You’re eating “healthy”, so you’re having a green smoothie for breakfast, and avoiding carbs with dinner. Maybe you’re doing it in response to a new PCOS diagnosis. Or maybe it’s because you bloat if you eat anything apart from meat and vegetables and green smoothies.
Either way, your new way of eating could become a real problem for your period.
As an active woman, you need about 2100 calories per day. Are you reaching that? Your green smoothie gives you 200 calories, and your can of tuna plus half a sweet potato gives you about 250. So far, you’re at only 450 calories. That’s less than a quarter of what you need, and it’s already afternoon.
⚠️ Tip: Please don’t worry about actually counting calories. Aim for at least three full, solid meals per day—and you should be okay. If digestive problems prevent you from eating that much, then seek digestive treatment (see below).
Not just calories, but carbs
Too few calories triggers a starvation response in your hypothalamus that disrupts luteinizing hormone (LH) pulsatility and shuts down ovulation. Too little carbohydrate (but enough calories) does the same thing. Therefore, as a woman, you may need more carbohydrate than a man. You probably cannot rely solely on protein and fat and non-starchy vegetables. (But of course, you do also need protein and fat and micronutrients.)
Signs you don’t eat enough carbohydrate:
- Under-active thyroid and elevated reverse T3
- Hair loss
- Amenorrhea (lack of periods)
This is true even if you have a normal body weight (BMI), because your hypothalamus cares less about body fat, and more about whether you eat enough to keep up with your activity level. This is called energy availability, and is calculated as a ratio between energy intake, body mass, and energy expenditure (exercise). If don’t eat enough, your hypothalamus thinks you’re in hard times, and makes the executive decision to halt reproduction.
Starvation-induced amenorrhea was a beneficial adaptive strategy throughout all of human history, because it prevented us from trying to make babies when there wasn’t enough food.
⚠️ Tip: Under-eating is one of the main causes of Functional Hypothalamic Amenorrhea (FHA).
⚠️ Tip: Hormonal birth control doesn’t solve the problem of amenorrhea because Pill-bleeds are not periods.
Not all women are the same. For example, your friend may eat lower carb than you, but she’s just fine. Your friend is different. She may have had insulin resistance, and so benefitted from a low-carb diet. Or she may have a different ovarian “set point” from you. For more information on ovarian set-point, please see Dr Grazyna Jasienska’s book Fragile Wisdom.
Energy is the key to understanding ovarian function. ~ Dr Grazyna Jasienska
What if you have PCOS?
Didn’t you read somewhere that carbohydrates are bad for PCOS? True, too many carbohydrates (especially fructose) are bad for insulin resistance, but insulin resistance and PCOS are not the same thing.
First things first: How was your PCOS diagnosed? If it was by ultrasound, then you may not actually have PCOS, because ultrasound alone is NOT enough to diagnose it (read The Surprising Truth About PCOS). You need a blood test for androgens and insulin.
If you’re avoiding carbs because someone saw polycystic ovaries on ultrasound, you may be on the completely wrong track.
But if, on the other hand, you do have insulin-resistant PCOS (and not another type of PCOS), then Yes, you may need to reduce carbohydrate. More specifically, you need to quit sugar, which is the worst carb, because concentrated fructose worsens insulin resistance and insulin-resistant PCOS. You may also want to moderately reduce starch, but only until you bring your fasting insulin between 30-60 pmol/L (4-9 mIU/L).
What if you can’t digest carbs?
If you can’t digest carbs, it’s probably because you have small intestinal bacterial overgrowth (SIBO), which causes fermentation of FODMAPs in the small bowel.
⚠️ Tip: Rice and potatoes are not FODMAPS, so they are generally the easiest starches to digest.
Reducing carbs to relieve bloating is okay in the short-term, but it’s not a solution in the long-term. Why? Because you need carbohydrate to have periods, and you need FODMAPS to feed your intestinal bacteria.
The long-term solution is to fix SIBO with a two month course of antimicrobial herbs and HCl digestive enzymes (taken after a meal). Please consult your local clinician for help, and keep going with treatment until you can eat all gentle carbs without bloating.
How long will it take to get your period?
Once you’ve increased calories and starch, you should see a period within 3-4 months. If no period comes, then you need to do more detective work. See Chapter 7 of my book for a full troubleshooting discussion of amenorrhea. And if you’re looking at the herbal medicine Vitex, please understand that it will not work unless you also increase your food intake.
Do you have an eating disorder?
If you’re frightened by the idea of eating more, then you may need to consider if you have an eating disorder. Approach it with self-love and self-forgiveness, and reach out for help. Here are some places to start:
- Office on Women’s Health—Eating Disorders (USA)
- NHS—Eating Disorders (UK)
- National Eating Disorders Collaboration (NEDC) (Australia)
- National Eating Disorder Information Centre (NEDIC) (Canada)
Eating disorder is incredibly common. You’re not alone, and you need not feel ashamed. Help is available.
Yours in health and love,