Is Paleo Healthy for Women?

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Take a minute to think up all the “woman food” you know. Soy milk, low-fat yogurt, salad when you really wanted the hamburger, quinoa, cupcakes, smoothies, boneless skinless chicken breast…it’s about as far from Paleo as you can get. In our culture, women get bombarded with messages that this is what they should be eating: lots of low-fat food, lots of grains, and as few calories as you can possibly manage.

Growing up in that environment can make Paleo pretty far beyond many women’s comfort zones. It can feel uncomfortably “masculine” to be enjoying red meat as a nutritious staple food, or to start eating full-fat everything without apologizing for it. It doesn’t help that Paleo gets stereotyped in the media as a “man’s diet:” unwashed modern troglodytes scarfing down heaps of steak and bacon in between their deadlifts.

That stereotype is incredibly damaging though, because Paleo is human nutrition. It’s not just nutrition for men, or lumberjacks, or tough-as-nails elite athletes. It’s also nutrition for ballet dancers and midwives and preschool teachers. There’s nothing “un-feminine” about eating the food your body was designed to thrive on.

To prove this once and for all, take a look at what nutrients women need for healthy metabolic and reproductive function, and how Paleo can deliver them.

What Women Need: Energy

At the most basic level, food is energy: without enough calories, everything else is largely irrelevant. Women, like everyone else, need energy to live – and Paleo is a whole lot better at providing it than a steady diet of yogurt and flax seeds.

How much energy? Probably a lot more than you think. Most women need around 2400 calories a day – and that’s if they’re not particularly active. If you don’t believe this, you can plug your height, weight, and activity into the Health Calc and see for yourself.

Without enough energy, women are in danger of a whole laundry list of health problems secondary to simple undernutrition. From an evolutionary perspective, this is pretty obvious. Think about the differences in how men and women evolved: for men, reproduction is relatively quick and undemanding. But for women, pregnancy can be very dangerous and hard on the body. That difference in sex roles means that women’s bodies are very sensitive to any sign of famine or danger. If the female reproductive system gets put under too much stress, it just shuts down, and that has consequences for your whole body – it’s not just about your period!

In the medical literature, this usually gets classified as one of two things:

  • Functional hypothalamic amenorrhea: loss of the menstrual cycle due to hormonal changes, with or without an eating disorder and with or without exercise. Often accompanied by osteoporosis.
  • Female athlete triad: three symptoms (amenorrhea, osteoporosis, and disordered eating) seen in women who eat too little and work out too much.

Women who have lost their period due to undernutrition have fragile bones, suppressed thyroid function, sex hormones that are all out of order, and chronically elevated stress hormones. Lost periods are just a symptom: under the chronic stress of inadequate calorie intake, these women’s bodies are simply breaking down.

These problems are very common in women who work out too much and eat too little, with a heavy emphasis on the “eat too little.” Even the female “athlete” triad isn’t about athletic as much as it is about sheer calorie math. This study, for example, found that thyroid hormone dysfunction only occurred in exercising women who ate a calorie deficit. Women who were eating enough to support their activity had no problems at all, even when they trained at a high intensity.

Looking at the menstrual response to famine-level calorie restriction tells us that this is precisely what women shouldn’t be doing. And yet, if you think about the typical “woman foods,” they’re all designed to reduce energy intake as much as possible. They’re low in fat (which has more energy per gram than protein or carbohydrate), or they’re just low in total calories (like fruits and vegetables). The typical diet plan is 1200-1500 calories per day! That’s about half as many calories as an active woman needs. This kind of diet is incredibly harsh and stressful to your reproductive system (not to mention everything else), and it’s not healthful in the short-term or the long-term.

Just to be clear: you do need a calorie deficit to lose weight. But you don’t need the kind of extreme crash diet that will send your period running for the hills and your overall health down the drain. “Women’s health” doesn’t mean starving yourself into infertility! Instead, try the Paleo approach: don’t count calories and eat enough energy-dense foods to keep your body out of “famine mode” even if you’re trying to lose weight. Paleo is a better option for slower, sustainable weight loss (if you want to lose weight – not all women do!) while preserving reproductive and metabolic health.

What Women Need: Carbs

Restricting carbs or “earning your carbs” through exercise is another piece of bad advice women frequently have to put up with. Sometimes you’ll hear that women have a harder time losing weight than men, so they need to be ultra-strict with carbs to make it happen. But when we apply the litmus test of menstrual function, we can see that this is also potentially unhealthy. What a healthy menstrual cycle shows us is that most women do better with a moderate amount of carbs, neither too many nor too few.

Some Carbs are Good.

Like getting enough calories, getting enough carbs is a signal of plenty and safety. Insulin, the hormone produced in response to eating carbohydrates, sends a message to the reproductive system that “everything is fine; there’s enough food available for you to have a baby” (you can read more about this in this study).

This makes a very low-carb or zero-carb diet a bad idea for many (although not all) women: it causes a hormonal “famine response” very similar to calorie restriction.

Too Many Carbs are Problematic.

On the other hand, women also have more fat-burning adaptations than men. For example, when they exercise, they naturally burn more fat and fewer carbohydrates; this suggests that they might do better with a greater proportion of fat as a fuel source. Too many carbs can also be a problem: insulin overload (leading to insulin resistance) and obesity are major contributory factors to infertility diseases like polycystic ovary syndrome (PCOS).

In other words, looking at healthy menstrual function tells us that the demand to restrict carbs is just as wrongheaded as the demand to restrict calories. There seems to be an ideal range of carbohydrates for women that’s neither too low nor too high. On average (although there are exceptions), women do not do as well on a ketogenic diet as men do, but they also shouldn’t be eating so many carbs that they crowd out that other essential macronutrient, fat.

To get a moderate and flexible carb intake, Paleo is a lot better than the typical “woman food,” which is usually either extremely high in carbs (the vegan, brown-rice-heavy model of “healthy”) or extremely low in carbs (the protein-based crash diet). Instead of either of the extremes, Paleo provides moderate carbs from safe starches, at a level that’s easy to adjust depending on individual tolerance.

What Women Need: Fat

baconLow-fat yogurt. Low-fat cheese. Low-fat ranch dressing. Skinless chicken breast. Fat is another demonized source of calories for women, but it’s one of the most important. Going back to the menstrual cycle yet again, we can see fat restriction as an independent factor in amenorrhea (loss of normal cycles) even after taking calorie restriction into account. It’s not just any calories these women need; it’s calories from fat.

  • This study identified “mild dieting, close to normal but prolonged and characterized by an important fat restriction” as a key driver of the hormonal dysfunction behind functional hypothalamic amenorrhea. Gee, does that sound like anyone you know?
  • In this study, both inadequate calories (1768 compared to 2215) and inadequate fat intake (333 calories from fat vs 639) were associated with amenorrhea.
  • In this study, women with hypothalamic amenorrhea consumed 50% less fat than control women of the same weight with regular menstrual cycles.

The lesson: women need fat. Even if you’re eating enough or close to enough calories, inadequate fat intake can still damage your health.

Saturated fat is particularly crucial for women, because it’s the backbone of all the sex hormones. From saturated fat comes testosterone (yes, women have testosterone too), and from testosterone comes estrogen. So for healthy hormones, you want enough saturated fat in your diet.

This has largely been studied in men, but take a look at this paper. Testosterone synthesis after exercise was highest in men who ate the most saturated and monounsaturated fat. A high ratio of PUFA to saturated fat was a predictor of lower testosterone response. Remember that testosterone is a precursor for estrogen: to get enough estrogen, you need enough testosterone first. And eating plenty of healthy saturated fat can help get you there.

Another type of fat to consider is Omega-3 PUFA. Omega-3s are important for just about everything, but in women, they have a special role. The composition of the fat in a woman’s diet affects the composition of the fat on her body – if she eats more Omega-3s, she’ll have more in the fat deposits around her hips and thighs. Now say that woman gives birth to a baby and starts breastfeeding. To help its brain grow and develop, that new baby needs plenty of fat, especially a type of Omega-3 fat called DHA. And that fat mostly comes from the mother’s pre-existing fat deposits – her diet while breastfeeding is a comparatively minor influence. If you ever want to have a baby, the Omega-3 fats you eat now are literally the baby’s “brain food” down the line.

Omega-3 fats are also important for other aspects of women’s health:

  • This study found a correlation between a high O6:O3 ratio and the severity of endometriosis.
  • In this study, a high ratio of O6:O3 was correlated with postpartum depression.
  • Adequate Omega-3 fats may help with menstrual cramps.

To sum it all up, women should eat plenty of saturated fat and Omega-3s to stay in optimal hormonal and metabolic health. That makes Paleo far and away better than the typical “skim milk and fat-free salad dressing” diet that women usually try to eat to “get healthy.” Skip anything with “fat-free” on the label, and enjoy some real butter on your vegetables.

What Women Need: Micronutrients

On top of the macros, there are also a few important micronutrients that women should be aware of.

One of the biggest areas of concern is iron: 12 percent of reproductive-aged women in the United States are iron-deficient. For Black women, that number goes up to 19%, and for Hispanic women, it’s 22%. This is clearly an important health problem, since iron is so important for energy, athletic performance, and mental health.

So why are women so deficient in iron? Partly it’s because they lose more iron than men (through bleeding every month), but partly it’s because most iron-rich foods aren’t considered “feminine,” so a lot of women avoid them. There are two types of iron, heme and non-heme. Non-heme iron is found in plant foods. It’s nice, but it’s less absorbable than heme iron, found in animal foods. Heme iron is really what you want – and the richest source around is red meat. Any kind of red meat will do. So all those women who order the chicken salad when they really wanted the steak are really just depriving themselves of a vital nutrient!

The deficiency statistics for other nutrients aren’t quite as dire, but they still deserve a mention. Calcium is important for preventing osteoporosis (a problem that affects women at a much higher rate than men), particularly for older women. Women also need to take special care to get enough iodine: a deficiency in iodine can cause amenorrhea and infertility.

How does Paleo deliver all these important nutrients? Take a look:

red meat & eggs

  • Calcium: turnip greens, collard greens, broccoli, bones/bone broth, bone-in fish, and dairy only if you tolerate it well.
  • Iron: any kind of red meat.
  • Iodine: any kind of fish or seafood, or pastured eggs.

As long as you’re eating enough food overall, you shouldn’t have a problem getting enough of these nutrients on Paleo. In fact, Paleo is a much richer in iron and iodine than the standard American “woman food,” so once again, Paleo comes out ahead.

What Women Don’t Need: Soy

Almost every woman gets told to eat more soy at some point in her life. Whether she has too little estrogen, too much estrogen, the wrong kind of estrogen, just enough estrogen…just one magical legume will apparently cure it all.

The magic behind these “benefits” is the phytoestrogen content of soybeans: phytoestrogens are plant compounds that look a little bit (but not entirely) like estrogen to the human body. They bind to estrogen receptors, but they don’t quite do all the things real estrogen does. Powerful, without a doubt, but do they actually help with any kind of hormonal condition?

  • From this Cochrane review of soy and menopausal symptoms: “overall there was no indication that phytoestrogens worked any better than no treatment.”
  • From this meta-analysis of soy and hormones: “In premenopausal women, meta-analysis suggested that soy or isoflavone consumption did not affect primary outcomes… In post-menopausal women, there were no statistically significant effects”
  • This overall report about soy in general concluded that “The evidence does not support an effect of soy products on endocrine function, menstrual cycle length, or bone health.”

Not exactly a rousing chorus of support! It’s safe to say that the health effects of soy for women are debatable at best, and quite probably nonexistent. And since there are so many other problems with soy, the advice to eat it all the time is extremely over-hyped.

Conclusion

To put it in a nutshell, the nutritional advice often targeted at women is really the opposite of what most women ought to be doing. For maintaining optimal reproductive health (and all the metabolic and hormonal benefits that come with it), Paleo is a much better bet. Women need enough calories, enough fat (especially saturated fat), and adequate carbs. They need a regular source of Omega-3s, and a lot more iron than they’re currently getting. Women do not need to waste their precious lives in starving their bodies into submission, and soy products are ineffective at best.  As strange as it sounds, plenty of red meat and butter might actually be the “most feminine” diet around – if “most feminine” means “most likely to help a woman stay healthy, fertile, and strong.”

P.S. Have a look at our Paleo Recipe Book. It's a cookbook we've created to help you eat the best Paleo food. It contains over 370 recipes and covers everything you need.

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