The reality is, what you don’t know CAN hurt you, and we are saddened by how poorly managed hormones are hurting many people. Menopause (women) and andropause (men) are not the only times hormones are poorly managed, but it’s often the only time we think about hormones. We often don’t think about hormones related to postpartum, depression/anxiety, digestive issues, fatigue, or poor sleep.
We will address issues with only replacing hormones versus the functional medicine approach of balancing whole body systems, look at five body systems that affect hormone balance, and foods that support hormone balance.
Most people are clueless when it comes to hormones, and there is a lot of “noise” in the health world about the “best way.”
One way that poorly managed hormones hurt people is through using only the replacement method.
This is a standard method of supporting hormones by testing hormone levels and using a hormone supplement to increase the level of whichever hormone is low. It seems simple and logical in theory, but in reality, hormones are far from simple and, at times, quite illogical.
Example of replacement method:
Low testosterone often occurs as men age or are chronically stressed. This is also called andropause (or “manopause”), and the common way to address it is through supplemental testosterone in the form of pills or creams. This will, as expected, increase testosterone levels, but can have unexpected complications. There’s a process known as aromatization which can be occurring. This is when the aromatase enzyme gets unregulated, usually because of insulin resistance. Aromatization causes testosterone to convert to estrogen. The goal of managing low testosterone in men is not to create more estrogen. There are better ways to increase testosterone without creating more estrogen and it doesn’t always need to be through testosterone supplementation.
The most common example of replacement therapy in women is to supplement with estrogen in menopause. Simply throwing estrogen onto low estrogen levels may have the unintended consequence of the body pushing supplemental estrogen into pro-inflammatory, cancer promoting forms. !NO BUENO!
So, you’re probably wanting me to outline the magic bullet, fail-proof way to manage hormones. Welp, sorry.
Not only is there not a simple fix, each person needs something different depending on what their body is doing.
Additionally, no amount of perfect hormone supplementation or management is going to replace the need to support and balance the other body systems that affect hormones. Before you run to your doctor looking for the right method of hormone management, there is a lot you can do and that you need to do. It may not even be worth supplementing if underlying systems are not addressed.
Diabetes is not the only reason to manage blood sugars. Blood sugar is the glucose circulating in the blood and not getting into the cells. The body uses insulin to unlock the door of the cells to move the glucose out of the blood where it is inflammatory into the cell where it is used for energy. Excess glucose + extra weight gain = insulin resistance. This is where the insulin receptors (like the door lock and key) gets worn out and doesn’t respond to the glucose at the receptor site (the knock on the door). Insulin resistance is one of the primary reasons for the upregulating aromatase enzyme, which causes testosterone to convert to estrogen in men. For women, it can cause testosterone to increase and cause PCOS, the leading cause of infertility.
Blood glucose is best managed by lowering sugar intake, having lower to moderate carbohydrate intake, limiting refined carbohydrates, having adequate protein at each meal, and consuming slow digested fibers like chia seeds and psyllium husks.
Bottom line: Too much glucose + weight gain = insulin resistance = testosterone becoming estrogen for men and excess testosterone for women, causing hormone issues.
Adrenal Fatigue Or HPA Axis:
This is essentially the system of our body that responds to both acute and chronic stress. Within the constructs of the HPA axis, the body has checks and balances for acute stress, but those systems wear out and become maladaptive with chronic stress. The reality check here is that most Americans are living in a state of chronic stress. Stress that disregulates the HPA axis includes all types of stress: mental, emotional, relational, physical, financial. This means lack of sleep, difficult relationships, financial issues, and over exercising all count here. There’s a ton to say about the HPA axis which includes adrenal function, but the main point we want to make is that chronic stress produces too much cortisol. Too much cortisol usually results in decreased DHEA levels, and DHEA is the precursor to making testosterone and estrogen. DHEA is also important for T3 and T4 thyroid hormone levels.
There are various theories for the connection between high cortisol levels and low DHEA levels. One theory is that under stress, the high cortisol levels use up all the pregnenolone needed to make DHEA, but there are few holes that can be poked into this theory that we won’t go into here. However, that doesn’t change that high cortisol levels results in low DHEA, causing thyroid, estrogen, progesterone, testosterone to be affected. A better way to look at this inverse relationship of cortisol and DHEA is to consider the feedback loops that occur through the whole body. Stress can alter the signaling of a hormone to the receptor site, the enzymes needed in the process can be up or down regulated and individual genomics all contribute to how effectively these processes work based on what signaling pathways are turned on or off by stress.
Most people are self–aware of their stress and recognize that it affects their health, but they do next to nothing to change chronic stress. One reason for this is that around every corner of our life is the potential for stress. In our years of practicing functional medicine at our Shawnee and Overland Park wellness clinics, it has become clear that lowering or dealing with chronic stress is harder for most people than changing their diet, which isn’t easy either. Americans simply do not yet understand the value of slowing down, simplifying and decreasing stress. Nor do we consider “good stress” as a reason to add in extra supports. For example: A fast-paced, high-pressure job that you love or a newborn baby that you obviously love are still stressful. Because babies become toddlers and/or the next baby is born, and jobs continue for years, these are chronic stress situations where other parts of life need to adjust and self-care must be present. There are far more physiological affects of stress than we readily recognize, and it’s likely a yoga class and a nap every four months just won’t be enough.
Bottom line: Too much stress = high cortisol and low DHEA via a number of different mechanisms that can throw all the other hormones out of whack.
Blood sugar (metabolic system) and stress (HPA Axis/adrenals) are the important body systems that contribute to hormone dysregulation and they actually feed off each other. It is a vicious cycle between metabolic function (blood sugar, insulin, etc), hormone signaling and stress. Think about it… High stress often leads to emotional eating. Comfort foods alter stress hormone signals within the brain. Therefore, food acts as a physiological (maladaptive) therapy for elevated stress signals. As a result, increased emotional eating becomes linked to perceived stress. So even the fear or expectation of stress can lead us to seek comfort foods. Additionally, comfort foods are by nature high in carbohydrate and fat. This combination for most people, is a recipe for weight gain. Weight gain is a primary contributor to insulin resistance which as we discussed earlier, can be the trigger for aromatization. Now is it clear why these two systems are most important to address in healthy hormones?
Addressing issues related to these two areas through a functional medicine approach will get you a long way down down the road of hormone balance. Conversely, hormone balance is difficult for the body to maintain when these two areas of life are not regulated.
GUESS WHAT? AN EXPERIENCED FUNCTIONAL MEDICINE PRACTITIONER AND HOLISTIC DIETITIAN CAN GET YOUR WHOLE BODY ON THE RIGHT TRACK.
You don’t have to feel like the lady in the picture looks!
You may want a supplement or prescription to just get the job done and reverse your symptoms – we get it. We often use supplements and medications to plug the holes while working on balancing the underlying systems, but can’t rely on them to actually fix the issue. Your hormone imbalances were years in the making. Each of the systems discussed in this series have been wearing out and working overtime without the support they need for likely YEARS before it shows up in overt symptoms related to hormones. The great thing is, you’re in the right place to begin getting better. It’s not hard, it just takes you showing up to your own life. Sound dramatic?
Maybe, but it’s still true. Ok, let’s get on with it.
There’s a ton of info out there about the gut (gastrointestinal symptoms) being the second brain, the true epicenter of the body, over 60% of our immune system and the home of most of our neurotransmitters controlling mood and more. It’s all true and this post won’t hold all there is to say about the gut, so I will highlight a few key points when it comes to hormones and the gut. First of all, an inflamed gut from stress, medications, poor food choice, and all the other reasons the GI tract gets inflamed can result in decreased adrenal, ovary and gonadal function – which is one of the primary ways the gut affects hormones. Dysbiosis (more bad bacteria than good/beneficial bacteria) can cause recirculation of estrogen and increase of 4-OH and 16-OH estrogens which can contribute to breast and prostate cancers. Poor elimination (constipation) and increased toxins add to this inflammation.
The ways to improve gut function are by the foods you choose, probiotics and cultured veggies. Diarrhea, constipation, heartburn/reflux, acne, psoriasis, eczema, developmental delays, headache/migraines, low mood and irritability are all signs of dysbiosis.
The liver and gallbladder are organs responsible for cleaning up in the body. They clear excess hormones circulating in the body. If these two organs are sluggish or (in the case of the gallbladder) missing, then detox can be compromised. Partially metabolized hormones can block the hormone receptor site – kind of like a bicycle parked in a car parking spot. It’s preventing a car from parking there, but it’s not a car. Then the brain doesn’t think there’s any hormones there and makes more, but the additional hormones it makes can’t actually park in it’s designated spot. This can actually result in pretty normal hormone labs but with all the clinical signs of hormone imbalances still present, which is why an experienced functional medicine practitioner is key. Too many people have had a doctor say, “You’re fine, there’s nothing we need to do,” when labs are normal, but completely disregard the person sitting in front of them saying, “I feel like @#*$.”
Another indication of poor detox is when someone is extra sensitive to supplements or medications. There are people who react strongly to small doses or have very erratic hormone patterns with a small adjustment resulting in a huge shift in hormone levels. This is an indication that the body’s detoxification pathways are clogged or tweaked by genetic polymorphisms. Epigenetics plays a role here, but mutations (polymorphisms) in the genetic code are generally not turned on to create issues unless detox pathways are impaired.
Good news! We see how pervasive this issues is so we created a simple and effective Body Balance Weight Loss System to open up the detox pathways and help the body manage stress.
Essential Fatty Acids
Fatty acids are the precursors to prostaglandins, which modulate our response to hormones. The body is incredibly dynamic and makes minor adjustments to imbalances constantly. Modulation basically means the system has the ability to do more or less of something as needed based on the signaling provided to it by the brain. Inflammation occurs and disrupts good hormone balance when omega 3 fatty acids are low and omega 6 fatty acids are high.
In historical hunter/gatherer diets before the Western (Standard American Diet) was the norm, and chronic disease (including hormone imbalances) didn’t exist, the ratios of omega 3 to omega 6 fatty acids were basically 1:1. In analysis of current eating patterns, the ratio for most Americans of omega 3: omega 6 fatty acids is more like 1:10 and in some cases 1:20. The oils that contribute to the out-of-whack ratios of omega 3: omega 6 are below. Supplementation of omega 3 fatty acids can help balance out the omega 6 fatty acids, but isn’t always necessary when the oils high in omega 6 fatty acids are avoided and fats with higher levels of omega 3 are consumed.
Hormones can’t be what they need to be with an unhealthy gut, poor detox system, and inflammatory fats. The combination of the five body systems for hormone balance we’ve addressed are what must be considered alongside hormone replacement.
Hormone replacement therapy is done poorly by many many practitioners, causing unintended negative consequences sometimes immediately, and other times down the road. Those consequences are often our concern because feeling great in two weeks but developing life–altering autoimmune conditions or cancers in the future is not really what you’re aiming for.
Making small, consistent, purposeful lifestyle changes can get you so far down the road. Working with a functional medicine dietitian who can work with you not only on the food changes that need to occur, but can be an invaluable resource in stress, sleep, and decreasing your toxic burden from your daily lifestyle choices.
EATING FOR GOOD HORMONE BALANCE IS THE FOUNDATION OF GREAT HORMONE STABILITY FOR THE LONG-TERM.
If the body is constantly having to recover from blood sugar spikes and drops, thrown off by endocrine disrupting chemicals, and without the raw materials of vitamins and minerals available for making hormones due to chronic stress, it is an uphill battle with hormonal imbalances that’s hard to win.
There is a lot that needs to be discussed regarding hormones and nutrition, but we can’t do it all here. There’s also a whole other body of information, great science, and patient histories concerning the dangers of many forms of hormone replacement therapy. In due time, we’ll get to it on the blog.
In the meantime, here are a few key points to help you navigate the hormone + medical world:
- Not all hormone replacement therapy is created equal.
- People can respond very differently to the different forms and any doctor who says their ONE way of doing hormones is the best way is misguided. Your story, your labs, and your clinical presentation should determine the best treatment.
- Food can take you a long way in supporting hormones but sometimes not all the way. You may need more support.
- The types and levels of estrogen being used in women can be very dangerous. Be careful.
- Stress, sleep, healthy fats, and restorative exercise are important parts of the big picture.
Blood Sugar Balance:
Having stable blood sugar levels is paramount to hormones for a multitude of reasons, some of which are discussed in Part 1. One way to help blood sugar stability is by having a larger breakfast and smaller lunch and even smaller dinner. Research shows that by having a larger, balanced breakfast, the glycemic response at lunch and dinner meals was more favorable than when a smaller breakfast was consumed. Breakfast sets the stage for better blood sugars all day. Additionally, having 12-14 hours between the last meal in the evening and breakfast in the morning can also support good hormone balance.
An example of a breakfast for great blood sugar control would be be something like: Two whole eggs, 1 cup vegetables, 1/2 cup fruit and 1/4-1/2 avocado. An “on the go” protein shake option would be 20g protein from organic pea protein powder, two handfuls fresh spinach, 1/2 cup frozen fruit blended with unsweet coconut or almond milk to desired consistency. This fritatta recipe is also a great start to a balanced breakfast.
Slow Down On Sugar:
Decrease refined sugars, including refined carbohydrates and sweet beverages. Juice, soda, and sweetened coffee drinks can throw blood sugars out of balance and for some, result in a fast drop in blood sugar (hypoglycemia). Both high and low blood sugar are stressful to the body. Stress, regardless of its source, increases cortisol levels and when chronic in nature can do a number hormones. Too much sugar also uses up vitamins and minerals, particularly magnesium, leaving the body depleted. Using fruits paired with protein and sweeteners like honey and maple syrup instead of white sugar can also help. For non-nutritive sweeteners aspartame, sucralose, and saccharin should be avoided at all cost, but Stevia and erythritol are quite safe.
The Foods From The Four Fats Your Hormones Need:
Short Chain Fatty Acids (SCFA): foods like grassfed butter, grassfed ghee and grassfed full fat yogurt contain a short chain fatty acids call L-Butyrate. This supports good gut bacteria, and helps the body produce more vitamins K2 and B12.
Medium Chain Fatty Acids (MCFA): Coconut products are the best source of MCFA or medium chain triglycerides (same thing). MCT oil is mostly coconut oil, but straight MCT oil is not necessarily better for you than coconut oil for what we’re talking about here. Types of MCFA’s are Lauric Acid, Caprylic Acid, Caproic and Capric Acids and they are all found in different sources MCFA’s. Coconut oil is predominantly Lauric acid which provides antimicrobial benefits too. Coconut oil, full fat coconut milk, and coconut cream are all examples of coconut sources of MCFA’s that can be burned directly as energy without the need for a glucose source, therefore helping to stabilize blood sugars and promote good hormone balance.
Omega 9 Fatty Acids: Some assume Omega 9 fatty acids are only proinflammatory, but sometimes this is because they don’t actually know what food sources Omega 9 fatty acids come from and lump them in with Omega 6, which we don’t want in too high proportions. Omega 9’s are actually quite necessary and beneficial in the right proportions and from quality sources. Sources of Omega 9 fats, also known as monounsaturated fats are: avocado, almonds and olive oil.
Omega 3 Fatty Acids: Most people are familiar with the need for Omega 3 fatty acids for their role in decreasing inflammation. Inflammation and good hormone balance are inextricably linked. Omega 3 fatty acid supplements can be used, but be sure your source is trusted as this can be one of the most poorly sourced supplements on the market. You can also take your Omega 3 fatty acid intake to the next level with delicious foods like: Wild caught salmon, mackerel, herring, tuna, sardines, chia seeds, flax seeds, walnuts and egg yolks.
Here’s an easy salmon patty recipe that incorporates 3 of these foods high in Omega 3’s!
P.S. Don’t be afraid of the sardines! They have a very mild flavor and aren’t even noticeable with the salmon
- 1 can wild caught Alaskan salmon
- 1/2 – 1 can sardines (drained)
- 2 eggs
- 1 tablespoon olive oil
- 1/4 onion, chopped
- 2-3 cloves garlic chopped (optional(
- Fresh herbs- optional (basil, sage, and thyme work well)
- 1/4 box of Mary’s Gone Crackers, crumbled
Mix all ingredients in bowl, use hands if desired to get mixed well.
Form into 5 patties and cook in stainless steal or cast iron skillet with grass-fed butter or coconut oil to prevent sticking.
Cook approximately 5 minutes on each side on medium heat.
If you are concerned that your hormones need more support than they are getting, your symptoms are not resolved despite normal labs, or you have a hunch the type of hormones being used may not be the best kind for you, we’re here to help. Contact the functional medicine specialists at in2GREAT today.
With an open mind, compassionate care, and years of experience you can be sure we will see YOU and find the best way for you to move forward into feeling great.