar way to spironolactone, but less effectively, and with more side effects. So spironolactone is typically the drug of choice.
Spiro has been hailed by many acne sufferers as God’s gift to womankind: it decreases testosterone activity. For many women this begets truly miraculous effects. Yet one should step cautiously with spironolactone. If a woman’s primary problem is not testosterone excess, spironolactone will very likely do more harm for her skin than good. (Check out the panicked discussion forums at acne.org to see what I’m talking about.) Moreover, even for those who have testosterone excess as their primary problem, spironolactone merits caution for a variety of reasons. First, spiro usually induces an infamous “initial breakout” which can last anywhere from weeks to months. This isn’t always the case– sometimes women improve immediately. Sometimes they never really do (I never did: in fact, my acne got worse on spiro.) But the typical case is for women to see an initial worsening of their acne, followed by relief in the upcoming months, especially if they increase their dosages.
Secondly, spiro cannot be taken by pregnant women because it induces birth defects, so women cannot stay on spironolactone indefinitely. This is problematic because spironolactone acts as a band-aid on the hormone problem, and does nothing to fix it whatsoever. What spiro does simply is block testosterone receptors. In most cases, if the underlying problem is not addressed while a woman is taking spironolactone, her acne will return once she comes off of the drug. This is why I recommend that women only consider taking spironolactone if they want a “quick fix” while they work on their diet and exercise in order to improve their PCOS.
Finally, spironolactone has a couple of other health concerns. First, it lowers blood pressure, since spiro is actually a blood pressure lowering drug proscribed “off label” for acne. Secondly, it acts as a diuretic, so women on it need to drink water constantly, may not be able to consume alcohol anymore, may have dysregulated salt cravings, and may never actually be properly hydrated. And finally, spiro acts as a potassium-sparing diuretic, such that women cannot eat potassium rich foods, lest they risk the chance of becoming hyperkalemic, which can lead to sudden death. It hospitalized me. An imbalance of electrolytes in the blood is no laughing matter, so women on spiro should limit their potassium rich foods as well as get their potassium levels checked periodically. Potassium rich foods include melons, bananas, potatoes, avocadoes, tomatoes, and leafy greens, among others.
For these reasons, spiro can help, but it cannot be relied on long term. It does not get at the root of the issue–drugs rarely do–and the true path to hormonal help is diet and lifestyle modifcation.
As a final note, bio-identical hormone supplementation can be helpful for women going through menopause. Estrogen patches can release small amounts of hormone into the bloodstream, and can lessen acne considerably. I do not think this is necessarily detrimental to a woman’s health, if it is in fact the case that her estrogen levels have simply dropped off during menopause. However, it does, in my opinion, make it difficult for estrogen levels to rise and hormone balance to re-establish itself on its own. This is a decision best left to the individual and to her doctor.
Hormonal acne is terrible, and for many women can seem incessant, and never ending. Girls are assured growing up that they will eventually out-grow their acne, yet many women see it persist throughout their twenties and thirties, and some actually do not even see the acne manifest until their twenties and thirties. Some women do not even see acne appear until after the birth of their first children, as their progesterone and estrogen levels are flying all over the map.
There are downsides to medication, and large ones. Medication is only ever a band-aid, and it can be a band-aid that in the long run leads to more harm than good.
Playing with hormones is like playing with fire. Sometimes things can go horribly wrong. For this reason, meds may be best left alone, depending on the circumstance and the level of risk a woman is willing to bear.
It is entirely possible as well as supremely healthy to cure acne from the inside out with good diet and lifestyle practices alone.
To do so with an experienced scientist (me!) walking you step-by-step through the process, check out my new program: Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.
Clear Skin Unlocked was written specifically for women like you in mind. It’s for when you’re frustrated, looking for answers, and tired of falling through the cracks. In Clear Skin Unlocked I discuss everything I did in this blogpost here at much greater depth, as well as provide a Four Week Jumpstart to Acne Freedom to get you on your way to robustly healthy and radiant skin, for good.
You may also wish to check out my guide on weight loss, or my guide to overcoming PCOS. It may take experimentation and patience, but don’t all good things, in the end?
For some of my favorite topical solutions to acne, check out the antioxidant cleansers, serums, creams and topical probiotics I use.
It is so incredibly common for me to hear from many women looking to resolve or eliminate their PCOS entirely. Often the problem is infertility; many women are looking to have children but are unable to because of PCOS. I am here to provide my personal research and experience in eliminating my PCOS symptoms, so that you can too share in my experiences and hopefully benefit from my best selling program, PCOS Unlocked.
PCOS unlocked is different than most PCOS solutions though.
So Why is PCOS Unlocked Different?
PCOS Unlocked is not just easy-to-understand, but simple to implement. Yes, it takes commitment. Yes, it takes making real changes to your life. Yes, it takes patience, and learning, and growth. Yes, it certainly takes energy.
But these are changes make you far and away more healthy overall and in the long-run. Most importantly, I make them easy for you. This manual is all about how to do this practically, as easy as 1-2-3.
Most women with PCOS get handed a pack of hormone pills by their doctor. Then they go home and read online that they need to cut carbs out of their diet and exercise more.
Unfortunately, PCOS treatment strategies are stuck in the 90s.
From trained medical professionals to instagram sensations, the vast majority of PCOS “experts” give the same old, one-size-fits-all advice to everybody.
But “eat less, exercise more, cut carbs” is not the cure. Through my extensive research I have been able to develop this program that I think will benefit you. Wondering what my program has to offer? Below, I elaborate on content covered in my program, but, my program goes so much deeper than this. Check out the info below to see why PCOS Unlocked could be the last PCOS solution you need.
Most likely if you are reading this you have either been diagnosed or are speculating you have PCOS. PCOS stands for Polycystic Ovarian Syndrome – which describes the condition of having multiple small cysts on the ovaries. Up to 15 percent of women in the states suffer from PCOS. It is the leading cause of infertility in the Western world.
In order to be diagnosed with PCOS, women need to have at least two of the three following characteristics:
1) Irregular or absent menstrual cycles
2) Elevated testosterone or other male sex hormone levels
3) Poly cystic ovaries (diagnosed via ultrasound)
1) Because I Explain What Causes PCOS
In order to understand this syndrome, first we must understand what causes it. If we understand what causes it instead of putting a band aid on symptoms, we can understand how to prevent it from the get-go. The following items are all suspected culprits of causing PCOS.
Insulin resistance is the state in the body that directly precedes diabetes. In diabetes, the body has been so flooded by blood sugar and insulin that the pancreas shuts down, and it needs insulin injections in order to keep the amount of sugar in the blood from becoming toxic.Insulin stimulates testosterone production, which will cause hormone imbalance when created in excess. This is the most common cause of PCOS in the world – though it is by no means the only one.
Being overweight is another common trait of women who have PCOS. It affects about 60% of women who have PCOS. The relationship between being overweight and PCOS is not 100% clear. Many very smart people believe that insulin resistance is caused by being overweight, so it’s possible that being overweight is the primary problem for a lot of women with PCOS. Yet others believe that insulin resistance causes people to become overweight, which reverses the causality. I personally think it’s more complicated than both of these cases, and that insulin resistance and being overweight often occur together, though not always.Being overweight also causes inflammation, which can cause testosterone levels to rise and nutrient deficiencies to become more problematic, as well as thyroid hormone levels to fall.
Dramatic weight loss:
PCOS is all about hormone balance. Specifically, it involves elevating male sex hormones like testosterone over female sex hormones like estrogen and progesterone.Weight loss can trigger this kind of hormone imbalance if the body perceives the weight loss as a significant deprivation of energy from the body. There is a specific command center of the brain called the hypothalamus, and the hypothalamus receives signals from metabolic hormones and fat cells that tell it how well fed you are.It is important for a woman’s body to always feel fed. When it does not feel fed, it shuts down reproduction. This makes evolutionary sense. Back in the days when humans roamed the savannah, it was a very bad idea to become pregnant during a time of famine. To prevent against that sort of thing, the female body developed a very sensitive hormone system.Dramatic weight loss is one of the ways in which it may feel starved. This is of course not the case for everybody who loses weight, but it does happen to some women
Low body fat
Much like dramatic weight loss, having a very low body fat percentage is another signal to the body that it is being starved. Often for women with PCOS it is hard to tell if it is the rapidity of the weight loss that caused PCOS, or if it was the amount of weight loss that caused PCOS.In my practice, I find that it is the amount of weight loss that causes PCOS more often, but both do definitely happen.When body fat percentage is too low, pituitary hormone production shuts down, and often PCOS results.
Overexercising is yet another way to signal to the female body that it is being starved.You may not feel like you ‘starve’ yourself per se. But exercise requires a lot of calories. If you burn more calories than you eat on a regular basis and do not have ample fat stores to burn, then your body may interpret this as ‘starving.’What qualifies as overexercising varies from woman to woman. It’s detrimental effects also build up over time. The longer the female body is in a caloric deficit, the more hormone balance suffers.
Hormone production occurs via something called a ‘cascade.’ The body starts producing hormones with one substrate, and then produces more and more hormones in a series that branches out and multiplies. What happens at the beginning of the cascade is therefore crucial for the later outcomes.One of the very first ‘decisions’ the body has to make when it produces hormones via this cascade is whether it wants to make stress hormones or sex hormones. It cannot make high amounts of both for any extended period of time – it simply cannot.If under any sort of emotional or cognitive stress (physical stressors like overexercising, inflammation, or bingeing or restrictive eating count, too), the body interprets this as a need for stress rather than sex hormones. As a result, estrogen and progesterone levels fall. LH and FSH will most likely fall. Sometimes testosterone will, too. Cortisol, the main stress hormone, and DHEA-S, another important if less well-known stress hormone, increase. This is problematic especially for PCOS because DHEA-S is an androgen – a male sex hormone. PCOS occurs when male sex hormones are elevated over female sex hormones.
Healthy thyroid function is crucial for healthy reproductive function. The thyroid system is responsible for delivering energy to cells. If reproductive cells don’t get the amount of energy they need, they lose their ability to function properly. There is a very clear and strong link between hypothyroidism and PCOS. There are many different ways that the thyroid gland can malfunction. The two primary ways are 1) via the autoimmune conditions Hashimoto’s Thyroiditis (see a great book on Hashimoto’s here), or 2) via the negative effects of stress on the liver’s ability to make the most important of the thyroid hormones, T3. A low carbohydrate diet can negatively impact T3, too.PCOS patients who present with subclinical levels of thyroid hormone often begin ovulating once regular thyroid functioning is achieved. One of my favorite articles reports that thyroid hormone replacement therapy achieves a “significant reduction in total as well as free testosterone,” and also states that “ovarian volumes of patients with hypothyroidism were significantly great compared with controls, and their magnitudes diminished significantly during thyroid hormone replacement therapy.”
Almost all non-organic fruits and vegetables are covered in chemicals that act as phytoestrogens in the body. Over time, specifically when young, these can have a major impact on reproductive physiology. Some foods are worse than others. A second endocrine disruptor, perhaps the most prevalent one in American lives today, is BPA. BPA is a polymer leached from plastics (though it is not the only one – thus why I recommend using glass tupperware) that disrupts endocrine function in a way not entirely yet understood, but appears to have negative effects on hormone balance.When rats are exposed to BPA, their male offspring have decreased fertility, and only after exposure to small doses.The BPA exposed males also had a significant amount of more more body fat than unexposed controls.Female rats are affected just as strongly, if not worse. THEY GET PCOS. They present with cystic ovaries, increased estrogen and testosterone levels, and decreased progesterone.Similar results have been reported in human females.
Women with PCOS, both lean and overweight women, have 40 percent higher levels of BPA in their blood than those without. Notably, the levels are even more markedly increased in thin women with PCOS. In thin women, PCOS patients had 1.6 times ordinary BPA levels, and in overweight women the ratio was just 1.3. Some researchers speculate that this is because BPA is being stored in fat cells, while other posit that BPA causes brain-related hormone signaling dysfunction, which could explain why so many people end up having PCOS at all.Hard plastics, the polycarbonate plastics such as #7, are worse than soft plastics. Plastics 1, 2, and 4 seem to be BPA free. Heated plastics leach at much higher rates than cold ones. Research has shown that BPA gets into bodies in even higher doses from eating out of aluminum cans than out of plastic. Cans are lined with BPA on the inside, so virtually everything eaten out of a can is swimming in BPA. Here’s a list of consumer tips.Another source of environmental estrogens is body applications. Parabens are phytoestrogens and are one of the most common elements in lotions and soaps. Receipts, oddly, are also very high in BPA and estrogenic supplements. Many cashiers wear gloves for this reason.
Birth control use
The birth control pill has a varied and complex effect on women’s reproductive health. Some women deal with it just fine. Others, not quite so much. Usually the problem happens when a woman stops taking BCPs: while on the BCP, women’s bodies often adjust to the exogenous hormone input. When coming off of BCP, the liver, hypothalamus, and pituitary gland all need to readjust to natural hormone production. This process can take a long time and will very often cause the symptoms of PCOS.For more on birth control and how to manage it’s physical effects, you can check out my small book on the topic, Birth Control Unlocked.
If LH, FSH, TSH, or Gonadotropin Releasing Hormone levels are significantly impaired, and if all other causes have been ruled, this is an indicator that an MRI should be performed.
2) Because I Dive Deeper into the Symptoms of PCOS
PCOS is a disorder of the endocrine system.Testosterone is the primary hormone to be concerned about for most women, though a hormone produced by the adrenal glands called DHEA-S is also a major concern.
Sometimes female sex hormone levels are low, but that’s not always the case. The two hormones to be on the look out for here are estrogen and progesterone. They need to be in proper balance with testosterone in order for the menstrual cycle to function normally.
When the menstrual cycles stops functioning normally, here are any of the symptoms you may experience. Most women with PCOS suffer from some, but not all, of the symptoms:
- Unpredictable ovulation
- Irregular or absent menstruation
- Acne, which typically appears around the mouth, chin, and jawline
- Male pattern hair growth (hirsutism)
- Male pattern hair loss (alopecia)
- Weight gain and increased difficulty in losing weight
- Low libido
- Difficulty sleeping
- Mood swings or disruptions in regular mood
This is just a brief overview of symptoms of PCOS. I fully analyze and discuss each of these options in my program.
I’ve been working with women who have PCOS now for more than 5 years. In this time, I’ve encountered hundreds if not thousands of specific cases. Iv’e read just about every blog, website, and article there is out there for PCOS. I’ve spent hours searching through online forums and facebook communities, learning about women’s experiences.
After all this time, I’ve learned a thing or two (or several hundred) about what’s right for PCOS, as well as what isn’t.
To help prevent you from making the same mistakes I see over and over again with women who have PCOS, I’ve put together a list of the 10 most common ones. Hopefully then you’ll be able to dodge the bullet, so to speak, and overcome PCOS quickly and painlessly.
Going on the Birth Control Pill
The birth control pill might be a good way to mask symptoms of PCOS, but it never fixes the underlying problem. In fact, many women who go on the pill find that their PCOS has worsens while on it, but don’t find out until they get off the pill, try to get pregnant, then can’t. Birth Control Pills are one of the most favored “solutions” for PCOS of doctors, but they are completely ineffective in terms of healing, fertility, or long-term freedom from PCOS.
Due to its ability to increase insulin sensitivity, Metformin is one of the most commonly prescribed medications in the Western world. Metformin can help alleviate complications from diabetes, as well as help women who have PCOS, especially type 1 PCOS (more on which in video #2). Metformin is a problem, however, since much like birth control pills, in that it never solves the underlying problem causing hormone imbalance and PCOS. It only ever covers it up.
Taking estrogen blockers
Thousands of women take Estro block or other estrogen blockers in hopes of helping their PCOS. However, estrogen is generally not the main problem for women with PCOS. If you’re taking estrogen blockers, you may be targeting the wrong hormones. Instead, consider looking into ways to decrease testosterone and/or DHEA-S levels, especially if you are “type 1 PCOS”. If you are “type 2 PCOS,” more estrogen might actually be what you need.
Taking herbal supplements
Admittedly, some women find great relief from herbal supplements. But just like with Metformin and birth control pills, they don’t provide permanent solutions. They only help to alleviate symptoms and cover up underlying issues. Also, they are not well studied by the scientific literature, so their effects are not well known. Most supposed “effects” of herbal supplements simply come from people’s stories. So it may be worthwhile to experiment with herbal supplements while addressing underlying issues, but this should be done carefully, and with due acknowledgement of the fact that it may not fix underlying issues.
Doing a lot of cardio
Is more always better? For exercise, the answer is no, especially if you’re spending all your time on a bike or a treadmill. The best way to exercise for PCOS is to shoot for efficiency: short, intense, effective exercises instead of long, grueling, stamina-demanding exercises are best. This is because short and intense work outs (such as lifting heavy weights) help improve insulin levels and hormone balance, while long-distances exercises can help, but not quite as much. Most women do well shooting for 3-4 weight lifting work outs a week.
Failing to investigate underlying causes
Trying to overcome PCOS without paying attention to its underlying causes is like shooting in the dark. Getting your hormone levels tested by a doctor, by a functional medicine practitioner, or with a home saliva test is a great way to get data on what’s going on in your body. If you don’t have access to that, learning about the potential causes and types of PCOS and their symptoms (which I’ll discuss some in video #2) may very well be enough. The more you know about what’s causing your PCOS, the more specifically you can treat it.
Low carb diets
Most women who have PCOS try a low carbohydrate diet. Is this effective? Sometimes. But not all women are helped by it. In fact, more than 20% of women who have PCOS may be hurt by it. If you try a low carb diet, pay close attention to your symptoms and see if they get better or worse. That way, you can stop yourself from doing damage if you are one of the 20% of women who really need those carbs.
Low fat, high protein diets
Common nutritional wisdom says that low fat, high protein diets are best. Nutritionists or magazines might tell you to eat salad with low fat dressing and lean chicken breast. But this is not necessarily best, and definitely not for women with hormone imbalance. Hormones (and other important parts of the body, such as brain matter) are made out of fat. Without it, as you heal from PCOS, your body won’t be able to produce the hormones it needs. Fat is a friend, for all women with PCOS.
Unfortunately, dining out in the West is full of potential dangers for women with PCOS. One of the worst dangers is the fact that the vast majority of restaurants use vegetable oil for their cooking. Vegetable oil (including corn oil, soybean oil, sunflower oil, rapeseed oil, canola oil, and more) is rich in omega 6 fatty acids, which cause inflammation. Inflammation is one of the most common underlying issues that women with PCOS suffer from. To help minimize your inflammation levels, consider dining out as little as possible, or specifically requesting olive oil or butter to be used for your meals. Additionally, adding a fermented cod liver oil supplement (fermentation prevents the fats from oxidizing and keeps them healthful) is one quick way to start reducing inflammation levels.
Ignoring potential red flags
Irregular or absent periods, acne, facial hair growth, and difficulty losing weight are all potential symptoms of PCOS. But it’s important when you’re looking for the underlying causes of PCOS to pay attention to other symptoms you experience. Do you have good digestive health? Are you chronically cold? Do you suffer from chronic headaches? Any symptom you experience in your body could help point to underlying causes.
4) Because I have PCOS
For the last five years I’ve run a women’s health blog that gets more than a million visits a year. I have also published a bestselling book on the topic of women’s health, and currently run a top-10 health and fitness podcast with more than a million downloads. This isn’t to say that these MEAN anything significant – but they do mean that I have experience.
I have personally been diagnosed with and overcome my own PCOS. I really did do so with the power of research in medical journals. After doing so I created this program which has now helped several thousand women on five continents. I also consulted women 1-on-1 for years before I became overwhelmed by balancing that practice with all of my writing demands and media appearances. In doing so I have taken part in and witnessed the success of several dozen clients following the PCOS Unlocked protocol.
I have a high honors BA in biogeochemistry from Dartmouth College. While there, I worked on projects for Mars rovers and studying meteorites under NASA grants. Afterwards I received a masters in philosophy at Boston University, and am currently a PhD candidate at the University of Oxford in the UK.
And, I want to help my clients by sharing my experiences and knowledge as a long term potential solution, not as a quick fix.
5) Because I Encourage and Provide Resources to Resolve, vs Providing Temporary Solutions
PCOS Unlocked: The Manual is a comprehensive program that gets results, fast. It works because it throws one-size-fits-all approaches out the window. No single case of PCOS is the same. You need personalized attention if you want to overcome PCOS quickly and for good. To make sure you get the personalized attention you need, I break PCOS down into different types. Simple diet and lifestyle changes are all it takes to heal PCOS… you just have to make sure you do the right ones.
PCOS Unlocked gives you the right tools for you. Your path to freedom with PCOS Unlocked is as fast and effortless as possible.
Most people aren’t aware that there are many different causes and types of PCOS – but there are.
Learn more about what type of PCOS you might have – so you can better treat your PCOS – with a short quiz I designed.
Take the 3 minute quiz –The quiz
So there you have it, love! PCOS Unlocked is different than typical solutions provideed by doctors because I help you determine what is causing or caused your PCOS in order to allow you to eliminate these factors from your biochemistry if possible. I also dive deeper into the symptoms behind PCOS and determining what kind of PCOS you have in order to understand your PCOS fully, because every case is different and unique to each individual. When troubleshooting becomes the primary hurdle, I walk you through each step to break down any confusion or accidental roadblocks in your PCOS treatment. And lastly, because I experienced it personally. Doctors have became very anti-personal, with face to face time with doctors decreasing by the minute each year. Doctors see so many patients it can be difficult to fully elaborate on any issues you may have with them.
I am hear to help. And as always, there is a 60 day money back, no questions asked, guarentee. Because for me, this is not about making all the money, this is about helping women that are going through what I went through. I never would want anyone to suffer through their PCOS, so I hope you find my program most helpful.
Let me know what you think in the comments below!
I was talking to a friend the other day about carb cycling for women, specifically regarding the luteal phase and the best workouts to do while in the luteal phase versus the remainder of the month. She asked me to elaborate, as this was something she had never heard before. She was aware of the 28 day cycle that women experience with their menstrual cycles, but had no idea there were phases inside the 28 day cycle.
For a monthly process that happens internally, it seems a little curious that we as women don’t know as much about our menstrual cycles, but not surprising based on the negative attribution society gives our periods. I hope to elaborate and explain the phases so you can learn the benefits, hormonally, mentally, and physically below.
I am going to take a second and shed a little shade on the patriarchy for not allowing women to feel positive curiosity towards their menstrual cycle. It is often still considered a “gross” or “unattractive” to even discuss menstrual cycles. I am here to declare that now, and in the new year, we will be moving forward in our society and eliminating the taboo regarding our periods.
They happen, and often, and health issues can occur, SO WE ARE GOING TO DISCUSS THEM.
The Phases of the Menstrual Cycle:
1) Menstrual or Bleeding Phase:
Day 1 of bleeding is considered day 1 of your cycle. Typically, a woman’s cycle is around 28 days long. This can vary women to women though.
The menstrual phase can be the most exhausting part of your month, as your body is on overdrive working to shed the inner lining of your uterus. This is the discharge and blood flow we experience during our period. Often menstrual cramps occur as the uterine and your abdomen contracts and releases to help facilitate the passing of the blood and discharge. These cramps can be experienced before the menstrual phase, too, as the uterus prepares for the shedding. More on that below.
Because this phase tends to consume a lot of our energy, we subconsciously move towards introspection and time alone to restore and nourish our mental and physical health. This is not to say a women NEEDS to stay inside and restore during her bleeding phase; I know most women do not have the opportunity to do so. Our body is signaling us to rest, however.
If you are looking for exercise activities that may be best for you during this phase, think gentle but brisk. VInyasa yoga or power walks can be restorative, and there is science behind using exercising as a way to eliminate cramps. This can also be beneficial and balancing to our mood during this phase (and all phases, really.)
2) Follicular Phase:
This phase overlaps with the Bleeding phase. Follicular phase initiates on day one but continues through until day thirteen. During this phase, the pituitary gland promotes egg growth by releasing FSH (Follicle Stimulating Hormone) to your ovaries. In the ovary, the egg growth continues while inside a follicle. The follicle must be strong enough and ready to release the egg, a process that takes thirteen days, hence the thirteen days of this cycle. Blood vessels and other soft tissue are now growing in the uterus due to more hormone secretion caused by the follicle. LH or “Luteinizing Hormone” is also produced at this time. LH basically tells the uterus to start thickening its lining that was once shed during the Menstrual/Bleeding phase.
The female body is naturally more insulin-sensitive in the follicular phase when estrogen levels are highest and progesterone levels are at their lowest. This means the body tolerates carbohydrates in these two weeks better than the rest of the time.
Since insulin sensitivity is at its highest in the first two weeks of the menstrual cycle, and carb intake is free to be at its highest because we tolerate them best, exercise can be more aerobic (long, moderate heart-rate-elevating cardio exercises). It is at this time that you can do your best high performance cardio training. Here you can challenge yourself with longer-term exercises that may be more “stressful” for your body, like long bike rides, tabata sprints, night-long dance sessions, and the like. It is at this time in your cycle that your body can handle the most aerobic stress.
3) Ovulatory Phase:
On the 14th day, the pituitary gland releases enough hormones to encourage the egg to be released. The egg is then ushered through the fallopian tubes via cilia found in the fimbria.
Hormone levels, specifically estrogen and testosterone, are peaking during this time. This can result in higher confidence and libido, a natural process of our body to externally guide us towards finding a partner to reproduce.
4) Luteal Phase:
The luteal phase begins on the 15th and lasts until the end of the cycle. During this phase, the egg cell stays in the fallopian for the first 12-24 hours. It is during this time that the egg cell must be impregnated by a sperm cell or the egg disintegrates. By the end of the cycle the endometrium (the mucous membrane in the uterus that prepares the uterus for pregnancy) is used up, causing the initiation of the new menstrual cycle.
The estrogen and testosterone that was prominent in the ovulatory phase starts to decline. This is when progesterone starts to peak.
In addition, the female body is naturally slightly less insulin sensitive when progesterone levels are higher in the luteal phase (after ovulation, in the last two weeks of the cycle). This means the body does not tolerate carbohydrate as well in these weeks. Women who are diabetic know this well. I’ve read many studies and heard from many women who increase their insulin injections in the second half of their cycle because their blood sugar levels are inordinately high.
Since insulin sensitivity is at its lowest in the final two weeks of the cycle, and carb intake is also at its lowest, exercise should be more anaerobic (this means hard and fast, really getting your heart pumping). It should be focused more on high-intensity interval training, with short bursts of high intensity work, either from brief sprint exercises or from weight lifting. This is an excellent way to sharpen insulin sensitivity while simultaneously burning fat, increasing muscle mass, and spending calories. It also helps the body stay healthy and as stress-free as possible during this time in which the body is gearing up to menstruate and the least capable of handling stress.
A Few Important Things to Note Regarding Our Cycles:
- Estrogen and progesterone are elevated at different points in the menstrual cycle. Estrogen levels tend to be the most dominant in the first and second weeks of the cycle (especially the second week). Progesterone levels are at their highest in the third and fourth week of the cycle. This can affect on our energy levels.
- Period symptoms including blood shed, cramp types and amount, and hormonal effects can vary person to person.
- Birth control is regulating our periods, so if you have been on birth control since you started your period, you may have a different flow then if you were to get off birth control.
Factors that Can Change Your Menstrual Cycle:
We have covered this quite a bit on the PfW blog. But just to remind you- stress causes our bodies to choose which functions are most necessary and appropriate in the moment of stress or danger. More than not, if your body is going through a period of distress, you will not menstruate – as it does not see this period of time as a safe time to reproduce. If you are looking to reproduce, this can be one of the primary things to concentrate on that will assist in conceiving.
- Sleep :
Irregular sleeping patterns will cause disruptive hormone secretion which can cause a lapse or change with your menstrual cycle. It is seriously so important to give your body an appropriate amount of rest!
- Medical Conditions like PCOS or HA:
Both of these conditions can affect hormone levels in the body, in turn affecting our periods. For women with HA (Hypothalamic Amenorrhea), the woman’s body believes it is starving so the body shuts down hormone production. The body does this based on our instincts. Being pregnant while starving is considered life threatening by the body, so the body does not allow reproduction to be a choice. Women with PCOS have an excess of hormone production resulting in inflammation, weight gain, high insulin levels, and more. Read more on PCOS here, and HA here.
- Diet :
This can most definitely affect your cycle. When I was vegetarian for 4+ years, I did not have a single period. I attribute this to the lack of nutrients I was giving my body. If your body is feeling deprived or missing crucial nutrients, it will stop producing the hormones needed to menstruate.
- Routine Changes:
Our body is cyclatory. We see this in our circadian rhythm and our menstrual cycle. If you switch positions at a job, or you move to the night shift, this disruption in your normal schedule can cause your menstrual cycle to shift resulting in longer or shorter cycles, or even missed cycles. This is usually not permanent.
I know this is a lot of information, but I hope it’s useful for you. I really do notice a difference in my aerobic vs. anaerobic activity throughout my different phases, as well as my carbohydrate tolerance and overall energy levels. There are so many factors surrounding our menstrual cycles, especially because women can be so incredibly different. I have included a few extra links to further reading on PCOS and HA below for your reference.
I am always very curious as to how other women adjust to their different phases, or if any of their physiological or emotional responses vary from what I have researched. Drop me a comment with your feedback!
Hypothalamic Amenorhhea further reading:
PCOS further reading:
Have you been using Dr. Google for a while now? Do you find yourself reading tons of health blogs (like this one!) but still having lingering symptoms? Are you confused about what is healthy and right for YOU?
Don’t worry! That’s normal!
For many of us, the path the greater health starts with self-exploration and private research. We find great blogs and books with scientific evidence, recipes, and advice.
We try to discern and decipher this advice for ourselves, and for a while it works. We feel better and our symptoms abate somewhat.
But over time, many of us find that we can’t hone in on those last few lingering symptoms. We simply need expert help.
That’s why we are so excited to be offering consulting services with a functional nutritionist, Amber Fischer, MS. She’s provided this post below to help acquaint you with three big ways she can help you back to optimal health. If you’re interested in learning more about her or what working with her is like, find her here.
#1 An Expert, Outside Perspective
A functional nutritionist is someone who looks deeply at the root causes of disease and dysfunction in the body and helps you improve your health from the inside out. We aren’t interested in covering up symptoms, but rather targeting those root cause issues and getting to the bottom of your problems.
One big way working with a functional nutritionist can help you is by giving you an expert, outside perspective on your problems. So often, we are blind to the very things that are distressing our bodies. Whether it be too much or too little exercise, a possible cortisol or hormonal imbalance, a food sensitivity, or many other things.
In my experience, we often need that outside perspective to help us discover what is really going on, and admit it to ourselves.
A functional nutritionist looks at your unique history and experiences and spends time talking with you about what has led up to this point. We don’t spend 15 minutes with you and send you on your way, we really want to deeply understand and know you so that we can truly help you.
We take that history and formulate an expert idea about what may be going on with you and then we filter that through our education and biochemistry background to formulate a unique plan for you.
#2 Hone in on issues
Because functional nutrition isn’t concerned with covering up symptoms, we understand how to look past symptoms that may be distracting you from the underlying cause.
Issues like hormonal imbalance typically indicate a deeper problem and when we use supplements and protocols designed to help manipulate those hormones, we miss the underlying reason the hormones have become unbalanced in the first place!
This is a skill that takes many years of vigorous education and experience to obtain. Functional nutritionists take numerous hours of advanced biochemistry, along with doing lots of research and seeing clients. This gives us a level of understanding and perspective that the average person just isn’t able to obtain.
When you need help figuring out your health goals, you will save time and money by going to an expert first.
#3 Unique functional testing and custom services
A functional nutritionist respects your story and intuition about what works and doesn’t work for YOU. We take your needs as a whole person into account before making nutrition recommendations. We offer customized plans and services for YOU.
We can also run some incredible functional testing that you won’t be able to get at your doctor’s office. Checking your adrenal gland rhythm, neurotransmitters, gastrointestinal tract, micronutrient status and more are all possible with a qualified practitioner.
These things may not seem that important, but knowing what is truly going on underneath can give you a world of information and perspective to help you attack lingering health issues.
If you’ve struggled with hormonal issues like PCOS, adrenal fatigue, thyroid disorders, lingering weight issues, gastrointestinal issues, or anxiety and depression, I’m here to help.
If you’re interested in working with me through Paleo for Women, learn more about me here.
You can also visit my website here and my follow me on facebook (here) where I publish my articles and often do videos to help keep you up to date with the latest in nutrition!
Metformin is a type of medication used to treat Type 2 Diabetes. Because there is a strong link between diabetes and PCOS, metformin is now commonly proscribed to treat PCOS. But should it be? What is the real relationship between metformin and PCOS? Can Metformin used for PCOS help lessen PCOS symptoms?
Metformin used for PCOS: The Science
PCOS is an infertility condition that often causes acne, facial hair growth, balding, low sex drive, weight gain, difficulty with weight loss, and mental health disturbances such as depression and anxiety in approximately 15% of women. It is also associated with a myriad of health conditions, spanning from diabetes to hypothyroidism and to heart disease.
PCOS is, in short, not a condition to sneeze at.
PCOS is a condition of hormone imbalance. With PCOS, male sex hormones such as testosterone and DHEA-S rise relative to the female sex hormones estrogen and progesterone. (…Roughly speaking – it’s complicated. For a full-blown account of the science of PCOS and how it affects you, see here.)
Elevated testosterone is very often the primary culprit in causing PCOS. (But not always! For one of my most thorough accounts of other things that can cause PCOS, see here.) Insulin causes testosterone levels to rise because insulin tells the ovaries to produce testosterone.
Basically, elevated insulin causes elevated testosterone, which causes PCOS.
This is where metformin comes into play. Metformin lowers blood sugar levels below what they would otherwise be after a meal. This is because it intervenes with the liver’s interaction with and production of glucose. Insulin is the body’s way of dealing with blood sugar. If blood sugar is lower, then insulin will be lower, and thus testosterone will be lower.
Metformin decreases blood sugar, which lowers insulin, which lowers testosterone.
Metformin used for PCOS: Is it Effective?
That depends on who you ask, and what you are trying to achieve.
Statistically, metformin has been shown to reduce LDL cholesterol (the bad cholesterol) and triglycerides (perhaps even worse for heart disease) in patients with Type 2 Diabetes. It is hotly contested whether metformin has a significantly helpful effect on overall cardiovascular health for patients with Type 2 Diabetes worldwide. It is definitely true that many people have benefited from metformin in terms of their ability to manage sugar and keep insulin levels in check.
In fact, metformin has been shown to help prevent Type 2 Diabetes in people who are insulin resistant and at risk of developing Type 2 Diabetes. BUT – and this is a point I will make several times – it has been shown to be radically less effective than a whole foods diet and moderate exercise. This study compared the two, and diet and exercise were shown to be 34% effective. Metformin, only 18.
Insofar as metformin can help mitigate the symptoms associated with PCOS such as acne and facial hair, it is often quite successful. The evidence supporting this is robust. Metformin used for PCOS does help reduce symptoms in women… at least for those who suffer from insulin resistance.
Metformin used for PCOS: The Limits
There are three primary limits to the efficacy of Metformin for PCOS:
1) Metformin may not be the most effective fertility treatment
So far as your fertility is concerned, clomiphene may be more effective than metformin (and diet and lifestyle more effective yet than that). This is a hotly debated topic in the world of metformin and PCOS. All fertility treatment options should be discussed with your doctor if fertility is your primary aim.
2) Metformin is not as effective as diet and lifestyle in the long run
Just as Metformin loses in long-term efficacy against diet and lifestyle (see my personal recommendations for diet and lifestyle in a blog post or in my PCOS program here) for insulin management and diabetes prevention, so it also loses in terms of managing the symptoms of PCOS.
3) Every person’s PCOS is different – Metformin does not work for everybody
Perhaps the most important point for me to make is that Metformin does not work for everybody.
While many women suffer PCOS because insulin resistance causes their testosterone levels to rise, this is actually only the case for about 70% of women with PCOS. For everyone else with PCOS, metformin’s effects will be minimal at best, and may in fact be harmful.
There are many different things that can cause PCOS other than high testosterone.
- low estrogen levels
- low progesterone levels
- birth control pill usage
- excessive exercise
- the MTHFR gene
- IBS and other gut problems
- and restrictive diets can all contribute to PCOS
If any of these are your primary problem, and not the excess testosterone that comes from elevated insulin levels, other treatments may be more effective for you.
If you do not know what is causing your PCOS, the first step towards getting better is to get some bloodwork done, educate yourself about PCOS and what your personal kind of PCOS may be, and find out!
Other Potential Drawbacks of Metformin used for PCOS
While Metformin does not appear to cause any significant or life-threatening problems, it does come with a host of negative side effects that can are short and the long-term.
The most commonly reported side effects of Metformin are gastrointestinal: at least some of gas, nausea, cramps, bloating, discomfort, and diarrhea are reported in upwards of 50% of cases.
Metformin increases homocysteine levels in the long-term. Homocysteine is a by-product of the body’s natural detox processes, and it is toxic in high levels. Elevated homocysteine has been shown to be associated with inflammation, heart disease, cancer, and just about every non-communicable disease out there (including PCOS!).
Metformin appears to influence thyroid hormone levels, though the mechanism and implications are poorly understood.
Metformin reduces testosterone levels, which can upset hormone balance. I personally suffered severe depression – suicidal depression – when I experimented with taking Metformin. I only had to take it for six days for the storm of sobbing and suicidal thoughts to hit. I stopped taking it, the depression went away, and then I tried again and the depression came back. Obviously everybody is different – but this is a real risk. Anxiety is another threat, as is low libido, poor memory, and sleep quality.
It is also worth noting that in the case of weak kidneys, Metformin can cause kidney failure due to lactic acidosis.
The Real Reason Doctors Proscribe Metformin for PCOS
There are many reasons doctors use metformin to treat PCOS. Most importantly, they know that it has been demonstrated to be helpful for a lot of women with PCOS. Yet it is also important to remember that doctors tend to over-proscribe medication as a general rule.
Doctors and patients both know that it is easier to take a pill than it is to make changes. (It also happens to be more profitable for the doctors, but they are not the only ones to blame here, since patients are usually the ones asking for the pills.)
But is it better?
It has been demonstrated over and over again that the most effective way to treat PCOS is to eat a whole foods diet and to exercise a few times a week. You can get very specific about the ways in which you do this, and I do go into great depth on these strategies in my program on overcoming PCOS here. Nevetheless the most important point here is to remember that dietary changes are healthy, natural and long-lasting.
What are your experiences with metformin and PCOS? Do tell! I’d love to hear if it has worked for you – or what you like better!
Many, many women suffer from anemia, the most common kind being iron-deficiency anemia.
But did you know there are actually several different types of anemia?
If you are very pale, with pale conjunctivae, have heavy periods, or lack energy, you may have anemia.
The only real way to find out if you do and what kind, is to see your doctor and have a blood test run. A good doctor will be able to discern these results to decide if your anemia is due to iron-deficiency, chronic inflammation or illness, macrocytic anemia or another cause.
I suggest a doctor who works in functional medicine if you don’t have one you like and trust already.
For my readers, I’m primarily concerned with two types of anemia- iron deficiency and macryocytic.
This is the most common kind of anemia and can result from a diet too low in iron, heavy periods or even regular menstruation coupled with low iron intake, vegetarian or vegan diets, or low stomach acid among other things.
Iron is found in two forms- heme and non-heme with heme being the most available, easily used form by the body. Heme iron is found primarily in meat while non-heme is found primarily in plants.
Vegetarians and vegans may be low in iron because they primarily consume non-heme iron. Several factors enhance and inhibit absorption of non heme iron. Inhibitors include polyphenols and flavanoids from things like tea and coffee, oxalic acid found in spinach, chard, berries, and chocolate, phytic acid from grains and legumes, and phosvitin from egg yolks.
Low stomach acid can cause iron deficiency anemia because stomach acid is where protein is primarily broken down for digestion.
Those with low stomach acid typically take a hydrochloric acid supplement (like this one) that helps supplement the acid in the stomach to properly break down proteins and fats. The best kinds are those which contain pepsin, an enzyme that helps digest protein. I like this one.
For those with low iron intake, who don’t eat much meat, or who need supplemental iron, I recommend this brand. It is easily absorbed and non-constipating. Make sure with your doctor or qualified nutritionist that you need iron before you begin taking it as too much iron can be toxic.
Megaloblastic Macrocytic Anemia
Sometimes women suspect they have iron-deficiency anemia when they really have a different kind of anemia called macrocytic anemia. Macrocytic anemia occurs due to deficiencies of Vitamin B12, Folate, or more rarely B6 which cause the release into circulation of red blood cells that are fewer than normal as well as large and immature. This type of anemia can occur in vegans and vegetarians, those eating poor diets, as well as women with PCOS or the MTHFR gene mutation.
In vegans and vegetarians, vitamin B12 deficiencies are common due to a lack of the vitamin in the diet. If this becomes chronic, B12 deficiences can cause macrocytic anemia.
In those with poor diet, sources of folate are rare. Those who I worry most about are those consuming very high protein, low carbohydrate diets with very few vegetables. Processed foods actually often contain folic acid, helping to avoid deficiency, but in an unprocessed diet that is very low in vegetables, deficiencies could occur.
Women with PCOS are more at risk of having the MTHFR gene mutation. This mutation causes poor methylation of B vitamins like B12 and Folic Acid. Chronically low levels of these vitamins can eventually cause macrocytic anemia.
For those with the MTHFR gene mutation, it is usually recommended to supplement with the already methylated forms of Vitamin B12 as methylcobalamin (find it here) and Folate as L-methylfolate (find it here).
Consulting a functional medicine doctor can help you get to the root cause of these issues and figure out the next steps. A qualified nutritionist can also help you navigate the interchange of diet and anemia.
Eating a diet with ample iron is important for women as well. Look out for a post next week on that very topic!
Have you struggled with anemia?