By Dr. Shawna Darou, ND
The thing most people find puzzling about a Naturopathic and Functional medicine approach to hormone imbalance, is that we rarely treat the hormones directly. Instead we are looking for where the body is out of balance, because this is what influences a change in hormone production, or a change in sensitivity to hormone levels. Everything is interconnected, so going straight to the hormones is not the best strategy, and will likely cause more side effects if we go there first.
Another way of saying this, is that we are looking “upstream” – asking why the hormones are out of balance. Determining what is causing an increased or reduced production of hormones, increased sensitivity to hormones, slower detox of hormones or a change in the transport of hormones.
It may surprise you that where we start with hormone imbalance is the same whether you’re going through puberty, trying to conceive, or at perimenopause. The three most important factors to address for optimal hormone balance are:
- Blood sugar balance
- Stress levels
- Gut health
When we optimize each of these systems, you’ll find that many hormonal symptoms such as premenstrual mood swings, irregular cycles, hormonal acne, heavy flow, breast tenderness, food cravings and sleep disruption will improve. The following image shows many of issues that we consider for hormone balance, and we’ll get into detail with the most important ones.
1. Blood Sugar Regulation
Eating to for blood sugar balance is especially important for PCOS (polycystic ovarian syndrome), but it also applies to many other hormonal issues. When you’re eating too many high carbohydrate foods over a period of time, insulin levels climb creating ‘insulin resistance.’ The relevance for hormone balance is that high insulin levels cause low ‘sex hormone binding globulin’ (SHBG) which leads to higher circulating free-hormones. It there are higher free hormones, there are more hormonal symptoms, especially acne, hair growth issues (increased facial and body hair), hair loss on the head, and more exaggerated PMS symptoms.
Along similar lines, high insulin levels are also associated with abdominal weight gain. Carrying too much visceral adipose tissue (VAT) on it’s own creates a higher estrogen load, since this type of fat cells produce estrone, one of the stronger estrogens. Extra abdominal weight is associated with all estrogen-dominant conditions: especially heavy periods, uterine fibroids, high estrogen levels during perimenopause and painful periods.
On the flip-side, there are hormonal consequences of fasting and low carbohydrate intake. Both situations create metabolic stress, which can impact ovulation creating irregular periods or amenorrhea (absent periods). Fasting for prolonged periods, even the popular intermittent fasting or time-restricted eating creates hormonal abnormalities in many women after a few months. This usually begins with a drop in free T3 levels (your metabolism is slowing down), and then can lead to changes in the menstrual cycle, and also low-thyroid symptoms such as fatigue and hair thinning. Similarly, women’s bodies need carbohydrates to maintain a regular cycle with regular ovulation. Eating too low carbohydrates during the peak reproductive years especially (20’s and 30’s) can cause a disruption in your cycle.
2. Stress Levels
In very simple terms, chronically high stress will amplify any type of hormonal issue, and most of us are living in a state of chronic stress. Here are a few ways that imbalances in stress hormones can impact your hormones:
- Low progesterone levels and short luteal phase
- Irregular ovulation or irregular periods
- More anger and irritability with PMS
- Changes in the gut microbiome which alters hormone detoxification
- Increased sensitivity to pain, including menstrual cramps
- Reduced fertility through multiple mechanisms
- Lower thyroid function, causing weight gain, cold sensitivity, longer cycles and dry skin
When we talk about stress, it’s not just your work stress or emotional stress that counts. All sorts of physiological stresses also stack up creating an accumulation of factors all impacting stress hormones. For example: lack of sleep, blood sugar irregularities, chronic pain or inflammation, food sensitivities, toxin exposure, over-exercising, chronic infections – all impact your stress response.
What this means however, that you can lower your overall stress by tackling some of the simpler things on the list: practices such as eating regular meals, exercising moderately, getting enough sleep and avoiding food sensitivities can make a significant impact. This will lower your load of stresses significantly and bring you farther from your tipping point.
The next step is to bring in practices to activate the relaxation response on a regular basis: meditation, time in nature, breathing exercises, heartrate variability, along with body work that calms the nervous system such as acupuncture, osteopathy and massage. Each of these practices will have a positive impact on your hormone balance, whether it’s irregular periods with PCOS, hot flashes at perimenopause or mood swings with PMS
3. Gut Health
The link between your gut and your hormones is one that many people are not aware of. Let’s start with the pathway that your body uses to clear out estrogen, when all systems are functioning optimally:
- Estrogen is first sent to the liver where it is deactivated
- It then passes into bile to be excreted into the intestines.
- Estrogen ideally stays inactivated, where it then exits the body though the stool.
When the gut microbiome is out of balance, certain bacteria which are now termed the “estrobolome” produce an enzyme called beta-glucuronidase that reactivates estrogen so that it goes back into circulation. Similarly, if you are chronically constipated estrogen is not being eliminated very effectively and is also being reabsorbed. Both of these situations create an excessive load of estrogen.
When estrogen is out of balance, and specifically being recirculated, we end up with an excess of estrogen, also called estrogen dominance that can cause many symptoms of hormone imbalance: heavy periods, painful periods, difficult PMS, breast tenderness, bloating and weight gain. It can also contribute to the long-term risk of conditions such as uterine fibroids and breast cancer.
Steps you can take to balance your estrogen through the gut:
- Eat more vegetables and increase fibre intake: Fibre from vegetables especially helps to create a healthy microbiome, and reduce beta-glucuronidase activity.
- Reduce sugar and alcohol, both of which negatively affect your microbiome and how you clear out estrogen.
- Take a probiotic: Even simple probiotics such as Lactobacillus acidophilus can improve your estrogen metabolism by decreasing the activity of beta-glucuronidase.
- Get help with clearing out the ‘bad bugs’– yeast, bacteria and parasites. With the right nutrition plan, anti-microbial supplements and a good probiotic we can very easily restore balance to the gut microbiome in a way that can profoundly help your hormone balance.
Focusing on the gut is the number one treatment for PMS mood swings, breast tenderness, bloating, food cravings. Rebalancing the gut microbiome, especially clearing yeast, adding fibre can make a phenomenal difference.
If you would like to really understand your hormone balance, and get to the root cause we begin by assessing each of these three categories: nutrition and blood sugar balance, stress levels, and gut health. It is remarkable how the body will bring hormones into balance when you treat the underlying cause. Hormones are truly my passion, and understanding how everything interconnects to create balance in mood, energy, motivation, fertility and outlook is a gratifying process with amazing results.
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