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My good friend has been a strict vegan for 3 or 4 years, and a vegetarian since she was 14 (over a decade). She was on birth control most of that time, went off it a year ago, and hasn't had her period once since. She also is generally a mess; very depressed and anxious, history of eating disorder and still with lots of food issues though a healthy weight/caloric intake, zero sex drive, no energy, skin problems, etc.

She has seen her dr, her gyn, and now an endocrinologist. They tell her that her 'estrogen is low' and that she should go on the Pill again to protect her bones. Zero help. She has all the symptoms of estrogen dominance.

Of course, I think her diet is the entire problem. She is currently getting her MA in nutrition, and disagrees- though she does come to me for advice about this, and thinks I'm pretty smart. :) She's not going to start eating animal products anytime soon, since she's a religious vegan - she agrees a vegan diet is not ideal, but doesn't think it's damaging, either.

What (vegan) diet changes, supplements, and hacks would you guys advise? I've already gotten her sleeping in total darkness, taking D3 (even though it isn't vegan!), and now starting to supplement with coconut oil in the hopes saturated fat will help...

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is she anaemic. has she had blood tests for typical deficiencies in vegetarians & vegans. ie B12, Red Cell Folate, full Iron Studies (iron, ferritin, transferrin, transferrin saturation) plus a fbc/fbe (full blood count/exam) panel – daz Jan 23 2012 at 3:47
No she is not and has never been anemic, yes she gets basic blood work to test for vitamin deficiencies etc yearly. I don't know if she's had a fbc/fbe though – animalcule Jan 23 2012 at 3:53
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get her to take fish oil, even though it isn't vegan either – The Loon Jan 23 2012 at 16:09
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Fish oil can make some people worse. I and others on here have made menstrual problems worse by taking fish oil. Chris Masterjohn says it's probably the EPA inhibiting arachidonic acid metabolism. Some people with certain SNP variations are more vulnerable to this. Algal DHA is both vegan and usually does not contain EPA. – Bread-Eating Beelzebub Jan 23 2012 at 16:48

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I'm going to go out on a limb and say that cutting out soy would probably help immensely. Also adding things like coconut oil and avocados. (This just coming from my own experience, anecdotal evidence all.) My hormones regulated after getting rid of soy other than miso and tamari, which are fermented over long periods of time. There are tons of vegans out there who are soy-free. It was relatively easy to do for me back in the day. All it requires is some planning and probably more properly prepared non-soy legumes. Obviously adding some animal products would be best, but to someone not open to that option you do what you've got to do.

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she may also have a low omega-3 fat intake & excessive omega-6 fat intake (i think soy has an approx omega-3:omega-6 ratio of 1:7). en.wikipedia.org/wiki/… – daz Jan 23 2012 at 4:00
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Tell her to start reading the blogs, Evolutionary Psychiatry and Hyperlipid. They are mostly about the macronutrient fat, not about meat. She could try steering herself away from allergic foods. Dr. Oz touts a mostly-vegan but allergen-free diet. Replace corn and wheat with rice and quinoa. Replace any fake foods with only real foods, that sort of thing.

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I'm totally digging the Evolutionary Psychiatry blog - glad you recommended it. – syrahna Jan 24 2012 at 6:16
aren't digging Hyperlipid? He's so funny! – The Loon Jan 24 2012 at 15:27
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In addition to what other people have said, vegan diets tend to be very high in copper and low in zinc. Get her to take zinc supplements (as picolinate), or eat oysters. Bivalves (of which oysters are an example), do not have a nervous system so your friend may be ok eating them.

Ideal Zn:Cu ratio is ~10, many vegan diets are as low as 4 (even 2 in fruitarian diets).

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It sounds like she needs to put on weight. Low weight or low bodyfat is often (not always but given what you said it seems likely) the cause of amenorrhea. And not necessarily an "underweight" BMI but it could just be a too low weight for her body.

I don't have the sources now, i couldnt find them sorry, but I've read that studies/research show the best method of recovering from an eating disorder is to eat a minimum of 2500-3000 calories until weight levels off (meaning weight would eventually stop increasing even on that many calories), otherwise the hormones may not quite return to optimal levels.

She should probably eat lots more fats: coconuts or coconut oil, avocados, nuts, nut butters, olive oil, etc.

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Thanks for the answer, I agree she needs to maximize fats. But I really doubt weight gain would help. She is around 140 lbs at 5'6", her weight has been constant since the 2nd year after she stopped starving/binging/purging (that was about 8 years ago now), and her bodyfat is higher than she'd like (very soft, curvy appearance - think Marilyn Monroe at her heaviest). Furthermore if she takes my advice and gains weight from adding fats/calories, she's going to be very unhappy... – animalcule Jan 23 2012 at 3:15
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She definitely needs to increase fat in her diet. Fat is an essential nutrient and cutting it will make the body think its starving, in which case it won't menstruate since it thinks there are not enough nutrients to acommodate a baby.

Focus on monounsaturated fats and saturated fats - olive oil, avocado, nuts (especially macadamias, almonds, coconut); Watch the PUFA - a skewed O3/O6 ratio can really mess up hormones - goes without saying that she should stay away from vegetable oils; go for whole foods, i.e. whole flax & hemp, instead of hemp oil or flax oil which are easily oxidised and high in PUFA.

More protein is also important, for tissue regeneration, especially as you say she has skin issues. Powder from a vegan source would be good ( Mark gives a pretty decent breakdown here: http://www.marksdailyapple.com/whey-egg-white-casein-pea-hemp-rice-protein-powder-supplement/#axzz1kIcXv9jb); to get more protein she could also eat Quinoa, which is a pseudo-cereal, a decent source of vegan protein and vitamins; I personally avoid all grains, grain-wannabes included, but quinoa is a good go-to when you don't eat meat, since its a complete protein. Make sure you soak it, and you'll be fine. Traditionally prepared beans (i.e. soaked & properly cooked) could also be an option for protein. Increase protein, but remember the main focus remains to increase fat.

Does your friend eat soy? for hormonal imbalances, it really important to eliminate soy, which is full of xenoestrogens and highly processed aswell. Though fermentation mitigates a lot of the harmful effects of soy, so something like Tempeh could actually be a good source of protein/meat substitute. Also, try sea vegetables! They are very rich in minerals - especially iodine - vitamins, and protein.

Sugar is also a culprit in hormonal imbalances. A lot of vegans get too much sugar, especially if they're going crazy with the juicer (eat the whole fruit, please. Or make a smoothie.) And especially if they're eating refined sugar! Cutting heavily processed industrial foods is essential to optimal health. A lot of people have had enormous success with hormone imbalances by cutting out refined sugar. You say she's got higher bodyfat than she'd like. Cutting sugar & increasing fat/protein will probably help her lean out, especially as far as belly/midsection fat is concerned.

Here are some vegan-friendly primal recipes: http://www.marksdailyapple.com/all-together-now/#axzz1kIcXv9jb

Good luck to you and your friend! Milla

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Hey, I don't know if you get on here anymore, but I was curious to ask you about your expierancee switching from veganism to Paleo.... god I wish they would have just called it carnivorism or something... anyhow, email is Benichastain@yahoo.com easy, you have to prove to her that plants are alive as well, (they are, and they do have souls) sadly, while many compassionate people who love animals think veganism is the way, it really is far more destructive to the natural enviornment then Carnivorism is. compare, Europes history with wildlife and Nature and other cultures to pre anglo American Indian cultures. enough said. Vegans need to realize that no matter what you eat, you ARE killing. infact, just by digging in the dirt you are killing, or using harvesters to get your "murder free" grains, while also decapitating multiple rabbits, mice, pheasants, quail, fawns, and etc that happen to be hiding in the field. if it makes her feel better though try explaining that one day when she dies, she will be giving back to the earth everything she took from it. it is a part of nature, Indian people have been aware of that for centuries, AND she can still do good things for animals, care for them, and Love them, even if you are going to eat them, treat them as your family. in the end, it won't matter because there is no way to escape death, but Death is not the end of existance, and therefore not to be feared. your a good friend btw. coconut oil might help with the ED but youve really got to keep her off soy, show her the multiple cases of where estradiol dominance cause abortions in animals. doctors are liars and thieves, save your money, I'm male and had/have SEVERE signs of estrogen dominance and they refused to give me medicine (thank god, I later found out most of their medicines have estrogen stimulating materials in them anyhow) eat lots of meat, not fed on grains soy or corn. kirkland signature Bacon you get at costco is supposedly free of all of those three items.

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