Katharina Dalton: The Dietary "musts" For Improving Progesterone (Hint: No Low Carb, No Starvation)

PakPik

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The great progesterone pioneer Dr. Katharina Dalton, who successfully improved the quality of life thousands of women -including many difficult cases with neurologic problems- by improving progesterone function in them, didn't seem to be very fond of low-carb and starvation / low calorie kind of diets and lifestyles. I got an understanding from her book "Once a Month" about her requirement of specific dietary measures for her patients -and it was with huge success-.

**Disclaimer**: This information is only presented with the purpose of sharing some of Dr. Katharina Dalton's work (specifically the dietary aspect as seen in her book Once a Month). No nutritional or medical advice intended.

The biochemical/metabolic "rules" to improving progesterone function

Dr. Dalton makes it very clear in her book that the treatment-plan for restoring the progesterone hormonal function in a woman must focus first and foremost on fixing the diet in such a way that:

1) Cells, at all cost, must not be deprived from or run out of of sugar
2) Adrenaline is kept as low as reasonably possible, not allowed to spike.​

As you may see 1) and 2) are closely related since when tissues are deprived from sugar, there usually comes an adrenaline response. Also, when adrenaline gets high, the blood gets flooded with free fatty acids, which in turn block the cells ability to metabolize glucose (Randle cycle). So 1) and 2) create a vicious cycle.

Dr. Dalton provides the following explanations for the above "rules":
  • "progesterone receptors cannot transport or bind to, a molecule of progesterone if there has been a drop in blood sugar"
  • "progesterone receptors do not transport progesterone molecules into the nucleus of cells if adrenaline is present".
Diet: the main focus for progesterone problems and therapy

Based on the aforementioned biochemical/metabolic considerations, she designed a diet to accompany the progesterone treatment, calling it "The Three-Hourly Starch Diet". This diet has the following characteristics:
  • Frequent carb snacking: "divide the day's starchy food so that you eat small starchy snacks every three hours during the waking hours and within one hour of waking and retiring to bed" [Note: she was fine with grains as a carb source.]
  • Minimizing overnight fast: "Ideally, the overnight fast should not exceed ten hours"
  • Overall diet: "Meanwhile, continue with a healthy diet with adequate protein and plenty of fruits and vegetables"
  • An ongoing practice: "Continue the diet throughout the menstrual cycle"
  • The diet "incubation" period and the risk of progesterone failure if the diet is not thoroughly followed: "It takes at least seven days before the benefit of frequent eating is appreciated, and unfortunately, if there are long gaps between eating and snacking it will take up to seven days to recover. ... It does not matter if you don't eat every hour or two as long as you don't wait longer than three hours."
  • Preparation to supplementation: "Before starting progesterone treatment ... Ensure that the patient has maintained the Three-Hourly Starch Diet for at least one week".
In fact, the diet is at the core of any program trying to improve progesterone function, more important than any progesterone supplementation itself. She boldly stated:

"...the Three-Hourly Starch Diet... by itself will relieve many of the symptoms of PMS; without this diet progesterone is not effective."​
Also:
"I would firmly start all patients on the three hourly starch Diet before prescribing progesterone"​

Some patients cured by diet alone

There are records of patients whose PMS was cured by diet alone!:

"When each patient returned her food forms, she was given advice about the Three-Hourly Starch Diet and advised to continue with it until her appointment. During the interval, several canceled their appointment, thanking us, because the diet alone had solved their problems; others came only to thank us as they did not need further help."​

Women's eating habits: past and present

In 1948, Dalton had her first six patients who responded to progesterone therapy for PMS. She explains that a typical 1948 woman was a housewife who spent lots of their time cooking, who "would have been nibbling all day. The well-heeled ladies had their breakfast, morning coffee, lunch, afternoon tea, supper, and a snack before bed to prevent night starvation.'"

She also makes the connection that "It was before the Twiggy era [the first world's supermodel], and before health education advised everyone to lose weight. ... There were no fast foods, no convenience food ..."

Differentiating between PMS and Menstrual Magnification/Distress

The PMS definition as given by Dalton requires that symptoms recur before menstruation, and are completely absent after menstruation. In contrast, in menstrual magnification or menstrual distress there is no absence of symptoms after menstruation, just a reduction in severity.

Dalton pointed out that the patients that were more likely to highly benefit from the diet measures were the PMS patients, but that the Menstrual Magnification/Distress patients diet can still be of benefit and they should follow it.

Note: Regarding the frequent snacking, she explained that it was more of a women's need; she said men [I assume healthy ones] can usually go longer without food, which is in line with what Peat says about women's typically lower liver and thyroid function as compared to men.

Katharina Dalton was definitely on to something. Hopefully we as women will be able to make better dietary choices and not fall for fads and tricks that can damage our well-being.
 
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tara

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The diet "incubation" period and the risk of progesterone failure if the diet is not thoroughly followed: "It takes at least seven days before the benefit of frequent eating is appreciated, and unfortunately, if there are long gaps between eating and snacking it will take up to seven days to recover. ... I does not matter if you don't eat every hour or two as ling as you don't wait longer than three hours."
I recognise this. The older I got, the longer it would take to recover from an accidental too-long between meals slip up. People around would not get why being hungry was such a big deal, but I knew it could take days to recover. Certainly more than 3 hours is no good for me, and two hours is usually better.
 

thegiantess

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Fascinating! I didn't know that Peat had said women have lower liver and thyroid function and therefore need to constantly "stoke the fire." Anecdotally, I don't know any men who are natural snackers... Most men I know seem content with eating large meals instead of many small meals. However I know several women (self included) who graze all day.
 

tara

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Most men I know seem content with eating large meals instead of many small meals.
Yeah. It can be frustrating hanging out with camels who can go from breakfast to supper without losing steam, and who don't get that we need regular refuelling.:)
 
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PakPik

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The older I got, the longer it would take to recover from an accidental too-long between meals slip up. People around would not get why being hungry was such a big deal, but I knew it could take days to recover.
I have faced similar sugar problems, but definitely if people around you haven't experienced it to the same extent they will probably think you're exaggerating!

Fascinating! I didn't know that Peat had said women have lower liver and thyroid function and therefore need to constantly "stoke the fire." Anecdotally, I don't know any men who are natural snackers... Most men I know seem content with eating large meals instead of many small meals. However I know several women (self included) who graze all day.
Well, Peat is probably right after all... I've also observed that men can be more carefree about foods/intervals without foods (just don't mess with their 3 or so large meals) as opposed to women. K. Dalton said men are "gorgers" and women "grazers".
 

Peata

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Thanks for posting this. Interesting. Lately I've been eating more frequent small meals like that (starch, protein, some fat) and feel better for it. The days I go longer between meals, it takes me time to recover.
 

Footscray

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As a male in my forties who is struggling with blood sugar crashes, surges of adrenaline and a general feeling of tiredness, this could be something I could really work with. I am a carpenter so I use a lot of energy. But I will have to keep reading and find out what sort of snacks to have prepared. Although all being well, we 'hunters' could go longer without food than the 'gatherers', once we've broken our constitutions, we all need these sort of ideas. Thanks.
 
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PakPik

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As a male in my forties who is struggling with blood sugar crashes, surges of adrenaline and a general feeling of tiredness, this could be something I could really work with. I am a carpenter so I use a lot of energy. But I will have to keep reading and find out what sort of snacks to have prepared. Although all being well, we 'hunters' could go longer without food than the 'gatherers', once we've broken our constitutions, we all need these sort of ideas. Thanks.
Hi Footscray,

I had severe blood sugar problems in the past, so I can sympathize. There can be many contributing factors to those issues, so I suggest keeping your research up.
Men can also get eventually imbalanced and with stressed physiology. If blood sugar crashes over and over, Katharina Dalton's ideas of frequent carb snacking/avoiding long periods without food may be something to consider, even for "hunters" :)
Low sugar availability to the cell not only detrimentally affects progesterone, but a wide range of other aspects.
 
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PakPik

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This is amazing, thank you for posting it! I think I might buy her book.
Interesting and valuable wisdom bits from Dr. Katharina Dalton successful experience with helping women, isn't it? A lot of us would have had an easier time with hormones, etc... if we had known early on about the importance of eating enough and correctly vs. restricting :). As for men, they have no free-pass either: going on starvation/low-carb style diet wreaks havoc on their hormones and wellbeing as exemplified by this interesting experiment Gues Who Wins?Van Tulleken Twin Doctors Go On Month Long High-fat And High-sugar Diet (BBC Document) (@Footscray may be interested to check the experiment out)
 

ilovethesea

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Yes it's incredible how simple and common sense her advice is, I'm sure I could have prevented a lot of problems if I knew about it. Modern life if you work in an office isn't really set up for frequent snacking.

Funny how before I found Ray Peat I had complained to doctors for years that I thought my hormones were off balance. I was told everything was normal, but oh did I want the birth control pill? Never once was asked about diet.
 
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PakPik

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Yes it's incredible how simple and common sense her advice is, I'm sure I could have prevented a lot of problems if I knew about it. Modern life if you work in an office isn't really set up for frequent snacking.

Funny how before I found Ray Peat I had complained to doctors for years that I thought my hormones were off balance. I was told everything was normal, but oh did I want the birth control pill? Never once was asked about diet.
Well, Katharina D. did her work, and her recommendations went even beyond common sense; she at least tried to explore the scientific reasons to progesterone's do's and don'ts. Unlike the kind of doctors you reference, who go around suggesting to "eat less" (as if a lot of people ate too much) without sound reasons for that dangerous recommendation; or suggesting estrogen for people who may not need more of it. I'm glad she stood against all of that (though there's a section in the book where she explains some women need to increase estrogen. I need to read her explanations.).
 

ilovethesea

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It's really too bad she's not more well known.

I think most women only vaguely think estrogen is bad because of news stories about environmental estrogens. But anyone I've talked to is still mixed up about their own menstrual cycle - they think progesterone is high in the last 2 weeks instead of vice versa. And they blame progesterone for the problems the estrogen is causing. Just one random example for 2 seconds of googling... Could Estrogen Levels Be Affecting Your Acne?. Anti aging doctors also talk about loss of estrogen causing aged skin.

Anyone I've suggested to try increasing calories to help their health problems doesn't want to hear it. They eat like 1500-1600 whereas I'm always trying to get above 2400-2500. They tell me they'd just balloon up, which may be true but better that than taking dangerous drugs and having surgeries. Meanwhile the FDA's calorie number isn't even accurate. Why Does the FDA Recommend 2,000 Calories Per Day?

I find doctors are pretty much all hostile to their patients, especially women patients.
 
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PakPik

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Anti aging doctors also talk about loss of estrogen causing aged skin.
It is more like undereating and chronic stress (like induced from exhaustive exercise, unhealthy lifestyle, etc) causes premature or bad aging. I know many of many mature women in my family and also acquaintances that are aging pretty well. Most of them have never done restrictive dieting nor estrogen pills. Oh, and most of them have never hit a gym once nor run in the park. Food is homemade. That is changing with the newer generations, though. Running+Restrictive Dieting has turned out to be a powerful pro-aging combo.

Anyone I've suggested to try increasing calories to help their health problems doesn't want to hear it. They eat like 1500-1600 whereas I'm always trying to get above 2400-2500. They tell me they'd just balloon up, which may be true but better that than taking dangerous drugs and having surgeries.
Yeah, that's true. Sad thing is that not eating enough may lead to more tendency to pack up pounds from the lowered metabolisn, stress hormones, etc...it backfires. Not a good strategy at all.

I find doctors are pretty much all hostile to their patients, especially women patients.
They think they have us figured out. They are trained to operate in the realm of the if you don't look visibly ill then "it's all in your head" or "tests are perfect, so you must be fine". I try to be understanding of them, though, since the system they've been trained in has just brainwashed them that way and really think they are doing the right thing (if I had been to medical school I would have probably been the same, at least initially before reality check). I hope life gives them some reality check and realize they haven't figured out most things and even much of their training is seriously inappropiate (they don't like being told they are mistaken -see what happened to the doctor that suggested that handwashing was needed to decrease disease spreading in clinics-, or see how they treated people with epilepsy, multiple sclerosis, diabetes in the past before those diseases were legitimized... and I haven't even mentioned how women suffering from PMS were sometimes horribly treated.)

Katharina Dalton really fought for legitimizing PMS as a real, legitimate syndrome. She also helped women who had had previous pregnancy problems ameliorate them and go through healthy pregnancies and give birth to healthy, on-term, and intelligent children. She really had a big heart and helped thousands of women and children.

In her book she was very outspoken on synthetic, non-bioidentical progesterone analogues inefficacy and even danger. Maybe that's a big reason why she is not very popular.
 

denise

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I've been thinking about doing this. I wonder how much is sufficient to eat for each snack? Is she talking about the equivalent of, say, a piece of toast? Or something more substantial?
 
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PakPik

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I've been thinking about doing this. I wonder how much is sufficient to eat for each snack? Is she talking about the equivalent of, say, a piece of toast? Or something more substantial?
Hi denise, I quickly checked her book and it says this (it doesn't say anything specific about portions, just a general rule):

"Divide the day's starchy food so that you eat small starchy snacks every three hours during the waking hours and within one hour of waking and retiring to bed. Meanwhile, continue with a healthy diet with adequate protein and plenty of fruits and vegetables."​
 

Xisca

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Why only starch and not also fruits? That would add fructose, is it bad and does she prefer glucose only?
Is the snack only starch, or with fat or other?
 

tara

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Why only starch and not also fruits? That would add fructose, is it bad and does she prefer glucose only?
Is the snack only starch, or with fat or other?

Overall diet: "Meanwhile, continue with a healthy diet with adequate protein and plenty of fruits and vegetables"
 

Xisca

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Yes I had read this, but why the snacks are starch and the fruits are in the meals?
Fruits digest quicker and are supposed to be good snacks....
It seems that it is about organising the moments you eat each type of nutrient....

As I am not good for digesting starch, I want to give this a try, as may be it is better to eat small amounts of starch?

Then what is strange for me is that I am obviously estrogen dominant, but I did not suffer a lot of PMS. I can say that I knew one day before that my periods were for the next day, so no big pain, and not at all now that I entered premenopause. As taking progest-E seems to make no difference, then the idea of adrenaline is relevant for me anyway.
 

Xisca

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I have been trying since friday.... actually, as I was snacking since tuesday because of the workshop, I am just more cautious about the timing.
I eat at least a piece of gluten free bred or rice toasts as snacks.
Let's see after more days, but today I was so warm that I had to ask people if the day was warmer, and it was not!
 
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