Stefani Ruper is the author of PCOS Unlocked: The Manual, a guide to polycystic ovary syndrome, a health issue that many women struggle with — without even realizing. Stefani also runs the website Paleo for Women,  “a community of vibrant, health-focused, loving women in pursuit of natural health and empowered womanhood.”

Stefani believes that health is holistic, and her writing spans a broad spectrum between technical articles on hormonal, neural, and reproductive physiology, and inspiring manifestos on the powers of forgiveness and self-love. She’s an important voice for women’s health in the world of Paleo eating.

The early scientific writings on Paleo-style eating and ancestral diets typically presumed an “everyperson” eater — often an implied male body that did not menstruate, get pregnant, hit menopause, deal with child care, have other women’s health issues, etc. Luckily, Stefani is part of a small but growing group of women’s voices in the ancestral diet community who are now attending to women’s specific health issues.

In a Stumptuous Files podcast, I talk to Stefani about the value of ancestral-style diets, women and body image, her experience with disordered eating, her work on PCOS, and the F-work — feminism — in the “Paleosphere”.

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PCOS Unlocked: The Manual

Stefani Ruper

At the time of her diagnosis with polycystic ovary syndrome (PCOS) in 2009, writes Stefani, “I knew nothing about ovaries. None of it made any sense to me. All I knew was that I was covered in acne, incapable of conceiving children, and doomed to an absent sex drive for the rest of my life.”

Few health care providers had useful answers for her. For one thing, why did a relatively fit, lean woman have PCOS? The standard narrative was that PCOS was simply a disease related to metabolic syndrome — the collection of symptoms that include insulin resistance, obesity, and disrupted reproductive hormones.

Yet Stefani had done the opposite. She’d lost a lot of weight, going from a size 9 to a size 0. How was this possible? For Stefani, something wasn’t adding up.

Her journey towards understanding her health situation — as well as that of the other women she met along the path — produced PCOS Unlocked: The Manual.

Biology ain’t destiny, but it sure carries a big stick

“We need to think deeply about what our bodies demand of us,” Stefani writes. “Nothing in the world is better at knowing how to be fertile than the natural world.”

And, one might add, never have we been more out of sync with our physiological and environmental cues. Most of us regard our bodies as an inconvenience, an embarrassment, or mostly just transit for our brains. (Which, by the way, are part of our bodies. In case you hadn’t noticed.) But those bodies are still working away, doing whatever it is that they do. When things get out of whack, our bodies let us know.

This argument forms the basis for Stefani’s recommendations. Fundamentally, PCOS is a disorder of imbalance. Androgen levels too high relative to other sex hormones. Stress and anxiety too high for too long. Dietary intake out of balance with physiological needs — whether too much or too little.

Although the general concept of imbalance cuts across all manifestations of PCOS, Stefani has developed and distinguishes three categories of PCOS sufferers:

  • Type 1 PCOS: insulin resistant, usually overweight/obese women (i.e. the “classic” PCOS presentation)
  • Type 2 PCOS: metabolically and/or psychologically stressed women (e.g. women training hard, restricting food intake, dealing with life stresses)
  • Type 3 PCOS: women with low-functioning thyroid

This is pretty innovative thinking, based on a careful observation of patient populations.Type 1s usually show the “classic” symptoms of PCOS, such as:

  • trouble losing weight (and weight collecting around the midsection);
  • acne
  • facial hair and thicker/darker hair on body
  • male pattern hair loss on the head
  • irregular periods
  • high testosterone levels
  • poor insulin sensitivity, glucose tolerance, and fasting glucose

Type 2s and 3s are the women who are likely to fly under the radar. Often, their lab values aren’t extreme. Or (especially in the case of Type 2s) they may “look” healthy. Indeed, Type 2s are often found lurking in the local gyms or health food stores. They’re typically educated, have high expectations of themselves, and face significant stresses that are physical, mental, emotional, and environmental. They too may have elevated androgens, but often only because their estrogen and progesterone are relatively lower.

As such, their symptoms are hard to puzzle out. Is the insomnia they experience due to that impending deadline, the low-carb diet they’re doing, or a tough training session that afternoon?

Drawing on the medical literature as well as the experiences of women she’s met, Stefani carefully develops her argument and recommendations. She provides in-depth exploration of each of the PCOS types, giving specific recommendations for diagnosis and treatment.

Complex problems, simple solutions

Luckily, while the underlying hormonal mechanisms of PCOS may be complex, the solution is relatively simple. (Not easy. But at least simple.)

“Food is medicine,” says Stefani. “Women surveyed in today’s surviving traditional hunter-gatherer cultures do not have PCOS. PCOS has emerged in Western society in response to changes in diet and lifestyle… The simplest and most healthy way to overcome PCOS is to re-align the foods that we currently eat with the foods that we are meant to eat.”

There is hope. “PCOS is best overcome by stopping the behaviour that causes hormonal disruption and by healing damage that has been done over time,” she writes. PCOS Unlocked, and the associated video material, lays out a clear step-by-step plan for fixing your busted hormones.

If you’re a woman with unexplained hormonal symptoms that include some signs of elevated androgens (e.g. acne, hair changes, changes in your body shape), menstrual irregularities, painful periods, etc. I strongly recommend you check out PCOS Unlocked: The Manual as well as Stefani’s writings and the community on Paleo for Women. It just might be what you and your doctor have been searching for.