Advice For Getting Back On Track After A Miscarriage

[j2mugs]

Sorry in advance for this long post. I'm looking for any thoughts on how to help my wife Suzanne.

We have been peating since the fall of 2014. We have both had tremendous health improvements over that time, but I'm beginning to believe that my wife's estrogen dominance might be a rather severe case and I'm looking for any thoughts on how to help her get her back on track.

We have struggled with infertility for our entire 14 years of marriage. My wife would seldom have a period (maybe 1-2 per year) and was (pre-Peat) diagnosed with PCOS - although they never found any cysts.

She saw many health improvements from the dietary changes but was unable to loose weight or have consistent periods. I spoke with Ray Peat near the beginning on 2017 and he suggested some dosing for Cynomel and Progest-E. Over 2017 Suzanne saw tremendous improvements. She lost more than 30lbs without a change in diet or exercise and had a normal 28 day cycle by August of 2017. She actually got pregnant in November of 2017 and we were both dumbstruck! Unfortunately she found out almost exactly a year ago that that the baby's heart beat had stopped and we lost the baby at 12 weeks. She wasn't miscarrying naturally so she had a D&C on Feb 1, 2018.

Ever since then things have not been able to get back on track. She had her first period in March 2018 (which was shocking that it happened so quickly) and we resumed her thyroid and progest-e at that point.

Every cycle since has now been 16-20 days long. She has tried upping her progesterone but CANNOT get her cycle to stop or even delay. Flow lasts no more than 5 days but it seems unstoppable now - in complete contrast to her earlier issues. She has gained back about 20 pounds over the year (again with no diet change) and has struggled to get her pulse and waking temps back up. Her hands are cold all of the time again and she is experiencing facial flushing, cold sores, PMS, and other symptoms that were largely gone during 2017.

She has always seemed to need very large doses of anything to make something happen. When we started the Cynomel in the winter of 2017 she started with a half tablet (12.5mcg) and would up the dose every two weeks until we got her waking temp into the right range. She was at 5.5 pills (137.5mcg) before her waking temps finally rose to 97.9-98.0 and he resting pulse was around 80. To give you context - when we first started peating her waking temp on some days was as low as 94.9 (I know that is hypothermic, so I was shocked to see the thermometer, but it happened multiple times). She eventually backed down her Cynomel to 4 pills per day (by late October of 2017) because she was able to maintain her temps and pulse without feeling winded.

She also needed very high doses of progesterone to get her cycles to stabilize initially. She would take 25 drops of Progest-E (~75mg) daily for her cyclical two week run when things were working properly in 2017.

Since Cynomel has been impossible to get she has been on Ideal Labs Tyronene (since Ray had recommended a straight T3 for her when I spoke to him). We have been dosing the same way as before and she is currently taking 1 drop every hour from 9am to 9pm (96mcg) per day. We've also been trying to test the upper limits of her progesterone intake to see if we can get a period to miss. She is currently taking 1 drop of Progest-E every 20 minutes totaling around 115mg per day. We pushed it to 120mg one day and she felt like she was drunk so I'm pretty sure her upper limit is around there.

We have been trying to stop this period for the last 10 days and it will not stop coming. She is spotting everyday (more in the morning and less by night so the progesterone is having some effect), but it seems like something is still pushing hard back against it. And since she is hitting an upper limit for progesterone intake there must be something else at play that I can't figure out.

Because these doses are so high and they seem so far beyond what most people talk about on the forums I wanted to reach out to see if anyone has any thoughts on something that we might be missing. Below is a list of everything that we are currently doing. These were all added one at a time over the years and were being done concurrently when she experienced the most success during 2017.

PUFA free diet
8-9 hours of sleep each night
4 glasses of 1% organic milk every day
4-5 glasses or orange juice every day
1 cup of coffee with milk, sugar, 1 tsp of coconut oil
Random snacks of cheese and fruit through out the day
Raw grated carrot salad with coconut oil and apple cider vinegar
~90 grams of protein per day
Liver weekly
Bag breathing 3 times (~2 minutes each day)
Red light ~10 minutes on thyroid each morning
Takes 8 drops of Estroban each day (A,D,E,K)
Takes 20 drops of Magnoil each day
No formal exercise but we have 4 young kids (adopted) and two of them are (twins) 2 year olds so needless to say she doesn't need exercise. :)
5ml of vitex daily (taking her days of flow off each time)
96mcg of Tyronene
100mg of Pregnenalone every 4 days (She is 34 - maybe this is too much?)
75mg of caffiene
300mg of niacinamide
400mcg of Methylene blue per day


An anecdotal observation as well. The moment they rolled her back into the room after her D&C she looked like everything had rolled back 8 months of progress. She was swollen all over looked like she had gained 15 pounds immediately. That has not gone away since the surgery. So my gut tells me this is just an insanely high estrogen response and I'm not sure what else to do.

I've also attached a photo so you can see the difference in her face shape over this period of time.

Any thoughts would be appreciated. Thanks so much!

 

[Peatful]

Hi and welcome @j2mugs

I’m not clear-
The goal is pregnancy? Or simply decreasing the estrogen dominance?

Regardless, my main encouragement is that- her body has been through a great stress hormonally and physically- not to mention emotionally.

Plus she has four children at home.
Even more stress.
Rich, rewarding and beautiful- but stress nonetheless.

Give it time.
She responded well before- so that’s great data.
Her body is readjusting the way I see it.

Blood sugar stabilization is key.
It allows the adrenals to produce progesterone rather than regulate blood sugar constantly.

Macros 40/30/30.
C/P/F.
Easy to digest, nutrient dense peaty foods.
Small meals every 3 hours.
I personally would back off on a lot of her supplements and use the sparingly and prn.

Kate Deering has a good book with recipes and guidelines I believe.

Seems like you are well versed in Peatland.
Keeping protein at 80-100 for liver support as it tries to detox her estrogen.
This is no time for calorie counting or restriction.

Anyway, my main point is that you’ve both been through a great stress. It’s literally showing itself months later in her face and body.
She needs support and time to get back on track.
Glad she has a partner that cares like you.

 

[Blossom]

I agree 100% with everything @Peatful posted. I think she just needs time and love to reach a balance after everything you both have been through.

 

[noordinary]

@j2mugs I'm sorry to hear about you wife...
Maybe it is worth looking into vaginal steaming:
Case Studies Show that Vaginal Steaming After Miscarriage May Speed Up Recovery

 

[danishispsychic]

My two cents- here is what I would do -
Stop all supplements - for me all the Progesterone ( Progest E ) and Preg made me more estrogenic. I also would suggest stopping all the OJ and milk. Tooooo many liquids and her kidneys I am sure are not filtering. So between that and a loaded liver... and add on meds and anesthesia from D and C which I know first had is a GNARLY procedure - there clearly is DETOX that needs to be happening and loading up with supplement is not going to do it . Dry fasting... shorter eating window , and just let her body do its thing. Not sure if the progesterone is going to stop the bleeding - are you SURRREEEE its estrogen dominance? what is her Testosterone looking like? i would stop all that regimented nonsense. her diet and supplements are crazy in my opinion.

 

[olive]

My two cents- here is what I would do -
Stop all supplements - for me all the Progesterone ( Progest E ) and Preg made me more estrogenic. I also would suggest stopping all the OJ and milk. Tooooo many liquids and her kidneys I am sure are not filtering. So between that and a loaded liver... and add on meds and anesthesia from D and C which I know first had is a GNARLY procedure - there clearly is DETOX that needs to be happening and loading up with supplement is not going to do it . Dry fasting... shorter eating window , and just let her body do its thing. Not sure if the progesterone is going to stop the bleeding - are you SURRREEEE its estrogen dominance? what is her Testosterone looking like? i would stop all that regimented nonsense. her diet and supplements are crazy in my opinion.

Second this
Do a prolonged fast to get everything reset and start again. Avoid dairy and excess liquids to start, add them back in slowly if you choose and watch for side effects. Many people do better without.
Most people also do better without supplemental caffeine. Drink coffee but avoid caffeine unless you deem it tangibly helpful.
Methylene blue is a tricky supplement to use especially when consuming cheese.
That dose of thyroid is excessive. It shows there’s a major underlying issue; by taking such a large dose she’s avoiding the problem instead of dealing with it. No one should need more than 50mcg of T3 per day at absolute maximum.
The diet in general looks lacking in many vitamins, consume more whole foods and make sure she’s consuming green leafy vegetables. Kale is really good steamed and covered in shredded coconut. Baby spinach works with everything. Folate is especially important if you’re thinking about conceiving.
Liver that often may cause excessive levels of retinol and cause harm to the liver. I’d reduce the frequency to biweekly, which is what Ray recommends IIRC.
All the doses of supplements seem excessive; 100mg pregnenolone for what reason? 300mg niacinamide for what reason? Are you just throwing the kitchen sink at problems or are you testing for their efficiency to help? What benefits does she achieve from such high dosages?

Track food with chronometer.

 

[lampofred]

Really sorry about the miscarriage. If the diet/lifestyle you're following now is the same as the one you were following before the miscarriage, the most logical implication to me is that it might be emotional stress which caused the shift in hormones. Peat has mentioned that emotional stress/trauma/shock cause estrogen dominance.

How is her salt intake relative to fluid intake? I think Peat recommends a high salt intake (relative to water) and adequate sugar intake for lowering adrenaline and other stress hormones associated with shock, along with non-dietary means as well. Also, this is probably not the main cause, but Peat has mentioned that most pregnenolone supplements today are contaminated with estrogen.

 

[somuch4food]

Stressful events will offbalance the body. I'm guessing her body is in a different state than before the miscarriage and will need a different regimen to support recovery.

What worked before is not working anymore because her body chemistry is different.

I would drop all supplements, start with diet changes and then add supplements one at a time back as needed to note their effects.

 

[j2mugs]

Thank you all for your thoughts and encouragement with this.

I'm sure that the stress is playing some role, and I agree the stress is different now. It just seemed that in 2017 the stress was much higher. We added two infants with developmental delays to our family in March of 2017 and we were not sleeping at all for months. They cried a lot and the stress in our house was very high and yet she managed to get her temps up, pulse up, periods normalized and lose weight over that same period of time.

So obviously her body chemistry has changed since the D&C because she is having the opposite issues with her cycles now, but that's the central question - what has changed?

Our main goal is not pregnancy right now, it's trying to get her cycles to normalize so she doesn't feel like she is bleeding all of the time. She's been pretty discouraged to only be off of her flow for about 10 days at a time. Secondly, it is just to get her temps and pulse back up to where they were a little over a year ago. The last goal would be for her to begin losing weight again. This has also been very discouraging for her as well, especially because she had lost so much just prior to the miscarriage.

We more of less did do a fast and supplement break for 8 weeks. We simplified our diet even more and she stopped taking everything including progesterone on January 23, 2018 and did not resume anything until the last week of March 2018. That didn't seem to change anything - if anything her temperature and pulse dropped a great deal, and her facial hair and edema increased. Starting the first week of April we slowly added things back to get us to where we are today.

She is eating well over 2000 calories a day. There is no calorie restriction going on. She eats to appetite and snacks often through out the day. Most days that we have tracked her calories she is between 2,200 and 2,400. We keep a pretty stable diet that lines up well with most of these suggestions (e.g. we eat looks of well cooked greens and salt everything quite heavily).

I agree about the incredibly high doses of supplements - that is my reason for posting. I have been doing all of this along side of her and have not needed anything close to the levels of supplements she has, so I too believe there is something else at work which is what we are trying to figure out. No matter what we have tried over the past 4+ years she seems stuck until the supplements reach these crazy high levels - so something else must be at work.

So I'm open to any thoughts. We are open to reducing the supplements for sure, but what kind of time frame are you talking about? The 9 week break she had before only seemed to make matters worse. We can make diet changes as well, but like I said most of our meals are already following pretty close to the suggestions above. We can reduce liquids, reduce liver, reduce supplements, but at the end of the day I really believe there is something more systemic that needs to be addressed and I'm stumped as to what it is.

Thanks again for your thoughts and time!

 

[j2mugs]

Also I forgot to mention that the plan was to try and suppress her period for a month or two by taking too much progesterone. The hope was that it might "reset" things for her and get her back onto a normal cycle duration. But the fact that 115-125mg of Progesterone per day will not fully suppress the cycle I think points to the fact that there is a much bigger systemic problem at work. According to things I've read on this forum that is an astronomically high amount, and obviously she can't tolerate more than that without feeling "drunk".

So since she can't take any more progesterone and this flow has been trying to start for 11 days now - it might be time to cut our losses, back off the progesterone and let this cycle finish. But the problem still remains...

 

[sweetpeat]

Have you considered getting some lab work done? Might help detect an imbalance somewhere

 

[Peatful]

Facial hair; edema...
High prolactin.

Needs Vitamin A, calcium to balance that.
Food; not supplements.

And objectively- I think you may not acknowledge the amount of stress you are under- giving your life and heart into your children.
Again, the rewards are without measure- but with two special needs children- I know there is sacrifice.

Have you seen this:
Estrogen and PCOS – Functional Performance Systems (FPS)

 

[alywest]

Also I forgot to mention that the plan was to try and suppress her period for a month or two by taking too much progesterone. The hope was that it might "reset" things for her and get her back onto a normal cycle duration. But the fact that 115-125mg of Progesterone per day will not fully suppress the cycle I think points to the fact that there is a much bigger systemic problem at work. According to things I've read on this forum that is an astronomically high amount, and obviously she can't tolerate more than that without feeling "drunk".

So since she can't take any more progesterone and this flow has been trying to start for 11 days now - it might be time to cut our losses, back off the progesterone and let this cycle finish. But the problem still remains...

125 mg of progesterone is not astronomically high for a woman. If you go to a website like ona's natural progesterone and read the reviews some women take upward of 600 mg. It's case dependent. I take 200mg daily during the luteal phase.

Also it probably depends on how she takes it if she gets that "drunk" feeling. I only ever experienced that when I took it orally in pill form and it wasn't at all unpleasant. I did it right before bed so I slept really well. It's really nothing like being drunk but it is a bit weird in that you really feel it as opposed to most of the time when you don't really notice anything from it except maybe more calm.
Rubbing into the gums is the Peat-friendly way, but there are also creams that you put on the skin. I recommend the one dissolved in vitamin e because you also get the benefit of vitamin e, and supposedly using the skin method makes it absorb into fat cells where it can actually store up and you can overaccumulate. Some people claim that vaginal application gives them yeast infections, but Peat says that yeast is really an overabundance of estrogen that forces the candida to the surface. Thyroid is really the most systemic way to improve the overall health of the hormones. Progesterone can be overwhelming if the thyroid is underactive because it will cause the thyroid gland to release all the stored up hormones that it was holding onto due to stress. Since she's been on thyroid, progesterone should be safe even in higher doses. I would up it to 200mg slowly, then if that still doesn't stop the bleeding and she doesn't feel the sedative effects yet, go up in small increments. I take mine all at once at night. I used to do the small doses all day long and that proved to be frustrating.

Also, 100mg of pregnenolone is probably too much. Maybe cut back to 5-10mg.

 

[j2mugs]

Thanks again for all of your thoughts and support on this.

@Peatful - Yes I had read that article, thanks for sending it along. In regards to her calcium and vitamin A intake I would be open to additional suggestions if this seems inadequate. Currently she is getting a minimum of 1700mg of calcium from her diet each day. She is taking no calcium supplements. I know on many days she is approaching closer to 2000mg so I haven't worried about those levels at all. We also avoid phosphate rich foods (grains, beans, and eat muscle meats sparingly - maybe once every 10 days). I assumed that was more than enough calcium and since we were reducing the phosphate intake that it would help reduce prolactin. I also assumed between the weekly liver, the daily cheese, daily butter and well cooked vegetables like winter squash and spinach a few times a few week that she would be getting adequate vitamin A from her diet. Is there anything else we should add or change? I saw kale as a suggestion earlier, but I feel like that should already be sufficient on the dietary vitamin A.

@alywest - Incidentally, regarding Ona's Progesterone, Suzanne was topically using 800mg per day of it before I spoke with Ray Peat. It was basically doing nothing for her and since the amount was so high I was worried about a deeper problem at work. He suggested Progest-E at that point and she has been using it ever since. She always applies it to the gums and rubs it in as he suggests. I haven't read much of anything on people taking over 100mg of Progest-E per day which is why I assumed it was high for a non-pregnant woman. We were working with a "peaty" naturopath who was constantly freaking out about her taking 75mg per day - saying that was too high. She described the feeling as being "drunk" (which is funny because I don't think she has ever been drunk in her life), so it's probably not an accurate descriptor. She was VERY groggy though and did sleep well that night. But it was interfering with the last three hours of the day so she wanted to avoid that in the future.

Again, her case seems unique. We started "Peating" with zero supplements. And after two years of eating peat-like she saw some improvements in her pulse, temp, hair loss, etc. But she was never able to get her waking temp over 97.2, loose an ounce of weight, or have more than 2 periods in a year until we started supplementing. We have helped several friends change their diet alone and seen tremendous changes (myself included), so I know this can be done without supplementation. I would prefer for her to not be on any supplements but without them her issues only worsen. Which is why I keep circling back to the fact that there must be something much more systemic at work. I have read everything I can get my hands on by Ray Peat, listened to every KMUD episode and read this forum like crazy for over two years and I have not yet come across a case similar to hers which is why I'm reaching out for help.

@sweetpeat - I think you're right - bloodwork might be the next best step. We talked about it last night and she is going to stop taking all of the Progest-E and let this flow finish on its own. Then we figured that we would do blood work a couple of days after flow stops and without adding the progesterone back in. Any thoughts on what all should be included in the test? Our medical sharing provider has some basic panels that we can get done relatively inexpensively. Would this one suffice or should I be looking for something else?
CMP - Comprehensive Metabolic Panel w/ eGFR
Complete Blood Count with Differential - CBC w/Diff
Estradiol
FSH - Follicle Stimulating Hormone
LH - Luteinizing Hormone
Testosterone - Total - LC/MS/MS
TSH - Thyroid Stimulating Hormone
T-3 Uptake
T-4 Total
T-4 Free
Vitamin B12 and Folic Acid
Vitamin D


Thanks again for the generosity of your time and for your input as we try to figure this thing out!

 

[somuch4food]

It won't sound very Peaty, but maybe you need more phosphorus and a bit less calcium. You sound like you avoid it like the plague.

I would also consider reducing vitamin A. High dairy consumption (High A high calcium) countries have higher incidence of osteoporosis.

 

[sweetpeat]

Any thoughts on what all should be included in the test? Our medical sharing provider has some basic panels that we can get done relatively inexpensively. Would this one suffice or should I be looking for something else?

I think that's a good basic list. I would add progesterone to be able to see the ratio compared to estradiol. Also either free or total t3 on the thyroid panel. Maybe cortisol if it's not included in the other panels

 

[Peatful]

It won't sound very Peaty, but maybe you need more phosphorus and a bit less calcium. You sound like you avoid it like the plague.

I would also consider reducing vitamin A. High dairy consumption (High A high calcium) countries have higher incidence of osteoporosis.

 

[Peatful]

Thanks again for all of your thoughts and support on this.

@Peatful - Yes I had read that article, thanks for sending it along. In regards to her calcium and vitamin A intake I would be open to additional suggestions if this seems inadequate. Currently she is getting a minimum of 1700mg of calcium from her diet each day. She is taking no calcium supplements. I know on many days she is approaching closer to 2000mg so I haven't worried about those levels at all. We also avoid phosphate rich foods (grains, beans, and eat muscle meats sparingly - maybe once every 10 days). I assumed that was more than enough calcium and since we were reducing the phosphate intake that it would help reduce prolactin. I also assumed between the weekly liver, the daily cheese, daily butter and well cooked vegetables like winter squash and spinach a few times a few week that she would be getting adequate vitamin A from her diet. Is there anything else we should add or change? I saw kale as a suggestion earlier, but I feel like that should already be sufficient on the dietary vitamin A.

@alywest - Incidentally, regarding Ona's Progesterone, Suzanne was topically using 800mg per day of it before I spoke with Ray Peat. It was basically doing nothing for her and since the amount was so high I was worried about a deeper problem at work. He suggested Progest-E at that point and she has been using it ever since. She always applies it to the gums and rubs it in as he suggests. I haven't read much of anything on people taking over 100mg of Progest-E per day which is why I assumed it was high for a non-pregnant woman. We were working with a "peaty" naturopath who was constantly freaking out about her taking 75mg per day - saying that was too high. She described the feeling as being "drunk" (which is funny because I don't think she has ever been drunk in her life), so it's probably not an accurate descriptor. She was VERY groggy though and did sleep well that night. But it was interfering with the last three hours of the day so she wanted to avoid that in the future.

Again, her case seems unique. We started "Peating" with zero supplements. And after two years of eating peat-like she saw some improvements in her pulse, temp, hair loss, etc. But she was never able to get her waking temp over 97.2, loose an ounce of weight, or have more than 2 periods in a year until we started supplementing. We have helped several friends change their diet alone and seen tremendous changes (myself included), so I know this can be done without supplementation. I would prefer for her to not be on any supplements but without them her issues only worsen. Which is why I keep circling back to the fact that there must be something much more systemic at work. I have read everything I can get my hands on by Ray Peat, listened to every KMUD episode and read this forum like crazy for over two years and I have not yet come across a case similar to hers which is why I'm reaching out for help.

@sweetpeat - I think you're right - bloodwork might be the next best step. We talked about it last night and she is going to stop taking all of the Progest-E and let this flow finish on its own. Then we figured that we would do blood work a couple of days after flow stops and without adding the progesterone back in. Any thoughts on what all should be included in the test? Our medical sharing provider has some basic panels that we can get done relatively inexpensively. Would this one suffice or should I be looking for something else?
CMP - Comprehensive Metabolic Panel w/ eGFR
Complete Blood Count with Differential - CBC w/Diff
Estradiol
FSH - Follicle Stimulating Hormone
LH - Luteinizing Hormone
Testosterone - Total - LC/MS/MS
TSH - Thyroid Stimulating Hormone
T-3 Uptake
T-4 Total
T-4 Free
Vitamin B12 and Folic Acid
Vitamin D


Thanks again for the generosity of your time and for your input as we try to figure this thing out!

I’m going to listen to this when I have time...

 

[j2mugs]

I’m going to listen to this when I have time...

I just listened to it this weekend actually. :) It's a really good episode, but unfortunately I didn't get any new insights from it.

 

[Peatful]

I just listened to it this weekend actually. :) It's a really good episode, but unfortunately I didn't get any new insights from it.

Oh cool. I look forward to listening!

The last thought I could offer you is something that I mentioned in my original post.
That’s blood sugar regulation.
To heal at a cellular level this is such an important piece.

Josh Rubin and his wife drill this principle hard.
East West Healing?

My estrogen dominant (3x estrogen driven cancer survivor) friend used Jeanne.
While not perfect, my friend healed.
No anxiety, able to sleep, good digestion, great energy, her labs are perfect and she’s happy/healthy.

Keep us posted as able.