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PCOS Unlocked: The Manual

By Stefani Ruper
Copyright Stefani Ruper Enterprises LLC, 2012







Fertile. Radiant. Energetic. Sexy. For Good.
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Introduction

Part I: What?
What is PCOS? What kinds of PCOS exist?
Who has PCOS, and what are they at risk for?
How do you know if you have PCOS?

Part II: Why?
Type I PCOS: PCOS caused by being insulin resistant and usually overweight
Type II PCOS: PCOS caused by metabolic and psychological stress
Type III PCOS: PCOS caused by hypothyroidism
Type IV PCOS: PCOS caused by brain abnormalities
Combining types of PCOS: Case studies
Discerning your type of PCOS
Factors that promote the development of PCOS

Part III: How to overcome PCOS
How to overcome PCOS: 75 percent diet, 25 percent strategy
Diet
Foods to avoid and why
Foods to eat and why
Changing our food habits: a brief Q & A about how to implement these dietary changes
Strategies for everyone
Specific strategies for type I PCOS
Specific strategies for type II PCOS
Specific strategies for type III PCOS: Hashimotos and non-Hashimotos hypothyroidism

Part IV: alternative treatments
Helpful supplements for PCOS
Herbs
Foods with potent PCOS-fighting properties
Optimizing thyroid function with medication or other interventions
Medication
Ovarian Drilling

Part V: Moving Forward

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READ THIS FIRST: ABOUT ME AND MY MEDICAL DISCLAIMERS

My name is Stefani, and I am a woman who has overcome PCOS, and who has read
widely in the medical literature, as well as engaged in discussion with women who
both currently have and who have already overcome PCOS.

I have not attended medical school. I have no official nutritionist training. I have
not been licensed by any kind of committee or board or government to give medical
advice.

The reason I have put together this guide is to share with women what I have
witnessed and the opinions I have formed in light of my experiences with PCOS and
nutrition.

Please know that I am not proscribing anything specific to you when I speak. I may
use the word you from time to time, but you are an individual whose body and life
are about which I know nothing. I am not giving you prescriptions. I am sharing
with you what wisdom I have witnessed personally.

Before embarking on any of the prescriptions or ideas I have shared in this text, I
recommend that you speak with your doctor about your plan. Your doctor knows
you, your doctor knows medical training, and your doctor knows medications and
treatments. Most doctors, I would argue, have lost sight of the facts that food can
be medicine, that humans are not inherently broken, and that diseases can be cured
by simple, healthful life choices. This is why I have produced this manual. I would
like to open your eyes to the diversity of PCOS as well as natural interventions for
overcoming it. Take any new ideas about diet and lifestyle that you might get from
this book and share them with your doctor. Craft a plan together as you move
forward. Your body is not my body and not under my control nor care. Take care
of yourself with your doctor, however you may see fit after reading this book or not.

I also have different opinions about PCOS than many in the medical community.
One of them is that food is the primary means by which we should heal ourselves.
Another is that underweight women can have PCOS. I know this personally since I
was underweight and had PCOS. That was when I decided to conduct research, and
when I learned so much about all of the different causes of PCOS. Because of this,
as well as my belief that you are the captain of your own body and health, I advise
you to weigh my words objectively against your own experience and knowledge.
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Introduction:

The traditional understanding of PCOS treats symptoms,
not underlying causes





I was diagnosed with PCOS in the fall of 2009. At that time, I knew nothing about
ovaries. None of it made any sense to me. All I knew was that I was covered in
acne, incapable of conceiving children, and doomed to an absent sex drive for the
rest of my life. It was not the end of the world, no. But sometimes it felt like it.

Nonetheless, I needed to figure it out. What was wrong with me, why did it happen,
and how could I fix it? I endeavored to learn all that I could about PCOS, and about
what I could do for it. I read everything. Textbooks, manuals, online forums,
personal testimonies. I tried everything. Foods, drinks, supplements, exercise
regimens, over-the-counter and prescribed medication. Taichi. Acupuncture.
Fasting. Cleanses. What followed were tumultuous years. But I have emerged
on the other side swimming in knowledge and eager to share.

What ended up being my personal journey will not be your personal journey. Thats
because PCOS is both diverse and complex. The name PCOS simply describes a
physiological problem having several cysts on the ovaries but it does not describe
how that happens. Therefore, in turn, knowing that we have PCOS does not
necessarily point us towards how to fix it.

So my way forward will not necessarily be your way forward. My hormones became
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imbalanced because I lost a lot of weight, which upset my estrogen balance. As
later sections in the guide will show, having proper estrogen levels is crucial for
having healthy ovaries and reproductive cycles. Dropping from a size nine to a size
zero did its damage. Moving up from a zero to a three has helped me enormously.
I feel normal, happy, healthy, and fully embodied in my female body like I havent in
many, many years. For most women, the way forward is the opposite journey.
You might lose weight in order to regain your fertility. Do not worry, this is common,
and your PCOS can be overcome. This manual will show you how.

Fortunately for us, the different nuances in moving forward for women with different
types of PCOS all fall within the broad category of eating real, natural foods. No
matter how our hormones got out of whack, each of us needs to rebalance them for
hormonal health. The way to do that is with food: to eliminate toxins that enter our
bodies through modern foods (think 100 calorie snack packs or diet Coke) and to
nourish our bodies with foods as close to the natural earth as possible (think
vegetables, fruits, meat, poultry, fish, nuts, and seedsanything that does not come
in a bag or a box.) As we will see in Section III, natural foods a) do not just eliminate
imbalances but actively restore hormone balance, b) provide the highest density of
vitamins and minerals for healing, and c) naturally heal a womans system such that
both her appetite and her waistline decrease (if needing to decrease) effortlessly.

Other lifestyle factors such as stress, meal timing, carbohydrate content and exercise
also play an important role in healing a womans reproductive system. The key to
these aspects, as with the diet, is to be mindful of what nature demands of our
bodies. If we currently do not exercise, we should try to move around a bit more,
and probably sprint and lift weights from time to time. If we exercise too much, we
should try to sit down more often. If we are stressed, we should probably (read:
definitely) re-think that. We need to think deeply about what our bodies demand
of us. Nothing in the world is better at knowing how to be fertile than the natural
world.

Language

The words that I use to describe my dietary preferences are natural foods.

Unfortunately, there is a lot of confusion out there in the world today about what
counts as a natural food or not. As perhaps the most obvious and important
example, many health advocates consider whole grain products to be natural,
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healthy foods.

I do not.

The reason I do not is because grains still require extensive processing in factories in
order to be consumed. Data is also currently revealing that many, if not most,
humans have not yet evolved the ability to digest wheat well. This leads to a wide
variety of health issues, least of which being autoimmune diseases, diabetes and
overweight, and mental illness.

So when I call a food natural, I almost always mean: This food can be found in the
wild as-is. I can hunt this food, or I can gather this food. Processed foods are
not natural foods. Some exceptions are healthful olive oil and coconut oil ring
particularly loud bellsbut even in those cases the oils are minimally processed, and
come from a fat that could naturally be consumed in the wild. (What I mean by this is:
humans can eat olives and coconuts as fat in the wild. Canola or corn, on the other
hand, must be extensively pressed and condensed in order to yield oil.)

This means that the foods I advocate line up squarely with foods on the lists of many
paleo dieters. I myself own the label paleo dieter and feel comfortable in those
shoes. Eating a paleo diet means using evolution to craft hypotheses about the
proper human diet, and I see nothing but excellent science and sound reason
underlying that method. Under that method, we always have the freedom to
change the foods that we are eating according to the research that is unearthed.
But only in accord with science and experimentation.

The reason I use the word natural is that I am choosing not to alienate anyone who
may or may not be associated with any diet, including the paleo diet. Nor do I wish
to be dogmatically aligned with food choices or dietary regimens. The point of all of
this is not to ascribe to any particular weight loss bullet or to a prescriptive diet, but
rather to shift the emphasis of our lives to a more natural, more intuitive paradigm.
This manual is not about being on a diet. It is about lining up our lives with the
nourishment of natural foods, and delighting in that lifestyle and the benefits it
brings as much as we can.

Types of PCOS

I have written this manual because I believe that there are a wide variety of
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hormonal influences on and problems related to PCOS. Each woman is an
individual, and she needs to be viewed and treated as an individual. No womans
PCOS is the same.

However, through all of my experiences and studies, I have unearthed what I believe
are three broad categories of PCOS. Each type is based on what has caused it, and
what is necessary to treat it. Each woman most likely has just one type of PCOS,
based on what caused her PCOS, though she may experience influences from other
categories.

This manual breaks PCOS down into three general types: Type I, Type II, and Type III
PCOS. These are categories that I have personally discerned existing in the PCOS
population, and ones that I have personally decided to use in my treatment and
discussion of PCOS. They are not categories that exist elsewhere.

The PCOS universe, I do believe, could greatly benefit from the categories I have
created. For now, however, this heuristic is limited to the scope of PCOS Unlocked.

Organization

This manual is divided into three overarching parts: the what, the why, and the how.
The What, Part I, covers everything about your present condition. What is PCOS?
What are the symptoms, and the effects, and the risks? What does a cystic ovary
actually do to a woman? Who has PCOS? Who is the most susceptible to PCOS?

Part II, The Why, is written to help you understand the causes of PCOS. Why do you
now have cystic ovaries? What diet and lifestyle factors lead to the development of
PCOS? PCOS is a complicated problem, and it can be begotten via a number of
mechanisms. In general, however, these mechanisms fall under three big
categoriesinsulin resistance, stress, and hypothyroidism--and I discuss each of
them in this section thoroughly.

Part III lays out my simple, intuitive, and nourishing plans for overcoming PCOS. In
section IV, I discuss the wide breadth of treatment regimens that doctors normally
implement, and how they might be used with caution in moving forward.

This manual ends with a discussion of what your future looks like. And the answer
is: brilliant. While it may be a major shift for you to undertake a diet free of sugar
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and other processed foods, what results is not just restored fertility, but also weight
loss, increasedsometimes even boundlessenergy, and freedom from a wide
variety of aches, pains, and symptoms. A diet full of nourishing, natural foods,
combined with a stress-reduced and happy lifestyle leads to nothing other than a
brighter, more healthful, and more exciting future.

The road to better health does not necessarily arrive at a destination, and not at a
specific time. It takes some of us longer to heal than others. This depends largely
on how much damage has been inflicted on our bodies, and how diligent we are
about treating ourselves well and being as nourishing and healthful as possible. But
it is progress and it does happen. PCOS is absolutely, 100 percent curable.
Frequentlyly just five pounds of weight loss will increase a womans regularity in her
cycle. So start down the road and begin reaping the multitudinous benefits. They
are plentiful, and they multiply over time. Fertility skyrockets. Libido flourishes.
And you can feel continuously more like an empowered, powerful, and sexy
nourished body.


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Part I: What?

What is PCOS? What kinds of PCOS exist?
Who has PCOS, and what are they at risk for?





What is PCOS?

PCOS stands for Poly Cystic Ovarian Syndrome. This means that a womans ovaries
have multiple small cysts on them. In order for a PCOS diagnosis to be made, three
things are almost always present:
-Cystic ovaries, detected via ultrasound
-Irregular or absent periods
-Elevated male sex hormone (androgen) levels, from blood tests
The first two of these indicators are almost always caused by the third. Elevated
male sex hormones are significant for PCOS diagnosis because an imbalance
between male and female sex hormones is almost always what causes cysts to form
in the first place.
The vast majority of the time, male sex hormones such as testosterone and DHEA-S
are high in PCOS patients. Occasionally, however, these levels are not so high that
they are out of the technically healthy range, but are instead high relative to
female sex hormone levels, which have dropped for one reason or another. In both
cases, male sex hormones have risen out of their normal balance with female sex
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hormones in the blood. This imbalance is what causes the menstrual cycle to get
off track in women with PCOS, regardless of how the imbalance is caused.
The menstrual cycle is entirely dependent upon the complicated pituitary gland
reproductive organ web. When hormone levels become imbalanced, a whole
cascade of negative effects can occur.
Who has PCOS?
Estimates of PCOS prevalence range between 4 and 15 percent of reproductive age
women in America. That means that at its lowest, six million American women
confront PCOS throughout their lives. At the high end, eighteen million women do.
For this reason, PCOS is well-known in the medical community as the leading cause
of infertility in the Western world.
PCOS is commonly regarded by the medical community as a genetic condition that
travels largely in families. They are not wrong: women who have PCOS are in fact
genetically predisposed to the condition.
This does not mean that you are doomed, however. What it means instead is that
you just have to be more careful than some of the other people you know.
Fortunately, the diet and lifestyle choices that cure PCOS are also the diet and
lifestyle choices that cure a whole host of other diseases such as heart disease,
autoimmune diseases, fibromyalgia, and even sometimes cancer. Learning how to
be careful--that is, by eating a toxin-free diet consisting of natural foods--might
end up saving your life for other reasons down the road.
So you might be unfortunate, but thats pretty neat, huh?






Epigenetics

One common idea in science and society today is that of genetics. From genetics, society understands that people acquire
diseases through their parents genes, that people gain weight because of their parents genes, and that people have certain
personality traits because of their parents genes. Everything comes from and is determined by genes. This is a rather grim
viewpoint on life. It implies that we are all doomed to whatever fate has had in store for us since conception.

Fortunately, science is beginning to disprove these deterministic notions.

Today, the more widely accepted interpretation of genetics is not that it runs the whole show, but rather that it loads the genetic
gun. People are not born with genes set for life. It is not fated.
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The different PCOS populations
PCOS is often treated by medical professionals as a condition with one cause and
one effect. This is an easy if unfortunate mistake to make. Doctors make it
because the majority of women with PCOS present with the same basic hormone
profile.
But this one hormone profile is not the only one possible with PCOS. Other, less
well-known and less well-studied factors influence PCOS. This means that there are
other populations of women with PCOS who need attention and need to be
accounted for. Otherwise, millions of women will continue to fall through the
cracks.
The fact that doctors often treat the whole range of diverse women with PCOS with
the same prescription leads to disappointment, pain, disillusionment with the
medical community, and seeking answers elsewhere. For this reason, these are
usually the types of women I work with-- women who have been frustrated by the
lack of individualized attention they have received via traditional treatment routes.
In this manual, I group the PCOS population into three categories. These are my
own categories, and not ones used by physicians and other health researchers:
1) Type I PCOS: insulin resistant, usually overweight patients
This is the focus of the medical community and comprises between 60 and
75 percent of the total PCOS population.
2) Type II PCOS: metabolically and/or psychologically-stressed patients
Approximately 25 percent.
3) Type III PCOS: hypothyroid patients
Instead, people are born with predispositions to certain ailments. It is never a certain thing they will get them. What
determines whether or not a certain trait becomes manifested in an individual, instead, is the environment. Genetics loads the
gun, but lifestyle and diet choices pull the trigger.

So what you inherited from your mother may have stacked the deck of life against you, but that does not mean that in a
moderately intelligently played round of Texas Hold Em, you still cannot get out with the winning hand.

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Has significant overlap with the other groups.
Stress, of course, is a major player in all of these women, but whats unique about
the stressed category is that stress for these women is the dominant factor in
causing PCOS. In types I and III PCOS, other factors are more significant.
Symptoms of PCOS
Many women exhibit all of the symptoms of PCOS. Some do not show any and do
not discover that they have PCOS until they have trouble becoming pregnant. So
the range of symptoms women experience varies greatly. Regardless, typical PCOS
symptoms include:
-Irregular or absent menstrual cycles
-Irregular or absent ovulation
-Infertility

-Male pattern hair growth.

The scientific word for this is hirsutism, and it occurs primarily on the face, but
also manifests in thick hair growth on the arms, stomach, back, and legs.

-Male pattern hair loss.

The scientific word for this is alopecia, and manifests primarily as balding or
thinning on the top of the head.

-Weight gain and increased difficulty in losing weight.

-Low sex drive.

-Adult acne.

This occurs primarily in cysts around the mouth and jawline, though can also
occur on the forehead and cheeks, and in more severe forms all over the body.
As a personal survivor of adult acne, I have written much about it at my
website, and all of the information there is free.

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Increased risks that PCOS patients face

PCOS is associated with increased risk for being overweight, metabolic syndrome,
diabetes, heart disease, sleep apnea, and ovarian and endometrial cancers.

How do I know if I have PCOS?

In order to diagnose you, your doctor will hopefully conduct both blood tests and an
ultrasound. An ultrasound proves whether or not cysts are present, so this is crucial
for the diagnosis.

But a blood test does two additional things: 1) it confirms that a hormone imbalance
exists, and 2) it demonstrates which type of hormone imbalance exists, so that you
can craft a treatment strategy appropriate to your situation. Each PCOS patient
should be treated individually according to her personal hormonal situation.

Hormones that you should have (and make sure to have) tested are:

testosterone, estradiol, estrone, DHEA-S, progesterone, prolactin, luteinizing
hormone (LH), follicle-stimulating hormone (FSH), and the thyroid hormones:
thyroid-stimulating hormone (TSH), T3, T4. If being tested for thyroid problems
specifically, reverse T3 and Hashimotos anti-bodies should also be tested. You
should also have your fasting blood glucose or fasting insulin levels tested to evaluate
your insulin sensitivity. Other types of glucose tolerance tests may be administered.
It may also be important to test the stress hormone cortisol levels. This test is best
taken as a saliva test throughout the course of a day. The following sections explain
and demonstrate the importance of each of these factors and tests.






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Part II: Why?

Why do I have PCOS? What caused it?
What do my lab tests mean?





There are a handful of different ways you may have gotten PCOS, and you may, in fact,
as well see later, have causes that overlap in all three of the PCOS patient categories.
Below I briefly outline the three primary PCOS categories, and then go into detail on
the chemistry of each one. This section concludes with a discussion designed to
help you determine what is causing your own PCOS and which category of PCOS may
be the best fit for you, as well the wide variety of causes of hormone imbalance.

Overview of Type I PCOS: caused by insulin resistance (pre-diabetes) and usually
overweight

The most popular cause of PCOS is being insulin resistant, or pre-diabetic. Most
people who are insulin resistant are overweightthe two conditions beget each
otherbut not all of them. 60 percent of PCOS patients are overweight. Another
~20 percent of PCOS patients are normal weight but still somewhat insulin resistant.
So this insulin resistant group comprises a significant portion of the PCOS population.
It is this group who receives the most attention from the medical community, and
about which all of the book on PCOS have ever been written.

Overview of Type II PCOS: metabolic and psychological stress

Secondly, you may have PCOS because your reproductive organs are under significant
stress, which comes from being underweight, losing too much weight, or
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psychological stress (and usually a combination of the three). This is a less common,
but equally powerful form of PCOS.

This group sometimes suffers from having fewer people in it than the overweight
group, so this group is less well-studied, and the steps their doctors take to help
them are usually better suited to overweight patients and therefore do not always
work. If you tell a thin woman with PCOS she needs to lose weight, for example,
this is definitely not going to help her. Strategies in this manual, however, will.

Overview of Type III PCOS: caused by hypothyroidism

And third, you may suffer from hypothyroidism. This means either that the thyroid
gland, which drives most of the energy usage in cells, has slowed down, or
something has interfered with thyroid hormone synthesis. Thyroid hormone is crucial
for the proper functioning of cells. Without it, reproduction shuts down.

--------------------------------
Each of these causes, while on the surface wildly different, is at least 75 percent
overcome by the same simple recommendation:
Eat a nourishing, natural foods diet designed to heal reproductive imbalances.
I detail those steps forward in section III. This section describes how and why each
of these different PCOS conditions evolve.

After ovulation comes the luteal phase. Here the ruptured follicle closes and forms
the corpus luteum. This makes the endometrium thicken, which produces
progesterone.





The Menstrual Cycle
In order to understand how menstrual dysfunction occurs, it is helpful to review what happens in healthy menstrual cycles:
The first day of a menstrual cycle is the first day of bleeding. During this period, the lining of the uterus is shed. This bleeding
continues for three-eight days, generally around one week. This week is the first part of the follicular phase, which lasts two
whole weeks. During the follicular phase, estrogen levels rise and cause the lining of the uterus to grow and thicken.
Detecting elevated estrogen levels throughout this phase, the pituitary gland increases its production of follicle-stimulating
hormone. This hormone stimulates the growth of 3 to 30 follicles on the ovary. Each follicle contains an egg. With time, the
levels of FSH decrease to the point at which only one of the follicles continues to grow. This solitary follicle produces estrogen,
and all of the other, smaller follicles break down.
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Isometrik, Wikimedia, 2010.
Detecting this shift after two weeks of growth and change, the pituitary gland releases luteinizing hormone. This makes the one
egg-containing follicle bulge and rupture, releasing its egg. This is ovulation. During ovulation, testosterone, which is
otherwise only produced at low levels by the ovaries, surges, and estrogen drops.
But if the egg is not fertilized within a few days of ovulation, progesterone levels fall, which triggers the shedding of the corpus
luteum and bleeding. Here the cycle begins again. Cycles are generally known to be 28 days long, but the length of a regular,
healthy cycle can vary a week in either direction.
If the woman becomes pregnant, progesterone levels never drop off. Progesterone prevents a woman from menstruating, so
this is why being late is the first sign women often have that they are pregnant.
TAKEAWAY
In a woman with PCOS, somewhere along the chain throughout the four weeks
of the menstrual cycle one of the hormonal signals goes haywire and gets
missed. Its easy to see why: the menstrual cycle is complicated! So in order
for a woman to be fertile a delicate balance must be maintained between all of
the hormones. Restoring that balance and getting the cycle back on track
wherever it derailed is the one way to overcome PCOS for good.
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Type I PCOS:
PCOS caused by being overweight and/or insulin resistant





Summary:

Type I PCOS is primarily caused by excess testosterone produced by the ovaries.
This testosterone is generally understood to have been stimulated by abnormally
high insulin levels in the blood. Insulin levels rise with being overweight, with
systemic inflammation, with stress and most especially with a processed,
nutrient-poor diet.

Indicators of type I PCOS:

Being overweight, specifically in the abdomen
Difficulty losing weight
Acne
Male pattern hair growth
Hair growth on the face, thicker growth on arms, legs, abdomen, and back.
Male pattern hair loss
Hair loss on the top of the head, hair thinning.
Irregular menstruation

Blood markers:

High testosterone levels
LH: FSH ratio higher than 1:1
Poor insulin sensitivity, glucose tolerance, and/or fasting glucose



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Insulin Resistance

Insulin resistance is a metabolic problem. It is the precursor to full-blown diabetes,
and people develop it over time. Sometimes insulin resistance is also called
metabolic syndrome, or pre-diabetes. I use these three terms interchangeably in
this manual. Insulin resistance is caused by the long-term damage of eating the
processed, Standard American Diet.

Almost all people with insulin resistance develop it slowly over time. This is
because the Standard American Diet is full of unnatural foods that inflict serious
damage bit by bit with every meal. Unfortunately, in todays unhealthy world,
foods are toxic enough -- and people are born into worse and worse nutritional
environments that the process now goes faster and faster. This is why type II
diabeteswhich originated in the elderly, and then started being diagnosed in adults
as adult onset diabetesis today cropping up in children as young as six.























The Standard American Diet

The Standard American Diet is a diet full of processed, manufactured foods. This is most obvious in the form of fast food, fried
foods, sweets, baked goods, soda, and snacks. These are all obviously manufactured foods. We all knowdeep in our hearts,
whether we admit it or notthat it might be a problem for us if we eat them. This is why they are called indulgences and it
also happens to be why we eat and love them so, very much.

However, there are many other, less well-known culprits in the American diet. A glass of orange juice contains more sugar
than a glass of Coke. A muffin has just as many calories, and perhaps as much trans fat, as a doughnut. A box of cereal has
as much sugar as a handful of cookiesand this includes the organic, granola, fruit-filled kind of cereal, too, not just the
Cookie Crisp or the Fruit Loops.

Foods that come in packages are deliberately designed to be tasty, and for us to continue to come back desperate for more.
(Read more about this in David Kesslers excellent book, The End of Overeating: Taking Control of the Insatiable American Diet.)
Very few people with profits on the line are interested in your health, and certainly not as much as you are. They are interested
instead in getting you to fall desperately in love with their foods, and keeping you hooked. At whatever cost to your well-being,
it does not matter. Your health matters to you, and is in your hands. With this manual, I am arming you with powerful
knowledge food manufacturers do not necessarily want you to know, which is: which foods are harmful and which foods are not.
Unfortunately for them, those which are harmful line up nearly precisely with those which they manufacture.

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Whats wrong with the Standard American Diet?

Aside from being chemically manipulated and packaged deliberately in order to make us addicted to them, processed foods are:

1) Full of unnatural chemicals.

For example:

-Trans fats. Trans fats are largely banned and avoided today. Most people know that they are poisonous. But
trans fats were hailed as a miracle when they first appeared on the shelves. Shortly thereafter, the extent to which
trans fats damage the human metabolism was discovered. But these suspicions went under the radar for far too
long, largely due to a lack of scientific objectivity and corporate interests. With common sense, however, we can
easily see where good science finally landed: trans fats are bad because the human body does not know how to
process them healthfully. They are manufactured in factories, and designed to have long shelf-lives, rather than to
suit the needs of the human metabolism.

-Folic acid. Folic acid is added to foods because it belongs to the class of B vitamins, and B vitamins are crucial for
survival. Folic acid is found in virtually every wheat, grain, and cereal product. Yet the true form of the B vitamin
the body uses best is called folate, not folic acid. Folic acid is produced solely in laboratories and must be converted
to useable forms of folate by the body. Folate is found abundantly in natural foods. High doses of folic acid have
been linked to lung, colon, and prostate cancer.

-Every preservative, every item on a nutrition label your grandmother wouldnt recognize. Preservatives, colors,
and sweeteners are also unnatural and accumulate in our blood and tissue. This large class of chemicals is not
well-explored, or studied. These unnatural compounds may play even more important roles in our bodies than we
have yet to uncover.

2) Poor in nutrition

-Bread, grains, cereals, chips, snack packs, frozen pizzas, noodles, Mac n Cheese these are all foods that contain
tasty calories but practically zero nutrients. Food marketing specialists have recently realized this is a problem,
since the American public is becoming smarter and smarter about nutrition. In reaction, they have sneakily begun
marketing processed, possibly toxic foods as health foods. Not fair! I once saw a Snickers bar marketed as a
source of protein4 whole grams! Presumably because there are peanuts in it. This is deliberately designed to
trick you into eating this food. You can get four, if not forty, or four hundred, grams of protein from animal and
natural plant sources, with lots of natural vitamins and minerals, and without all of the toxic accompaniment.
Even supposedly healthful foods such as bread contain almost minimal nutrition next to vegetables, fruits, and
animal products.

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The science of insulin resistance

Insulin is one of the primary fat storage hormones. When we eat food, our blood
sugar levels rise. This makes sense, right? We put food in our stomachs, and it
almost inevitably has some form of sugar in it, so the sugar enters our blood.
Having too high of blood sugar levels--just more than one or two teaspoons of sugar
in the body at a time-- however, is toxic. So humans have a built in mechanism in
order to prevent sugar toxicity. It is called insulin.
c) Full of foods that humans are not designed to eat:

-Humans evolved eating foods from the natural environment. This means that humans are primed for them, and
that bodies are craving and needing them always. The nutrients available in the wild are the exact nutrients the
body needs. Getting them from manufactured foods is almost impossible. Instead, if we eat a diet that aligns
with what is available nature, then we can be near certain we are giving our bodies the fuel that they need.

-The types of foods that may be harmful for humans include these processed chemicals and preservatives, but also
many foods you might not have considered unnatural before: newly manufactured oils such as vegetable oil, corn
oil, or canola oil, sugar, soy, and grains, and dairy. That may come as a surprise to you. Arent these natural,
whole foods, too? Somewhat. But grains are certainly manufactured foods. They must be milled in a plant in
order to be digested at all. Additionally, both grains and dairy are comparatively recent additions to the human
diet. This means that some people can eat them without harmhaving evolved an ability to digest them--and
some people still have the old set of genes, and develop health problems when eating them. I discuss each of
these foods in greater detail in section III below.

TAKEAWAY

The Standard American Diet is full of unnatural foods that the human body has a
hard time recognizing.

Sometimes we know that chemicals are poisonous, and sometimes we do not. The
best bet in order to be safe is to avoid all of them. At the very best, when the
toxicity of a manufactured food is unknown, it is neutral. At worst, it could be as
bad for you as trans fat. Natural foods contain far more nourishment than these
foods, but without all of the harm and fear.

21


In order to clear sugar out of the bloodstream, the pancreas secretes insulin.
Insulin finds its way to the sugar, takes hold of it, and escorts it to fat cells. We can
think of sugar as a group of rowdy kids causing trouble, and of insulin as the local cop.
The insulin comes out to squash the riot and escort delinquents away for the night.
In this model, fat cells are the county jail. When the insulin and sugar arrive at the
fat cells, insulin asks the fat cells for permission to enter. The sugar needs to be put
away for a while.

In a healthy person, the fat cells hear this request, and immediately let the insulin
in to store the sugar as fuel in the cell. In an unhealthy person, the fat cells do not
have the ability to respond properly. They do not hear the request, and both the
sugar and insulin remain outside of the cell, in the bloodstream.

Insulin resistance is a condition that occurs of the surfaces of fat cells. In an insulin
resistant body, insulin and sugar make it all the way to the surface of the fat
cellsbut because the metabolism has broken by poor nutrition, and this repeated
cycle of hyper-driving into fat storage, the fat cells have lost the ability to hear the
request to enter.

But the sugar needs to get into the fat cells.

So when this is the case, the pancreas secretes even more insulin. Thankfully,
having so much insulin in the bloodstream convinces the fat cells to finally let the
sugar in for storage. This saves lives. It prevents sugar toxicity. But then there is
a lot of insulin left over in the bloodstream.

The more insulin a person has in her system over time, the less and less sensitive
her fat cells become to it. It becomes harder and harder for the surface of the fat
cell to detect the need for it to open up for the sugar and insulin to enter. This
decrease in sensitivity is called insulin resistance. The blood sugar metabolism has
broken. The woman is becoming increasingly overweight as she continues to eat
too many empty calories and as her metabolism tries harder and harder to keep up.
This insulin resistant woman is not always overweight, but usually the two conditions
accompany each other. In either case, her insulin levels become chronically
elevated.


22













Why high insulin levels are bad for the ovary

Insulin directly stimulates testosterone production in the ovaries.

That is so important Ill say it again:

Insulin directly stimulates testosterone production in the ovaries.

Having high testosterone levels means that testosterone is elevated relative to
estrogen in the reproductive system and in the bloodstream. This blocks normal
menstruation from occurring. Without proper testosterone and estrogen levels, the
ovaries cannot communicate with the pituitary gland, so the menstrual cycle
continually chugs forward in fits and stops. It is always trying to work, but the
testosterone is getting in the way.

Because high testosterone levels interrupt signals being sent from the ovary to the
pituitary glands, and because the pituitary gland is still trying desperately to cause
menstruation to move forward, the ratio between LH and FSH this type of PCOSin
women with insulin resistance and high testosterone levels--is greater than 1:1, and
sometimes as high as 3:1, though in a healthy woman it is actually 1:2.

Does a woman have to be overweight to have type I PCOS?

No. Women are overweight when they are insulin resistant more often than not,
but not always. Sometimes the metabolism can run off track while the body
manages to keep a womans waist line in check. Insulin resistance is the more
TAKEAWAY

If we eat a calorie-appropriate, natural foods diet, insulin signaling works
properly.

If we eat too many calories, too many sweets, and too many toxic foods as a
part of the standard American diet, our metabolisms will break and our insulin
signaling mechanisms start having problems.

23

important marker for type I PCOS, more so than weight status. Nuances in these
two approaches to battling PCOS are detailed in section III.



















I discuss how to normalize insulin levels for insulin resistant and/or overweight
women in Section III. It is a solution based entirely upon eating natural, hormone-
and insulin- friendly foods, specific eating strategies, gentle, hormone-friendly (and
painless) weight loss, and moderate amounts of exercise.

According to the National Institute of Health, moreover, women with Type I PCOS
need to lose just five pounds of weight in order to increase their chances of getting
pregnant.







TAKE AWAY

Because insulin elevates testosterone production, and testosterone levels directly
inhibit fertility (as well as cause all of the male-pattern symptoms of PCOS such as
acne and hair growth), normalizing insulin levels restores fertility in a significant
portion of PCOS patients.

Type I PCOS TAKE AWAY

Women with type I PCOS produce too much insulin as a result of eating damaging
foods characteristic of the Standard American Diet. Excess insulin levels lead to
excess testosterone production in the ovaries. These women are usually,
though not always, overweight.

24




Type II PCOS:
PCOS caused by metabolic and psychological stress

Summary:
Type II PCOS is characterized not by hormone excess but by hormone deficit.
Eating a restrictive diet, exercising excessively, and weight loss can all decrease levels
of pituitary and female sex hormones in the blood. These are all metabolic
stressors. Psychological stress is also significant and can halt menstruation.
Usuallyand most often recognized by medical professionalsthese phenomena
lead to the menstrual disorder hypothalamic amenorrhea. But in some women,
cystic ovaries develop, giving them PCOS instead. The biochemistry of these
womens stress responses as well as the degree of metabolic damage (such as insulin
resistance) that has been done to them in the past is what combines hypothalamic
amenorrhea and PCOS in this specific population of type II PCOS patients.
Indicators of type II PCOS:
Drastic weight loss (> ~20 pounds)
Weight loss below level of body fat during puberty
Daily exercise
Obsession with exercise and/or body image
Low body fat
Extreme stress
Poor sleep
Blood markers:
Low LH
Low FSH
Low Estrogen
Possibly high cortisol
Possibly high DHEA-S
Higher than average testosterone
Low prolactin
25


Comparing Type I and Type II PCOS
Type II PCOS, somewhat opposite to type I PCOS, develops through a hormone
disruption opposite to that which happens to overweight women. A good way to
think about it is in terms of tipping scales.

Type I PCOS


Type II PCOS


26

When a woman is insulin resistant and overweight, her testosterone levels increase.
This tips the balance in favor of testosterone, the male sex hormone, even if the
woman has experienced an increase in estrogen levels as well.
Yet when a woman is underweight, underfed, or over-stressed, her estrogen, LH, FSH,
and progesterone levels drop. This phenomenon also tips the balance in favor of
testosterone. Thus why PCOS can also develop in an underweight woman. She
has a testosterone-dominant hormone imbalance just like her sisters above, but
she has gone about getting it a totally different way.
Taking a quick step back: understanding this type of PCOS by understanding
another menstrual disorder, hypothalamic amenorrhea
Normally, women who exercise too much and eat too little stop menstruating
because of a problem called hypothalamic amenorrhea. This is the scientific way of
saying hypothalamus induced loss of menstruation. The hypothalamus is the
hormone center in the brain, and amenorrhea is the scientific term for not
menstruating.
Hypothalamic amenorrhea is a problem of over-stressing the hypothalamus. This
results from being too stressed, eating too few calories, exercising too much, and
having too little body fat. In essence, it is a condition caused by hypothalamic
stress and fatigue.
In hypothalamic amenorrhea, a womans body goes into starvation mode. This
makes sense from an evolutionary standpoint: when food is scarce and women are
stressed out, it is probably not a good time to have a baby.
For this reason, low food intake and high stress levels very often disrupt womens
menstruation. Second to PCOS, this is the greatest causes of infertility in American
women.
The relationship between hypothalamic amenorrhea and PCOS
The relationship between hypothalamic amenorrhea and PCOS is unclear. Many
researchers believe it is impossible to have both hypothalamic amenorrhea and
PCOS at the same time. This is because PCOS is classically considered a disease of
excess and hypothalamic amenorrhea is considered a disease of restriction.
From my own personal experience, however, from the experience of many women
in my health community, and from my own research in female hormone systems, it
27

is 100 percent reality that a woman might develop cystic ovaries while underfed,
underweight, over-exercised, and over-stressed.
The way that a woman can have symptoms of PCOS and hypothalamic amenorrhea
at the same time is through the imbalance referenced at the beginning of this
section.
Some women, when their bodies are overly stressed experience a wholesale
decrease in all of their hormone levels. This is classic hypothalamic amenorrhea.
Yet in other women, male sex hormone levels remain high, normal or increase while
their other hormone levels decrease. This results in PCOS type symptoms for
these women, even though the majority of their PCOS and reproductive problems
stem from classically hypothalamic issues.
The ways in which this might happen are complex, and are explored below both
under the headings about stress, as well as in case studies I detail of mixed PCOS
diagnoses.
There are a variety of factors that contribute to hypothalamic amenorrhea and this
type of PCOS. Below I discuss the hormone leptin, which is responsible for the
bodys starvation response, the role fat cells play in estrogen production, and the
role stress plays in reproductive shutdown.
Detecting Starvation
A womans body undertakes a starvation response once it has detected low body fat
levels, too little food intake, or the expenditure of too many calories via exercise. It
does this primarily through a hormone called leptin.
28



The role of leptin
Fat cells produce leptin. Leptin levels increase in the bloodstream when fat stores
increase, and leptin levels decrease when fat stores decrease. For this reason,
having sufficient leptin levels in the blood is crucial for indicating to the brain that
the body has been adequately fed. If a womans leptin levels fall too low, her
hypothalamus shuts down pituitary action, and sex hormone levels such as LH and
FSH drop. Without LH and FSH, reproduction stops.
Leptin is also secreted when a woman eats food, right alongside insulin. This
means that extreme forms of fasting and low calorie diets can also tell the brain that
a woman is starving. In this case, too much fat is being burned, and not enough
food is coming into the body.
Estrogens role
Estrogen may be even more important than leptin. This is because estrogen is also
secreted by fat cells.
Estrogens first role:
When a woman gains weight, her estrogenprecisely, estrone--levels rise. When
she loses weight, her estrogen levels drop. The hypothalamus has estrogen
Low Leptin
Starvation
Response
Too Low Body
Fat
Low Calorie
Diet
Excess
Exercise
Excessive
weight loss
Prolonged Low
Carbohydrate
Diet
29

receptors in it, so estrogen is also important for signaling to the body that it has
sufficient energy stores.
Estrogens second role:
It is also crucial to maintain appropriate levels of estrogen in the bloodstream. If a
womans body has become reliant on a certain level of estrogenestrogen secreted
both by the ovaries and by fat cellsthen when estrogen levels dip below this point,
reproductive signals may misfire.
This estrogen set point is dependent upon a womans development, size, and
hormone environment throughout puberty. This factor is particularly relevant for
women who have experienced dramatic weight loss since puberty. Reproduction
depends on having a certain level of estrogen in the blood, some of which comes
from fat cells. For this reason, weight gain is a solution for some women who suffer
from PCOS.
Am I saying that weight loss causes PCOS?!
Not usually. Sometimes, it does.
If a womans body fat dips below what her body can handle, then her menstruation
will cease.
But it does not when it is done slowly, and with as little stress as possible, and when
it stops at a natural, healthy point within the normal range of body fatness.
A woman can experience a healthy amount of weight loss without detrimental
effects. And as a matter of fact, she should. She can eat a natural foods diet and
land right in the normal range, and feel as sexy and empowered as her heart desires.
But sometimes women do this with too much stress, exercise too much, go too far,
and are too stressed out and all of these factors combined lead to decreased
menstrual activity.
The effect of psychological stress on reproduction
Psychological stress plays just as big of a role in reproductive health as physical stress
does. When a woman is psychologically stressed, two effects that are common in
PCOS patients occur. It is not a rule that they occur, nor that they occur in
30

conjunction. Many women who have PCOS do not experience these types of
hormonal disturbances. Plenty of others, however, do.


One of the effects of stress is that the brain, via the hypothalamus, turns off pituitary
activity. This leads to a cessation of LH and FSH signaling, which in turn decreases
levels of estrogen and progesterone in the blood. Prolactin levels may also
decrease. These facts make it impossible both to ovulate and to menstruate.
Two other effects that may occur as a result of stress occur as a result of increased
adrenal function.
First, increased adrenal function leads to secretion of cortisol, the stress hormone
which in turn elevates blood sugar levels. High blood sugar levels can elevate
insulin levels, which in turn, as we saw in type I PCOS, has the power to increase
testosterone production in the ovary.
Secondly, increased adrenal function can lead to an increase in production of
DHEA-S, a hormone produced in the stress glands.
DHEA-S is, like all other hormones, an important and very healthful hormone in
proper balance. But if the stress glands are in overdrive, they might over-produce
everything, including DHEA-S. This is detrimental, because DHEA-S is also a
classically male sex hormone, and it plays a role similar to testosterone in PCOS.
DHEA-S in excess blocks estrogen signaling, interferes with LH and FSH signaling, and
also increases hormonal acne. DHEA-S can play a role in both type I and type II
PCOS.
Stress
High Adrenal Function
High DHEA-S (male
sex hormone)
High Testosterone
(male sex hormone)
Low Pituitary Function
Low LH, FSH,
Estrogen &
Progesterone (female
sex hormones)
31

















Combining physical and psychological stress
Physical stress, such as that from eating too little food, and psychological stress, such
as that from our personal lives, are both detected as stress by the hypothalamus.
They are nearly indistinguishable to the hypothalamus, and both crucial for
reproductive health.
For this reason, it is crucial for all women to reduce their stress levels in order to
have optimal fertility. Reducing stress is just especially important for women who
TAKEAWAY
Stress has the power to decrease female sex hormones, as well as to increase male
sex hormones in the body, the hormone imbalance that is the direct cause of
PCOS.
The only way to reduce DHEA-S levels is to reduce stress.
And the only way to convince the pituitary to start working again is to reduce
stress.
Isnt stress important for overweight women, too?
Yes. We just saw that the two primary reproductive effects that can occur in response to stress are a decrease in pituitary
activity and an increase in adrenal activity.
Usually the problem of decreased pituitary activity occurs in underweight, under-fed, and over-exercised women. Women with
type II PCOS often see decreased LH and FSH levels for this reason.
The problem of increased adrenal activity, which leads to high DHEA-S levels, and sometimes testosterone, occurs both in
overweight and underweight women. It does not happen to every woman, clearly. But it does happen, and it can result in
the growth of ovarian cysts.
Stress can also in all women exacerbate inflammation, elicit adrenaline secretion, impact immune system function, and hurt
brain chemistry, among other things all of which contribute to poor reproductive and general health.
32

have type II PCOS indicated not only by stress but also usually by low body fat,
dramatic weight loss, and hyper-athleticism.




Type II PCOS TAKEAWAY
Decreased calorie body fat levels and result in decreased estrogen and leptin
levels, both of which are physical stressors and tell the brain that the body is
starving. When the body is starving, it does not conduct reproductive cycles.
Psychological stress is another factor that tells the brain it is not a good time to
have babies.
For these reasons, all activities that cause metabolic and psychological stress can
cause type II PCOS. These activities include under-eating, fasting, restricting
calories or carbohydrates, over-exercising, under-sleeping, and failing to engage
in stress-reducing activities.
33





Type III PCOS:
PCOS caused by hypothyroidism





Summary:

The final category of PCOS is PCOS caused by hypothyroidism. Hypothyroidism can
be the primary cause of PCOS, but it can also be a secondary cause, making type III
PCOS for some women an important aspect to consider even if their dominant PCOS
profiles are type I or type II.

Hypothyroidism is usually caused by an autoimmune condition called Hashimotos
Thyroiditis. Other factors that can decrease function of thyroid hormone are
calorie restricted diets, severely carbohydrate restricted diets, and stress.

Indicators of type III PCOS:

In addition to classic PCOS symptoms, hypothyroid symptoms such as
Fatigue
Difficulty losing weight
Cold hands and feet
Hoarse voice
Gut issues

Blood markers:

Low or high TSH
High T4
Low T3
High reverse T3
Hashimotos Thyroiditis anti-bodies
34


How the thyroid gland works
The thyroids primary job is to get energy to cells. The final and important step in
the thyroid-forming process is the delivery of T3, the active form of thyroid hormone,
to cells. Unfortunately, the thyroid must undertake a complicated series of
chemical changes before this can happen, and something can go awry at every single
step along the way.
First, the pituitary gland produces thyroid stimulating hormone, TSH. TSH then
signals to the thyroid gland to create thyroxine, or T4, which acts as a bit of a thyroid
reserve molecule, floating around in the bloodstream until it is needed. When
the body detects a need for T3, the hormone that is crucial for cell functioning, then
it draws upon the T4 pool and converts it to T3.
When a woman is experiencing low thyroid symptoms, it is because she does not
have enough T3 working in her cells. One reason this may happen is because of
poor conversion somewhere in the links between TSH, T4, and T3. Another is an
autoimmune condition called Hashimotos Thyroiditis. Regardless of the cause,
however, having low T3 in the blood is strongly correlated with cystic ovaries. This
is because thyroid hormone is necessary for cells to perform all of their regular
functions. Without T3, a reproductive cell cannot reproduce properly.
Symptoms of hypothyroidism
-Fatigue
-Sluggishness
-Increased sensitivity to cold
-Cold hands and feet
-Pale, dry skin
-Hoarse voice
-Puffy face
-Elevated blood cholesterol levels
-Unexplained weight gain
-Pain, stiffness, or swelling of the joints
-Muscle weakness
-Brittle fingernails and hair
-Depression
35

Studies have shown on multiple occasions that women with hypothyroidism who
correct their thyroid deficiencies regain regular menstrual cycles.
What causes hypothyroidism
The most common cause of hypothyroidism is Hashimotos Thyroiditis, which
accounts for up to 90 percent of hypothyroid cases in the western world.
Hashimotos is one of several autoimmune diseases, a class of diseases marked by
the immune system mistaking a human cell for a toxic compound, and developing a
conditioned immune response to that type of human cell.










Figuring out if you have Hashimotos
Your doctor will run blood tests for you. There are specific antibodies that in the
vast majority of cases show up on a blood test and will definitively tell you whether
or not you have Hashimotos Thyroiditis.


Autoimmunity, inflammation, and gut health
Scientific literature is beginning to suggest that all autoimmune diseases have a common root. This root is the intestinal
conditioned called leaky gut.
Leaky gut is caused by consumption of foods that your gut might not necessarily be able to handle. Grains and dairy, and even
legumes, are high up on this list. These gut-abrading foods and other system-inflamers such as sugar can in many people cause
leaks to begin showing up on the gut lining. As the leaks in the gut continue to be torn wider, toxins that are passing through
the normal path of the intestines begin to pass through the gut walls and into the bloodstream. From here, the immune
system attacks these foreign bodies. But sometimes the foreign bodies look a lot like human cells, so the immune system
learns to attack human cells as well.
This manifests in different people in different ways. This is why some people with leaky gut get autoimmune diseases such as
Hashimotos Thyroiditis, and other people with leaky gut might experience rheumatoid arthritis (another autoimmune disease),
or lupus, or alopecia, instead. Poor-functioning guts have also been linked to insulin resistance and being overweight.
36

Other causes of hypothyroidism
Four other important causes of lower thyroid function are stress, poor sleep,
restricted calorie intake, and a long-term carbohydrate-limited diet. You may
notice that many of these causes overlap with causes of type II PCOS.


Stress is a likely culprit in the other 10 percent of hypothyroid cases. Stress makes
the body produce a hormone called cortisol, which interferes with the conversion of
T4 into T3.
Inflammation is another culprit. All women are subject to thisand not just
overweight womenthough it is statistically more likely to be a factor for
overweight women. Inflammation is caused primarily by eating inflammatory
foods such as sugar, omega 6 vegetable oils, and grains.
Low or restricted calorie diets. The body responds to energy input. A low or
restricted calorie diet causes thyroid functioning to slow down. This is a significant
concern for women who are possibly underweight, or who have lost significant
amounts of weight--for some, as little as 20 pounds--or who exercise frequently.
Increasing caloric intake can do wonders for women in under-nourished conditions.
Another factor that may create hypothyroid type symptoms in women is a very low
carbohydrate diet (<~50 g or 1 cup of rice) per day. Glucose from carbohydrates is
required for the conversion of T4 into T3 in the liver. The body is capable of
Decreased
Thyroid
Activity
Inflammation
Stress
Carbohydrate-
Restricted Diet
Calorie-
Restricted
Diet
37

manufacturing glucose on its own when it hasnt been fed carbohydrate, but this
process can become taxed over extended periods of time. Women who are
experiencing phenomena such as cold hands and feet, fatigue, or decreased mental
clarity on very low carbohydrate diets may want to consider increasing their
carbohydrate intake to 100-200 grams of natural carbohydrate per day.


Type III PCOS TAKEAWAY
Hypothyroidism can be a sole cause of PCOS--and it very often is in the case of
Hashimotos Thyroiditis--or it can make pre-existing PCOS worse. For women
who test positive for Hashimotos, it is crucial to repair gut health with the
anti-inflammatory natural foods diet described below. They may also wish to
supplement with thyroid hormone, depending on how advanced the disease is.
All women, however, would do well to maximize thyroid health, being sure to
reduce stress, sleep well, eat an appropriate amount of calories and
carbohydrates, and never be overly-restrictive with diet or lifestyle choices.
38





Type IV PCOS:
PCOS caused by brain abnormalities




There is a final cause of PCOS: there is a small chance the hormone disruption is due
to a tumor on the hypothalamus or the pituitary gland. An fMRI is in order. Your
doctor should know when to test for something like this, and one primary example
of a flag she would see would be a wildly high prolactin level. You may also wish to
ask for testing if no other method of correction seems to fit or to work.

39





Combining types of PCOS:
Case studies



While different causes of PCOS can lead to the development of useful PCOS
categories such as type I, II, and III PCOS, these types can occur in combination in
many womens bodies, and in fact often do. A woman can be born with a
predisposition to insulin resistance, for example, and then when she encounters
significant stress later in life, each factor which may have been fine on its own now
combines with the others to give her cystic ovaries.
In order to demonstrate the wide variety of situations that may occur, I detail below
a few different examples. Some are complex, and some are simple. Hopefully
this can help you discern the story of how you developed your own particular PCOS
profile.
-A woman is really stressed out by work and life. While most of her hormone
production plummets because of that fact, her DHEA-S production skyrockets
because her adrenal glands are in over-drive. DHEA-S acts as an androgen, and it
encourages the development of cystic ovaries. This is especially problematic if
estrogen levels are not high. Since this womans estrogen levels have fallen as a
result of stress, she has PCOS.
-A woman yo-yo diets and experiments with low calorie diets for many years, which
up-regulates her stress response and down-regulates pituitary activity. These
activities also reduce the rate of conversion from T4 to T3 in her liver. The
combination of all of these factors over time gives her PCOS.
-A woman is fairly healthy but has slept poorly throughout her entire life. This
inclines her body both towards insulin resistance and towards increased cortisol
production. Cortisol signals to decrease pituitary activity, and it does so. Her
40

hormone levels all decrease. This womans predisposition to insulin resistance from
poor sleep, coupled with the stress-induced hormone fluctuations, however, triggers
the development of ovarian cysts.
-A woman is stressed out, and this stress manifests itself in the typical hypothalamic
pathways, so her pituitary activity decreases. Testosterone and estrogen levels are
low but okay, and the woman is probably thin but may also be larger, depending on
her degree of stress. Nevertheless, this time it is progesterone that takes the largest
hit from the stress, possibly because of a genetic predisposition, and menstruation
can never occur without sufficient progesterone levels.
-A woman has a tendency towards insulin resistance from metabolic damage and
stress over the years, and is overweight, but then she loses weight. While this
corrects the insulin problem, the drop in estrogen levels she experiences from the
weight loss causes an imbalance in her ovaries, which are predisposed to
testosterone production from her early life.
-A woman is stressed and her body responds by increasing DHEA-S levels, regardless
of her weight.
-A woman is hypothyroid and overweight.
-A woman is hypothyroid and underweight.


41

Discerning your type of PCOS

While it is important to recognize all of the different factors that have affected your
hormone profile, it is also both useful and true to zero in on one of the primary PCOS
categories. It may be difficult for you to group yourself, however. Do you meet
all of the hormonal requirements? (You dont have to.) What if you are insulin
resistant and underweight? What if your weight has fluctuated a lot throughout
your life, and you have no idea what has been the most significant impact on your
health? What if you are stressed out and overweight? What if you do not know
your hormone profile?

The first step towards healing your PCOS is getting as good of a handle on the picture
as possible. That means, of course, getting blood work done, and it means talking
about your results with your doctor. It also means being honest with yourself, and
facing the cold hard facts about how much you are eating, and when, and how, and
all of the lifestyle behaviors you have that may be less-than-healthy for you.

In my experience, it is fairly easy to put ourselves in one of the categories after we
have made an honest assessment of who and what we are. Of course there may be
overlap between our types of PCOS, but there is also a dominant factor that
determines which category we live in primarily. That is the category that we should
consider ourselves in. After that, we can take what we have learned in this book
about what might be secondary problems for us, which might be, for example,
hypothyroidism, and apply some of those lessons and strategies to our lives however
we deem appropriate. This manual is designed to empower you with knowledge of
PCOS and of your own condition. With knowledge of all the types of and influences
on PCOS, you now have the power to discern what your greatest problems are and
what else might be influencing you, and then move forward with all of the tools I
provide.

If you are still having trouble with your categories, try and imagine what your most
important problem is. If you are overweight and insulin resistant, for example,
then your primary cause is definitely type I PCOS. You might be stressed as well, or
have hypothyroid influences on your health. The best way to move forward for you
in that case would be to focus on the type I PCOS protocol and to include
appropriate strategies from the other protocols as well (such as an autoimmune diet
or stress reduction), according to what you believe your needs are.

42

If you are normal weight and insulin resistant, you should consider yourself within
type I PCOS, but also pay close attention to problems you might have in other
categories, such as being stressed or having hypothyroidism. I also, in the sections
below, when I talk about specific strategies for each type of PCOS, separate out the
normal weight from the overweight and insulin resistant categories, in order to
speak to this population more specifically.

If you have recently lost weight, are an athlete, have been a frequent dieter
throughout your life, eat a low carbohydrate, low calorie, or high-fasting diet, or face
significant life stressors, you should probably consider yourself type II PCOS.
























If you cannot find any obvious problem with yourself regarding your weight, your
exercise, or your diet, then perhaps stress is the major factor for you. That would
group you under type II PCOS as well, and you would modify your recommendations
to focus on stress reduction.

Determining whether you are over, under, or normal weight

Many different measures exist for determining the weight status of individuals. The most popular measurements are the BMI
and body fat percentages.

BMI stands for body mass index, and is a simple calculation found at a wide variety of websites. You can also, if you wish, do the
math yourself: BMI = ( Weight in pounds / height in inches squared ) x 703
BMI = ( Weight in kilograms / height in meters squared )

Technically, a BMI below 18.5 is considered underweight. 18.6-24.9 is normal weight. 25-29.9 is overweight. > 30 is obese.

The BMI is a significantly flawed index, however, because it fails to account for muscle mass. A muscular woman with very little
body fat could come up as overweight, and an overweight woman with no muscle mass could come up as normal weight.

The second, more popular measure of weight status is body fat percentage. This is more difficult to measure, but can still be
approximated. Use the formula below or a calculator online such as at bmi-calculator.net.

Factor 1 = (Total body weight x 0.732) + 8.987 Factor 2 = Wrist measurement (at fullest point) / 3.140
Factor 3 = Waist measurement (at naval) x 0.157 Factor 4 = Hip measurement (at fullest point) x 0.249
Factor 5 = Forearm measurement (at fullest) 0.434

Lean body mass = Factor 1 + 2 +3 +4 + 5

Body fat weight = total body weight lean body mass

Body fat percentage = ( body fat weight x 100 ) / total body weight

Or you may choose to eyeball it. A typical swimsuit model sits at 15 percent body fat, and might go as high as eighteen. A
55 size one or zero is likely at around fifteen percent, and a 55 size nine is likely around twenty-five percent.

However, there remains one flaw with both of these measurements for PCOS. The problem is that the absolute weight level
for PCOS is important, but often what is more important is a womans current weight level relative to earlier periods in her life.
If a woman has recently lost a decent amount of weight (>20 pounds) or has lost weight below how much body fat she had when
she went through puberty, or has dipped below whatever body fat / hormonal set point her body is used to operating under, she
may experience a starvation response. The weight at which this might happen should almost always occur within the
normal range, but the place at that range varies for each women.


43


If you have Hashimotos Thyroiditis, you most likely have type III PCOS as your
primary cause. Yet thyroid problems very often overlap with other metabolic issues,
so it is up to your best judgment to consider whether or not you need treatment for
being under- or over- weight as well.

This manual is about knowledge, and it is about crafting a plan that is right for you.
I do my absolute best to cover all of the bases, and to describe all of the situations
you might find yourself in. If you feel as though you are falling through the cracks,
perhaps you just need to learn about natural foods and the cast of strategies that
exist, and then pick and choose based on what feels right for you. This manual and
these strategies cover a broad a range as issues possible, and they are designed to
support you first and foremost.

If you feel confused by any of this, remember the takeaway: every woman who has
PCOS has it because of damage that has been caused by straying away from what
her body naturally needs. And remember the guiding principle: move constantly
towards natural nourishment.

Listen to your body and your blood tests, and feed yourself what you need. This
means with food, and it also means with your psychology and with your actions. It
is at its root very simple: eat real foods, do not stress out, love your body, and listen
to your body. Be natural, and at one with yourself. Implement whatever
strategies you think you might need after reading this book, and see how they feel.
Watch how your body reacts, and continue moving forward based off of what you
have seen. Your body is ready to heal; you just need to nourish it as much as
possible with the natural nourishment it is craving.

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Factors that promote the development of PCOS
The medical conditions which cause cystic ovaries include being overweight and
underweight, being insulin resistant, being stressed, and having hypothyroidism.
These conditions do have genetic components. But they only become realities
when certain environmentscertain foods, certain lifestyle behaviors, and certain
habitstrigger the genes into action.
Over the next few pages, I briefly overview the food and lifestyle factors that trigger
the development of PCOS. Following that, in section III, I detail specifically why
each element is problematic, how to switch off your triggered genes, and how to
return your body to a more natural, fertile, healthy and sexy state.
Food:
-Sugar
Sugar spikes blood sugar levels, which in turn trigger testosterone production in
the ovaries.
-Soy
Soy is a phytoestrogen. A phytoestrogen is a molecule that resembles but is
not chemically the same asestrogen in the body. This leads to a lot of
hormone confusion. One study measured phytoestrogen levels of different
foods, and while some vegetables had an order of magnitude greater than
others, soy itself has 10,000 units per gram, rather than 4 or 5 hundred like the
vegetables that follow it.
-Grains and dairy
Grains and dairy both may contribute to poor gut health, insulin resistance, and
autoimmune diseases such as Hashimotos Thyroiditis. They also have potent
inflammatory properties in a womans body, depending on her genetics.
-Bad fats: trans fat, deep fried foods, and omega 6 vegetable oils such as
vegetable oil, corn oil, soy oil, and canola oil
These oils are inflammatory. Inflammation leads to metabolic distress, which
in turn causes fat storage and insulin resistance.
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Chemicals:
-BPA
BPA is a toxin found in plastics such as plastic water bottles and aluminum cans.
This toxin acts as an estrogen in the body. This has been shown to be
detrimental in both rodent and human studies. When rats are exposed to BPA,
for example, their male offspring have decreased fertility. Female rats, when
exposed to BPA in utero, develop PCOS. These rats also have lowered fertility
and higher BMIs than non-exposed rats. Similar results have also been
reported in humans. A high correlation has also been shown between mothers
with high levels of BPA having children with mood, behavior, and personality
disorders. Moreover, women with PCOS, both lean and overweight, have 40
percent higher levels of BPA in their blood than those without. This may be
because of the way their bodies are equipped to filter out BPA, or it may be that
the BPA is in fact having a direct effect on their metabolic functioning.
Hard plastics such as #7 are worse for estrogenic activity than soft
plastics. Plastics 1, 2, and 4 are BPA-free, but they may still contain estrogenic
compounds. These numbers can be found on the bottom of every plastic
product. Heated plastics leach at much higher rates than cold ones. Finally,
research has shown that BPA gets into bodies in even higher doses from eating
out of aluminum cans than out of plastic. Cans are lined with BPA on the inside,
so most things eaten out of a can are laden with BPA. The FDA has
comprehensive resources on which canned foods have more BPA than others if
you wish to take action.
Behaviors:
-Snacking
Todays world is filled with opportunities to eat food. Some office spaces even
make it a rule that each employees desk must be within 100 feet of a food tray
at all times. We are also often told to eat regular, small meals throughout the
day. But if we do not allow our bodies to become hungry before we eat, then
our metabolisms never have a chance to catch up and clean up before the next
round of food.
46

Both leptin and insulin signaling become more sensitive when we consume our
food in a few meals rather than spread out continually throughout the day.
-Overeating
Foods in the Standard American Diet tend to turn off satiation signals and to
ramp up appetite. They are also designed specifically in order to make us
crave them more and consume more foods. Soda is one powerful example of
this. Soda is a sweet beverage, so it gives us cravings, but it also has zero
nutrition, so it does not fill us up at all.
Eliminating sugars and moving towards natural foods can do wonders for a
persons appetite. It may not be a magic bullet, but it does in fact increase
satiety and make it somewhat effortless for people to consume appropriate
amounts of food. With natural foods, rather than manufactured ones, a
persons metabolism is enabled to have the right kind of hunger and satiation
signals. It may take a while for these drives to fall in lineespecially if
psychological problems with food need to be addressed as wellbut they do
come and they do promote healthful eating and fertile ovaries.
-Restrictive eating
Many women feel pressure to look and be their best, and as such over-do it in
terms of diet and exercise. They hear that carbohydrates are fattening so cut
them down to zero; they think they need to eat a certain amount of calories or
less every day and try to do that; they go to the gym daily because thats what
the cover of exercise magazine makes them feel like they have to do.
Yet restrictive behaviors trigger starvation responses and shut down hormone
production. Healing from these behaviors takes a long time and often a fair
bit of psychological work, yet it is crucial for women who have been overly
stressed throughout their lives. Their pituitary gland, much like the rest of
their bodies, need to be nourished and rested.
-Inactivity
Exercise, and particularly sprint-based exercise (in moderation) is one of the
best ways to sharpen insulin sensitivity. When we become inactive, our
metabolisms become inactive, too. This is a major factor and exercise can be
a major help for women with insulin problems.
47

-Stress
For both over- and underweight women, stress plays a big role in PCOS. Stress
acts as a wildcard in the hormonal game. Which hormones will it increase,
and which will it decrease? Will it put hormone production into overdrive or
slam it into the basement? Both of these cases, or even a mix of them, are
entirely plausible.
In animal studies, monkeys at the bottom of the social ladder experience
irregular periods and impaired fertility. There is zero difference between their
nutrition and the nutrition of their superiors. The only difference is that they
are less happy. Stress is a real factor that all women with PCOS need to
address.
-Poor Sleep
Sleep is crucial for metabolic fitness and insulin sensitivity. Studies have
shown conclusively that poor sleep increases both appetite and fat deposition.

All of which is to say

PCOS is complicated. But overcoming it is not. In each of these
situations, what the woman needs is to de-stress, to eat a whole foods
insulin-sensitizing hormone-free diet, to focus on nourishment and
positivity, and to achieve a healthy weight.









48








Part III: How to overcome PCOS

Natural Diet and Behavior, Type-Specific Strategies,
and Intervention Options




While I attempt in this manual to answer every question you might have about PCOS,
which includes all of the various treatments in addition to all of the various causes, I
still clearly have a bias about what the best kind of treatment is. If I am going to
explain how to overcome PCOS, I am clearly going to favor some treatments over
others. I have researched the vast majority of them and all of their side effects
and benefits extensively.

My approach to PCOS is based on the philosophy that food is medicine. Women
surveyed in todays surviving traditional, hunter-gatherer cultures do not have PCOS.
PCOS has emerged in Western society in response to changes in diet and lifestyle.
For this reason, the simplest and most healthy way to overcome PCOS is to re-align
the foods that we currently eat with the foods that we are meant to eat. We need
to eliminate foods and behaviors that have negative hormonal influences and that
damage our metabolisms and make us overweight. When we do that, we enable
our bodies to return to the natural, healthy, happy, and sexy states that they keep
desperately trying to be. All we have to do is get on their side, love, and support
them.

That being said, other treatments for PCOS such as medical interventions also
deserve their place, and they may be undertaken by women safely for given periods
of time. You may choose to experiment with medication. That is fine-- that is
wonderful. I want you to be as best informed as possible and to do what is best for
you. I am simply sharing my views and knowledge with you. For that reason, I
49

discuss the positive and negative aspects of a wide variety of interventions for PCOS,
as well as the natural foods approach that I clearly favor.

From my perspective and experience, approaching PCOS with diet and lifestyle
changes is the healthiest, most long-term, most effective, and
most-laden-with-other-positive-benefits approach to PCOS. Medications may be
efficacious for a short period of time, but they do not heal underlying wounds.
Only re-aligning your diet and lifestyle with what your body is designed to handle can
do that for you.







50





How to overcome PCOS





PCOS is best overcome by stopping the behavior that causes hormonal disruption
and by healing damage that has been done over time. No medication can do this
for you. Only repairing your body with natural, hormone-balancing foods can.

You can overcome PCOS by eliminating harmful foods that confuse your body, and by
focusing on natural foods that your body was built for.

Eating a diet of natural, whole foods is the first and most important step for every
woman who has PCOS.

In fact, I would argue that it is 75 percent of the battle, for every woman.





51

The reason that food is 75 percent of the battle is that food has such a powerful
influence on our hormonal environments. It is the determinant alongside
behavior that tells our bodies what which hormones to produce, and when.

The only foods that promote proper hormonal signaling are the ones that human
genes are built for; this is why a natural foods approach is the right approach to take
for every woman. No matter which direction your body needs to move
inwhether it is decreased testosterone levels, decreased DHEA-S, or increased
estrogen or increased progesteronea natural foods diet is going to be supremely
powerful in making that happen.

The remaining 25 percent of the cure is implementing this diet in the proper context
for each woman. Every PCOS patient has become estranged from what her body
naturally needs in a certain way, yet these ways have important differences.

Some women need to eat more in order to be properly nourished, and other women
need to eat less. Some women need more carbohydrates, and other women need
less. Some women need more exercise, and others need less. This is because we
all have moved away from what is natural for our bodies in one direction or another.
So with natural foods on our side, and armed with knowledge of ourselves and how
we have each personally lost touch with our bodys natural needs, we can move
forward with the proper corrective strategies. In doing so, we will be constantly
evolving into increasingly fertile, increasingly healthy, and increasingly sexy,
empowered, and naturally beautiful beings.

The core of the cure: overcoming PCOS with natural foods

Foods that are confusing or harmful to the body, and cause hormonal disruption,
have all been recently invented.

None of our ancestors or even our grandmothers ever had access to high
fructose corn syrup, for example. For this reason, when a person eats high fructose
corn syrup, her body has no built-in mechanism for dealing with it. It panics; it gets
confused; it becomes overweight even though being overweight is unhealthy. The
same applies for virtually all foods that have gone through a factory or been
packaged in a box. The body does not know how to handle them, so metabolic and
hormonal chaos ensues.












Continuing your exploration of PCOS in
PCOS Unlocked: The Manual





The rest of PCOS Unlocked: The Manual is available for download and purchase at
another site. It has not been included in this bundle because of its relatively high
and extraordinarily specific value. Fortunately for everybody involved, the rest of
the manual is still far discounted below the normal price, a special sale for the people
who have purchased this bundle.

We apologize for any inconvenience or consternation this may cause you, but
everything possible has been done to assure you an easy transition to your time with
the full guide.

Instructions for purchasing the rest of PCOS Unlocked: The Manual plus audio and
video version and supplemental guides at another discount are as follows:

Go to the website http://paleoforwomen.com/pcos-unlocked-the-manual and scroll
all the way down to the bottom of the page where it says for discounts.

Here, type in the code paleoplanbundle which is always a valid coupon code.

This will get you the entire manual plus extras for 23.00!

This includes:

The rest of Part III, Part IV, and Part V of the manual

The Blood Test Interpretation Tables
The Hormone Glossary
The Stress Checklists
The PCOS Typing Flow Chart
The Type-Specific Indicators Chart
The Foods Guide
The Type-Specific Summaries

Audio Version

Video Version


Enjoy!


If you have any questions, please feel 100 percent free to email the author Stefani
Ruper at stefaniruper@paleoforwomen.com at any time!