11 Reasons Your Period Is Missing (besides Pregnancy)
iStock/flocu Birth control pills, patches, rings, shots, patches, and IUDs aren't guaranteed to stop your cycle entirely but missed periods are a recognized side effect of hormonal birth control—one many women are quite happy about. This is because hormonal birth control methods are designed to both inhibit ovulation and thin the lining of the uterus, explains Alyssa Dweck, MD, ob-gyn and co-author of V is for Vagina: Your A to Z guide to Periods, Piercings, Pleasures and so much more. No egg to protect and no lining to shed means a lighter or non-existent period. The Mirena IUD and the Depo-Provera shot are the types most known for this side effect, along with pill packs, like Seasonique, that are designed for this express purpose. iStock/mihailomilovanovic The "female athlete triad" refers to a pattern of undereating, amenorrhea (loss of periods), and osteoporosis that stem from an extreme workout routine. But despite the word "athlete" in the name, you don't have to be bound for the Olympics to be at risk. According to a recent study, it can affect women in any shape, form, or weight—not just the stereotypical "ballerina physique"—who are exercising too much. How much is too much? The answer is specific to each woman's body and circumstances, but a good rule of thumb is if your workouts make your period go missing, it's too much for you. Here are other bizarre side effects of exercise. You have PCOS iStock/shironosov Polycystic ovarian syndrome (PCOS) is an increasingly common cause of amenorrhea, says Renée Volny Darko, DO, a board-certified ob-gyn practicing in Pennsylvania. PCOS is the most common hormonal endocrine disorder in women, affecting 5 to 10 percent of all women and is thought to be responsible for up to 70 percent of infertility. The syndrome is Continue reading >>
Absence Of Periods On Low Carb With If
Can a low-carb diet combined with intermittent fasting result in an abscence of periods? And if so, what do you do? Get the answer to this and other questions – could dairy be a problem in PCOS? – in this week’s Q&A with the fertility specialist Dr. Fox: Loss of period Almost five months ago I started LCHF due to insulin resistance and PCOS. I lost about 40 pounds (18 kg), and feeling great. But, after two months of regular periods (31-35 days), I simply lost them. The last was on March 26th. This is now my third missed period. When I look back, it seems to me that perhaps I shouldn’t have done IF, (i didn’t fast first two months, and then I had my periods). Now my doctor has put me on progesterone to induce periods, and gave me cyclo-progynova to restore hormonal balance. What has happened doctor Fox? The last ultrasound showed that my endometrium is very thin (before was great). Though, my right ovary had no cysts. Can these hormonal pills harm my health? I am also taking glucophage xr 1000mg a day. I’ve also noticed increased hair loss… Thanks in advance, P.S Keep up the good work!!! Thanks for every advice, lecture, interview! Ivana Dr. Fox: That overall is a hard question. My best guess and it is a guess, is that you may have an underlying hypothalamic dysfunction, maybe due to prior exercise, or eating disorders, hypoglycemia, sleep apnea etc, that has predisposed you to be very sensitive to physiologic stress. The IF if not done during a time of absolute ketoadaptation, could produce such a stress signal that then could have shut off the signals from the hypothalamus to the pituitary and hence decreased the FSH (follicle stimulating hormone) signal to the ovary. This could explain your scenario and would be the most likely thing we would see. Evalua Continue reading >>
Adverse Reactions To Ketogenic Diets: Caution Advised
As the ketogenic diet gains popularity, it’s important to have a balanced discussion regarding the merits of this diet. Let me emphasize right out of the gate that this is not a diet without merits (excuse the double negative); in fact, it has significant therapeutic potential for some clinical pathologies. However, it is also a diet with inherent risk, as evidenced by the extensive list of adverse reactions reported in the scientific literature—and this has not yet been a thorough enough part of the public discussion on ketogenic diets. The AIP Lecture Series is a 6-week video-based, self-directed online course that will teach you the scientific foundation for the diet and lifestyle tenets of the Autoimmune Protocol. This is the first of a series of articles discussing various facets of a ketogenic diet with an inclination toward balancing the discussion of the pros and cons of this high-fat, low-carb, low/moderate-protein diet. My interest in this topic stems from concerns I have over its general applicability and safety, simultaneous with its growing popularity. I feel a moral and social obligation to share what I understand of these diets, from my perspective as a medical researcher. The dangers of a ketogenic diet was, in fact, the topic of my keynote presentation at Paleo F(x) this year (links to video will be provided once available). This series of articles will share the extensive research that I did in preparation for this presentation, including all of the topics covered during my talk as well as several topics that I didn’t have time to discuss (also see the free PDF Literature Review at the bottom of this post). For every anecdotal story of someone who has regained their health with a ketogenic diet, there’s a counterpoint story of someone who derai Continue reading >>
Do Very Low-carb Diets Mess Up Some Women's Hormones?
Studies show that low-carb diets can cause weight loss and improve metabolic health (1). However, even though low-carb diets are great for some people, they may cause problems for others. For example, following a very low-carb diet for a long time may disrupt hormones in some women. This article explores how low-carb diets may affect women's hormones. Your hormones are regulated by three major glands: Hypothalamus: located in the brain Pituitary: located in the brain Adrenals: located at the top of the kidneys All three glands interact in complex ways to keep your hormones in balance. This is known as the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is responsible for regulating your stress levels, mood, emotions, digestion, immune system, sex drive, metabolism, energy levels and more. The glands are sensitive to things like calorie intake, stress and exercise levels. Long-term stress can cause you to overproduce the hormones cortisol and norepinephrine, creating an imbalance that increases pressure on the hypothalamus, pituitary and adrenal glands (2). This ongoing pressure may eventually lead to HPA axis dysfunction, sometimes controversially referred to as "adrenal fatigue" (3). Symptoms include fatigue, a weakened immune system and greater risk of long-term health problems such as hypothyroidism, inflammation, diabetes and mood disorders. Many sources suggest that a diet too low in calories or carbs can also act as a stressor, causing HPA dysfunction. In addition, some evidence suggests that low-carb diets can cause increased production of cortisol ("the stress hormone"), making the problem worse (4). One study found that, regardless of weight loss, a low-carb diet increased cortisol levels compared to a moderate-fat, moderate-carb diet (5). Eating too fe Continue reading >>
When Not To Be On A Ketogenic Diet
When Not To Be on a Ketogenic Diet A ketogenic diet is a very low carbohydrate, moderate protein and high fat based nutrition plan. A ketogenic diet trains the individual’s metabolism to run off of fatty acids or ketone bodies. This is called fat adapted or keto adapted, when the body has adapted to run off of fatty acids/ketones at rest. This nutrition plan has been shown to improve insulin sensitivity and reduce inflammation. It also improves cellular healing and mitochondrial biogenesis which supports stronger and healthier cells. All of this leads to reduced risk of chronic disease as well as improved muscle development and fat metabolism (1, 2). Where Ketosis Can Be Extremely Beneficial There are certain cases, where I typically recommend a ketogenic diet as the research appears to support that ketosis significantly improves the functionality of these individuals. Overweight or Obese Neurodegenerative Conditions such as dementia, Alzheimer’s and Parkinson’s Most Cancers but especially those of the brain, nervous system and blood (leukemia) Chronic Pain Seizure Disorders Non-Elite athletes or individuals looking for higher mental & physical performance The final one is the area that I and many others who have pursued a state of ketosis fall into. At this point in my life, I have no chronic diseases, I feel great 99% of the time, but I am always looking to improve my productivity and performance. I have found being in mild-ketosis to be one of the best ways to improve my energy, mental acuity, creativity, physical strength and overall life performance. There is no one diet that works perfectly for everyone. Ketosis has the potential to benefit everyone, but under unique circumstances it would not be warranted. Here are a list of special cases where long-term st Continue reading >>
Paleo And Menstrual Cravings
Any kind of cravings can be the death of good dietary intentions, but menstrual cravings get a special mention because they’re so common (roughly 1/4 to ½ of premenopausal women, depending on which study you look at) and they can be so intense. So where do those cravings come from? Looking at the evidence shows that they’re probably not a direct effect of hormone shifts (which affect hunger, but not cravings) or caused by a nutrient deficiency. They’re more likely to be a complicated combination of mood changes, cultural factors, and the woman’s level of dietary restraint (i.e. whether or not she’s really worried about weight and dieting). Here’s a look at where menstrual cravings come from and what kinds of nutritional strategies help with fighting them. Hunger vs. Cravings First of all, it’s important to distinguish premenstrual hunger from premenstrual cravings. It’s actually normal for a woman to be hungrier right before her period, because her metabolism speeds up at this time of the month, so she’s burning more calories. Healthy women naturally eat more during the luteal phase (the part of the menstrual cycle right before bleeding starts), and one study found that they also eat more protein and specifically more animal protein. Other studies have shown an increase in carb consumption. It’s not a huge difference, but this really is a documented thing that happens, and there’s no reason to fight it because it’s completely normal. How do you know if you’re experiencing premenstrual hunger? It’s probably hunger if… A nutritious meal of animal protein, healthy fat, and vegetables sounds good. You’d dig right into a big plate of chicken drumsticks and roasted broccoli. The desire to eat goes away after a healthy meal without any sweets o Continue reading >>
Have You Lost Your Period To A Low Carb Diet?
A few weeks ago, I tweeted my concern about a low carb diet for young women. Apparently, my tweet was offensive to some people (men). They explained to me that it’s purely “anecdotal.” There is no known mechanism, they said, so it must not really be happening. Except it is really happening. Ask anyone who works with young menstruating women. Or not menstruating, as the case may be. True, we don’t know the exact mechanism. That’s because no researcher has yet asked the question: What does a very low carb diet do to periods? Until we have the answer, we can only surmise. I surmise that for some women inadequate starch signals the hypothalamus that there’s not enough food to reproduce. It may be via the hormone leptin. It may be via the microbiome. It is an adaptive starvation response, and may also be why a low carb diet can cause hair loss. [For an update and a possible mechanism, please see my 2016 post Are You Eating Enough to Get a Period?] In contrast, some women do well on a low-carb diet. They may even regain the periods they’d lost on a high-carb diet (see insulin-resistant PCOS discussion below). It comes down to this: There are different individuals in the world, with different glycemic responses. There are also different carbohydrates. For example, there is sugar and there is wheat, and they are two worst carbohydrates. Sugar is the worst carb Sugar is bad for health and for period health. High-dose fructose causes insulin resistance and inflammation and is more inflammatory than the long glucose chains of starch. That’s why some researchers have called for a ‘fructose index‘. I discuss fructose in my insulin resistance post, my PCOS post, and Chapter 6 of my book. Whole fruit is okay, but none of us should be eating desserts, sweet drinks, Continue reading >>
Ketosis And Menstrual Function: A Canary In The Mine?
In the 1920’s, researchers at the Mayo Clinic used a ketogenic diet to treat adults with ideopathic epilepsy. In 1930, Dr. Clifford Barborka published a paper detailing their findings with their first 100 patients. Among other findings, Barborka notes that 20% of the women involved in the study experienced complete cessation of menstruation during treatment, which didn’t return until a normal diet was resumed. He only reported on menstrual cessation, but given more contemporary research on the subject we can reasonably speculate that many more women experienced menstrual irregularities that stopped short of complete cessation. Subjects were eating appropriate calories to maintain their weight, so weight loss was not a confounder here. He speculates that it may have been related to a vitamin B or E deficiency, but has no clear explanation. (Note that this was many decades before the discovery of Leptin and it’s role in hormonal regulation.) In 2003, researchers published their retrospective study of 45 adolescents aged 12-19 treated for epilpsy with a ketogenic diet over 8 years. They noted that 45% of the girls involved in the study reported menstrual irregularities, most (2/3) of whom experienced complete cessation of menstruation (the other 1/3 were reported as experiencing delayed puberty or menstrual irregularity). Most resumed menstruation after ending the diet. 2 were treated with hormone therapy to induce and regulate menstruation. A majority of the girls did not lose weight on the diet, so again, weight loss was not a confounder in most cases. Researchers speculated that: “The diet may mimic the menstrual side effects seen in starvation and certain female athletes.” In 1999, a group of researchers published a review of a small group (9 women, 2 men) of Continue reading >>
Females, Carbohydrates, And Hormones
Oh, carbohydrates. Just like politics and religion, discussion on this macronutrient is not dinner table material. There are many strong opinions on just how many carbohydrates are “safe” to consume. Some advocate “high” carb, others prescribe a “moderate” amount, others “low” or even “very low”. And to mystify things further, what’s considered a low amount of carbohydrates to some, may be considered too high for others. Even the scientific literature doesn’t seem to agree on a common definition. See how it can get confusing? The purpose of this post isn’t to tell you which way is better. In fact, that is a decision you may never make. What works for some people, won’t work for others. What works for you now, may not work for you next week. If something is working for you, great! Right now, I want to explore one piece on the topic of carbohydrates that isn’t discussed often in this community. I bring up this topic because I personally struggled with finding the “right” amount of carbohydrates for my body. I want to make sure others don’t have to go through what I did. In the past, I’ve done damage to myself by going too low (almost on accident) and I want to stop you before it’s too late. If you’re in the same boat as I was, I’m hoping this will be an aha! moment for you. When I first started with my Paleo lifestyle, I realized just how amazing I felt going lower carb (probably in the range of 100 grams a day). The problem was, I was also doing high intensity workouts (kickboxing, interval training) multiple times per week. At first, I felt great. I was recovering like a champ, my sleep was perfect, I had a very stable, positive mood, and even though I knew I would probably benefit from more carbohydrates, I stubbornly went on Continue reading >>
Ketosis And Hormone Changes
While working as a nurse with Dr. Robert Atkins, I adopted a low carb diet. My goal was to avoid my genetic tendency for developing obesity and type 2 diabetes. I had the tools at hand to monitor urinary and breath ketones frequently. After months I noticed that a few days before my period, ketones would drop or even disappear. This coincided with mild PMS symptoms including weight gain and the re-emergence of hunger and cravings. Ketones would return by the 2nd day or so of my menses. I began to mention this to my patients who wanted to monitor urinary ketones. I didn’t want them getting discouraged if they experienced the same. Many would return and tell me they noticed the drop in ketones as well. They appreciated having advanced warning. We also observed that with low-carb regimen, PMS symptoms over time would decrease, sometimes to the point that a woman would be surprised when she began her flow. At the start of the plan others would mention that the first period would in some way be worse before getting better. To my knowledge this has not been studied. What I learned is that any hormone changes in women can increase insulin resistance, which makes the body produce more insulin to get the same insulin benefit. At puberty and menarche when girls need to gain body fat they become more insulin resistant. I have been a carb addict but my cravings increased significantly at this time as did my weight. Hormones also fluctuate during the menstrual cycle. During pregnancy, peri-menopause, and menopause there are significant hormone changes accompanied by increased insulin resistance. This change of life stage (peri-menopause) for me was difficult. I lost ketones but still gained weight on my maintenance plan (my strategy was to adopt a 20 gram carbohydrate level and st Continue reading >>
The Side Effects Of A Low Carb Diet
Who should go on a low-carb diet? Low-carbohydrate diets — like the ketogenic diet — are effective for weight loss and improving health. They are also especially helpful for anyone who: Is overweight or obese Is sedentary Has epilepsy Has polycystic ovarian syndrome (PCOS), fibroids or endometriosis Is diagnosed with type 1 or type 2 diabetes Has a neurodegenerative disease such as Alzheimer’s or Parkinson’s Has certain forms of cancer Has cardiovascular disease A typical low-carb diet limits the daily intake of carbohydrates to between 60 and 130 grams, while a ketogenic diet tends to stay below 30 grams of carbohydrates. This is done by excluding or limiting most grains, legumes, fruits, bread, sweets, pasta and starchy vegetables from the diet and replacing them with added fats, meat, poultry, fish, eggs, non-starchy vegetables, nuts, and seeds. When we eat in this way, our bodies begin to change dramatically — especially for those who habitually eat plenty of carbohydrates with each meal. Not all of these changes, however, are going to be positive. When carbohydrates are restricted, it is stressful for the body because it must find another way to fuel itself. This can cause side effects, like nausea and headaches, that is commonly called the “keto flu”. The lack of carbohydrates will also lead to fluid and mineral loss and hormonal changes that can cause health issues if not addressed. The Most Common Side Effects The most common side effects that are experienced when restricting carbohydrates are: Headache Bad breath Weakness Fatigue Constipation or diarrhea It is important, however, to consider how common these symptoms actually are. In studies that put obese patients on a ketogenic diet for 6 months or longer (up to two years), no side effects or co Continue reading >>
Ladies: Extra Mini-periods?
Whoo! Sit down with a nice hot cup of tea. I've got a big answer. Pardon me, while I dust off my soapbox. ;) DISCLAIMER #1: If you want to have children some day, then you should seek specific professional guidance (ie someone who deals specifically with reproductive health) when dealing with reproductive hormones. What you do today could have serious consequences years from now. That said, most women can correct years of hormonal imbalance in just a few cycles and still conceive. DISCLAIMER #2: It's hard to say what's "normal" for someone doing paleo while on the pill, because I don't think being on the pill can be considered paleo. As people following a paleo diet, we're basically trying to regulate our hormones by eating quality food and getting quality sleep. Unless we have a real medical condition that requires prescribed hormones (the use of which usually tends to follow natural rhythms); we should not be messing with our body's natural monthly hormonal rhythms by using the pill. So here's another situation where it's important to understand how the hormones are working and how they affect your body. Every cycle, under the influence of Follicle Stimulating Hormone (FSH), about two dozen eggs start to mature. Each egg is encased in a follicle. The follicles produce Estrogen. Estrogen is the hormone necessary for ovulation to occur. Eventually, when Estrogen reaches a threshold that is high enough, one eggs bursts out (ovulation!). This usually takes about two weeks from the beginning of menses but can take anywhere from 8 days to several months! Following the release of the egg, the follicle that held the egg begins to release progesterone (typically for only 12 to 16 days). This is known as the Luteal Phase. Progesterone prevents the release of all other eggs and Continue reading >>
Symptoms Of Ketosis:
If you are considering the ketogenic diet or have already started down this carb-free road, you may wonder what you can expect. Here’s the thing. Ketosis looks different for everyone, but I will share many of the most common symptoms with you today. If something other than what’s listed here is happening to you, just do a quick Google search for that symptom and keto. You should be able to find what you’re looking for! The Early Signs: The early signs of ketosis vary from person to person. The biggest impact on how quickly you notice the symptoms of ketosis will have a lot to do with how you ate before you started the diet. If your diet was very high carb, you might get hit pretty quickly and furiously with what we like to call the “Keto Flu.” This can last anywhere from 3 days to a week or more. Once your body has adapted to burning ketones for energy instead of glucose, you’ll be golden so don’t give up! Here’s what you can expect within the first 2-3 days of starting the Ketogenic Diet: Fatigue & Weakness (lack of concentration) Headaches Metallic taste or sweet taste in your mouth (I experienced this, and it tasted like blood in my mouth) Lightheaded / Dizzy upon standing Heightened Thirst Hunger / Sweet or Carb Cravings Dry Mouth possibly paired with “Keto Breath.” Stomach Discomfort / Mild Nausea / Cramping Trouble Sleeping or Staying Asleep (early waking) Water weight loss (perhaps an excessive loss of weight within the first two weeks) Frequent Urination Allergies or cold like symptoms may flair up For the ladies: Period issues: You may experience a longer, shorter, earlier, later period because of Keto. Seriously it causes all of that. Each woman is different, and I have experienced every one of those issues with my period since starting ket Continue reading >>
Possibly Worth Studying: Women And Low-carbing
Trigger Warning for Eating Disorders/Body Image/Diet Talk In two weeks, I will report my low-carb findings. Right now, I can’t stop being surprised by how little of the information on low-carbing available online is relevant to most women. After two decades of trying to lose weight, I thought I knew what to expect with low-carbing. What I’d never considered was the fact that while most weight loss plans are dominated by and at least somewhat geared towards women, low-carbing is one of the few where men seem to make up a majority, at least online. Exact numbers vary according to personal experience, and I have no hard data, but in my research on the matter (i.e. hours spent searching and bookmarking specific keto concerns), I’ve discovered that many of the answers I’d found are only relevant to most men, i.e. not so for most women. Medical studies often ignore how drugs can affect women differently; similar issues can be found with exercise studies. The phenomena below have yet to be studied, but many ladies on keto report having experienced them (I apologize for the problematic name of that sub-Reddit). Proper scientific studies on diet and exercise are difficult to conduct and therefore rare, and even rarer are ones that take such differences into account. Again, to clarify: This list does not represent peer-reviewed scientific studies because such research has yet to be conducted. I do think that any item would make an excellent hypothesis to be tested. It would be interesting to find out whether or not the following phenomena occur at all, and, if so, are due to women low-carbing. 5. Does keto trigger early periods? Not only does the infamous “Atkins flu” cause PMS-like symptoms (irritability, incessant hunger, nausea, weakness, fatigue, and so on), but i Continue reading >>
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Epilepsy And Your Changing Hormones
Women with epilepsy face different issues than men with epilepsy. For some women, the pattern of epileptic seizures is directly affected by the normal hormonal cycles they experience throughout their lives. Two primary sex hormones flow through women's bodies. One is estrogen and the other is progesterone. Most of the time, your body has about the same amount of each. What does that have to do with epilepsy? Doctors have learned that both of these hormones interact with brain cells. Estrogen is an "excitatory" hormone, which means that it makes brain cells give off more of an electrical discharge. Progesterone, on the other hand, is an "inhibitory" hormone, which means that it calms those cells down. When the body is making more estrogen than progesterone, it can make the nervous system "excitable." In other words, you could be at greater risk for seizures. The hormones aren't actually causing the seizures, but they can influence when they happen. Some women with epilepsy have more seizures when their hormones are changing. For example, some young women have their first seizures at puberty. Other women have more seizures around the time of their menstrual periods. This doesn't happen to all women, so doctors are still learning about how hormones and epilepsy interact. Some women have a form of epilepsy called catamenial epilepsy. This refers to seizures that are affected by a woman's menstrual cycle. Doctors aren't completely sure how many women with epilepsy have this, but they think it's about 10% to 12%. The exact cause of these seizures is unknown. However, some women have most of their seizures when there is a lot of estrogen in their body, such as during ovulation. Other women have seizures when progesterone levels tend to drop, such as right before or during thei Continue reading >>
