Getting your bounce back is possible. Low libido has many causes ranging from low testosterone or iron to body image dysmorphia, chronic stress, and hormone imbalance.
The DUTCH Hormone Panel
Functional lab testing is thorough and shows what’s really going on. Hormone health can be complex. I see so many patients who are at the end of their rope. Why am I so tired? What makes my period heavy or irregular? My doctor wants to put me on the birth control pill and an anti-depressant. Is there anything else I can do? I want a natural approach. I don’t feel heard.
The Dutch test is different than the adrenals stress index and saliva tests that are typically done. Its the most comprehensive in that we see both the total and active forms of cortisol which can indicate patterns of metabolic or thyroid disease. We also see all the sex hormone metabolites which is helpful for treating and preventing a number of hormonal imbalances including PCOS, painful periods, irregular cycles, and yes: low libido.
Stress is Primary
Low libido and other hormone imbalances are likely to occur when stress is too high for too long. Cortisol is upstream of all of these other hormones.
Nutrient imbalances are another cause. Iron deficiency and other types of anemia play a role in low libido. Basic survival needs have to be covered in order for us to have the energy for sex. This makes sense from an evolutionary perspective because having children when there is famine or the threat of predators and war is not ideal. For many people today their physiology is telling them they are in a time of threat when in fact they have a shelter, food, and loved ones around. This can be due to trauma, gut infections, overwork or a difficult relationship. Recent research looked at the effects of being in a relationship that is not healthy. This situation actually affects the gut microbiome negatively as well as the mood.
Four Triggers to Keep in Check
Perceived stress: new, unpredictable & individual based on past experience, belief systems. Some new and unpredictable stress can be exciting. It can help us expand and grow but too much is not good.
Inflammation: purely a physiological thing which adds to our allostatic load or what we can handle.
Blood sugar dysregulation: which is an epidemic in our country, and also physiological.
Circadian disruption: too much exposure to artificial light at night and not enough exposure to natural light during the day. It’s only in the last 150 years where we’ve had significant amounts of light at night.
Pleasure and Play
Saying “no” and building in more downtime are great ways to manage stress and kick your libido into gear. The more we allow ourselves to do things we enjoy the more we wire our bodies for pleasure. Things like a meditation practice, yoga, deep relaxation or any other way you know to connect with your body are great. When we get real rest (meaning away from screens) then we have more energy to move, have fun and socialize. These are key for a full and happy life.
Endometriosis happens when the endometrial tissue is found growing outside of the uterus. This tissue is shed each month during menstruation if it’s where it normally should be. When it spreads to the pelvis, ovaries and fallopian tubes it can’t be shed. Lesions, or nodules, then cause severe, chronic pain or infertility. It is difficult to diagnose endometriosis without surgery. Ultrasound and other imaging can’t rule it out but new options are emerging.
Debilitating pain during menstruation, during and after intercourse, and bladder or bowel problems also occur. One out of ten or up to 200 million women are affected. There is a lack of knowledge in the public and medical community about endometriosis. This means many women don’t get the help they need & there are likely many more suffering than are reported. Pelvic pain in women is often minimized.
Difficult to Diagnosis
Symptoms associated with endometriosis are not unique to the condition itself. I saw two patients this week who experience chronic pelvic pain. When there are hormone-related symptoms and digestive issues, both need to be examined. Each of these women suspects endometriosis as a possibility. One would like to avoid surgery while the other is ready for more information now.
Laparoscopic surgery is currently the only way to properly diagnose endometriosis. During this surgery lesions can be removed if discovered. There is currently no cure in conventional medicine. Anti-inflammatory drugs are used along with birth-control pills to suppress estrogen & ovulation. The Merina IUD is used to suppress the uterine lining. Surgery is the gold standard but is usually followed up with hormonal treatment because endometrial lesions regrow within 5 years in 50% of cases.
Functional Medicine For Endometriosis
There is convincing evidence that endometriosis is autoimmune. Addressing underlying cause shows positive outcomes clinically. I’ve seen this. We do this by improving immune function and reducing inflammation naturally. This can be done with or without other treatments like surgery.
Diet Has A Huge Impact
Avoid dairy and gluten: Both A1 casein from cow dairy and gluten contribute to endometriosis. Eggs can also disrupt immune function in some people by stimulating the release of inflammatory cytokines. Other autoimmune triggers that can be ruled out through an elimination diet are nuts and seeds or nightshades.
A few of my favourite ways to address underlying causes:
N-acetyl cysteine (NAC) acts as a liver support to remove excess estrogens. It also supports gut health and acts as a natural anti-inflammatory. In a clinical trial it was used to treat endometriosis. Lesions were reduced by 1.5 mm in those treated whereas the control group saw a 6.6 mm increase in size. Of those treated, most cancelled their laparoscopic surgery after the trial because of the significant reduction in pain. The researchers concluded, “NAC represents a simple, effective treatment for endometriosis, without side effects, and a suitable approach for women desiring a pregnancy”.
Turmeric is a well known anti-inflammatory. In research specific to endometriosis it reduces the size of lesions and a reduction in activity. More research shows that it blocks the stimulating effect of estrogen. Turmeric is best taken in a concentrated form where the active components are bioavailable.
Berberines also repair intestinal permeability and is anti-inflammatory. Its anti-microbial action treats bacteria in the gut reducing endotoxins which may contribute to endometriosis. Berberines can only be taken short-term and not during pregnancy and breastfeeding. Please talk with a health professional.
New Technologies for Research & Diagnosis
I’m checking out a female run company called Dotlab. I pulled this quote off their website:
“When did we accept that a woman can wait years for answers to her health? Did it begin when her physician mistook her chronic pain as “all in her head?” Was it when she paused at the thought of laparoscopy for diagnosis, not ready to face the physical, emotional, and financial burdens of surgery? At DotLab, we’re ending the delay because an easy test means an early, actionable answer.”
Another tool is an app called Phendo. It was created by researchers at Columbia University. It seeks to understand disease from the perspective of the patient. NextGen Jane is another project.
Menstrual blood is being researched to diagnose because it has not only endometrial lining but also, cervical and vaginal cells. Hopefully we’ll be seeing more clinical trials using this information to shed light on endometriosis and other diseases. Early detection is an important step in reducing the suffering.
Migraines are common and disabling to people. They make up 5% of hospitalizations, and 20% of neurology consultations. Women experience them twice as much as men. Those with chronic migraines can end up relying on strong pain medications.
Migraines are usually associated with other symptoms such as nausea, vomiting, dizziness, extreme sensitivity to lights, noises, and smells, lack of appetite, and disturbances of bowel function. I am seeing more people suffering with these extreme symptoms so I wanted to break-down the different causes, testing and treatment.
Premenstrual syndrome can be a trigger for migraines. Vitamin E is an effective treatment for menstrual migraines. It does this by lowering prostaglandins without any negative side-effects.
Use of an oral contraceptive pill or hormone replacement therapy can lead to too much estrogen and not enough progesterone. This is another hormonal imbalance that can lead to hormonal migraines in menstruating women or those in peri-menopause.
A whole-food, low-glycemic diet that is high in phytonutrients with plenty of organic flax, fermented soy, and cruciferous vegetables such as broccoli, cabbage, brussels sprouts and cauliflower can help. Avoid alcohol as it contributes to leaky gut. Caffeine, sugar, and refined carbohydrates should be removed as well. Exercise and stress reduction techniques are also key.
Mitochondria & Cellular Health
Along with migraines you may feel fatigue, muscle aches, and brain fog. This can be a methylation defect or simply poor cellular regeneration. Mitochondria are the powerhouses or batteries of our cells. Certain micronutrients like B vitamins (especially B2) and CoQ10 are essential for mitochondrial function. Other b vitamins, alpha lipoic acid and vitamin c are also important. An organic acids test lets us see the weak link.
Magnesium is also important for mitochondrial function. A deficiency can contribute to migraines, constipation, anxiety, insomnia and other stressors. Feeling of irritability, noise sensitivity, muscle cramps or twitching, and heart palpitations are possible symptoms. Magnesium glycinate is best for muscles whereas citrate targets constipation. Magnesium theonate is specific for brain health.
The connection between migraines, constipation and liver function is well understood in Functional Medicine. Our bodies filter chemicals and hormones the liver. They are released through the colon. If the liver detox capacity or digestion is impaired there is a build-up. This toxic load often ends up in the bloodstream where it can cross the blood-brain barrier. If you’ve heard the term ‘leaky brain’ this is what its referring to.
Chemical responses are also be triggered by certain foods. Processed-food diet including aspartame, MSG (monosodium glutamate), nitrates (in deli meats), sulfites (found in wine, dried fruit etc) are all common chemical triggers. Tyramine-containing foods like chocolate and cheese are also worth checking.
Digestion & Migraines
Brain fog, bloating, irritable bowel syndrome, joint or muscle pain, and sinus congestion can all indicate an imbalance of the microbiome. Whether its a food related trigger or not, an elimination diet is a good way to start. Remove gluten, dairy and eggs. Corn can also be a problem. Stool testing is used to assess possible pathogens or dysbiosis as well as inflammation and triggers. Urine testing is excellent for fungal yeast, mould or bacterial imbalances.
The Conventional Approach
A diagnosis of chronic migraines is given to those where over 15 days of the month are migraine days. Triggers are sometimes identified and a prescription of preventative medication can be taken daily. These medications all have side effects. None of them cure migraines. Some of them have a rebound effect, meaning when the medication wears off, a rebound headache occurs.
The most popular form of birth control in the industrialized world is the pill. Ninety-nine per cent of women have used this synthetic hormonal contraceptive at one time. Despite evidence indicating there are health risks associated with it, one-quarter of women using non-permanent forms of birth control choose the pill. Other options used are the patch, implants, injectables, vaginal rings, condoms and IUD’s. Ten percent use fertility awareness methods. Vasectomies make up 13%.
The pill depletes our healthy gut bacteria and can cause yeast overgrowth or other infections. Dysbiosis in the gut has been linked to migraines, fibromyalgia, endometriosis, psoriasis, depression & even infertility. Often women who have been on the pill for years can have trouble conceiving.
To metabolize hormonal contraceptives, the liver requires extra B vitamins, vitamin C, magnesium and zinc. If your diet is poor & your digestion is inhibited then you won’t have these essential nutrients available to you. Other health issues are likely to arise.
The pill is prescribed commonly for many reasons including fibroids, pain, PCOS, skin issues, PMS and heavy cycles. Its often paired with an anti-depressant for mood issues. Evidence indicates that most women know the pill affects their whole body. One of the main negative side effects is on mood.
I’m part of that 1% who never took the pill. So what have I done instead?
Get to Know Your Cycle
Strengthening your natural menstrual cycle is an excellent way to optimize your health in general. If you want energy, a libido and the ability to get pregnant then track your cycle. Maybe you simply want to enjoy sex without fear of harming your body. I know a master herbalist with teenage daughters who agrees with this approach. We don’t want to suppress the body’s wisdom. We want to get to know it, respect it & work with it.
There are 3 simple ways to know when you ovulate: waking temperature, cervical position and cervical mucus. The last two require that you to be intimate with your body. Learn how to contact your cervix. Notice the monthly discharge that comes with feeling aroused or a sensation in the ovaries which some women experience. Temperature can be charted by technology. I suggest trying all these methods & relying on two.
The Lady Comp takes your temperature and tracks your cycle. This device will chart what is happening for your fertility. It lets you know with a simple red, green or yellow light. On the green days you don’t have to worry at all. Our fertile window is about 6 days so the rest of the month will be in the green meaning good to go.
The longer you use it the more data you have. There is a six hour window in the morning to take you temperature but it has to be taken upon waking. Any movement or activity will alter your temperature.
There are many devices and apps available to make tracking temperature easier. This is just one that also offers a fertility aspect.
Fertility and Influencing Gender
If a baby is what you want then you can get the baby version of Lady Comp. It allows you to turn it to the best time to make babies and how to optimize your chance of having a boy or a girl. It can do this b/c male sperm move faster and female sperm last longer.
Risks associated with Contraception
Estrogen dominance, blood clots, osteoporosis and cancers are all associated with long-term use of hormonal contraception. I’m not going to go into detail about this but have a look at this research for more information.
The copper IUD can lead to chronic inflammation and deplete the body of zinc because zinc balances copper. It can also have a negative impact on gall bladder function.
Many of my colleagues agree that this era of birth control use on a massive scale will be looked back on as a very strange time in the history of women’s health.
Get Your Sexual Partner(s) On Board
Thirteen percent of men choose to have a vasectomy. The rest of them can get on board with understanding women’s cycles. The best partner knows his partner’s cycle better than she does. This allows her to relax, feel safe and enjoy herself.
Talk about fertility, family planning and why you do or don’t want a baby. Fertility is an integral part of sexuality. A woman’s ovulatory cycle can be a fun part of your sex life.
Let me know what you think! I’d love to hear from you.
In the last decade, oral contraceptive usage has dropped. This suggests a collective desire to regain control of our bodies and health. Many women report headaches, weight gain, mood issues and a host of other symptoms from taking the pill.
What is replacing the Pill?
Last time I visited a sexual health clinic I was pleasantly surprised to see the fertility awareness method (FAM) included on the intake form. FAM has not always been an accepted form of contraception. This was the first time I’ve seen it alongside the IUD and hormonal birth control.
I have never taken oral contraceptives. Not once although it seems like such an easy option. My mom told me how they work. This encouraged me to explore other options. When I asked about FAM and the IUD in my 20’s I was laughed at by clinicians. That’s putting it lightly. The sexual health clinics were somewhat coercive. If I wasn’t there to get the pill why had I come? I had read Taking Charge of Your Fertility and was getting to know my body.
Research,Technology & Men
Today there are a number of new books on the subject. There are also cycle-monitoring apps and social media groups devoted to fertility awareness. Packed with research, these offer accessible information. Learning what’s normal is a big deal. Then we can get support about what’s happening with our menstrual cycles.
In the 90’s, the intrauterine device (IUD) wasn’t offered to women prior to giving birth. Now women can choose the copper or Mirena IUD whether or not they have children. These devices can be disruptive in other ways but work well for some women who want to avoid the side effects that come with the pill. The Mirena has hormones and a woman may still lose her cycle. With the copper its important to monitor your zinc: copper balance. Some women also experience gall bladder issues or other pain along with a heavier cycle.
One of the most important changes that is occurring is men taking more of an active role in fertility and contraception. I presented at a conference a couple years ago and was speaking to this. A master herbalist was following me on stage. I invited him into the question and answer portion of my talk.
Supporting women’s menstrual cycle is a way to prevent unwanted pregnancy. He explained that he knew exactly when his wife was ovulating. Instead of showing his daughters what herbs prevent pregnancy, he shows them how to normalize and track their cycle. It is encouraging to have male allies in this important work. Men are getting on board with cycle tracking. This allows women to relax and enjoy their bodies more.
‘A Women’s Health Epidemic’
This shift comes at a time when our collective hormonal health seems to be getting worse. Experts know this is largely a result of our modern lifestyle. High stress, environmental toxins like xenoestrogens and a diet high in processed food are all factors. Then there is a lack of research and focus on women’s health. Conventional medicine rarely tests hormones. Invasive interventions are offered before gathering basic information that directly relate with women’s symptoms.
“I absolutely believe we are in a women’s health epidemic,” Nicole Jardim, a New York-based hormone expert.“I believe that there are a number of different reasons why that’s occurring right now. Most of them can be attributed to the fact we live in a crazy modern society. Women have super-human expectations of themselves. Other people have them too.” This creates a lot of pressure and stress.
Jardim is a nutritionist and holistic health coach specializing in hormonal and reproductive health. She says that electronic addiction and poor nutrition wreak havoc on women’s bodies.
“Combine that with the insane stress so much of us are under, our lack of sleep and I think we have a perfect storm for hormone imbalance,” she adds.
All the Same Root Cause
Ninety percent of women experience difficulty with PMS now. Polycystic ovarian syndrome, breast cancer and difficultly with menopause are not as separate as they first seem. Underlying all of them is a lifestyle and environment that is mismatched with our bodies.
We can shift this culture by learning to adapt and care for ourselves differently. Enough meditation and rest is important. Choosing medical marijuana instead of harmful pain medications is another step we can take. Getting thorough hormone testing is also very empowering.
Permanent sterilization by a procedure called Essure was approved by Health Canada in 2001. It was sold in the US until just a few months ago when it was finally banned. Bayer bought this product in 2011 despite many complaints from users of its safety and efficacy as a contraceptive device.
There are now an estimated 16,000 lawsuits filed against it. Women have reported severe injuries, including perforation of the uterus and the fallopian tubes. Several deaths, both of mothers and infants, have been attributed to the device or complications arising from it.
Bayer officially states it stopped sales prior to the ban not because of safety. They said a decline in its use prompted them to stop because women were simply choosing other options. The company denies that it was due to the litigation or the complaints.
Women and advocacy groups repeatedly demanded that the Food and Drug Administration ban the device. The FDA repeatedly declined until recently.
What is Essure?
It was meant to replace tubal ligation for women which is an invasive procedure. Micro inserts placed into the Fallopian tubes via the cervix are meant to elicit enough scar tissue to block the tubes. They were manufactured to stay in the body permanently. What are they made of? Heavy metals and polyester.
Today the FDA has received ten of thousands of complaints regarding the devices. Dr. Shawn Tassone, OB/GYN is a patient advocate. After seeing patients of him suffer and get pregnant with the device he figured out how to remove it safely. He is now training other doctors to remove Essure. Surgery for removal requires general anesthetic but only takes 30-45 minutes. Recovery time is 2 days to 2 weeks.
Dr. Tassone mentions that the only safe sterilization method available is the vasectomy for men.
“Women have reported serious complications from Essure, and there has been no unbiased long-term research to refute or confirm those reports,” Diana Zuckerman, president of the National Center for Health Research. “Both the FDA and the company are responsible for a situation where women could not make informed decisions.”
It should never have been approved. Why is it protected?
Women who reported severe injuries, including perforation of the uterus and the fallopian tubes. Several deaths, including of a few infants, have also been attributed to the device or complications from it. Reports of severe abdominal pain are often dismissed by doctors even after several visits to the ER.
I’m reminded of the Dalkon Shield of the 1970’s which should never have been on the market. This IUD was dangerous but got passed for profit. I lost a sister because of this device. My mother’s doctor suggested in place of a copper IUD which was working just fine for her.
How does this still happen in 2018?
Dr. Tassone mentions that somehow Essure received a label which protects the device itself from legal action. This protection is usually only given to products that are used in life-threatening surgeries like a heart stint.
Dr. Tassone goes on to say that we would never react this way if a man’s testicle was perforated and he was experiencing the kinds of side-effects these women have. I looked at a support group where there are 40 000 plus women are sharing the negative side effects they’ve experienced. What’s worse is they are having trouble getting these devices removed because doctors aren’t taking them seriously. Its ‘just abdominal pain’. Seriously? We can do better than this.
When it comes to their hormone health, visiting a doctor is the last thing many women want to do. Why is this? Writer Maya Dusenbery explains why in her new book called “Doing Harm”. I came across her work recently. I want to highlight a few points. Her research points to one of the most common things I hear in clinic.
“I Feel Dismissed by my Doctor”
For decades women have been left out of clinical research. It wasn’t until the 90’s that law suits changed this. Isn’t this shocking! It was to me. Huge studies happened with no women involved. The FDA was excluding all women of childbearing age. It’s not surprising that we are still seeing a huge gap in women’s care. Especially if you consider the number of years it takes for research to filter into the conventional medical system,
Endometriosis is a good example. There is very little research on this topic yet 1 in 10 women are affected. It is common that a woman suffers debilitating pain for a decade before receiving a diagnosis. This is partially because it takes time for the condition to develop. Women’s symptoms are also minimized in a system with insubstantial evidence to support what they are experiencing.
The Knowledge Gap
Women’s health concerns have not been prioritized. Diseases and syndromes that affect women more than men receive less attention. There is a gap in knowledge because of the lack of research. Doctor’s don’t know. We see intelligent women dismissed when they know something isn’t right. Opportunities for early intervention and preventative treatments are lost. Compounding this, women are also more likely than men to have negative responses to pharmaceuticals.
Let’s continue to discuss endometriosis to understand how this plays out. The level of pain a woman with endo experiences is much more intense than regular menstrual cramps. Her symptoms are dismissed as ‘just part of being a women’ and she feels unheard. Wouldn’t you start to feel crazy?
Hormones are Neglected
Hormones are rarely tested but hormones are offered as treatment all the time. There are obvious problems here. Estrogen dominance may be an underlying cause. Instead of finding out why estrogens are building up in the system, it’s assumed that progesterone is low. I’ve seen patients with excess estrogens who don’t have low progesterone. Natural progesterone isn’t always the answer. Even if it is indicated, there are likely other imbalances to rule out including autoimmunity. Endometriosis is often autoimmune and this is usually ignored.
Imagine this patient who has suffered for years. She has likely made some changes and can manage symptoms better than before. Then a stressful life event occurs. Perhaps she’s pursuing a Masters degree. Maybe she’s trying to get pregnant and can’t. Without the right information and support its difficult to maintain a lifestyle that prevents endometriosis from spreading. Finally she gets a referral to a gynecologist. Surgery is offered. Then multiple surgeries. Then a hysterectomy.
Surgery doesn’t treat the root cause
Whether surgery happens or not its not addressing the underlying cause. Autoimmunity effects women far more than men. There are reasons for this. Our hormones influence our gut health differently. We are more susceptible to IBS or SIBO. On the flip side our hormones protect us from heart disease. When we do present with heart disease it takes longer for us to be treated because the presentation is different. There are reports of young women being turned away at the ER during a cardiovascular event because of this.
The researcher I mentioned discovered that women commonly take a male family member with them to the doctor so they are taken seriously. I had one patient who did this at my clinic. After she discovered that I listened, she stopped bringing him along. We made significant progress. She thanked me several times for helping her understand why she was having the symptoms she was having.
The added stress and anxiety of not being heard is compounded by the fact that a male voice might be given more weight. When it comes to your body, you are the expert! Women know they might be considered a difficult patient and passed along.
Learning To Listen
My focus for many years was working with marginalized populations. I’ve always been curious about the strength and resilience of people who are treated unfairly in a broken system. Within this current medical system there are heroes.
There is a gynecologist who is listening to what’s happening to his patients and responding. He knows that avoiding hysterectomies is ideal. He discusses best practices, the role of diet and the sinister side of pharmaceuticals. I met him in one of my functional medicine forums. People like him inspire me to continue this work.
PMS affects at least 75% of women. That’s right, the majority of women are feeling it. Of these some suffer more than others. Twenty percent of women with PMS require regular interventions with medication. Eight percent have symptoms so severe they are now labeled with premenstrual dysphoric disorder (PMDD).
What is the underlying cause of PMS?
PMS is not inevitable. It does not require medical intervention in most cases especially if we address the root cause. Are our bodies so flawed that we need ongoing medication to manage monthly symptoms? Hell no.
What I learned first from my mother and from my education is that our bodies are extremely intelligent. I love working with women in clinic. So much about their overall health is gleaned just from the specifics of our cycles. This is true even if a woman is no longer menstruating.
Symptoms associated with PMS include: irritability, depression/anxiety, headaches, mood fluctuations, fluid retention, bloating, breast tenderness, sugar cravings,and insomnia.
The number one cause of PMS is excess estrogens being recycled through the body because the liver is overloaded by stressors and the gut is not able to help in eliminating these properly so they recirculate. A diet that includes industrial raised meats and dairy contributes. Environmental toxins also play a major role.
“Isn’t this just part of being a woman?”
No its not and you shouldn’t have to suffer. What big pharma wants you to do is use birth control pills, antidepressants & NSAIDs like Advil. If you are diagnosed with PMDD you may be prescribed Danazol. Sounds like it comes with sparkles, doesn’t it? What it actually does is suppress ovulation. I personally enjoy ovulation and wouldn’t want that to be taken from me. It also increases facial hair, acne, and can deepen your voice.
An expensive drug that affects gonadatropin-releasing hormone (GnRH) is emerging. It changes brain chemistry to turn off the ovaries’ production of estrogen and progesterone. Osteoporosis is a side effect. Diuretics are used to treat fluid retention. A drug called Bromocriptine is used to stop prolactin production and is used to treat breast tenderness. Seriously? In one cycle we can resolve breast tenderness easily without a drug that inhibits an important hormone.
Dr. Mark Hyman highlights that PMDD was created at the same time that the patent on Prozac was running out. Prozac is now called Sarafem (really?! Sara Fem?) and has a new indication. That’s right folks. Prozac has a new name and is being used to treat the new disease PMDD.
I’ve worked with patients who have declined the oral birth control pill and antidepressant offered to them by their doctor. Instead we make a few changes and symptoms resolve usually within a couple of cycles.
What Can You Do?
Move your body. This includes anything you feel better during and afterwards. Consensual sex is highly indicated along with dancing, trail walks, cycling, swimming or any sport you enjoy. Strength training gives you the most bang for your buck when it comes to hormone health.
Love your liver with a diet rich in colourful vegetables. Grow your own or have your local farmer do it for you. Eat grass-fed and nose to tail as this balances the amino acids that support both phases of liver detoxification. Reduce caffeine as this does the opposite.
Eliminate excess estrogens from your diet and environment. Clean out your bathroom and kitchen! This is where we have power to create change. The largest unregulated source of pollutants is right in your home. If you can’t read the label and wouldn’t eat most of what you can read, don’t use it.
Do less, say no & other stress management tools that induce a sense of relaxation. Meditation is profoundly helpful and is supported in the medical literature as being a key factor in health. Do what you love. Love who you love & give to what is creating positive change in this beautiful world.
Eat for your gut health and especially support your colon so your liver doesn’t have to work as hard. If you need help then reach out. Functional medicine testing helps pinpoint gut infections and imbalances so you can feel better.
I don’t recommend taking a bunch of supplements without testing or working with a licensed practitioner. However there are a few that are safe and worth integrating into your diet. Of course, eliminating refined foods and those with poor nutrients density is important.
Phytoestrogens block the receptor sites for the unhealthy estrogens so they can’t accumulate. Ground flax seeds support your colon and are a phytoestrogen! I love the dual action.
Magnesium in the glycinate form helps with muscle relaxation. The uterus has a lot of muscle tissue. Keep in mind that the heart does too and these two organs are intimately related. Care for both.
Healthy fats especially omega 3’s from diet and supplemental evening primrose oil for its gamma-linolenic acid (GLA). Omega 3’s are found in grass fed meats and wild fish. These are both naturally anti-inflammatory.
As we head into the darker months many people begin to supplement with vitamin D. In many cases this is a good step in maintaining mood, immune and bone health. In fact many people don’t realize that every cell in the body has a vitamin D receptor. Hundreds of genes and their expression are influenced by this important nutrient. Muscle and cell growth also requires adequate levels of vitamin D.
Up to 70% of our population may be deficient. This is largely due to diet and lifestyle factors that need to be addressed. Supplementation alone is not the solution. Given that deficiency is so common and linked with so many of our chronic, modern diseases its understandable why supplementation has become so popular.
What you didn’t expect about Vitamin D
In recent years high dose supplementation has become commonplace. What you may not expect is that high levels of vitamin D in the body can be as harmful as low levels. As a fat soluble vitamin we need to consider the consequences of toxicity. Evidence shows an increase of cardiovascular incidents, kidney stones, headaches, nausea, vomiting, diarrhea, loss of appetite, and even low bone density.
It’s great that more doctors than ever are testing vitamin D levels. However, like many nutrients, vitamin D follows a U-shaped curve, meaning that both low levels and very high levels are associated with negative health outcomes (16).
Deficiency Linked to all the big ones
With an increased risk of heart attack, cancer, diabetes, asthma, and autoimmune disease there is real cause for concern. Unfortunately, few practitioners are aware of the dangers of vitamin D toxicity. Many are testing serum vitamin D once and recommending a daily 5,000 or 10,000 IU supplement. Ongoing monitoring during supplementation along with other interventions is what we need to see.
Testing Vitamin D
Vitamin D status is measured by 25(OH)D in blood. This is the precursor to active vitamin D and is generally considered the most accurate single marker to assess vitamin D status. The laboratory reference range for adequate 25(OH)D is 30 to 74 ng/mL.
But a large body of evidence in the medical literature strongly suggests that optimal vitamin D levels might be lower than these figures. There is little to no evidence showing benefit to 25(OH)D levels above 50 ng/mL
Sunlight has Hormonal Benefits
Sunlight induces relaxation and increases pain tolerance via a natural opiod called beta endorphin. A 20-year study following 30K subjects found that those individuals avoiding sun exposure were twice as likely to die from all causes. This is because peptides like substance P and calcitonin gene are stimulated by UV rays reducing oxidative stress, vascular inflammation and hypertension. Libido is increased and cortisol is lowered by two hormones that also reduce appetite and regulate the immune system.
Exposure to bright light during the day activates neurons in the suprachiasmatic nucleus of the hypothalamus, which sends signals to the pineal gland that regulate melatonin production. Our circadian rhythm is associated with mood, cognition, and metabolic health.
We can use parathyroid hormone (PTH), calcium, and active vitamin D3 as markers for a more complete picture of vitamin D status. Dr. Chris Masterjohn suggests that serum PTH levels above 30 pg/mL may be indicative of biological vitamin D deficiency when 25(OH)D levels are borderline low. Conversely, if 25(OH)D levels are borderline low or even slightly below the laboratory reference range (e.g., 25 to 30 ng/mL), but PTH is less than 30 pg/mL, it is unlikely that vitamin D is deficient. Therefore more vitamin D is not necessarily better. For optimal calcium and bone health we want to see parathyroid levels suppressed adequately. Ask your doctor to test PTH if you have concerns about bone health.
The functional range for 25(OH)D is between 35 to 60 ng/mL. This is variable though. For example the optimal range may be a bit lower for those with darker skin pigmentation. Anyone with autoimmune disease may need to tend on the higher end of the range to maximize the immune benefits of vitamin D.
Don’t just supplement Vit D without knowing your level
less than 20 ng/mL: Combine with daylight exposure, cod liver oil, and even a vitamin D supplement at this level.
20 to 35 ng/mL: If your parathyroid hormone is less than 30 pg/mL then supplementing is likely unnecessary.
35 to 50 ng/mL: Your current diet and lifestyle is maintaining adequate vitamin D levels. Continue on course.
greater than 50 ng/mL: Reduce your vitamin D supplements. Ensure you are getting adequate amounts of the other fat-soluble vitamins to protect against toxicity
Test and Retest Your diet, lifestyle, or supplements changes can mean that retesting after three to four months makes sense. We want to see if what we are doing is working or working too well in some cases.
Sunlight is the primary source of vitamin D Reap the many benefits of sunlight beyond just subcutaneous production of vitamin D, and reduce your chance of achieving toxic levels. Spend about 15 to 30 minutes, or about half the time it takes your skin to turn pink, in direct sunlight. Sunscreens not only block production of vitamin D, but also all of the other beneficial photoproducts produced in the skin in response to UVB.
Micronutrients from food sources are safer Cod liver oil is a good source of vitamins A and D. Pastured butter and dairy can provide adequate vitamin K. Sweet potatoes, bananas, plantains, and avocados all contain significant amounts of potassium. Magnesium is a safe micronutrient to supplement as we can’t get enough from food due to soil depletion.
Birth control or oral contraceptive pills are given out for everything. If you have unexplained heavy cycles, skin issues or experience PMS (pre-menstrual syndrome) your doctor will likely prescribe birth control. Why is this a problem? It masks what it going on underneath. Our cycles give us a ton of information about our bodies and our health.
Birth Control Messes Up the Gut
Yeast and fungal infections increase as soon as six months after beginning the pill. Often women are on the pill for many years but don’t put the two together. Chronic yeast infections lower immunity and are a stress on the body.
Other pathogenic bacteria become opportunistic and inhibit the absorption of critical nutrients like B12, vitamin K and folate. A B12 deficiency has several symptoms including:
Nerve problems like numbness or tingling, muscle weakness, and problems walking
Mental problems like depression, memory loss, or behavioural changes
A B12 deficiency can result in irreversible symptoms if left untreated.
Vitamin K is responsible for transporting calcium to the bone and therefore is important for preventing osteoporosis later in life. It also plays a role in blood clotting which is one of the more serious health concerns with taking the pill.
Low folate can have a genetic factor and is implicated in:
Poor immune function; frequently getting sick
Chronic low energy
Poor digestion; issues like constipation, bloating and IBS
Developmental problems of the brain and spinal cord of the fetus during pregnancy
Canker sores in the mouth and a tender, swollen tongue
Changes in mood, including irritability
Premature gray hair
Our Hormones & Gut Work Together
Estrogens increase peristalsis (movement of the intestines) and pain sensitivity. If you have gut symptoms you may notice more cramping and diarrhea when estrogen spikes and drops. This happens twice. Once before ovulation and again before menstruation.
Progesterone, on the other hand, slows peristalsis. This is why women experience bloating with PMS when progesterone naturally increases. It also peaks in the first and third trimesters of pregnancy and is the cause of constipation. Who knew?!
When there is an imbalance in gut flora, peristalsis plays an important role in recovering. We don’t want the bacteria hanging around where they shouldn’t. This rhythmic motion ensures that bacteria don’t colonize the small intestine where we absorb our nutrients.
Why Not Test?
If you want to know why your cycle is heavy then you’ll want to test. Often estrogen dominance causes heavy cycles but so can a weak digestive system. It can and often is both. Heavy cycles quickly lead to iron deficiency, fatigue and anxiety. Testing lets us see where the imbalance is and what to do about it. By testing we also prevent other, more complex problems later.
The other option is to take the pill and hope for the best. Women are offered the pill along with an anti-depressant. With a few dietary and lifestyle tweaks a lot can normalize even before test results come in. Then we go deeper.
Sex & Other Risk Factors
Women are often told about the increased risk of blood clots and strokes when taking the pill. But these more common and chronic symptoms aren’t discussed.
If you are taking birth control to avoid pregnancy what other options are recommended?
Get to know when you ovulate. A barrier method or abstaining can work during this time. Exploring sex without intercourse during ovulation is also an option. Men who know their female partner’s cycle can take responsibility for birth control too. These men are often the best lovers. The Fem Cap and copper IUD which are excellent options for some women. The Fem Cap requires a spermicide lubricant. Find a natural option. They do exist. The copper IUD can result in a zinc-copper imbalance and gall bladder or liver issues.
Over this past year I’ve been working with PCOS patients. Nearly always there is an underlying blood sugar dysregulation, gut issue, inflammation and hormone imbalance. Thyroid can be implicated as well especially if autoimmunity is a contributing factor. I’m delighted when I haven’t heard from someone in awhile and then receive a note saying a baby is on the way.
It is possible to conceive before your health is perfect. I always ask patients to give me 2 months to focus on their health prior to conception. We can get a lot done in 8 weeks. Its enough time to get the gut working, optimize micronutrients and open the pathways for hormone balance.
The woman who I hadn’t heard from in awhile had a hormone retest showing a marked improvement on many levels. Although we hadn’t resolved everything, the most important markers were in range.
What are the most important markers?
I want to see total and free cortisol in range. I also want to see the three month blood sugar marker under the functional level. When insulin resistance is primary than we’ll want a more in depth panel. If inflammation has come down then we know we are on track. These are the three big ones. Then there is ferritin. Before conceiving we want to see healthy levels of iron stores along with folate.
When androgens are primary then checking to see the metabolite pathways is important but again sex hormones are downstream the big three I mention above.
Building in stress management and a dietary routine prior to baby coming is so important. These will be what carry you through any difficulties that may arise in the first months of parenting. They also set the stage for the child’s health and habits which are easier to influence earlier rather than change later in the game.
Some of my favourite, effective supplements for PCOS
Inositol: balances blood sugar, prevents gestational diabetes and metabolic syndrome. Effective for treating anxiety and other mental health issues.
Alpha Lipoic Acid: an anti oxidant that balances glucose levels.
Glycine: an amino acid that supports good digestion, calms the nervous system and promotes restful sleep. Best to test your levels before doing higher doses. (see note below)
Heme Iron: the most bio avalable and absorbable form of iron.
Omega 3’s: found in fish, grass fed meats and pastured products these are anti-inflammatory.
Nettles: increases the production of SHBG (sex hormone-binding globulin) which reduces levels of free testosterone in the blood. SHBG is often low in PCOS.
Reservatrol: a polyphenol found in red wine and grapes that helps counter the effects of androgenic activity that is commonly found in PCOS.
Testing for Optimal Health
Basic blood work and hormone testing is important. The organic acids lab work looks deeper. By giving another view of gut health and nutrient absorption we can see more of the underlying cause for illness. It’s proving more accurate for yeast and fungal overgrowth for instance.
Often patients are come back after the initial treatment. They want to do another next layer of work. The Organics Acid test can act as a yearly check-up. Its an overview not just of the gut but also the brain, fatty acids and cellular energy production.
If you’ve been hearing about mitochondrial health then this how you can get a peek into yours. Is your DNA is replicating well? What micronutrients are low? Is your liver functioning optimally? This test provides insight in tough cases or tweaks treatment plans for anyone wishing to thrive.
Going back to fertility, both parents can use this test to address lingering health concerns prior to conceiving. Retesting after the first few months or years after birth can be a good check-in. Ensure you have the energy to enjoy your little ones through all their stages!
Skin issues like acne, exzema, psoriasis, keratosis polaris, and rosacea are common. In fact, 40% of adults have keratosis polaris characterized by rough, dry skin.
How can conventional medicine discount diet in the treatment of skin conditions yet use synthetic retinoids (Vitamin A) for acne and psoriasis? Retinol promotes cellular regeneration and inhibits sebaceous glands. It helps with epidermal differentiation and suppresses androgen formation. Dry, rough skin, wrinkles, sun damage, rashes, and fungal infections are likely when retinol is deficient. So let’s start there. Here’s how to improve retinol levels and take your skin health back:
Vitamin A, in the active form of retinol, is found in organ meats like kidney and liver. Grass-fed dairy, pastured egg yolks and cod liver oil at 1 tsp per day offer enough as well.
Eat more Omega 3’s from cold water fatty fish. Reduce omega 6’s found in industrial meats and seed oils. Whole food omega 6’s don’t increase inflammation or worsen skin conditions. Avocado, nuts, poultry, and pork are fine despite their omega 6 content.
Zinc is essential for protein and DNA synthesis, wound healing and cell division. It is protective against UV and is anti-inflammatory. Zinc works with Vitamin A to increase the blood levels of retinol. Studies show that dietary zinc may reduce acne as effectively as tetracycline, a popular antibiotic. Those with bad acne have low levels of serum zinc.
Vitamin C helps produce and regulates collagen which maintains the skin’s cellular stability protecting against early wrinkles and loss of structure. Scurvy is a severe deficiency and has early signs that include: red, dry, and rough skin. Vitamin C is an anti oxidant, prevents UV damage, reduces water loss, supports healing, and improves repair of scars. Citrus fruit, leafy greens, and broccoli are sources. Again steaming or raw is best as this vitamin is another one that is heat sensitive.
Biotin just sounds like it’s good for your skin. As a co-factor to the enzymes that regulate fatty acids it protects against water loss and damage. Biotin helps with hair loss, dermatitis, and dandruff. Egg yolks have biotin as does liver, chard, romaine, almonds, and walnuts. Good gut bacteria produce biotin so treating the gut is of course important. Too much biotin can change some lab results, so keep that in mind and let whoever you are getting labs from know what you are taking.
Compromised gut and soil health contribute to selenium deficiency. This nutrient protects against skin cancer and reduces acne. Food is safer than supplements as high doses can be toxic. Seafood, organ, and muscle meats are good sources. Two brazil nuts per day is adequate. Aim for less than 200mcg/day and take breaks if supplementing short term.
Silica deficiency leads to poorly formed collagen. It builds skin tissue and works with hyaluronic acid to promote cell growth. It increases skin hydration and elasticity. Leeks, green beans, garbanzos, mango, celery, asparagus. and rhubarb are rich in silica.
B3 (aka niacin) deficiency can cause dermatitis with a dark, scaly rash. Malabsorption is common in celiac disease, SIBO (small intestine bacterial overgrowth) and IBD (irritable bowel disease) including Crohn’s and ulcerative colitis. Inadequate intake is also common. Sources of B3 include meat, poultry, tuna, salmon, seeds, milk, green leafy vegetables, coffee, and tea. Tryptophan can be converted to B3 in the liver.
Sulfur is another nutrient necessary for collagen synthesis. Inadequate intake has been shown to increase wrinkles. It is required for glutathione synthesis to prevent oxidative damage which is the primary cause of aging. Because sulfur regulates prostaglandins it reduces inflammation. Found in egg yolks, meat, poultry, fish, garlic, onion, brussel sprouts, asparagus, and broccoli. Fermentation make sulfur more bioavilable , particularly fermented cruciferous vegetables like cabbage or kale. Eat your sauerkraut!
Vitamin E is secreted on the skin’s surface protecting against free radicals inflammation. A synergistic affect with selenium increases glutathione and prevents UV damage. Vitamin E is involved with immune function, gene expression while suppressing arachidonic acid. Sources include leafy greens, sunflower seeds, almonds, bell peppers, asparagus, and broccoli. Olive and avocado oil contain vitamin E and are great to cook with. Do not supplement this vitamin as there is an increased risk of cardiovascular disease.
Pantothenic acid, or B5, supports wound healing. Topically B5 regenerates skin cells, increases glutathione levels, and protects against oxidative damage. The richest sources are organ meats, egg yolks, and broccoli. It is found in fish, shellfish, dairy products, chicken, mushrooms, avocado, and sweet potatoes. Be aware that high heat processing reduces pantothenic acid levels by up to 75%. Eat a mix of raw and lightly steamed foods.
Vitamin K2 prevents calcification of elastin in skin preventing lines and wrinkles. People who can’t metabolize vitamin K can develop premature wrinkling. Vitamin A needs K2. Food sources of vitamin K2 are limited. High-fat grass-fed dairy, especially cheese and ghee, egg yolks, liver, natto (fermented soybean), and sauerkraut are sources. Grain-fed products do not contain K2. Vitamin K1 from grass is converted into K2 in the cow. Conventionally raised cows eat grain so their milk won’t contain K2. Check your supplement for 3rd party testing.
BONUS: The gut-skin axis has been studied since 1930. Probiotics impact skin conditions like rosacea, atopic dermatitis, and psoriasis. One study showed that at least 80 percent of patients with rosacea have SIBO. Leaky gut causes inflammation that leads to skin diseases like acne. Stress can cause the epidermal barrier to become porous. Increased infection and decreased antimicrobial, fatty acids, and lipid layers can be called leaky skin. Neuropeptide substance P is produced by the gut and also found in the skin and the brain. Probiotics decrease lipopolysaccharide, an endotoxin common in leaky gut that can cause skin reactions.
The best source is home-made kefir. Other sources are fermented foods like sauerkraut, kimchi, yogurt, and kombucha. In addition fermentable fibers have a prebiotic effect. These non-digestible carbohydrates feed the beneficial bacteria. Onions, leeks, garlic, Jerusalem artichokes, starchy vegetable, and then some supplements. I carry a soil-based probiotic that has prebiotics, is shelf-stable, and shows excellent clinical results.
“Why do I have abdominal weight gain?” – This is a question I often get from patients.
Basically it’s an imbalance of hormones beginning with our stress hormones and involving insulin. You may have heard me talk about how cortisol is a glucocorticoid. Gluco meaning glucose or blood sugar. Cortisol meaning stress.
When we get stressed we either overeat or under-eat and this is why. Both make sense from an evolutionary standpoint. Overeating is a way of preparing for famine, and storing abdominal fat was how we did this. Under-eating prepares us to flee as in the flight response when the predator is on our tail. Keep in mind stress hormones are upstream from our sex hormones including testosterone, progesterone and estrogen. These often get out of balance when there has been prolonged stress either perceived, or internally caused by physiology. You may remember that cortisol, when functioning optimally, is an important anti-inflammatory.
One night of poor sleep can increase inflammation. The problem is that no one want to hear this because we are all not sleeping well, especially those who are parents with young children. What I notice when I miss lunch is I can’t rest at night. The combination of stress, no food, and insomnia creates a cluster of other problems. Simple changes at any one of these junctures goes a long way because all these systems are interdependent.
For example, the number one hormone imbalance affecting women and causing infertility is polycystic ovarian syndrome (PCOS). It is strongly associated with insulin resistance, inflammation, and HPA axis dysregulation (hypothalamus pituitary adrenal). Adrenal glands produce cortisol.
My doctor tells me to “Just lose some weight!”
This research suggests that high-intensity interval training (HIIT) is the most beneficial way for for women with PCOS to exercise. By improving insulin sensitivity, body composition, and endothelial function, HIIT targets several of the key components of PCOS. This can all happen in the absence of weight loss which is interesting. Often women with PCOS are told by their doctors to lose weight. I hear over and over how this is not helpful and I understand why. When a perfect storm is happening on a physiological level weight loss is not possible. A body that is stressed will not be adapted to lose weight no matter what. We also know most doctors don’t have the diet and lifestyle information to help. HIIT can be an adjunct to other interventions that support hormone balance including a stress management program and the right dietary approach. Many places offer HIIT classes, making this an accessible option.
HIIT improves insulin resistance. In this study thirty-one women were assigned to either high-intensity interval training, strength training, or a control group for 10 weeks. The HIIT group performed two weekly sessions with four minutes of exercise at 90 to 95 percent of maximum heart rate. This was separated by three-minute periods of moderate intensity exercise at 70 percent of their heart rate maximum . They also performed one weekly session of 10 bursts of maximal intensity HIIT separated by one minute of rest.
Strength Training vs Moderate Aerobic Exercise
In this study each woman chose her mode of exercise. They regularly used a treadmill, bicycled, ran, or walked outside. The strength training group performed eight weightlifting drills with progressively increasing weight on gym equipment three days per week. The control group performed 150 minutes of moderate-intensity exercise per week.
After the 10-week exercise intervention period, it was found that insulin resistance improved significantly only in the HIIT group. HIIT also increased HDL cholesterol, improved endothelial function, and decreased body fat percentage.
I wrote another article about how resistance training is the number one form of exercise to integrate into your lifestyle. The long term benefits outweigh all other forms and it is the antidote for our current culture. For anyone who hopes to age gracefully this is the ticket. However this memo has not made its way to the mainstream yet. Most medical research still focuses on aerobic exercise. This is why I was so excited to see this article pop up last month.
I see a patients every week with iron deficiency who don’t know it. Standard blood work isn’t enough. In this article I’ll explain why. There are several markers that help us understand why iron is low but again conventional medicine rarely tests these. Low iron can cause fatigue, anxiety, depression and insomnia just to name a few common symptoms.
“My doctor says its all in my head but I know it isn’t.”
Other symptoms of iron deficiency include palpitations, rapid heart rate, restless legs, infections, poor mental function brain fog and decreased tolerance for exercise. Athletic performance and capacity to work will be lower. This is because when iron is low it decreases oxygen availability and then myoglobin levels in muscle drops. Lactic acid builds up.
It can also be difficult to maintain proper body temperature. This can lead people to believe they have a thyroid problem. Brittle nails, sores around the mouth and loss of taste can occur. Iron deficiency happens prior to clinical anemia which is the final stage. Eight percent of premenopausal women are iron deficient but I’m guessing this number is more given the number of women I see who are undiagnosed. A quarter of those are anemic.
In clinic I listen carefully to my patients symptoms and teach them how to read their own signs. Iron deficiency is often visible in a person’s complexion, cuticles or tongue depending on what else is going on. Postural hypotension or feeling dizzy upon standing can be a tell-tale symptom.
Functional Medicine Solutions
That being said, I always want to see comprehensive lab work. This is the best way to know what is actually going on. Recently I suspected a patient to be low in iron but her lab work showed two parasitic infections with healthy iron stores. As we treated the gut infections, her complexion and energy changed rapidly.
Another patient had a chief complaint of anxiety and fatigue. This had been going on for 4 years, since the birth of her second child. Her ferritin was the lowest I’ve ever seen. She is in the final stage of iron deficiency and clinically anemic.
Why is ferritin not monitored more closely, especially in mothers?
In the final trimester before my son was born I was also anemic. My symptoms were so uncomfortable I would cry at night before bed knowing I faced another night without sleep and in pain. Restless legs and insomnia can be incredibly painful.
This could have been caught earlier and prevented. I was seeing a primary care provieder weekly so why was this missed? I trusted that my bloodwork was being monitored properly. My diet was excellent but at this stage more supplementation was needed. Once I began I felt better within a few days.
3 Stages of Iron Deficiency
There are three stages of iron deficiency. Iron stores are measured in ferritin. When ferritin is between 10 to 15 ng/mL there is deficiency but not exhaustion. During this stage, there may not be any symptoms that conventional medicine would recognize.
The difference in Functional Medicine is that we flag anything under 30 ng/mL. In this way we prevent stage two when iron stores become exhausted and ferritin drops below 10 ng/mL.
The final stage is when there is no iron in bone marrow stores. Red blood cell production and hemoglobin drop. Anemia is more obvious, and symptoms can become severe. Unfortunately, most clinicians in primary care settings don’t test iron or ferritin. They only look at hemoglobin, red blood cells, and MCV levels. This is why a lot of patients in stage one and stage two are being missed.
In fact, its fairly common that people are iron deficient for decades without knowing it. Iron deficiency affects 1.62 billion people worldwide. That’s 25% of our global population.
Functional medicine understands there is a connection between depression, anxiety, fatigue, insomnia and low iron. Observing a patient and feeling the pulse is often enough to suspect iron deficiency. This is part of my basic training.
We also know how to investigate the underlying cause. Is it simply lack of nutrient intake? How can we increase iron rich foods into the diet? What other lifestyle factors are contributing? Is there gut dysbiosis leading to malabsorption? Are there any infections that need to be cleared? Is the body shunting iron to protect from something more serious? Is heat masking some of the signs we check?
Ferritin is an acute-phase reactant that increases the inflammatory response much like C-reactive protein. This can be confusing and its why a comprehensive panel is important to have. This is especially when chronic pain or more complex conditions are present. So a patient can be iron deficient but their inflammation is raising ferritin. Seeing a normal value in the face of clinical anemia does happen. Functional testing catches this by looking deeper.
In many places people can order their own bloodwork but the interpretation is important. I ask patients to get copies of their labs so we can look over them together from a Functional perspective.
The spirit of ‘DIY’ or ‘do it yourself’ is a quality I admire in patients. I love working with people who are engaged in their health and want to understand what is at the root of what they are experiencing.
Both women and men want to optimize health prior to conception. Addressing underlying health concerns at this time is ideal. Pregnancy, birth and caring for an infant is a time of joy. It also requires a lot more energy than most admit. Stress can be high. Get to know what keeps you both going and support this. Know your weak spots before there is a baby. Then you can create a support plan.
I ask my patients to allow two to three months to focus on their own health before conceiving. This gives enough time address anything acute and level out stress. A nutrient dense diet sets a baseline, stabilizes blood sugar and addresses deficiencies or intolerances.
Hormone testing can show a lot. The lab I use includes a look at neurotransmitters. Preventing post-partum depression and anxiety for both partners is highly recommended. Our children’s stress response is wired to ours even as they are conceived. The early years provide the foundation for a happy life if we tend to our own selves first.
Here is the latest research around fertility:
Daylight & Vitamin D
Vitamin D plays a role in the regulation of the female reproductive system and fertility. Vitamin D3 and increased sun exposure have shown to be positive for those suffering from PCOS (polycystic ovarian syndrome), endometriosis, and infertility. Keep in mind that too much vitamin D can also pose a problem and this is why testing is important.
Going back to sun exposure this research indicates that shifts in the light/dark cycle disrupt the circadian system and the female reproductive system. For women looking to optimize their fertility and have a healthy pregnancy this information is important. Advising against shift work for their women who are hoping to become pregnant and reducing artificial light at night may enhance fertility. Wearing glasses that block blue light and normalizing sleep schedules are two helpful tricks. The sleep/wake cycle is tightly linked to the light/dark cycle. This is why early morning exposure to daylight and being outside for at a minimum of 15 minutes per day are crucial for restful sleep, healthy stress response and fertility.
Microbiomes: Oral & Genital
Healthy genital microbiomes increase positive pregnancy outcomes. Lactobacillus reduces the harm that spermicidal contraceptives and antibiotics cause. Treating gut health optimizes the immune system as well. Infants receive their immunity from us as we pass them on during birth and breastfeeding. Yes the skin also has a microbiome too! It’s ideal to address infections and imbalances prior to pregnancy. It becomes more difficult to resolve these safely until after breastfeeding is complete.
Gingivitis is a common infection that occurs in the mouth. It may affect a woman’s ability to conceive by causing a systemic inflammation. Reducing carbohydrates in the diet while increasing antioxidants, omega-3 fatty acids, and fibre reduced periodontal inflammation. Specific probiotics are used to target the oral microbiome.
The Functional Approach
I enjoy working with people who are committed to addressing the root cause. Infertility rates are rising each year which is concerning on many levels. Environmental toxins, high stress, poor food quality, and lack of sleep all play a role. These are the trends and yet each patient is unique. We investigate what’s happening for you. These discoveries increase connection and pleasure. Both release oxytocin, the hormone of love. Making simple changes that are specific to you can result in the arrival of a healthy baby.
I often hear from female patients that they have been prescribed oral contraceptives without hormone testing. Perimenopause, low libido and even depression or skin issues can be rooted in an imbalance. Why not test to see what is actually going on? In Functional Medicine this is exactly what we do.
Recently a patient came to me with a list of symptoms including anxiety, poor recovery from exercise, insomnia and low libido. Was it perimenopause as was suggested to her? I didn’t think so. After testing we had clear picture of what was actually going on and it wasn’t perimenopause at all.
The Estrobiome: A Healthy Gut = Healthy Hormones
A new and exciting area of research is around the estrobiome. The gut deals with getting rid of some of our excess hormones. Estrogens that enter the gut from the liver may be recirculated if the microbiome is not healthy. Enzymes like beta glucuronidase are thought to play an important role in whether or not estrogen is recirulated. In one study, 44% of women with healthy estrogen excretion had higher levels of this enzyme. We are finding out that treating the gut could mean lower rates of estrogen related cancers overall.
Stress, the Liver & Detoxification
Especially for women with heavier cycles and those who have taken oral contraceptives there is likely an issue of hormone buildup. Our livers are responsible for clearing hormones through the bile and into the gut. If stress is high, diet is poor and one is exposed to environmental xeno estrogens then the liver is unable to keep up. Boosting your body’s natural detox capacity is essential to help with hormone clearance.
Natural Detox in 4 Steps
Step 1: Lower stress by moving your body. Our liver’s love movement. Choose activities you enjoy so you are inspired to do them often.
Step 2: Eat Veggies and Drink Water. The liver loves veggies! Increase fibers from root veggies and phytoestrogens from specific plants like flaxseed and yam. Two litres of water/day is your baseline.
Step 3: Get your hormones and gut tested. Then you will know what you don’t know! I can’t tell you how many patients are surprised by their results. The DUTCH test shows metabolites which is key. I use stool and breath tests to look at gut health.
Step 4: Appropriate supplementation based on comprehensive lab work makes treatment more effective. Get the support of a trained clinician and get started today. Each person is unique and we decide together where to start. Often we focus on the gut or the stress response because both have a significant impact on hormone health.
The Science of Estrogen Metabolism
I’d like you to understand why its important to see hormone metabolites in your lab work. I will break down the 3 pathways: 2, 16 and 4. You’ll see that synthetic and equine sources of estrogens from hormone replacement therapy and birth control are metabolized down the less favourable pathway. Bio identical hormones and botanicals are received favourably.
Keep in mind that the liver has 2 Phases of detoxification. The first is hydroxylatin and the second is methylation. Both need to function well as you will see.
The 2 pathway is the most favourable and we want to see it used more. It excretes estrodial and estrone. Estrone is converted into 2-Hydroxyestrone (2-OHE1) as part of Phase 1 detox which is known as hydroxylation. 2-OHE1 is a ‘good’ estrogen because it doesn’t stimulate cell growth. When it is methylated into the 2-MeE1 in Phase 2 it becomes cancer protective. Enough exercise, higher protein diets, and specific supplements can raise 2-OHE1 levels.
Estrogen is also metabolized through is the ’16’ pathway. We need this route however it should be used significantly less than the 2-Hydroxyestrone pathway. Phase 1 in the 16-Hydroxyestrone pathway is also hydroxylation. Phase 2 is a reduction phase that produces Estriol which is a weak estrogen.
Higher levels of the 16 pathway are associated with breast cancer, obesity, hypothyroidism, pesticide toxicity (organochlorines), high Omega-6 fatty acids, and inflammatory cytokines.
The last metabolism pathway is the 4-Hydroxyestrone. Estrone is hydroxylated through Phase 1 detox to form 4-OHE1. In Phase 2 it is methylation to form 4-MeE1. When 4-OHE1 is properly methylated to 4-MeE1 it is relatively benign as the 4-MeE1 is easily eliminated and risks are low.
When its not methylated 4-OHE1 builds up. Then it converts to 3,4-Quinones which are carcinogenic similarly to the 16 pathway. Women with uterine fibroids may have increased levels of 4-OHE1. High levels of estrogen across the board are associated with heavy cycles.
Why are so many women affected with hormone imbalance?
The answer is simple. Most of it is due to environemental factors. Many chemical substances mimick estrogen. Stress also inhibits the function of the liver as we’ve talked about. Lastly, compromised gut health inhibits the proper excretion of the excess estrogens.
More about the Bad Stuff:
Xenoestrogens – compounds that have with estrogenic activity including polychlorinated biphenyls (PCBs), bisphenol A (BPA), and phthalates are xenoestrogens. These are chemicals that disrupt normal estrogen balance. Eliminate from your environment along with any industrial raised meat products. These have added hormones and are pro inflammatory.
Contraceptives from equine sources favor the 4-OHE1 pathway as do synthetic hormones.
Some of the Good Stuff:
Diindolylmethane (DIM) increases 2-hydroxylation favoring the more healthy metabolic pathway
Rosemary and Curcumin
B6, B12, Folate, MTHF, TMG
Omega-3 Fatty Acids
Antioxidants: Vitamin E, A, C, Selenium, NAC, Polyphenols, Flavonoids, Lycopene & Alpha Lipoic Acid
Phytoestrogens: Flax seeds in whole form ground or soaked. The lignans help with estrogen metabolism. Kudzu – this is another phytoestrogen. So are yams.
Trimethylglycine (TMG): a compound found in beet root and other plants and animal foods like choline. It protect cells from stress and act as a source of methyl groups. Betaine hydrochloride is made out of (TMG). This is a supplement that increases stomach acid which I use to optimize gut health.
Sulforaphane glucosinolate (SGS): is a naturally occurring phytochemical found in cruciferous vegetables. It supports Phase 2 detox and decreases 3,4-quinones.
Fatigue, depression, and irritability can caused by a hormone imbalance. Getting to know the key players can help. The endocrine system rules hormones and I’ll explain a little about how they all work together. The metabolites tell us about how the body is responding and excreting each one. This is important information for preventing disease and feeling better.
Androgens are important in maintaining bone and muscle strength. DHEA and testosterone are two I look at closely. DHEA-S can indicate inflammation. Androgen metabolites will push one way if there are PCOS like symptoms like acne, head hair loss or facial hair growth on women. Anxiety and depression in men can be due to low testosterone. Specific botanicals and nutrients can shift the metabolism to a more favourable path. GLA, zinc and saw palmetto are some key ones I use.
Estrogens are essential for female characteristics as well as brain, bone and heart health. The pathways for estrogen have been studied extensively. Preference for certain metabolite pathways may prevent breast and ovarian cancer. Excess estrogen can cause weight gain, heavy cycles, fatigue and irritability. Depending on the pattern, we can support the 2 methoxy pathway with diet and supplements from cruciferous veggies. Boron can support estrogen or testosterone when these are low in women. Perimenopausal women will have a different healthy hormone profile.
Cortisol affects all of the other hormones so when we are looking at testosterone for example we must also assess the role cortisol is playing. Cortisol is anti-inflammatory. It manages immune function, blood glucose, energy and metabolism. Depending on the pattern there are several nutraceutical grade supplements that can balance cortisol. Adaptogens are not always the answer. In Functional Medicine we use the phrase, “why guess when you can test?”
Progesterone balances estrogen and also is protective of brain, bone and heart health. It’s essential for menstruation, fertility and pregnancy. Estrogen dominance is when progesterone is low in relation to estrogen. Increased consumption of healthy dietary fibres can improve estrogen elimination. Phytoestrogens like flax seeds are excellent because they block xenoestrogens from accumulating in the body. These are prolific in our environment especially if you use any conventional beauty care products or have plastics in your kitchen.
Melatonin is often thought of as the sleep hormone. It’s secreted from the pineal gland and regulates the sleep-wake cycle. Its lesser known that melatonin is an anti-inflammatory and antioxidant. It works with serotonin. Adequate sleep is important for reducing pain and cravings. These are actions of serotonin. Micro dosing melatonin can see better results. Trytophan or 5HTP can support serotonin.
Medications like opioids, steroids and Accutane can damage the endocrine system. For example, a common acne medication is known to destroy cells in the hypothalamus. Another example is thyroid medication at too high of a dose can cause increase total cortisol. Its important to do thorough testing and if you need to take a medication please have it monitored.
Other Safe supplements for balancing common hormone imbalances include nettle, broccoli sprouts, food high in zinc, inositol, fibre from whole foods. Nettle works on the increasing androgen metabolism down the 5a reductase pathway which is good for anyone with PCOS like symptoms. Broccoli sprouts contain a chemical called sulforaphane. This is one of the most potent antioxidants and detoxification substances that we know of. Inositol balances blood sugar which at the root of many hormone issues. Zinc is often deficient and can be found in oysters, pumpkin seeds, spinach and a variety of pastured meats. Fibre from root vegetables, flax and chia seed and gluten-free supplements can help clear excess hormones.
Polycystic ovarian syndrome affects 10% of North American women in their child-bearing years. It’s the leading cause of infertility and is on the rise. Syndromes are a group of symptoms that conventional medicine groups together. PCOS is more of a pattern than a disease. Cysts on the ovaries are not always present. Acne, irregular cycles, weight-gain, facial hair growth and loss of head hair can be part of the presentation.
The Underlying Cause
Blood sugar plays a huge role in PCOS. Insulin is a hormone and it helps regulate sex hormones. PCOS is really an imbalance in hormones.
Stress has a huge influence on all our hormones. Environment also is a key factor, more than genetics even. Genetics express if triggered by an exogenous factor so we are back at lifestyle, nutrients and yes meditation. The habits that lead to blood sugar dysregulation are not genetics. These are choices that we can change PCOS is an epidemic and there is a lot we can do as far as education to influence this.
Insulin Resistance & Female Hormones
Insulin pulls sugar out of blood and escorts it to our cells. Eating refined foods means our bodies will stop responding to the massive overload that hits the blood at once. Fibre in whole food is really protective on so many levels and this is one of them. The pancreas will continue to produce insulin despite high levels accumulating in the blood because insulin is overwhelmed and not responding. So now we have high sugar and high insulin in the blood.
FSH and LH are two important female reproductive hormones that are affected by insulin directly. Then in turn these affect progesterone and estrogen. We have so much more control than the medical model suggests in terms of understanding how an individual is adapting. Comprehensive hormone testing that includes metabolites of progesterone, estrogen and the androgens including testoterone. Looking at blood sugar levels in at least two ways is also important. A diagnosis can be helpful but only if the patient feels like she has options and is in control of her treatment.
Weight Gain is a Cause? Or a Symptom?
Old school doctors will tell patients to just lose weight. The problem with this is how? By any means? This will likely exacerbate the symptoms because the majority of weight loss measures promoted are extremely problematic.
Plus weight gain is not the cause! It’s a symptom. Yes weight gain, inflammation and other factors are part of the vicious cycle of insulin resistance and PCOS. But keep in mind certain hormonal imbalances make it very difficult to lose weight. So what works for most people won’t make a dent no matter how hard a woman tries. This is insanity.
A few important steps anyone can take to regulate blood sugar are:
1. Eat enough protein: our body has an innate stop button when it comes to protein. You will know when you’ve had enough. When we are nourished with longer burn foods, we don’t crave simple carbs and sugar. 2. Root veggies: get your carbs from the veggies that grow below ground. These also have a longer burn, are packed with vitamins and support the health of your colon. This is where we eliminate excess hormones like testosterone. Another problem of refined food is that it results in poor colon function and these hormones will be reabsorbed and recirculated. 3. Clean up all your beauty products especially beware of scents. Look through your cleaning products too. Our detox system is burdened by all of these and make it harder to eliminate hormones. They are full of xeno estrogens (xeno is bad). Stay away from plastics as much as possible. 4. Eat more healthy oil and fats. Omega 3’s are especially important. Studies show that androgens are lowered by diets higher in omega 3’s. They are also anti-inflammatory meaning less pain. 5. Chromium helps regulate blood sugar. It can be found in a variety of foods including grass-fed beef, eggs, broccoli and sweet potatoes. Most of us are deficient. Cinnamon regulates blood sugar too. Yes, food is medicine!
Conventional medicine has lost sight of prevention and treats PCOS as though it’s a disease that needs life-long medication. Birth control and metformin are often prescribed. What is needed is a deeper look at what’s going on. In fact there are many ways to address PCOS that are natural.
First things first: Birth control is NOT the only solution for heavy cycles! In fact, when it comes right down to it, birth control is more of a band-aid than a solution. Are you someone who wants to understand what actually going on? Underneath there are several possible imbalances at play and we always want to know which it is.
Technically the medical term used to describe heavy cycles is menorrhagia. It’s not a disease but it sure sounds like one. The problem is that it can be very depleting and generally difficult to live with each month. A cycle that lasts more than 7 days or a blood loss around 80 ml is considered heavy. A tampon or pad can hold about 5 ml. If you use a Diva cup you can calculate this accordingly. In comparison a normal cycle is 35 ml or less per month and lasts between 3-7 days.
Every woman is different so determining your own normal is key. Track your cycle to see how many days and ml yours is. If you are soaking around 16 pads or tampons in one cycle it’s definitely heavy.
A Few More Guidelines
Take note if it comes in less than 25 days or more than 35 days
Changing your pad/tampon or emptying your diva cup every 2 hours
Your ability to work, exercise or engage in other activities due to fear of leakage
Having to get up in the night to change
A diagnosis of anemia
Feeling fatigued, short of breath or depressed
What’s Happening to Cause this?
Heavy cycles happen when estrogen is higher in relation to progesterone. This commonly occurs at the beginning or ending of reproductive age. Teens and peri-menopausal women are affected the most. This is because the part of the endocrine system that communicates with the ovaries is either revving up or slowing down. It’s the hypothalamus that triggers ovulation and progesterone production follows ovulation.
Keep in mind that estrogen has many positive effects in the body. It’s anti-inflammatory, and supports the immune system. Its also anti-oxidant and regulates enzymes, gene expression and metabolic function. Estrogen is critical to brain development and decreases the incidence of strokes. Women may live longer than men due to estrogen. It is also protective. For example estrogens support gut health. It also reduces the incidence of prostate and breast cancer.
Related Patterns of Hormone Imbalance
Heavy clots indicate more estrogen in relation to progesterone. Estrogen causes proliferation so more uterine lining, swollen breasts, weight gain, skin issues, PMS and headaches can involve a pattern called Estrogen Dominance.
Poor thyroid function is another major factor. Subclinical hypothyroid is more common than we think and is poorly diagnosed. It causes poor clearance of estrogen from the body as well as limits the amount of progesterone produced.
Fibroids are also caused by a e-dominant pattern. One type of fibroids can actually cause heavy bleeding but this is not common.
Post pregnancy including miscarriage, abortion or full-term birth. Blood loss of this variety is due to deficiency.
Birth control like the copper IUD and depo provera shot can cause heavy cycles.
A bleeding disorder known as coagulopathy affects 20% of teenagers with heavy cycles.
Inflammatory disease of the pelvis, liver or kidney
Steps You Can Take
Rule out anything serious by getting your routine pelvic exam. Request an ultrasound to check for fibroids and to see the thickness of your endometrial lining.
Blood work needs to include a full thyroid panel and a complete blood count to check for anemia. Regular STI checks and pap smears are also important.
Birth control is commonly prescribed for heavy cycles especially the oral birth control pill and the Mirena IUD. D & C ‘s are used to remove uterine lining temporarily or an endometrial ablation or hysterectomy are permanent interventions.
A Functional Medicine Approach
I focus on nutrient intake first. Vitamin A from cod liver oil has been shown to reduce heavy cycles significantly. B vitamins can reduce excess estrogens by supporting liver function and therefore estrogen metabolism. With b vitamins quality and bioavailability is important. I use Seeking Health because of this. Buffered Vitamin C at doses around 3000mg per day has been shown to reduce heavy bleeding and improve the absorption of iron. There is a cycle of blood loss, anemia and fatigue that requires some lifestyle adaptations as well as diet changes.
Real rest and meditation help cortisol regulation. Cortisol is upstream of all sex hormones and usually plays a significant role in hormone imbalance. I do thorough testing to see what is actually going on prior to treatment that includes free and total cortisol, its daily rhythm and all of the sex hormones plus their metabolites.
Every Woman is Unique
No two bodies are the same so getting to know yours is the most powerful step in this journey. We are always changing so this is a process we do again and again. Send me your questions. This post came out of multiple patients asking what caused their cycles to change and what could be done other than birth control.
I hear the word genetics used to describe conditions that we can’t control. It’s true that there’s is a lot we have no control of. When it comes to genetics we actually have a lot more power than we think. Diet and lifestyle choices are heavy players. In fact 90% of what gets expressed genetically is due to factors within our control.
Here are 6 steps you can take to lessen the impact of living in today’s world:
1. Each day our bodies are exposed to thousands of chemicals. One of the biggest culprits is personal care products. This industry is completely unregulated. Luckily we have groups like the Environmental Working Group (EWG). Moisturizer, toothpaste, shampoo, deodorant, and cleanser alike have hundreds of ingredients. Most of these are chemicals that our detoxification system has to deal with. It’s a huge burden and stress to our liver, lymph, lungs and skin. Only choose products you trust with labels you can read. If you aren’t sure use the Skin Deep Guide or the Healthy Living app to check a product.
2. When it comes to food local and organic makes a huge difference. Grow your own if you can. Check the soil quality where your food is grown. Since cost is a real factor use the EWG’s Dirty Dozen and Clean Fifteen. These list can help you decide where its crucial to buy organic and where you can get away with conventional varieties. These lists are updated each year so its worth having a look to see what this season holds.
3. As my son enters school age the challenge of making lunches looms large. Storing food safely is actually a big deal. Plastic containers have hormone disrupting chemicals like BPA. Even BPA free plastics have other chemicals that aren’t tested or safe for bodies. Glass and stainless steel containers are the way to go.
4. Water bottles are the same and the water that goes in them is also very important. The EWG has a Water Filter Guide. The Berkey is popular as are reverse osmosis systems like Radiant Life or carbon filters like Crystal Quest. Make sure that whichever one you decide on removes chlorine, fluoride and lead along with other toxins. Get your water tested regularly. If you live in an urban area or a damp environment consider an air filter for your bedroom. Open your window at night for fresh air if you live close to nature.
5. Household cleaning products are full of chemicals. Use safer ones that have been tested by the EWG. They’ve tested thousands and have a free directory you can access to make sure you are using safe products in your home.
6. Eat real food and drink two litres of water per day. Manage stress, sweat often, play more and get enough sleep. All of these play an important role in detoxification. Help your body do its job and enjoy all the benefits.