Lets say that a nutrient-dense, real food , plant base diet, is a great starting place but not necessarily the solution in all cases of hormonal disregulation. The most important thing that I want to get across as context for this blog is that there are two different models of endocrinology, which is the branch of medicine that deals with hormone issues. There’s the replacement model of endocrinology and the functional model of endocrinology. The replacement model is basically measuring what’s low and replacing it. So you go to the doctor and they measure your hormones. Let’s say you have low oestrogen and progesterone,( the main reason for infertility and menopause ) and you are given oestrogen and progesterone to replace those and bring those levels back up. That’s the replacement model. The functional model is slightly different. It is concerned with determining the underlying cause or source of the problem and addressing it at that level, and then once you do that, the hormones basically take care of themselves because there are basic systems in the body that are required for proper hormone function, and if you make sure those systems are functioning well, then the hormones will usually be in balance and at optimal levels. I believe in treating hormone deficiency with functional approach and replacing when required. We need to address the underlying causes to the extent , but in some cases addressing those underlying causes may not be enough to fully address the problem.
A great example of that is in people with hashimoto’s thyroiditis, an autoimmune thyroid disease that can cause hypothyroidism. What happens there is the body attacks the thyroid gland and destroys thyroid tissue, and thyroid tissue is where thyroid hormone is produced. And at least as far as we know, once the thyroid tissue is destroyed, it doesn’t come back, so if you’ve had hashimoto’s for many years before it was diagnosed and before you took any steps to reverse it, it’s possible that you’ve lost so much thyroid tissue that you don’t any longer have the capacity to produce adequate amounts of thyroid hormone internally. So in those cases, taking supplemental or replacement thyroid hormone such as thyroxine or natural thyroid extracts or any of the “bioidentical” replacements is necessary and beneficial because the benefits of thyroid hormone are so great and thyroid hormone is so universally needed in the body that the benefits of replacing it with medication far outweigh any potential side effects of that medication. So that’s one example where replacement would be part of any kind of functional plan that involves addressing the underlying causes.
What you need to know about taking hormones .One of the risks with taking hormones over a long period of time is the way that the body regulates hormone production through a process called negative feedback. We have glands in our brain, particularly the pituitary gland, that monitor levels of hormones in the body, and this is true whether you’re talking about thyroid hormone or estrogen or progesterone or testosterone or whatever. Let’s say that your thyroid hormone levels are low. Well, the pituitary as the control tower that monitors these hormones will pick up on that, and it will send out larger amounts of thyroid-stimulating hormone, which then acts on the thyroid to produce more thyroid hormone. The converse is also true. If you have high levels of thyroid hormone in your blood, the pituitary will see that and it will send out less thyroid-stimulating hormone in order to make less thyroid hormone because it sees that there’s already too much in the blood. So what happens when you take exogenous – which just means supplemental from outside of your body – hormones? Well, the levels of those hormones go up in the bloodstream and then your pituitary gland sees that and it reduces your own internal production of that hormone. Now, that may not be much of a problem when you’re taking that hormone because the hormone is coming into your body from outside, and even though you’re not making as much, you’re still getting what you need by taking it. But there’s another problem that happens when you have chronically higher levels of hormone in your blood, which is that the receptors for those hormones get down-regulated. That means that a given amount of hormone in your blood will actually have a lesser effect because the receptors aren’t sensitive to that hormone anymore. So you can develop this hormone resistance problem, and I’m sure a lot of women or men who’ve taken supplemental hormones have experienced this. What happens is the dose that they started on that was effective at first becomes no longer effective as that hormone resistance develops, and they have to continue to take higher and higher doses to get the same effect. That’s a problem that develops over time and often seen in hypothyroidism. Let’s just say that there are some cases where hormone replacement is necessary, and at the same time, we want to do everything we can to address the hormone imbalances without using additional hormones if possible. So the old motto is start low , go slow and wait and see. We have even seen some studies on, like, hydrocortisone where that feedback mechanism happens in days, where it starts to shut down internal cortisol production.Cortisol resistance is really fascinating. Some of the research suggests that what we’re calling adrenal fatigue syndrome is often not related to high cortisol or low cortisol or even cortisol rhythm problems, but instead it’s more caused by cellular resistance to the hormone cortisol.
There are five critical systems that you need to focus on in order to ensure optimal hormone production and balance, and this is true whether you’re male or female and regardless of what the hormone is that we’re talking about. The idea is that before you even start to fiddle around with taking hormones, you need to make sure you have these addressed. In some cases, it’s fine to take some additional hormone while you fix these things, but you should never take hormone without focusing on these things as well.
The systems are
1. Blood sugar
2. Adrenals or hypothalamic-pituitary-adrenal axis or hpa axis
3. The gut
4. Detoxification/liver and gallbladder function
5. Essential fatty acid balance
Let’s discuss them in a little more detail.
The first is blood sugar regulation. Now, insulin resistance, which is often a problem with blood sugar issues, affects hormones in several different ways. Insulin surges can up-regulate aromatase, which I mentioned earlier, and aromatase is an enzyme that converts testosterone into oestrogen. In men, what you often see is a normal or low normal testosterone level but a high oestrogen level, and this is commonly seen in andropause or “manopause,” and in order to fix it, you really have to address the insulin and blood sugar issue because the problem isn’t low testosterone, per se, although the symptoms are caused, in a sense, or are reminiscent of low testosterone symptoms. The problem in this case is insulin resistance. Now, in women, the way that insulin resistance or high insulin tweaks hormones is that it up-regulates an enzyme called 17,20-lyase, and this increases the production of testosterone and leads to pcos, which is the number one cause of infertility, and it also causes thinning of the hair or hair loss in the scalp, facial hair growth, weight gain, depression, and a whole bunch of other symptoms. And as a side note, pcos, I think, is a more common cause of hair loss in women than hypothyroidism. Even though when a woman is losing hair the first thing a lot of us will think about is hypothyroidism, often pcos, increased production of testosterone and/or inflammation are to blame there. What’s interesting is that not only do testosterone levels go up with insulin resistance in women, but oestrogen levels can also go up because 17,20-lyase converts dhea, which is an adrenal hormone, into the oestrogen-testosterone pathway, so all of the hormones in that pathway go up, including oestrogen, but testosterone goes up more proportionately, which is why you see the pcos symptoms. But oestrogen going up suppresses fsh, which is a pituitary hormone that acts on the ovaries, and that suppression of fsh is actually what causes infertility in that particular pattern. So that explains why blood sugar regulation is so important, and so taking steps to address blood sugar dysregulation, like eating real food, avoiding flour and sugar and industrial seed oils (I.E. Canola oil , adjusting your carbohydrate intake based on your blood sugar response, doing high intensity strength training and not sitting as much, getting enough exercise, making sure you’re getting enough sleep and managing stress – all the things that we normally talk about in terms of addressing blood sugar – are important here. There are definitely supplements. Some of the compounds in cruciferous vegetables can help reverse some of the issues that we’ve just discussed here, so upping your cruciferous vegetable intake from a food-based perspective is helpful. Dim a supplement can help in some cases with too much oestrogen , although in others it doesn’t. It can help reduce the conversion of testosterone into oestrogen. Zinc, copper , b’s , p5p, b12 , chromium, selenium , iodine all help with hormones production. These should be dosed after blood tests done.
The second problem is hpa axis dysregulation, which is also referred to as adrenal fatigue syndrome. I think this and the gut, are probably the two biggest issues with hormone imbalance. Pregnenolone is the mother of all hormones. It’s the precursor to all of the different adrenal and sex hormones that are produced in the body, and the enzyme that converts cholesterol into pregnenolone – so cholesterol is the precursor to pregnenolone, and that’s why cholesterol is so important in the body. But really low cholesterol can be a problem for hormones .The enzyme that converts cholesterol to pregnenolone is limited, and it requires a lot of atp, which is cellular energy. It’s an energy-intensive process. That means that the amount of pregnenolone we can make in the body is limited, and there’s something called the pregnenolone steal that I’m sure many of you have heard of ( if not google it) which describes a process where the majority of the pregnenolone that we produce on a daily basis is channeled into cortisol production, and this happens when we’re under a lot of stress because cortisol is one of the hormones that’s involved in the stress response. So if you’re not sleeping well, you’re not managing your stress, you’ve got a lot of stuff going on in your life, and/or you have gut infections or you’re eating a poor diet or you’re dealing with any kind of chronic illness/injury/pain problem, that’s going to create a stress response in the body, and that in turn will divert pregnenolone into that cortisol pathway, and it takes it away from the dhea pathway, and the dhea pathway, if you go down that road, that’s where oestrogen and testosterone are produced. So if you have low dhea levels on a lab, that’s often a sign of pregnenolone steal, and getting back to the replacement model, if you just give that patient more pregnenolone, it can actually make things worse because it just channels more raw material into that cortisol pathway. The solution in this case is that you have to decrease stress physiology, so you have to address the underlying causes of the stress, whether it’s a gut infection or poor diet or lack of sleep or emotional/psychological factors. You have to also address blood sugar issues because that can be a stressor on the body. Insulin resistance can lead to elevated cortisol levels, and high cortisol levels can lead to insulin resistance. And of course, you need to do all of the other things that we’ve talked about at length to manage stress, so making sure you’re getting enough sleep, doing some regular stress management, addressing any gut issues or any other chronic health issues that are causing a stress response in the body. Managing stress is hard to do. But what I can tell you in doing a lot of testing, treating well over a hundred patients now with these kinds of problems, almost every man or woman with a sex hormone issue, like in women they either have low progesterone and oestrogen dominance or excess testosterone or men with low testosterone, I can tell you that virtually every single one of these patients that I’ve treated had an underlying hpa axis issue. So I can’t emphasize this enough. You have to address the adrenal side because if your pregnenolone levels are low or they’re getting diverted into cortisol because of stress, you just will not have enough raw material to make the sex hormones, and that can lead to infertility, it can lead to menstrual cycle issues, mood imbalances, low libido – all the classic hormone symptoms. I’ve noticed that dietary changes are challenging for people, but a lot of people have an easier time doing that than making the changes to deal with stress management.
The next area of focus is the gut, and again, this is right up there with the hpa axis in terms of its importance. Impaired gut function can mess with hormones in several different ways, so if you have a parasite or a fungal overgrowth or dysbiosis or leaky gut, that causes inflammation. Inflammation suppresses the function of the hypothalamus and the pituitary in the brain, which produce the stimulating hormones, and then it also suppresses the function of the adrenals and the ovaries and the gonads in men that produce the actual hormones. Inflammatory cytokines can also cause hormone resistance, which we talked about just now, where the levels of hormones may be fine but the receptors on the cells aren’t sensitive to those hormones, so you end up getting the same symptoms. Dysbiosis has been shown to increase the activity of something called beta-glucuronidase, which reverses hormone conjugation in the liver, which means that you get a recirculation of deconjugated hormones like . Dysbiosis also increases the production of certain downstream oestrogen metabolites like 4-oh and 16-oh, which are proliferative. (I.E. Cancerous) that means that they actually can contribute to breast and prostate cancer, and dysbiosis decreases the production of 2-oh, which is protective against those conditions. I mean, this is just a tiny sliver of the ways that gut issues can affect hormone production. Suffice to say that healing your gut is a really crucial part of addressing hormone problems. I like using tcl gut repair with lemon juice three times a day , and a good probiotic with over 60 billion potency , daily fibre added to the diet. This is after all potential but infections screened and removed.
The next or number four issue is proper detoxification. The importance of detoxification, is that the liver and gallbladder play an important role in clearing excess hormone from the body. Defects in hormone detox can cause hormones to be only partially metabolized, and discussed an example of that with beta-glucuronidase and the recirculation of oestrogens back into the blood and how that can cause oestrogen dominance. Partially metabolized hormones compete for receptor sites with active hormones, but when they bind to the receptors, they don’t have the same effect, so they actually block the receptors from the active hormones, and that ends up throwing off proper negative feedback that we talked about before, which is the way that hormones are regulated in the body, and the end result is you get a patient with symptoms of hormone imbalance but relatively normal labs or a patient that’s extremely sensitive to any drugs or supplements. A growing issue, right, and there are some genetic mutations that predispose people to that, but those mutations generally won’t be activated epigenetically unless there’s some kind of issue here with impaired detox pathways. Of course, the key here is to make sure those pathways are functioning well and to reduce the toxic burden that we’re exposed to. We’re exposed to toxins in food, of course, with the standard australian junk food diet, the flour, the seed oils, the excess sugar, the chemicals, preservatives, and things that are increasingly used in processed and industrially refined foods, but there are also environmental toxins like bpa and phthalates and the many other chemical agents that are introduced into our environment every year with very little regulation or concern for safety. So using natural skincare and cosmetic products, shampoos, soaps, natural home cleaning products – all of this can help reduce the toxic burden and give our detox pathways a little bit of a break. And then there are a lot of things that we can do to improve detox capacity, like improving our methylation status, improving our glutathione levels, etc. Drink carbon filtered water with supportive herbs.
The last concern for hormone balance is fatty acid balance. Fatty acids are precursors to compounds called prostaglandins, and prostaglandins, in turn, modulate hormone receptor sites and our response to hormones. Excess omega-6 fat can lead to a number of different problems, and one of the problems that this can cause is altered hormone receptor function. Too much omega-6 and not enough omega-3, the long-chain omega-3’s like epa and dha, essentially ends up driving the production of prostaglandins that are proinflammatory. So you have not enough omega-3 and too much omega-6, that leads to an inflammatory environment, but if you get sufficient amounts of omega-3 by eating cold-water fatty fish or taking fish oil, epa and dha, that promotes the conversion of the prostaglandins into less inflammatory substances or pathways. And then epa and dha, the longer-chain omega-3’s, also improve insulin sensitivity and glucose tolerance.
What you’ve probably noticed with all five of these systems is they’re important to focus on in their own right, but they all are also interacting with each other. Blood sugar problems can lead to adrenal and hpa axis issues and vice versa, gut issues can cause adrenal and hpa problems, and having chronic so-called adrenal fatigue can definitely make it more likely that you’re going to have gut issues. Inflammation from fatty acid imbalance can affect the gut and the adrenals and blood sugar. These are the five fundamental areas that you need to focus on to maintain proper hormone balance, and any approach you do, whether you’re taking replacement hormones or not a great way to get back in balance.
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