The following is a guest post by a fellow health blogger – Kate – who had an infertility problem then fell in love with leptin.
If you are facing infertility due to PCOS or want to learn to embrace your natural sexiness, my books, Sexy By Nature and PCOS Unlocked may be incredibly helpful for you!
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I used to have a bit of a body fat phobia. Although at 13% body fat, I didn’t really have that much to worry about from what other people would think. I was impressive right?
Problem was, along with no body fat, I also had no period, no ovulation, and, no fertility. I was diagnosed with hypothalamic amenorrhea. I looked “healthy”, but my reproductive dysfunction indicated otherwise. I knew I had to get this sorted, and fast, as my partner and I were trying to conceive.
I consulted a few of my health practitioner friends. They all suggested that maybe putting on a bit of body fat might help kick things back into gear. As a group fitness instructor who was paid to stand up in front of others in skimpy lycra, this was the last thing I wanted to do. Being the stubborn person I was, I needed justification as to why, and how, fat would help to restore my fertility. Cue leptin.
Leptin is one of the more recently discovered hormones and is often referred to as the “anti-obesity” hormone. In fact, the word “leptin” is derived from the Greek term “leptos” meaning “thin”. This little hormone, which is produced predominantly in adipocytes (fat cells), conveys information to the brain about the amount of energy available in the body. Leptin levels rise with increasing food intake, telling the brain “Yay! All is well. We have sufficient nutrients to do our thang”, and the fall in times of food deprivation, telling the brain “Things aren’t so good. Looks like we’re in a famine and need to shut off non-vital functions”. Unfortunately, reproduction is one of those non-vital functions. We do not need to reproduce in order to survive. Simple as that.
But really, it’s not as simple as that.
We now know that leptin acts as more than just an energy thermostat. Indeed there are over 19,000 papers that have been published on leptin (no, I have not read them all, sorry), showing that leptin has various physiological roles. But back to the case in point – aside from signaling energy sufficiency to my brain, how would body fat and, as a by product of increased body fat, leptin help me to recover from hypothalamic amenorrhea and restore my fertility?
That depends on what’s going on during a healthy menstrual cycle.
During the first half of the cycle, otherwise known as the “follicular phase”, follicles (in the ovaries, which house an egg that has the potential to be fertilized) develop. The pituitary gland releases Follicle Stimulating Hormone (FSH) to, as the name suggests, stimulate the follicles to mature and secrete estrogen, which will have the lovely effect of producing fertile cervical mucus. Sorry, we’re getting graphic now.
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Once FSH and estrogen have things looking all fertile and sexy, the pituitary gland releases Luteinizing Hormone (LH) to stimulate ovulation, where an egg will burst out of a follicle and wait patiently (for about 12-24hrs…pretty impatient, really) to be fertilized. Meanwhile, the follicle that was left behind becomes the corpus luteum, which secretes progesterone and prepares your body to house a mini-human (think pro-gestation).
So FSH and LH (also called gonadotropins) are pretty important. Without them, your sex organs would not receive the message to produce your sex hormones, or to ovulate, or to menstruate. But we are missing an important step. FSH and LH need a little encouragement too, and this comes in the form of another hormone – Gonadotopin Releasing Hormone (GnRH), which is released by the hypothalamus. Are you lost yet? Female hormones are confusing! Quick recap – GnRH stimulates the release of FSH and LH, which promote ovarian function and a healthy menstrual cycle.
Now here’s the kicker – leptin has been found to play a regulatory role on GnRH secretion and hence, overall reproductive function. Whether this is a direct or indirect role remains to be discovered. However, what we do know is that women with hypothalamic amenorrhea (when menstruation ceases due to dysfunctional signals between the hypothalamus and the pituitary) tend to have lower leptin levels than women with healthy, ovulatory cycles, as a result of low body fat and/or increased physical activity and/or insufficient food intake often found in amenorrheic women. These low levels of leptin then contribute to alterations in GnRH secretion, as evidenced by disruptions to LH secretion (Ackerman et al, Goumenoua et al). Interesting, right? Thought so.
Now I know what you’re thinking – what happens if we give someone leptin? Will that get things back on track? Well yes, Welt et al (2004) treated a small number (n=8) of women with hypothalamic amenorrhea with leptin over a period of 3 months and found that the treatment did restore menstruation, ovulation and hence, fertility.
Similarly, Mantzoros et al (2011) boasted this: “Our results indicate that leptin therapy resulted in resumption of menses….in 70% of the subjects [and] 60% of these women also ovulated”
Woo hoo! Let’s all go and get us some leptin to inject….
OR we could just eat more, exercise less and embrace our booty!?
[Stefani notes: You cannot get leptin over-the-counter, or have it tested for in a blood test. I’ve tried both.]
After 2 years of being in denial about the importance of body fat and desperately holding on to my 8-pack abs, which I had thought was my defining feature, I succumbed. I put on (quite) a bit of body fat. I ate more. I exercised less. And I realized that my friends and family probably loved me for more than just my body. Doctor Seuss was right after all when he said:
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Smart man that Dr Seuss.
I put on weight. That was the goal, after all. And I definitely was no longer 13% body fat, as evidenced by my increasing bust line (yay) and decreasing (absent) thigh gap (also yay, I think – that shit is just not normal for my body.). One other lovely effect – my period returned. Hurrah! It just goes to show that with a little dedication and a (pretty big) mental shift, beautiful things can happen.
Ladies – your period is a luxury, not a right, and definitely not an inconvenience! If your lady holiday is MIA, see it as the canary in the coalmine and do something about it before the shit really hits the fan (think osteoporosis, heart problems and infertility). Stop trying to reach some warped perception of the “ideal” body and start embracing your natural feminine curves. And remember – you are so much more than what you look like. Be kind to yourself for once.
-x
If you want to know more about women’s fertility, check out Stefani’s book, Sexy By Nature. It’s AWESOME. You can also see PCOS Unlocked and Birth Control Unlocked.
References for all you fellow nerds out there:
- Ackerman, K.E. et al. (2012) “Higher ghrelin and lower leptin secretion are associated with lower LH secretion in young amenorrheic athletes compared with eumenorrheic athletes and controls”, The American Journal of Physiology – Endocrinology and Metabolism, 302: E800–E806
- Goumenoua, A.G. et al. (2003) “The role of leptin in fertility”, European Journal of Obstetrics & Gynecology and Reproductive Biology, 106:118-124
- Holtkamp, K. et al. (2003) “Reproductive function during weight gain in anorexia nervosa. Leptin represents a metabolic gate to gonadotropin secretion”, Journal of Neural Transmission 110: 427–435
- Mantzoros, C.S. et al. (2011) “Leptin in Human Physiology and Pathophysiology”, The American Journal of Physiology – Endocrinology and Metabolism, 301: E567–E584
- Moschos, S. et al. (2002) “Leptin and reproduction: a review”, Fertility and Sterility, 77(3): 433-444
- Quennell, J.H. et al. (2009) “Leptin Indirectly Regulates Gonadotropin-Releasing Hormone Neuronal Function”, Endocrinology, 150(6):2805–2812
- Rexford, S.A (2004) “Body Fat, Leptin and Hypothalamic Amenorrhea”, New England Journal of Medicine, 351 (10): 959-962
Kate is a Holistic Nutritionist, Personal Trainer and Lifestyle Coach specializing in hormone healing. Kate has over 13 years of experience in the health and fitness industry. She is passionate about helping others achieve optimal wellness through nutrient-dense traditional whole-foods, adopting mindful and sustainable life practices, and moving in ways which rejuvenate rather than deteriorate the body. Kate’s goal is to educate, inspire and empower others to live life to the fullest each and every day. Kate can be reached at www.theholisticnutritionist.com
Kate!
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I have never liked the word “booty,” it’s crass.
Thanks, new hormone, interesting. Paul Jaminet writes in PHD that eating carbs at night supports leptin cycles. On the body fat, I think women have to worry about upper body fat and not lower body fat basically. So the bust line shouldn’t fluctuate but the booty can….I checked this out because I was worried being overweight made me subject to my fat cells’ hormone secretions. But it turns out upper body subcutaneous fat and lower body sc fat are totally different, and thankfully I’ve always gained weight in the gluteal-femoral region. What made you ovulate was the fat surrounding your ovaries and below the navel, it’s very sensitive to insulin, so inactive it’s called silent in comparison except for beneficial hormones, and doesn’t weigh down the spine, esp in the case of pregnancy. ..Bottom line, it’s easy to mobilize for reproduction and isn’t pathogenic, unlike upper body fat, which is hard to get rid of as it generates itself. People from Northern climates may have a small insulating layer, but in excess it leads to insulin insensitivity and diabetes and disrupts circadian rhythms, the free fatty acids being active at night.
Here’s a related article
http://m.atvb.ahajournals.org/content/24/5/795.full
And this pretty much sums it up: Role of Body fat Distribution and the Metabolic Complications of Obesity http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585758/
Love the post Kate! Thought I would just point out that you actually CAN get your leptin levels tested – I’ve had patients do it before. I find low leptin levels in chronic dieters all the time, even if they have sufficient or even excess body fat.
It’s an unusual/uncommon test but you can definitely get it done!
ALSO INTERESTING – because my doctor said he simply couldn’t run the test. Maybe only in some states or at some hospitals?
You can actually even order the test yourself at http://www.directlabs.com
Unless you live in NY, which is kind of ridiculous.
I had the same problem and still can’t cope with my hormones. After years of low fat, vegetarian diet and over exercising, I gained weight and have period again but still there is a lot of mess in my body.
And I also can’t stand my new shapes, I hate to be fatter than before. And what is very sad – other people also tell me that I looks so good when I was skinny. That makes me very stressed and lead to fasting and overeating. I have some knowledge about health and loosing weight but I feel to frustrated to do anything.
It is hard to resist the global opinion that skinny is the best. I agree with everything you write here, I also promote such approach but I still feel very bad with my fatter body 🙁
Hello! I am leptin resistant. I have HA since 5 years, low estrogen, low progesterone, high and low cortisol, low thyroid among other problems. I’m sorry to just write like this but I rescently found your blog and I have just ordered your book, Sexy by nature, can’t wait! 🙂 I am 25 years old and live in Sweden. 2010-2013 I was daily raped and abused in a cellar and almost never got to be outside. When my family found me I weighed 88 pounds (to my 169 cm length, that’s 66 inches I think) I now weigh 158 pounds. I REALLY take care of myself, banning stress. But I am leptin resistant, and I can’t sleep without a big bowl of rice every night. If I eat approximately 800 cal RIGHT before bed I get 4-5 hours of sleep, then I must eat some slow carbs again to continue my sleep. So this is my story, and my problem is leptin resistance. I can eat until my tummy hurts and still continue. I can’t feel satiated and need help. And I think that if I heal leptin, then my cortisol and the rest will heal. But HOW DO YOU HEAL LEPTIN WITH CARBS IN THE DIET? Thank you. I am so grateful that I found your blog, because I have eaten low carb for 1 1/2 year and it made everything so much worse. Thank you <3
Correction: I converted my weight in kg wrong; I weighed 101 pounds (46 kg) when I was my lightest, after the abuse which happened september 2010 – february 2013. Thank you!
Hi Louise,
Thanks for writing and for sharing your story. I actually experience a very similar phenomenon, perhaps the same: I MUST eat a big meal before sleeping, and if I do not then I cannot sleep more than a few hours, if at all. In the middle of the night I must wake up and eat again in order to fall back asleep.
I am not sure that leptin resistance is the problem. I think that could be part of it, but I personally do not think I am leptin resistant (I’ve been working on this problem for years now). Most likely it seems to me like a conditioned response to starvation – the body has a type of neurons in it called Hypocretin Neurons. These neurons are active when you are hungry, and they also cause you to wake up! For many people this can be overriden with better circadian rhythm timing and – you are correct, leptin sensitivity – but sometimes the main problem that needs to be solved is the starvation.
It also seems possible to me that you are low on estrogen, as that happens when women are starved and become quite thin. There is plenty of literature to back that up. Stress does not help. Estrogen is pretty critical for a full night’s sleep. I have personally noticed that I manage to sleep more hours when my estrogen levels are higher (say, at different times in my cycle, or when I consume high amounts of phytoestrogens).
Stress is of course an issue, as is perhaps meal timing, blood sugar regulation, and the like.
I talk about this in one episode of the podcast… I THINK it is 022, but I am not sure.
I hope this helps, and all my deepest love to you on your journey.
OMG Stefani! I have just been, literally, glued to your blog the last 42 hours! And exactly as you say; you and ! have the EXACT same sleep-issues! (At least what I have found so far) And I can not believe it! I really just can’t. I thought I was going crazy, I have searched info about this condition every day, for 2 years, with no success, and then I found you. I also found the PDF that you shared by Julia Ross. It also said so much. And how many things have’nt I, and you, tried! I have tried so many herbs, supplements, behaviors and life style changes but nothing works in the long run! So I also found the power of food, it makes me gain weight tho, to eat at night, but it’s okay. I actually look sexier 🙂 And I have’nt got the hang of a high carb diet yet, because I still have many meal-habits from a LCHF diet, so I found it difficult to reduce the fat! So I’m eating a high carb, high fat diet just for the moment while transitioning and I can’t complain, haha! But I am grateful that you gave me the final push to go all in on the carbs, thank you! So. Sleep. That you mention the starvation cause gives me hope, because it confirms my own interpretation of what my body is saying. I am fairly poor, because I can’t work right now with my injuries, but every month I put away some money to be able to try something foor sleep (besides monthly vitamins, minerals, cod liver oil, HCl) and last month I bought Phosphatidylserine, and been experimanting with it. I also have GABA at home and your PDF by Julia Ross made me think about the Phosphatidylserine and GABA combo. What are your thoughts? Do you even think I should supplement or just rely on food? How do you think when it comes to you in this matter? I definitely have cortisol imbalance and it’s such a hard and delicate matter to treat. Slightly overdoing anything and your efforts will cause everything to aggravate for a period of time.
I send you so much love with this reply… I think that a human can endure most things, but not complete insomnia. When you can’t sleep, everything puts on hold. And I don’t think that anyone that has’nt gone thru the same problem can ever know how it feels not to be able to sleep. And that’s also something that makes it so much harder; the loneliness. The desperation. I promise you, that if I some day heal my mind and body, and that I can sleep 8 hours straight, without eating all night, I will tell you what I did and found. PROMISE! And also one more question: what do you eat when you wake up during the night? Thank you! Your strength gives me strength, even across the world.
Hi love,
I just wrote a SUPER LONG response to you and accidentally deleted it. Such an idiot. Okay, here goes again.
My deepest love to you, too, and hugs and gratitude for your sympathy.
Shit, what did I say?
Okay, so – I always eat apples, olive oil and sea salt over lettuce (salad?), and ground beef at night. Other fruits like mangoes and berries sometimes, but I am very consistent. I have found what works and it works. I could also do fish if I needed to. During the day I also eat eggs and greens and some sauces and things, but I am always safe with my food at night. It works very well.
I have found that eating all of the macronutrients is very important. A moderate amount of protein, plenty of carbs and fat. I eat until I feel FULL. I think… I think our bodies are deficient in some amino acids, probably tryptophan, that are important for sleeping, which makes protein crucial. Yet carbs and fat (carbs especially) can help move tryptophan (the most rare amino acid) into cells, so it’s important to make sure you get enough carbs.
It is important to NEVER STARVE. Ever. I mean, it’s okay to feel a bit hungry here and there, but err on the side of caution whenever you can. This is especially important before you sleep. Your body has probably upregulated its hippocampus activity in response to some starvation signals (and that will keep you alert and awake, that’s its job), and feeding it will calm the activity down. These are called hypocretin neurons.
Supplements can help. Something that helped me sleep a lot was a supplement called Serotonin Fx, made by The People’s Chemist. You could also try tryptophan or valerian – valerian is supposed to help with GABA. The reason I don’t take these regularly is that they can be somewhat immunosupressive and I was always getting sick when I took them. BUT that might not be the case for everybody — just me.
I do take melatonin every night, I have for years now. It definitely helps. I only take 1mg – any more than that and you build up a resistance and become INCAPABLE OF SLEEPING AGAIN, which is the worst. But this low dose works very well for me, and it is inexpensive.
I have also found… I have found that alcohol helps me, quite a bit, actually. And I don’t mean I need to drink until I pass out, but just a couple glasses of chardonnay a week, and I find that I am sleeping much better. I think this is probably because it increases estrogen levels a bit… and I am low in estrogen. I am NOT saying this is your answer but it APPEARS to have helped me somewhat.
In the end, nourishment is key, and figuring out what might be ‘upticking’ or ‘upregulating’ your body and then eliminating it is also key. Potassium was a problem for me… but who would have guessed? It might simply be overcoming the low carb and fasting stuff for you… all in good time, love. All in good time.
I hope that helps, and please, please keep me posted!
All my love.
And yes, I do suffer from amenorrhea. 5 years now since last period, although I was on birthcontrol the first 3 years which made it go away. I also was overweight until I was 19, so I have lost considerabel weight during those 4 years. So when you say that when your estrogen is slightly higher, you sleep better, it makes me feel calmer, because I have my period at top priority, that’s why I’m not going to worry about the weight until it gets back. If I ever will “worry” about it again, you know 🙂