6

votes

Curves and Ketosis: LC + IF + Trans* HRT?

Answered on August 19, 2014
Created May 16, 2012 at 10:06 AM

Dear Paleo-people,

Let me please start off with a few questions that I think will resonate with a wider audience. For cisgendered women and other normatively female-bodied type paleo people, when you want to maintain the curves just in those places deemed socially acceptable (butt, hips, breasts), where do you aim for in terms of carbohydrate intake? What if, hypothetically, you were underweight and sporting only an A-cup?

Alternatively, if a girl going through puberty went on a low carbohydrate (LC) diet and started an intermittent fasting (IF) schedule, would it interfere with the timeline of their bodies development?

My issues are a little different than those in both above suggested cases, though incidentally, I am undergoing what is essentially puberty, if really for a second time, starting at the tender age of 25. As of today, I believe, I'm one year on transgender Hormone Replacement Therapy (HRT).

Most trans girls like me reach near-normative body fat distribution (butt and hips) one to two years into hormones, with breast development continuing slowly for years after. Less to normative female-body standards, however, I am 6'3" and weigh 135lbs, and though I am still doing much better for the curves than I was a year ago, I worry that the process of fat redistribution has been hindered largely by the lack of body fat available for redistribution in the first place.

135-150lb appears to be my set point, the range from which deviation seems futile. I wonder whether being on hormones will change my set point over time, however, as women generally have more fat than men. My body just hasn't seemed to figure out that it's trying to stretch the fat that I actually do have over the twig that is my body. I thought I would gain weight with hormones, but I think I've instead lost weight, probably from the three ounces of muscle mass I had prior to medical transition. The muscle atrophy in my arms is surprisingly visible.

I'm newly on what I am aiming to be a pesco-vegetarian paleo diet, and I am trying to figure out what my daily carbobohydrate intake should be. I've currently been aiming for 100-150g/day, along with 50g or more of protein, but I've also started a daily 18/6 intermittent fasting schedule for which 50-80g might more effectively put my body in ketosis. My issue, of course, is whether putting my body in ketosis is really a good idea when I actually WANT FAT, if only in the "right places", according to social norms? And is there really any point in IF unless I am also on a LC diet?

What I like about the idea of IF on a 50-80g carb diet is training the body to initiate fat-burning metabolism (ketosis) on an as-needed basis. As long as my body is not in ketosis 24/7, would I still be able to deposit new fat stores according to my body's hormonal trajectory?

A little personal background: My goals with paleo and IF are general health maintenance and improved cognitive functioning. I am autistic and was also recently diagnosed with co-morbid ADHD-I. The dietary changes I have made in the way of paleo and fish oil supplements have had a noticeable effect on the ADHD symptomology, and particularly with the "brain fog" that would sometimes come over me.

Best,

Anya

(If you see anyone off topic in the way of cissexism, please join me in a little ad hominem fun! Point and laugh to your hearts content, but remember to then abruptly move on. It gets boring after a while.)

7bf306ada57db47547e9da39a415edf6

(11214)

on September 07, 2013
at 01:28 AM

You should aim for 170lb. Maybe you get happy in the 160s and stay there, but I am the same height as you. You have to start reading about estrogen- http://raypeat.com/articles/. I don't know a good strategy here- you will have to study a bit and come up with one. With so many women being doped up w/ estrogen (this is not paleo, as if I need to mention that) at least you've got some forums and support boards out there where you can get some ideas. Now I have to do something with this strong impulse to say 'Repent!' very loudly. It might scare the children.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 17, 2012
at 12:48 PM

Full-fat Greek yogurt is da bomb.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 17, 2012
at 12:46 PM

Have you looked into Strattera? It works only for a small percentage of folks, but it's in the nonstimulant class and (I speculate) therefore less likely to induce adrenal fatigue.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 17, 2012
at 12:41 PM

Ah, the joys of hyperfocus. I am ADD-inattentive type myself, and biologically female, and parlayed that hyperfocus to get me into mid-adulthood before diagnosis ("but you're not hyperactive! Why do you think you have ADHD?"). I also have a sleep disorder. If you ever want to improve your sleep architecture, the very boring subject of "sleep hygiene" can be of some assistance. I know this wasn't the focus of your question, but getting more restorative sleep (longer stretches, to facilitate deeper sleep) can help any body rebuild, and you are rebuilding your body more profoundly than most.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 11:42 PM

I go to sleep at all manner of times, and frequently after dawn. I'm a vampire, what can I say? I've seen independent studies about melatonin production being disordered in both autism and ADHD, and ADHD co-morbidity has perhaps a 70% incidence in the autistic population. My guess is that over-focus may be the mechanism for both my disordered sleeping and eating. ADHD is funny that way, in that it very often involves TOO MUCH attention, however displaced in a billion directions at once and/or limited to a special interest, disrupting response to metabolic signals like satiety and fatigue.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 16, 2012
at 10:56 PM

Your comment above about "absence of circadian rhythms" caught my eye. Is your sleep irregular?

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:34 PM

Thank you for the link and info! Yes, this does clear up some of my confusion about IF.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:28 PM

Thank you for the suggestions. I only tend to get colds one or twice a year, though I do seem to have a perpetual case of mild allergies; read, stuffiness. I've recently started to include in my diet all the foods you recommend, and I am hoping those work in terms of weight gain. August has given me a pretty stern warning that my weight level is dangerously low, and will be probably taking there advise and jugging down a gallon of milk here soon! :) My energy levels are great, and I am holding off on Adderall until I figure out Paleo.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:16 PM

And I think I will take your suggestion of milk up, August. I was raised on 1% and made the meager transition to 2% to appease my girlfriend. When I discovered the joys of Paleoland and that whole milk is actually better, I cut milk out of my diet entirely, because of concern about dairy protein and the elimination of cereal. The thing is that I have shown absolutely no indication of sensitivity to dairy protein, so it's kind of a rash decision to eliminate milk.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:10 PM

I have kind of internalized that my current weight is my "natural weight" / set-point. If I did eat 4000 calories a day, force feeding myself along the way, wouldn't I simply return to my previous weight? Another problem I have in life is not knowing what weight I should be aiming for in the first place. I guess I should at least try to stay at the top of my range, 150lb. I suspect disordered eating may be somehow part and parcel with my variety of hyper-focused ADHD / autism; that, and the complete absence of anything looking like circadian rhythms.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 07:38 PM

@Twinkletoes, thank you for the encouragement, and yes, certainly realizing that I have agency in my body through medical transition is a lot of what brought me to Paleo! :) @elysia, I am taking fish oil for Omega 3's and also Vitamin D. I was recently prescribed 20MG Adderall XR, but have decided to hold off regular intake until I have the Paleo diet figured out. I do have concerns about adrenal fatigue. My hope is that fatigue is less likely if the adrenal glands are given regular opportunity to rest, as opposed to 40g Adderall & 3+ cups coffee every day, which doesn't seem unusual! :)

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 07:19 PM

Thanks you for the advise, Joy! Time to buy coconut oil wholesale, it seems! And Diane, haha, x-posting that tidbit to Facebook feed.

Cd2305a4a4c2126418a13c41b6e61050

(100)

on May 16, 2012
at 03:29 PM

Diane made me laugh really hard. So true, so true.

Medium avatar

(195)

on May 16, 2012
at 02:27 PM

what supplements are you presently taking? are you on medication for ADHD? Stimulants can speed the metabolism and induce adrenal fatigue.. Also be sure to get your Omega 3's for brain health!!

Medium avatar

(195)

on May 16, 2012
at 02:22 PM

the tone of this comment is a bit crude... It's important to be sensitive in situations such as these.. but I completely agree with the overall message: calories and fat are key and you should not be avoiding them, or trying IF... but Ketosis does help ADHD and autism spectrum disorder

D1728f99db66ff91d695a6df5cd38b02

(1368)

on May 16, 2012
at 02:03 PM

So true! There is no way in the world I could make fat go to by boobs from by huge but and thighs and no way anyone else could do the opposite! Right now, I think you may benefit from eating more calories in general, because at your height and weight as you mentioned, you do not have much fat on your body. If you really want fat on your hips then eat more until you get some fat, if you are on a Paleo diet it should balance out on your lower region, instead of on your stomach. I cannot guarantee this however! BTW, I think its cool that you are doing transgender hormone replacement!

0905a0f8cd1e48f6d39fe625a65b6ef1

(2890)

on May 16, 2012
at 10:21 AM

I don't have the knowledge to answer your question, but I wanted to say that becoming the person you know you are, the person you were born to be is as paleo as it gets. And to love and accept yourself at such a young age is a gift. I have a child (and forgive me if I mess up the language here, as I am a mom who is learning), who, because of "her" body I considered my daughter, until HE talked to me last year and told me that he was my son. He is now going through puberty at the age of 27. I'm so proud of him and love him with all of my heart. Life is short and beautiful and complicated. :)

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5 Answers

10
F9638b939a6f85d67f60065677193cad

(4266)

on May 16, 2012
at 01:04 PM

Welcome to the world of being a woman. The fat is never distributed where you want it.

D1728f99db66ff91d695a6df5cd38b02

(1368)

on May 16, 2012
at 02:03 PM

So true! There is no way in the world I could make fat go to by boobs from by huge but and thighs and no way anyone else could do the opposite! Right now, I think you may benefit from eating more calories in general, because at your height and weight as you mentioned, you do not have much fat on your body. If you really want fat on your hips then eat more until you get some fat, if you are on a Paleo diet it should balance out on your lower region, instead of on your stomach. I cannot guarantee this however! BTW, I think its cool that you are doing transgender hormone replacement!

Cd2305a4a4c2126418a13c41b6e61050

(100)

on May 16, 2012
at 03:29 PM

Diane made me laugh really hard. So true, so true.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 07:19 PM

Thanks you for the advise, Joy! Time to buy coconut oil wholesale, it seems! And Diane, haha, x-posting that tidbit to Facebook feed.

3
7bf306ada57db47547e9da39a415edf6

(11214)

on May 16, 2012
at 02:08 PM

I seriously want to arrest, convict, and lock up your doctors.

But to you point- EAT SOME FOOD! It would be a good idea your calories come from paleo sources, but the overriding factor, in your case, is fucking survival. You need protein. You need calories. You need fat. Hell, you need ice cream. Avoid the ones with grains or legumes, but in your case milk may be medically necessary because it encourages growth. Seriously, go buy a gallon and eat it. It makes no sense whatsoever for you to IF. It already sounds like you are engaging in an extremely sophisticated version of medically assisted suicide, no need to drop intermittent fasting into the mix. You should be eating like 4000 calories a day until you are back up to a decent weight for your size.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 17, 2012
at 12:48 PM

Full-fat Greek yogurt is da bomb.

7bf306ada57db47547e9da39a415edf6

(11214)

on September 07, 2013
at 01:28 AM

You should aim for 170lb. Maybe you get happy in the 160s and stay there, but I am the same height as you. You have to start reading about estrogen- http://raypeat.com/articles/. I don't know a good strategy here- you will have to study a bit and come up with one. With so many women being doped up w/ estrogen (this is not paleo, as if I need to mention that) at least you've got some forums and support boards out there where you can get some ideas. Now I have to do something with this strong impulse to say 'Repent!' very loudly. It might scare the children.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:10 PM

I have kind of internalized that my current weight is my "natural weight" / set-point. If I did eat 4000 calories a day, force feeding myself along the way, wouldn't I simply return to my previous weight? Another problem I have in life is not knowing what weight I should be aiming for in the first place. I guess I should at least try to stay at the top of my range, 150lb. I suspect disordered eating may be somehow part and parcel with my variety of hyper-focused ADHD / autism; that, and the complete absence of anything looking like circadian rhythms.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:16 PM

And I think I will take your suggestion of milk up, August. I was raised on 1% and made the meager transition to 2% to appease my girlfriend. When I discovered the joys of Paleoland and that whole milk is actually better, I cut milk out of my diet entirely, because of concern about dairy protein and the elimination of cereal. The thing is that I have shown absolutely no indication of sensitivity to dairy protein, so it's kind of a rash decision to eliminate milk.

Medium avatar

(195)

on May 16, 2012
at 02:22 PM

the tone of this comment is a bit crude... It's important to be sensitive in situations such as these.. but I completely agree with the overall message: calories and fat are key and you should not be avoiding them, or trying IF... but Ketosis does help ADHD and autism spectrum disorder

1
870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 16, 2012
at 03:08 PM

At 6'3" even a setpoint of 150 seems extremely low, although 152 would put you at a BMI of 19. At 135 do you find you get colds and such a lot?

With reduced testosterone you're going to find it more difficult to build muscle mass than in the past, but at a bodyweight of 135 I suspect you would benefit by adding muscle as well as fat. Do you have adequate energy and strength to sustain yourself through your daily life? Are you using one of the stimulant meds for ADHD? They may suppress appetite.

More fat would be good. Salmon. Macadamia nuts. Coconut oil. Ghee.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 17, 2012
at 12:41 PM

Ah, the joys of hyperfocus. I am ADD-inattentive type myself, and biologically female, and parlayed that hyperfocus to get me into mid-adulthood before diagnosis ("but you're not hyperactive! Why do you think you have ADHD?"). I also have a sleep disorder. If you ever want to improve your sleep architecture, the very boring subject of "sleep hygiene" can be of some assistance. I know this wasn't the focus of your question, but getting more restorative sleep (longer stretches, to facilitate deeper sleep) can help any body rebuild, and you are rebuilding your body more profoundly than most.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:28 PM

Thank you for the suggestions. I only tend to get colds one or twice a year, though I do seem to have a perpetual case of mild allergies; read, stuffiness. I've recently started to include in my diet all the foods you recommend, and I am hoping those work in terms of weight gain. August has given me a pretty stern warning that my weight level is dangerously low, and will be probably taking there advise and jugging down a gallon of milk here soon! :) My energy levels are great, and I am holding off on Adderall until I figure out Paleo.

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 11:42 PM

I go to sleep at all manner of times, and frequently after dawn. I'm a vampire, what can I say? I've seen independent studies about melatonin production being disordered in both autism and ADHD, and ADHD co-morbidity has perhaps a 70% incidence in the autistic population. My guess is that over-focus may be the mechanism for both my disordered sleeping and eating. ADHD is funny that way, in that it very often involves TOO MUCH attention, however displaced in a billion directions at once and/or limited to a special interest, disrupting response to metabolic signals like satiety and fatigue.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 16, 2012
at 10:56 PM

Your comment above about "absence of circadian rhythms" caught my eye. Is your sleep irregular?

1
92a19963b5cba1a49bea650b393a4d15

on May 16, 2012
at 12:25 PM

Hello!

In response to 'And is there really any point in IF unless I am also on a LC diet?'

Mark Sisson did a 7 part easy-read series on the benefits of IF. Part 1 is weight loss, but the next six involve cancer risk reduction, brain activity, longevity and enjoyment of life, the benefits of exercising in a fasted state and different methods of fasting and picking one that works for you. Here's a link below.

http://www.marksdailyapple.com/fasting-cancer/#axzz1v2D5QgAq

In regard to socially acceptable fat deposits and repositioning, well, you might not end up with most or all of what you want, but it sounds like you're really healthy and doing well and on a great path, so congratulations!

63773045ee0e45b06631ca05daf16e24

(30)

on May 16, 2012
at 08:34 PM

Thank you for the link and info! Yes, this does clear up some of my confusion about IF.

0
55d7ec5654e74a65bef0cbf652d1d565

on September 28, 2012
at 09:00 AM

One year is nothing in the world of HRT. It took me two years and a switch from oral to injectable Estrogen before I started seeing any real hip sentiment. I'm 6'-2"and after 2.5 years on HRT, I've settled in at 155 lbs (vs 175 pre-transitiion.) At one point, before I started HRT, in an effort to eliminate upper body muscle mass, I starved myself down to 140 lbs. As far as fat, keep in mind that it does not "redistribute." Fat doesn't migrate. What happens is that under the influence of estrogen, existing fat stored in "male" areas (typically belly) will diminish. At the same time, your body begins to accumulate reproductive fat, which is qp quite different from a male who is overweight. Reproductive takes priority, and once it has accumulated, your body is loathe to rid of it. This is the fat that ensures a baby can be carried full term, so when a female diets, she'll lose whatever fat she's added after puberty, but losing that pubertal fat is extremely difficult. So, you need to EAT, because like you pointed out, you're going through puberty, and your hormones are trying to prepare your body to make babies, even though that's obviously not possible.. Also keep in mind that while anti-androgens reduce testosterone considerably, as long as your testicles are intact, your body is going to be hormonally confused, and you won't get full fat distribution. Most people see additional changes after they have surgery.

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