Female Hormones, Weight and Auto-Immunity

December 29, 2011 in Categories: , , , by

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I write this post in the midst of a huge hormone adjustment.  My youngest weaned just a couple of weeks ago and my body is still trying to figure it out.  I was pregnant or lactating for over 5½ years (I got pregnant with my second daughter only few weeks after my oldest weaned), so I don’t expect this adjustment to be easy for my body.  I feel more tired and emotional and find myself craving sugar (not good during the holidays when sugar is so easily found).  

The hormones that regulate a woman’s menstrual cycle, pregnancy and lactation have a complicated interplay, some going up while others go down in a way that is specific to what is happening in your body.  It is truly amazing to think of how many different jobs these hormones do.  But there are also “side effects”, the most familiar of which is either weight gain or a resistance to weight loss.  Women experience this while pregnant (and their bodies take over with hunger and food cravings so that they will gain weight), but also while lactating and while taking hormonal birth control.  Many women experience increased hunger and food cravings slightly before and during menstruation, also attributable to these hormones.  But, this frustrating hormone “side effect” is really an artifact of society and our own desires (for example, wanting to be thin instantly after having a baby).  It makes prefect sense from a physiological and evolutionary perspective that our bodies should prioritize maintaining higher fat levels when pregnant or lactating (or when your body thinks it’s pregnant because you are taking hormonal birth control).  

If you are a woman who is struggling to lose weight, hormones may be to blame.  But be patient.  If you are breastfeeding your child, you are giving them an amazing gift, so be patient.  Your child will eventually wean and your hormones will stop making it so difficult to lose those last ten pregnancy pounds.  If you take hormonal birth control or hormone replacement therapy, again, be patient.  You have already weighed the benefits of this choice (like not getting pregnant before you are ready) and struggling with those last ten pounds is okay.  There’s an important piece of information buried here:  most women only struggle with the last 10-15 pounds.  These hormones don’t really kick in to inhibit weight loss until that point.  Many overweight women successfully lose most of their weight even while taking hormonal birth control or lactating.  (If you need help, see my posts on paleolithic nutrition, paleolithic lifestyle and diet vs. lifestyle as a place to start.)

These hormones have another very important job while you are pregnant.  They reduce your auto-immunity so that your body does not attack the baby growing inside of it.  Auto-immunity is also reduced to a lesser extent while you are lactating or on hormonal birth control.  Women with auto-immune conditions often find that their symptoms decrease while pregnant or even go into full remission.  But too often, the payback is not fun.  For many, the symptoms return with a vengeance after the hormones return to normal.  This is something that I am struggling with right now.  I suffered a form of psoriasis (called lichen planus) prior to getting pregnant with my first daughter.  When my second daughter night weaned last summer, I started seeing a few patches again.  This was actually the driving force for me to switch to paleolithic nutrition.  Now that my daughter has completely weaned, I am experiencing a huge increase is psoriasis.  This is the driving force behind my NewYear’s Resolutions, which are all focused on decreasing inflammation in my body. 


Ekkk. I am trying to be patient. Really trying. My daughter is 13 months. Since having her I have gone paleo with the exception of coffee cream and hard cheese. My weight has fluctuated in that I have the last 10 pounds to lose and will lose 5 and regain it. I can have a good tight diet or a crappy diet with cheats and it doesn’t seem to change the weight loss.
I don’t know if I need to tweak my Paleo harder or this is strictly horomonal and anything I do right now due to lack of sleep etc will be in vain?
I have a weakness for coconut oil and probably (ok most certainly overeat that ;). I find I have to have a snack before bed or I wake up to feed her in the night and am STARVING. However, I can also wake up STARVING even with a snack. I am eating lots throughout the day. I can chomp through a bucket and I mean bucket of lettuce with every meal.
Any advice or insights you could offer would be greatly appreciated before I drown my sorrows in a box of chocolate (dark chocolate that is ;). I can find little info on breastfeeding and paleo weightloss.

I know it’s hard to be patient. My youngest weaned 4 months ago and my hormones are still not back to normal. I understand very well the frustration of wanting to be smaller than my body wants to be. Try and be patient because it’s quite possible that nothing will work until your hormones are back to normal (and there’s really nothing wrong with that!). If you are really determined to force your body to be happy lighter, here are a couple of things to try:

1. Get more sleep. Especially if you are up alot in the night still. Either try and grab a nap during the day or go to bed earlier.

2.If you have to have your bedtime snack, try and at least make it 2 hours before bed. If you wake up starving, try a tall glass of water.

3. Step away from the cheese (heavy cream in your coffee should be okay). It causes a spike in insulin which will make all the hormone issues you are dealing with worse and potentially increase cortisol, which is why you’re hungry in the evening.

4. How is your exercise? Going for long walks in the sunshine is probably the best choice. Make sure that whatever you are doing that you don’t push yourself too hard. If you’re not getting great sleep, intense exercise can increase cortisol and make it harder to lose weight.

Good luck!

In addition to the excellent recommendations above, insist that any dairy or animal protein is from sources that adhere to organic standards (pesticide-free, grass-fed/free-range/wild caught, hormone- and antibiotic-free). As a compounding pharmacist, I’ve learned how critically important adrenal gland (nutritional and environmental) support is for all forms of hormonal imbalance; James Wilson, N.D., Ph.D., is an excellent resource at http://www.adrenalfatigue.com

Hi! I think my hormone issue might be a bit different being that my kids are a little bit older, but now so am I. 😉 What tips do you have for losing the last 5 or so pounds due to possible pre-menopausal hormone issues? And its all in one location…abs. I work out like crazy and eat an amazingly “clean” diet… So this is my self diagnosis. 🙂

Hi Sarah! I love your site! i am dealing with postpartum hypothyroidism and possible autoimmune issues. We haven’t yet figured it all out yet and I was wondering if you could suggest which tests would be the most beneficial for me to understand what’s really my situation. I have ALOT of anti-bodies flying around but have no symptoms so far. I definitely feel a gluten issue and am trying to stay off…… Is it possible to email you offsite? Also will you international shipping for your book? I live in Israel. Thanks!!

I would suggest implementing the autoimmune protocol. Selenium test, iodine test, and vitamin D test are probably useful… then supplement to get your levels in the normal range (retest to check). Yes, the book will be shipping internationally. 🙂

Dear PaleoMom – I would like to see you do an interview with a post-menopausal paleo mom. What about the rest of us who are older, whether we’ve had children or not. You are still in your childbearing years. I officially became menopausal in 2008. What about us?

I have been primal for about a year. I lost about 30 pounds, and then the weight started to creep back up, even though I rarely cheat and even gave up my dark chocolate habit. I also gave up dairy for a few weeks at one point to make sure it wasn’t contributing to the weight or my chronic pain issues. I’m at a loss as to why I’m not losing anymore, especially since my weight is pretty significant (almost 260). Could an IUD (and its low level hormones) be responsible for preventing weight loss? I was already at this weight before the IUD, so it’s definitely not the cause of my excess weight. I’m sticking primal because I feel awful when I eat any significant amount of wheat or sugar. Before going primal, Weight Watchers wasn’t working either, even when I counted and stuck strictly to the plan. I’ve just about accepted that I’ll never be thinner, but it’s frustrating. Any tips would be appreciated.

Im so angry! Ive been doing the autoimmune paleo diet for 1 month now, along with Dry July! Its been 3 weeks and I was annoyed that I hadnt lost weight after cutting out so many foods and alcohol and had in fact gained some. My symptoms at the time of starting were next to nothing, so it was easy to measure the effectiveness of the diet and medication change. I usually have just one knee that is always flared. So they have recently switched me from enbrel and methotrexate to Actemra. I have had 2 infusions and my 3rd is on Tuesday. I have started to get a lot of pain and stiffness in the mornings again, especially in my good knee. Now I have woken up with 2 flared knees. Now Im not annoyed about the weight but the fact this medication is less effective than my last and all my efforts in this autoimmune paleo diet have done absolutely nothing! Im so sad I feel like Ive taken 1 step forward and 2 steps back.

Did they switch you before or after AIP? The goal with the AIP would be to wean off DMARDs since these will stop your body from ever properly regulating your immune system (and some like methotrexate cause a leaky gut.. I don’t know if IL-6 blockers do or not). The pill might be a problem too, but I think you should be able to see some improvement even without going off it. 3 weeks is pretty early in the game… Some people see differences within a day or two on the AIP, but others take longer (seems to depend on what else is going on in your body and just how leaky your gut is). I took about 4 months. It’s really important to eat lots of fish (omega-3 fatty acids) with RA as well as glycine-rich foods like broth and organ meat (you could try a collagen supplement too). It’s also common for people who had micronutrient deficiencies going in to not lose weight or even gain weight initially (it’s as though the body is still trying to hold on to everything because it’s used to not getting enough) for even a month or two before the weight starts dropping off. Also make sure you’re eating plenty of vegetables and some fruit (being too low carb can cause high cortisol which could explain both the worsening knees and the lack of weight loss).

Hi Sarah,

I have been put back on methotrexate to help my Actemra infusions. Does this mean this diet will be no good for me? If the Actemra does not work after 1 more month WITH the methotrexate, my rheumy will put me back to enrel or possibly try Humira.

Actemra didnt work, I have been taken off it as of yesterday as I could no longer walk. I have been put on methotrexate and humira. Will the AIP diet work for me?

Thanks Sarah, I decided after nearly 2 weeks to cut out fruit, because I was getting so bloated. I also cut down on coconuts at your suggestion. I havent made any broths yet and cant get my head around cooking organ meats. Maybe I will try a broth this weekend. Ive been cooking lots of roast meats. maybe this is the cause of my weight gain. I will try to up my fish intake and take collagen. I started Actemra on 25th June and started the diet on 1st July. It is early on in the game I agree, but I feel very unmotivated today to keep up the diet, however I am not going to quit now. It could be my medication wearing off, I havent taken methotrexate since the end of June and enbrel probably a few weeks before that. I was on 25mg Methotrexate weekly injectables, and 50mg weekly Enbrel.
Thanks for your help, I will try your suggestions, Im just having a bad day and clearly feeling very sorry for myself. 😉

Great post but you left out the information for those of us on the other side of the spectrum, namely menopausal women, hormones and weight loss!

Hi. I too have suffered with lichen planus so found the above interesting to read. It first surfaced during a time of stressful exams. Then a few years later returned severely when I was nursing my 1st child – lack of sleep & high sugar diet bought it on, I think. From then on, it comes & goes. I am just starting paleo to address IBS. Have you written anything else where a paleo diet has helped the psoriasis? Tx. Found your website very helpful.

Thank you for this post! I gained 15 pounds after going on brith control and can’t seem to get that finicky weight off. I have been considering even going off birth control for that reason. My biggest problem is the monthly cravings. Do you have any suggestions on how to curb cravings during that time of the month?

Hi Sarah,

I posted a question in then nightshade section, but one of the questions dealt with female hormones, so in case you answer it, I’ll also put it here for other people reading. I have Crohn’s disease and had been on SCD for almost 2 years, and didn’t notice much difference if any. I never had very long remissions (this is while on all types of meds, biologics, methotrexate etc.), but I was in remission before I got pregnant and then pretty much from the moment of conception I flared horribly. I ended up in the hospital on IV steroids and they started me on sulfasalazine to help with the joint pain. There was talk of starting another biologic after I got of the steroids, but somehow I was able to maintain on sulfasalazine only. I had the longest remission ever with just that and paleo.

I just recently got my first postpartum period and have flared horribly. I’m still nursing, but obviously my hormones have fluctuated. I know you mentioned above that the shift in hormones can cause flares. I found it interesting that I was able to maintain remission while nursing since the pregnancy hormones made me horribly flare. It seems like any hormonal fluctuation makes me flare. Is there anything women can do to try and mitigate the hormonal flares besides birth control? That made me flare as well. I’m afraid when my daughter fully weans it will bring on another flare.

Could doing the AIP possibly mitigate any more hormonal-related flares? I just started but I’m also on prednisone right now. Will being on prednisone mask any symptoms I may have if I start to reintroduce foods after a few months? Do you recommend being on the AIP without introducing regular paleo foods for longer than a few months? I’m so desperate to not have to go back on another biologic or immune suppressing drug to control my Crohn’s. Does your book go any further into the link between female hormones and autoimmunity?

Yes, prednisone can mask symptoms so I would suggest holding off on reintroductions until you can get off steroids without having a flare.

Yes, my book does discuss the link between sex hormones and autoimmune disease, as well as thyroid hormones, stress hormones, circadian rhythm hormones, hunger hormones, metabolic hormones, and the complicated links between all of these and diet and lifestyle. The best things women can do to avoid flares with hormone shifts are eat a super nutrient-dense diet, sleep a ton, and keep stress very low.

This is really interesting to me because I suffered ungodly terrible acne after weaning, and have lately come to suspect that my ongoing acne is more of an AI issue than a skin issue. I’ve read Tara Grant’s book, and I do have HS on other parts of my body, but after reading the book, I decided to treat my facial lesions as if they were AI and have seen positive results. (Nightshades = cyst city.) Reading that pregnancy and lactation suppress auto-immunity seems to be further evidence of what I have been suspecting because man, that post-weaning flare was hellish.

Thanks for the info!

Hi Sarah, This makes so much sense to me. My eczema has gone into remission since becoming pregnant. I assume I also would have to wait to do gluten cross reactivity testing until after I give birth – I assume the test results would be skewed since pregnancy regulates your immune system…?

Hi Sarah, I’m a confused mess…I was diagnosed with “lupus like ” symptoms 5 years ago, they dumped me on prednisone and there I’ve stayed since Ive been so comfortable and I am at a low dose. ( between 2-5 – 5 in winter ) . My issues are mostly arthritis in my hands and feet, blisters on knuckles and reynauds. I am allergic to plaquenil. My last bone density is showing that the pred is causing significant bone loss so my doc wants me off pred and on metho. Deathly afraid of that drug. I’ve been very close to Paleo for years and found your site and am considering AIP. 2 problems with this: I am on ortho try cyclene low and on my way down of weaning off pred ( 1 milligram per month…i’m at 4 ) I get to about 2 and start to ache. I am fine to go off birth control, done having babies and husband has been “taken care of ” 😉 I just don’t know when??? is the birth control helping to control pesky hormones? (i’m 39 yeas old ) or is it hindering my desire to heal my gutt?

Some background: In order to get pregnant with my youngest I had to go on high doses of chlomid and my first flare didn’t show up till after I went back on the pill after he was 6 months old …suspicious of my hormones….so do I come off the pill now, or wait? I wasnt going to do the AIP intil I was at about 2 mgs of pred…is that even a good idea?

I do recommend getting off birth control, which can exacerbate many health problems including autoimmune disease. When to do it is up to you and your doctor, but many people find that they are better able to wean off or give up their medications after the AIP has yielded some results. – Christina, Sarah’s assistant

I just started eating paleo I’m 32 weeks now it’s only been 13 days today and I’ve had a really hard time with my mood the last week I thought maybe it was a detox or withdrawal but I didn’t think it would last this long. Will it get better soon because I’ve been a monster and my husband said I should get on anti-depressants. Please tell me it will go away soon.

Thanks for your posts, I love reading them and they’re making a big difference to my health. I seem to have had the reverse to what most women go through hormonally and I’d be keen to see if you have any ideas?
I loose weight during pregnancy, without even trying and without being unwell. I was unable to breastfeed both my girls – I seem to have IGT (insufficient glandular tissue) so only made max about 30ml per 24 hours. And now, post second pregnancy have the beginnings of RA. My Dad has it, so it’s not completely out of the blue, but your post on hormones for me thinking – could there be something else going on?
Any ideas? Thank you!

Hi Sarah,

This is a very interesting and helpful article 🙂
I have first found out about my autoimmunity once I stopped taking the pill, on which I was for 12 years. I got an very annoying eczema in my private parts and it took me while to get it under control, and it was thanks to your site and following the AIP. So I owe you a very bit thank you for this. I am a big fan and got all your books, eagerly awaiting the cookbook at the moment.
I wanted to ask you whats the best way to avoid the flare ups and my symptoms returning all together. I am currently breastfeeding my 5months old baby and am planning to continue for as long as possible. During the pregnancy I was able to tolerate more foods such as nuts and the occasional coffee or an egg.
Would it be a good strategy to follow a very strict AIP again when weaning? And if so for how long? Or do I have to eat very strict even now, while breastfeeding?
Thank you very much for any advice or tips!

Interesting. I had 3 kids in a matter of 4 years….and nothing came back normally. My period, which previously had come and gone like clockwork, was erratic at best and by the time my youngest was in kindergarten I was diagnosed with MS.
Any suggestions?

I wonder what hormonal changes occurring during peri-menopause might contribute to auto-immune symptom enhancement?

I came down with an chronic case of hives coincidental with my second missed period. Having adopted the Paleo Approach in concert with Chinese herbals has significantly reduced the daily inflamations (some days it’s hardly noticeable) but I keep going back to the coincidental timing with peri-menopause and hormone imbalance.

My GYN told me there’s no connection but traditionally trained doctors have often been wrong. I do have the MTHFR gene and “going” Paleo has significantly reduced chronic digestive problems including stemming what may have been the start of IBS (my mother has 4-5 autoimmune diseases, including IBS).

Any thoughts on hormonal changes at peri-menopause would be much appreciated.

Hives can be caused by any number of things, including low thyroid function and histamine intolerance. If you’re interested, Sarah has consultants available at ThePaleoMomConsulting.com to help troubleshoot these complicated medical problems. – Christina, Sarah’s assistant

Emily C October 9, 2014 at 7:41 pm Your comment is awaiting moderation.
Hello Sarah,

I suffer from plaque psoriasis (scalp, hairline, forehead, nails, elbows). My psoriasis worsened during my first pregnancy to include my between my breasts and nipples. After giving birth, I also developed psoriasis in the genital area and recently on the crease of my nose. My beautiful, healthy son is now 5 months old. My query is: In your book ‘The Paleo Approach’ (which I absolutely love) you state that those who experience worsening of their autoimmune symptoms during pregnancy often see some relief after giving birth. Mine worsened during pregnancy and after birth (I breastfed for 3 months and witnessed worsening of symptoms upon weaning). My psoriasis has seemed to ‘calm’ down a bit recently in that it is not as ‘flaming red’, but once it’s triggered in a certain area (scalp, nipples etc..) it just seems to slowly grow and spread (In the 15yrs I’ve had it has never been in remission). Thank goodness I can hide my forehead, scalp etc with a new hairstyle, but psoriasis on the crease of my nose, as you can imagine, freaks me out!! It is pretty obvious that hormones have triggered the worsening of my psoriasis….My review of the scientific literature confuses me in that some papers report that increases in estrogen worsens psoriasis while others say it worsens it. Why do you think my psoriasis worsened both during and after pregnancy? I’ve just started the ‘Paleo Approach’ and I’m so excited to see the results.

Your book is so interesting and such an incredible achievement. So deserving of a New York Times Bestsellers.



Dear Paleo Mom,

Thank you for all the great info. I followed autoimmune protocol and now introducing foods…My period is late more than 2 weeks. Is it normal that on autoimmune diet menstrual cycle goes crazy a bit? (I did test and am not pregnant) Thank you very much for your answer.

I have been following the AIP diet for about a year now. A month into the diet I stopped having cycles and my female hormones all plummeted. After 6 months on the diet and my hormones in premenopausal state at age 32, I was forced to start bio-identical hormones, which are causing excesive fluid retension and bloating, depression and anxiety, and fatigue. If I stop them my symptoms of low estrogen and progesterone return. Unfortunately, I’ve seen many medical providers and no one has been able to figure this out. I wish the diet has regulated my hormones instead.

Hi sarah. I went paleo almost 5 years ago and got fitter than ever, i felt and looked great. 2 years after i got pregnant, and i stuck even more to a clean diet cause i wanted my baby to develop on the best possible conditions. I gained 13kg and lost 13kg after giving birth to my awesome daughter. The following 2,5years i’ve been nursing her and although my abs never came back, my weight has been quite stable (2kg up or down from time to time). But here comes my spectacular weight gain in only a couple of months: i’m still nursing my daughter, but a couple of months ago my menstruation came back, and since then, i’m more bloated than ever, and my clothes don’t fit me anymore, i’ve gained almost 8kg and i’m always hungry and craving sugar… I think it all started with my menstruation, so i guess a hormone imbalance is behing all my issues. Besides prioritizing sleep, some exercise and eating cleaner than ever, is there any other recommendation you can advise me? Thanks for your help

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