Taken from the December edition of Paleo Magazine
"Carbohydrates for Female Hormonal Health
By: Stefani Ruper
Paleolithic dieters often gravitate towards low carbohydrate diets, and not without good reason. Low carbohydrate diets (<50 g/day) are largely beneficial for people who have historically eaten the Standard American Diet. A low carbohydrate diet is a quick way to lose weight, a means by which to mitigate diabetes and sharpen insulin sensitivity, and a potent appetite suppressant in the short term.1 Low carbohydrate diets can also be therapeutic for cancer, migraines, and chronic infections or psychological disorders.
On the other hand, low carbohydrate diets can act as significant metabolic stressors, in particular, often causing negative effects on women’s hormonal health. The more restriction a woman undertakes-restriction of calories, restriction of energy, or restriction of macronutrients, for example-the more her body responds by shutting down hormonal activity. This is even more potently the case for women who are athletic and/or normal weight.
The hormonal shut-down that sometimes accompanies low carbohydrate diets does not of course apply to every woman. Many women, especially overweight women, undertake low-carbohydrate diets and experience great energy, life, and liberation from symptoms of their previous lifestyles. But women who experience infertility, hypothyroid symptoms, irregular or absent menstrual cycles, sleep and or mood and mental health related issues may find significant relief from adding carbohydrates (>100g/day) back into their diets.
There are two primary mechanisms by which carbohydrates promote female hormonal fitness.
Hypothyroidism affects nearly 10 percent of American women. Ninety percent of this population has Hashiomoto’s Thyroiditis, which is an autoimmune thyroid condition. The remaining 10 percent suffer poor thyroid health via other mechanisms. One such mechanism is poor conversion of T4 (the inactive form of thyroid hormone) into T3, the active form. Outside of this population, there remains many more women who do not have clinically-low hypothyroidism, but who suffer low thyroid symptoms as an effect of poor T4 to T3 conversion.
This is in part because glucose is necessary for the conversion of T4 to T3. Many paleo dieters are aware that the liver is capable of producing its own glucose via gluconeogenesis. This process, however, can become taxed over time. Even the most efficient gluconeogenesis does not, in many women-especially women who are stressed, who practice caloric restriction, who fast, or who are recovering from poor nutrition, dieting, or disease-consistently produce enough glucose for optimal thyroid and hormonal function.
Regularly ingesting glucose assures that a woman’s liver does not have to work overtime. This helps the body function more efficiently and less stressfully in general, but it also specifically optimizes thyroid activity. Thyroid activity is crucial for reproductive function. Without thyroid hormone, the reproductive system does not have enough energy to produce hormones and to perform reproductive function. For this reason, hypothyroidism is strongly correlated with hormone disorders such as PCOS and hypothalamic amenorrhea. Moreover, hypothyroidism is implicated in mood disorders, skin conditions and in weight gain, among other things. Because of these multiple factors, many women, contrary to popular paleo belief, in fact lose weight once they add carbohydrates back into their diets.
One powerful and well-studied benefit of thyroid effects on reproductive health is the resumption of menstruation in women who have both low thyroid issues and polycystic ovaries. Clinical research studies have shown time and time again that if these women correct their thyroid function, either with T3 supplementation or with natural interventions such as a higher carbohydrate diet, their cysts diminish and they begin menstruating more regularly.
Glucose intake signals to the hypothalamus a “fed” state
From a low-carbohydrate diet perspective, insulin is a metabolic demon that needs to be avoided at all costs. And in some ways, it should be. Chronically elevated insulin levels can lead to diabetes and other sorts of metabolic disturbances. But insulin spikes, the type of insulin action that occurs with regularly eaten meals that can contain a wide variety of macronutrient ratios on the other hand, are well-tolerated. They are so well-tolerated, in fact, that they play an important role in ensuring female reproductive function.
When insulin levels spike, leptin levels spike right alongside them. Leptin is a crucial hormone. It rises both with fat stores and with ingestion of carbohydrates. What this means is that its primary role is to signal to the hypothalamus, the part of the brain which controls activity of the adrenal and pituitary glands, that a woman has access to sufficient energy resources. Without leptin, a woman’s brain thinks she is starving. The first action the brain then takes is to shut down hormone production in the pituitary glands. With depressed hormone levels, ovulation and menstruation do not occur. Worse however, is the fact that without sufficient hormone production, even more problems can dogpile on top of infertility. These include acne, depression, anxiety, and insomnia.
Different macronutrients have different effects on leptin spiking. Since leptin works in tandem with insulin, leptin levels do not rise in response to fat at all, and respond very little to fatty meals. Protein triggers leptin secretion, to an extent, but only carbohydrates have a significant leptin-elevating effect. Studies have shown on multiple occasions that a woman’s average leptin levels increase in parallel with the amount of carbohydrate she eats.2
Which carbohydrates to eat, and how
All whole carbohydrate foods-vegetables, fruits, white rice and starchy tubers such as potatoes, sweet potatoes, taro and cassava-are free of the toxic effects of the Standard American Diet.
The amount of carbohydrate that is appropriate for each woman to eat is of course particular to her own life, history, and preference. Women recovering from high stress or from highly restricted diets may need significant carbohydrate intake in order to recuperate thyroid and hypothalamic function. Women who are overweight probably need less.
At minimum, however, 100 g/day is a good and safe starting point from which women can experiment.
All this being said, what is most important for health is nourishment and adherence to paleo, non-toxic foods, not given macronutrient ratios or orthodoxy. Carbohydrate restriction may be appropriate in some cases, but in many it is not, and in others still, carbohydrates are vital. In all cases, it is safe, important, and potentially life-saving to experiment with them. Nourishment is the name of the game. For some of us, carbohydrates may play an important role in being on the winning team.
1 I refer to you the work of Dr. Stephan Guyenet at wholehealthsource.blogspot.com for more information.
2 Without question the most important source of leptin in the blood is fat cells. Carbohydrates can help raise leptin levels, but they cannot make up for the metabolic damage of having too little body fat or ingesting too few calories."
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