Chapter 13
The Paleo Diet for Women
Feeling Better: Liz’s Story
I am a sixty-one-year-old woman. I started the Paleo Diet in November 2005 and have been on it ever since. I do indulge in some of the forbidden foods, such coffee with half-and-half, a habit seemingly impossible for me to break. It gives me the energy to do the things I want to do, and unless you can give me a formula for getting more energy otherwise, I may be in trouble on that one. Also, after experimenting without or with drastically less salt, I have added back my habitual amounts of salt again. But it is a lot, lot less than in the typical American diet, I assure you. Other than that, I stick to meat, vegetables, and fruit. No dairy, no grains, no legumes, no potatoes. I don’t miss any of it.
I found an organic farmer in Marin County near where I live and got a hog, a quarter steer, and chickens from them. The meat is lean and outstanding. I get fresh-caught fish and vegetables from the farmer’s market, as well as organic eggs. My trips to the supermarket are now limited to bananas, half-and-half, and a few other things occasionally.
I feel good. Some friends say I am the picture of health. At the start of the diet, I weighed 145 pounds; now I weigh 130 pounds and have stayed there for months.
I never suffer from indigestion now. My husband, who is also on this diet, eats toast and butter and jam for breakfast, a gourmet lunch with his colleagues, and what I cook for dinner. Even so, he has gone from having a hiatal hernia, with daily doses of Mylanta and Prilosec, to no problems at all. And he has lost at least 30 pounds. I would like to see him eat better; maybe he’ll come around.
For a while I did experience daily leg cramps. Once I read one of Dr. Cordain’s papers on potassium and what contained the most potassium. I try to get those vegetables and throw mushrooms into everything when I have them.
Since I have been on the diet, I have been virtually free of almost weekly, random, very debilitating headaches. I feel so free and at this point take it for granted! There used to be days when I just would have to stay in bed because the headaches were so bad, and the doctor always said they were tension headaches.
Bottom line—I like eating the way I do, and I will never change.
The Paleo Diet is a lifetime way of eating that has been adopted by hundreds of thousands, perhaps millions, of people worldwide. Men, women, and children of all ages and from all walks of life have decided to replicate the diets of their hunter-gatherer ancestors but with foods commonly available at their local supermarkets. There are many ways to approach the Paleo Diet—many different Paleo diets, so to speak. People can fine-tune this nutritional plan to their individual needs, and I have always felt that this is the correct approach.
We should use the Paleo Diet as a starting point for optimal nutrition, but we should always listen to our own bodies, as we adjust our diets to our specific nutritional and lifestyle requirements. For instance, I view freshly steamed crab legs with pleasure and consider it a favorite food, whereas others may have allergies to shellfish that would obviously exclude this nutritious food. Some people seem to do better on higher-fat versions of the Paleo Diet, whereas others prefer less meat and more fruit and veggies.
It is increasingly becoming clear that one size doesn’t necessarily fit all. A modern-day Paleo Diet may be one of the best strategies for you and your partner to become pregnant. Once women have a successful conception, however, it is important for them to reduce their protein intake during pregnancy.
There is no doubt that contemporary Paleo diets will provide you with considerably more protein than the amount consumed in the typical U.S. diet. The average protein intake in the U.S. diet is 98.6 grams per day (15.5 percent of the total calories) for men and 67.5 grams per day (15.1 percent of the total calories) for women. Animal products provide approximately 75 percent of the protein in the U.S. food supply, followed by dairy, cereals, eggs, legumes, fruits, and vegetables. Because dairy, cereals, and legumes are not part of the Paleo Diet, you will be obtaining nearly all of your protein from animal foods. Diets that contain 20 percent or more protein have been labeled high-protein diets, and those that contain 30 percent or more protein have been dubbed very-high-protein diets. Accordingly, a high-protein diet (20 to 30 percent protein) for the average U.S. man would contain between 125 and 186 grams of protein per day and for the average woman from 89 to 133 grams of protein per day. Most contemporary Paleo Dieters follow high-protein diets because their protein intake falls between 20 and 30 percent of their daily calories.
I need to point out that there is a physiological limit to the amount of protein you can ingest before it becomes toxic. A by-product of dietary protein metabolism is nitrogen, which in turn is converted into urea by your liver and then excreted by the kidneys into your urine. The upper limit of protein ingestion is determined by your liver’s ability to synthesize urea. When nitrogen intake from dietary protein exceeds the ability of the liver to synthesize urea, excessive nitrogen (as ammonia) and amino acids spill into the bloodstream, causing toxicity. For most people, the dietary protein ceiling occurs when protein exceeds 35 to 40 percent of their normal daily caloric intake. Consequently, very-high-protein diets for the average U.S. man could range from 187 to 270 grams per day and for women, 134 to 246 grams per day.
Our hunter-gatherer ancestors knew that they could get too much of a good thing and avoided eating very lean, fat-depleted animals. Excess consumption of protein from the lean meats of wild animals leads to a condition referred to by early American explorers as “rabbit starvation,” which resulted in nausea, then diarrhea, and eventually death. Anthropologists, including my colleague John Speth at the University of Michigan, have documented that hunter-gatherer women have a lower tolerance for protein when they become pregnant. The medical literature has recently substantiated the anthropological observations, and it is now known that during pregnancy, women have a reduced ability to metabolize dietary protein. High maternal protein intake increases the risk for low-birth-weight babies and overall fetal mortality. During pregnancy, the estimated safe upper limit for dietary protein is about 25 percent of the daily calories. Here’s a breakdown of protein content in the average American diet.
- Average protein intake in the United States: 15 percent of caloric intake
- Diets considered to be high protein: 20–30 percent of average caloric intake
- Diets considered very high protein: 30–40 percent of average caloric intake
Most modern-day Paleo Dieters eat high-protein diets that contain between 20 and 30 percent protein. If you are pregnant, a 25 percent protein limit would amount to no more than 110 grams of protein per day. This goal can easily be achieved by eating fattier cuts of meat; fatty fish such as salmon, mackerel, and herring; and more nuts, avocadoes, and eggs, along with using more olive oil in your salads and cooking. Besides including more fat in your diet, you should also displace lean proteins with more carbohydrates. Yams, sweet potatoes, bananas, and other fresh fruits are a great starting point.
Eating Paleo is perhaps the best strategy you can take in becoming pregnant, and by slightly lowering your protein intake during pregnancy, you can help assure yourself of an easy delivery and a healthy baby.
Paleo Diets and Gestational Diabetes Mellitus
One of the greatest risks for pregnant women and their fetuses is the development of diabetes during pregnancy. This condition is known as gestational diabetes mellitus (GDM) and is present in 4 to 7 percent of all pregnancies in the United States. GDM heightens the risk for premature births, birth defects, and still births. For the mother-to-be, GDM increases her chances of developing preeclampsia, a blood pressure condition that can be life threatening to the mother and the child. The chief metabolic problem with GDM is that maternal blood sugar levels remain elevated during pregnancy; this condition is largely responsible for the health risks in both mother and fetus.
GDM is definitely bad news, but the good news is that low-glycemic-index/load diets are known to improve pregnancy outcomes if they are started from the first trimester onward. My colleague Jennie Brand-Miller from the University of Sydney has recently demonstrated that low-glycemic-index diets effectively halved the number of women who required medication to control their high blood sugar levels during pregnancy. And a recent study from David Ludwig’s group at Harvard Medical School showed that a low-glycemic-load diet resulted in longer pregnancy duration, greater infant head circumferences, and improved maternal cardiovascular risk factors.
Because the Paleo Diet is a low-glycemic-index nutritional plan, it represents one of the best steps pregnant women can adopt to prevent GDM and improve their own health and that of their children.
The Paleo Diet, Omega 3 Fatty Acids, and Pregnancy
One of the most therapeutic aspects of the Paleo Diet for virtually all chronic Western diseases is its high omega 3 fatty acid content, particularly EPA and DHA. So it should not surprise you that these essential nutrients will also help ensure a successful pregnancy and a healthy baby. Adequate maternal intake of EPA and DHA during pregnancy can improve your infant’s cognitive and visual performance because these fatty acids represent the building blocks of fetal brain and retinal tissues. Omega 3 fatty acids play a key role in determining the length of gestation and may reduce the incidence of preterm birth. Some studies also suggest that sufficient consumption of fish (high sources of EPA and DHA) during pregnancy may be effective in preventing postpartum depression. Unfortunately, many pregnant women avoid fish because of concerns about adverse effects of mercury and other contaminants.
The Paleo Diet is an extraordinarily rich source of omega 3 fatty acids, particularly if you consume fatty fish such as salmon, mackerel, herring, or sardines a few times a week. Shellfish and leaner fish are good sources of EPA and DHA; grass-fed meats and omega 3–enriched eggs contain moderate amounts of these health-promoting fatty acids. Pregnant women should strive for a minimum of 200 mg of DHA per day. Note that a 100 gram serving, around 4 ounces, of Atlantic salmon gives you 300 mg of EPA and 900 mg of DHA. If you don’t like to eat fish or seafood or have worries about mercury and other toxins in fish, I recommend that you supplement with fish oil, either capsules or liquid, during your pregnancy.
The Paleo Diet and Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is the most common hormonal disease in females, afflicting between 5 and 10 percent of all women of childbearing age; it is a major cause of infertility. Common symptoms include menstrual irregularities, ovarian cysts, and high levels of male hormones, producing acne, excessive body hair, and hair loss. The majority of women with PCOS have insulin resistance and frequently are obese. They maintain a ten times greater incidence of type 2 diabetes than healthy normal women and are at a much greater risk of dying from premature cardiovascular disease.
The good news is that diet is known to be a major player underlying this syndrome. Weight-loss programs seem to reduce disease symptoms, but more important, so may low-glycemic-index diets. A new study by Dr. Jennie Brand-Miller has shown that a low-glycemic-index diet could improve PCOS symptoms by preventing menstrual irregularities. Two other new studies have demonstrated that supplementation with omega 3 fatty acids may also be therapeutic in PCOS patients. The Paleo Diet is just what the doctor ordered if you have PCOS. Because our ancestral diet is a high-protein, low-glycemic nutritional plan, rich in omega 3 fats, it will help you to lose weight, normalize your hormones, and reduce your risk for developing diabetes and cardiovascular disease.
Relieving Menstrual Problems: Phyllis’s Story
I have not read of any other women talking about relief from period pain on a Paleo diet, but if only I’d known about it years earlier!
I have always had extremely severe cramps in the first few hours of my period. I spoke to many women but have met only a few who seemed to experience the same degree of pain as me. If I didn’t take medication in time, I always repeatedly vomited, even after my stomach was empty. I had diarrhea and terrible cramps. I just could not believe how painful they were. My hair was usually wet within minutes, due to my sweating from the pain, and I could see the sweat bead down my arms, too. I could not even sit upright; mostly, I just curled into a ball. I lived in terror of being caught away from home, without medication, when my cramps started.
Although being on the pill solved the problem for a couple of years in my twenties, I did not want to be on the pill long term. No other solution worked, and even referrals to gynecologists did not help. Yet for the two years I lived in Japan in my midtwenties, I was free of all pain. I put this down to a diet high in seaweed, tofu, and fish and was frustrated that I never managed to replicate the benefits at home in Australia, despite trying hard to achieve a similar diet.
It seems odd now that I didn’t realize that the solution lay in what I was not eating in Japan: I was eating very little dairy and wheat. A doctor who specialized in nutritional medicine made this clear to me. After one week on a Paleo diet, I had my first period in eleven years that did not require medication. I was astonished and jubilant.
I have experienced most of the other benefits that people have talked so much about, such as weight loss, increased energy, and no colds. My premenstrual tension is almost entirely gone after months of getting progressively worse. My favorite thing is not having an afternoon slump during my workday.
The Paleo Diet and Breast and Other Cancers
Although many women fear breast cancer—and rightly so—the greatest risk to health for both men and women comes not from cancer but rather from cardiovascular disease.
Male Deaths from Various Causes
The leading cause of death in the United States is cardiovascular disease, followed by cancer. In both men and women, cardiovascular disease plus cancer are responsible for a little more than 60 percent of all deaths from all causes combined. The Paleo Diet contains many nutritional elements that can greatly reduce your risk of contracting both of these diseases.
Female Deaths from Various Causes
Male Cancer Deaths
There is no doubt that breast cancer is a serious illness that in many cases can be life threatening. The graphs on this page show the top ten causes of cancer deaths in the United States in 2007. Note that for both men and women, lung cancer is responsible for nearly twice as many fatalities as the next leading cancer deaths—breast for women and prostate for men. Almost all lung cancer is caused by smoking and consequently is preventable by eliminating this nasty habit.
Female Cancer Deaths
Breast cancer was rare or nonexistent in historically studied hunter-gatherers and other less-Westernized peoples. Similar observations have been consistently noted for almost all of the other common modern cancers: prostate, colorectal, pancreatic, leukemia, and ovarian. Some of the most convincing evidence demonstrating that cancer is a disease of modern civilization comes from studies of the Inuit (Eskimo) people as they made the transition from their Stone Age way of life to the Space Age in less than two generations.
Here is a quote from an article on Eskimo health that appeared in theCanadian Medical Association Journal in 1936: “In the Western Arctic Dr. Urquhart has as yet not met with a single case of cancer in the seven years of his practice. Cancer must be extremely rare in the Eastern Arctic also.” Similar observations come from yet another frontier physician, Dr. Samuel Hutton, who treated non-Westernized Inuit people in Labrador from 1902 to 1913: “Some diseases common in Europe have not come under my notice during a prolonged and careful survey of the health of the Eskimos. Of these diseases the most striking is cancer. I have not seen or heard of a case of malignant new growth in an Eskimo.” As the Inuit people became more and more Westernized and began to replace their traditional foods with processed foods, their relative immunity to cancer diminished. In a paper published in 1984, Drs. Hildes and Schaefer examined cancer rates in the Inuit from 1950 to 1980 and noted, “The most frequent tumours in the most recent period studied were lung, cervical and colorectal cancers. Breast cancer was absent before 1966 and was found in only 2 of 107 Canadian Inuit women stricken with cancer from 1967 to 1980, whereas the recent rates in the longer-acculturated Inuit of Alaska and Greenland have approached those prevailing in modern Western women.”
The virtual absence of breast cancer and other common Western cancers is not entirely restricted to the Inuit. The Nobel prize–winning physician Dr. Albert Schweitzer commented, “On my arrival in Gabon, in 1913, I was astonished to encounter no case of cancer . . . I cannot, of course, say positively that there was no cancer at all, but, like other frontier doctors, I can only say that if any cases existed they must have been quite rare. This absence of cancer seemed to me due to the difference in nutrition of the natives as compared with the Europeans. . . . In the course of the years, we have seen cases of cancer in growing numbers in our region. My observations incline me to attribute this to the fact that the natives were living more and more after the manner of the whites.” Dr. Schweitzer got it right. The virtual absence of breast, prostate, colorectal, and other common Western cancers in the hunter-gatherers of Gabon had everything to do with their diet.
The Paleo Diet maintains multiple nutritional characteristics that will help protect you against breast and other common Western cancers. The Paleo Diet is a low-glycemic-index, low-glycemic-load diet. A recent meta analysis involving ten studies and more than 575,000 subjects by Drs. Dong and Qin clearly show that high-glycemic-index diets increase the risk for developing breast cancer. Similar results were observed in an even larger meta analysis by Dr. Barclay and colleagues from the University of Sydney.
It is not only the Paleo Diet’s low glycemic index and load that will protect you from breast cancer but also its rich omega 3 fatty acid content and low levels of high omega 6 vegetable oils. In tissue and animal models of breast cancer, omega 6 fatty acids from vegetable oils stimulate cancer growth, whereas omega 3 fatty acids inhibit it. A large meta analysis by Dr. Saadatian-Elahi showed a significant protective effect of omega 3 fatty acids on breast cancer risk.
The Paleo Diet is a milk- and dairy-free diet. As discussed earlier, milk drinking boosts your blood concentrations of female hormones, whether you are a man or a woman. If you are a woman, elevated blood estrogen and its metabolites increase your lifetime risk for breast and ovarian cancers. For men, milk’s added estrogen may heighten your risk for prostate and testicular cancer.
The Paleo Diet is also exceedingly rich in fresh fruits and veggies. These foods are Mother Nature’s best medicine; meta analyses of population studies confirm that fresh fruits and vegetables protect women from breast and many other cancers.
However you look at it, the Paleo Diet is a good natural way to prevent cancer.
Surviving Breast Cancer: Debbie’s Story
I am a breast cancer survivor. I was first diagnosed with breast cancer on May 25, 2001: T1, Node Negative, Her 2 positive and nuclear grade 3. I had a lumpectomy, aggressive chemotherapy, and radiation. On March 26, 2004, my breast cancer returned to my L-1 disk in my spine. I had six months of weekly chemotherapy and radiation. By December 15, 2004, I was declared in remission.
Herceptin was part of the chemo protocol that I had received in 2004, and I have been receiving it every three weeks since the beginning of January 2005. Tumor marker tests are also conducted every other month. Unfortunately, my tumor markers started rising, and by the end-of-May tests, the upward trend was disturbing.
On May 28, I shared this news with my pharmacist, who is also a certified nutritionist. He recommended that I immediately eliminate sugar and grains from my diet. I found the Paleo Diet and started to eliminate sugar, grains, and dairy from my diet that day.
The results have been astonishing, to say the least. On May 24, 2005, my CA 27 29 marker was 43 and as of October 24, 2005, is 24. My CA 15 3 marker was 28.6 on May 24, 2005 and is now 22.9. I am 100 percent convinced that it is a result of my being a very compliant follower of the Paleo Diet. Cancer likes sugar. Sugar is not my friend and is an enemy to my health.
I am very thankful to an astute pharmacist/certified nutritionist who is on top of the current diets and their effects on one’s health. We are what we eat. I do not miss any of the sweets that I craved so, and I love the fact that I have finally lost the 25 pounds of chemo/radiation weight that I could not lose, no matter how much exercise or dieting I did since 2002. Fresh fruits, fresh vegetables, and lean meats and fish are the mainstay of my current good health.
I will continue to spread the message to my support group and other women I meet who have breast cancer. Mind, body, and soul—keeping each healthy is essential to survive this terrible disease. The diet recommended to me on May 28, 2005, empowered me to continue to do everything possible to win this battle.
The Paleo Diet and Osteoporosis
One of the greatest fears many women have when they first adopt the Paleo Diet is how—without drinking milk or eating dairy products—they will get enough calcium to build strong bones to prevent osteoporosis. As I mentioned, large meta analyses (combined population studies) clearly show that neither calcium supplementation nor increased milk drinking reduces the risk for osteoporotic fractures. The current obsession with calcium intake as the single and most important factor involved with bone health is misguided. What the dairy lobbyists don’t tell us is that bone mineral content is determined not only by calcium intake but rather by calcium balance.
The calcium stores in your bones are like your checkbook. If you spend more money than you earn, your checking account will have a negative balance. Similarly, if we lose more calcium in our urine than we ingest, we will be in negative calcium balance. This phenomenon helps explain why U.S. women maintain one of the worst rates of osteoporosis in the world, despite having one of the highest calcium intakes.
When we talk about calcium balance, calcium loss in the urine is just as important as the calcium we ingest from our diets. Urinary calcium losses are primarily dependent on dietary acid/base balance. After digestion, all foods ultimately report to the kidneys as either acid or base. If our diet is net acid producing, the acid must be buffered by the alkaline stores of base in our bones. Acid-producing foods are hard cheeses, cereal grains, salted foods, and almost all processed foods, meats, fish, and eggs. The only alkaline base–producing foods are fruits and vegetables. Because the average American diet is overloaded with grains, cheeses, and salty processed foods at the expense of fruits and vegetables, virtually everyone in the United States has an acid-yielding diet that leaches calcium from his or her bones.
Because Paleo Dieters consume anywhere from a third to half of their daily calories as fresh fruits and veggies, their diets are net alkaline yielding—reducing urinary calcium losses and restoring a positive calcium balance. High-protein diets such as the Paleo Diet are also bone healthy because protein increases calcium absorption and stimulates production of a hormone (IGF-1) that promotes new bone formation. Besides yielding a net alkaline load to the kidneys, most fresh veggies are rich sources of calcium, particularly leafy green vegetables—think broccoli, kale, cabbage, Brussels sprouts, cauliflower, kohlrabi, and mustard greens.
Vitamin C from fresh fruits and veggies, like protein from meats and fish, increases calcium absorption, further promoting a net positive calcium balance. Vitamin D is also one of our best allies in ensuring strong, fracture-resistant bones. Elsewhere in this book, I show you some simple dietary and lifestyle strategies you can adopt to ensure adequate blood levels of vitamin D.
Rest assured, evolution via natural selection has engineered successful biological systems that build strong, fracture-resistant bones for every species of mammal on the planet—including us. Without drinking cow’s milk.