Phytoestrogens are foods that interact with the estrogen receptors in our body. Isoflavones and lignans are two types found in specific seeds, plants and legumes. Although they won’t raise estrogen levels they do support hormone balance and are preventative against a number of conditions. Red clover, yam, flax seed and soy all have this action in the body.
Genetic variation is determined heavily by food and lifestyle choices. Estrogen is influenced by one in particular: COMT (catechol-O-methyltransferase). You may have normal COMT gene but lifestyle factors can change how it expresses. Let’s talk about how.
Phytoestrogens protect you from high estrogen levels that occur due to genetics and environmental factors. Endocrine disruptors are toxins around us that mimic estrogen. They are found in personal care products, plastics and household cleaners. They build up in the body. Basically if you can’t eat your make-up, shampoo and bathroom cleaner you are being exposed.
Build up of excess estrogens also occurs when our digestive system is not functioning properly. Excess hormones are excreted through our stool when the microbiome is healthy. When it’s not, an enzyme will unpack estrogens that are ready to be excreted. They then get recycled through the liver once more. When they leave the liver a second time, it’s often down a metabolite pathway that is less protective.
Phytoestrogens stop this cycle before it even gets started by allowing less estrogens into the body. This can prevent symptoms like heavy and painful periods. There is evidence that they have a positive effect on PCOS because legumes increase insulin sensitivity. Phytoestrogens may also protect hormone sensitive cancers. Estrogen is highest in women during our reproductive years but menopausal women can use isoflavones to reduce hot flashes.
A few limitations
Don’t go taking soy isoflavones if you have thyroid issues. At least not in concentrated forms as it can suppress function. Foods will not hurt as long as your other thyroid nutrients are adequate. Soy can also cause a reaction in some women with endometriosis.
Many people react poorly to eating lectins. Flax seeds are an excellent phytonutrient and are beneficial for the gut but if you don’t tolerate lectins they could set off an immune response. This goes for other seeds and legumes. Individualize your diet. Your body knows best.
Seed cycling for hormone health has no evidence behind it. Enjoy a variety of seeds. Don’t worry about which menstrual phase it is.
Children and men do not require phytoestrogens in the same way as women and a high enough dose of them could be detrimental.
How Genetics Play In
We have twenty thousand genes in our body. There are more than ten million genetic variations that may or may not express. These are called SNPs (single nucleotide polymorphisms). COMT is the one we’ll look at today. Like a handful of others, COMT has the power to influence hundreds of other genes. It plays an important role in estrogen metabolism.
Keep in mind that you can be born with as many as 1.2 million SNPs but only forty thousand of these have the potential to alter your genetic function. Even if you aren’t born with a SNP you can express the genetic variation due to lifestyle factors! You also can have a SNP but never express it.
COMT: Mood, Focus & Estrogen
Each SNP has strengths and weaknesses. People with a fast or slow COMT gene have incredible focus, lots of energy and healthy skin. They also can tend towards insomnia, feeling irritable or anxious and a variety of estrogen sensitive conditions like fibroids, migraines and PMS. There is a vulnerability to addiction, especially work addiction because of their ability to focus and be alert for long periods of time.
Lifestyle to Support Estrogen Balance
People with a COMT expression do well when stress management is part of their focus.
Early bedtime supports the liver to metabolize hormones.
Avoid plastics and BPA or other chemicals that mimic estrogen.
Roundup is especially troublesome as it affects aromatase activity. Aromatase converts other biochemicals to estrogen.
‘Maintain a healthy weight. This helps with regulating estrogen.
Eat local, organic and grass-fed as much as possible. Beets, carrots, onions artichokes, cruciferous veggies and bitters are great!
Regular meals take the pressure off the COMT expression by reducing stress hormones.
Plan regular times to play, move and be social
I know that many of these could be considered healthy habits for anyone. However, when I start looking into symptoms and labs for individuals the patterns of gene expression are clear. There are other SNPs that relate to food sensitivity or cardiovascular disease. There is one that inhibits detoxification and another that causes carb cravings. Getting to know your body in a deeper way means you can respond better. You can enjoy your strengths and mitigate the negative factors by providing the right support.
Progesterone restores a sense of calm. For those balancing the responsibilities of home, work and family, progesterone helps you keep your cool. It acts on the gamma-aminobutyric (GABA) receptors in the brain. These are the receptors that sleeping pills, anti-anxiety medications and alcohol act on. Optimal progesterone levels help with:
clearing brain fog
allowing you to stay asleep, especially between 2 and 4 am.
supporting elasticity in the skin
helping neural growth in the brain
preventing puffiness & bloating
What’s GABA all about?
GABA is the primary inhibitory transmitter in the brain. It settles the mind and protects our brain from overstimulation. If you worry a lot or experience anxiety you may be low. GABA comes from protein we eat and some people respond well to supplementation. If you don’t, it may be a good sign. The molecule is quite large so some research has hypothesized that it shouldn’t readily cross the blood-brain barrier. However, it will still have a positive effect because we have a lot of neurotransmitter receptors elsewhere in the body. Mood can improve when GABA reaches the cells in our liver and gut.
If you are deficient in GABA, you may experience a kind of physical anxiety that is difficult to shake. Muscles may tighten and your immune system is less able to do it’s job. One of the best tips about GABA is to use it before bed on the days that you strength train. It increases Human Growth Hormone (HGH) levels in the blood by up to 5 times with 90 minutes of taking it. The rate of muscle growth is influenced by HGH levels which are highest when you sleep. Use GABA and see the results. There are no negative side-effects from taking GABA.
Promote Peace & Calm Naturally
Here are a 6 more ways you can bump up your GABA:
Theanine from green tea, matcha or the supplement.
Foods high in zinc and magnesium: liver, red meat, shellfish, dark chocolate, pumpkin seeds, halibut, spinach, and okra.
Chamomile tea: this has a bioflavonoid called Apigenin that binds to GABA receptors in the brain. It calms the nervous system.
Potassium rich foods: acorn squash, spinach, brussel sprouts and yogurt.
Ensure your serotonin levels are optimal: tryptophan in food or supplemental 5HTP support serotonin & enhance the effects of GABA.
St. John’s Wort and Ginkgo: both these herbs have different actions in the brain to increase uptake of GABA.
Ovulation is a Important
The birth control pill means you won’t get the surge of progesterone mid cycle and near the end of your cycle. Progesterone supports your brain, thyroid, bones and breast tissue. It also reduces inflammation, We produce far more of it than estrogen. It keeps estrogen from becoming dominant in both males and females which has several health risks. Progesterone is also an essential for building block for other hormones including cortisol and adrenaline. Men produce progesterone in their testes and use it for general health as well as sexual function.
Ovulation supports estrogen to promote muscle gain, insulin sensitivity and a healthy cardiovascular system. Missing out on ovulation is an unfortunate reality that many women experience. They aren’t told the full story of oral contraception. More and more women are saying no to the pill and the long list of side effects that accompany it.
Symptoms of Low Progesterone
Many of my patients come to me with symptoms that could be low progesterone levels. Anxiety, sleepiness, headaches, weight gain, irrational fear, moodiness are just some. Miscarriage and infertility can be caused by low levels. So can endometriosis, PCOS and depression. Around menopause hot flashes, low libido and night sweats can be alleviated by using herbs to mitigate what is a natural drop in progesterone.
Dopamine is a neurotransmitter that is released from the pituitary gland. It acts like a hormone giving you a feeling of confidence, excitement, motivation and energy. When it is released you can feel pleasure, satisfaction and increased willpower. It is the chemical of reward and success. Dopamine depression comes with a significant amount of fatigue, apathy, inability to think clearly or feel enthusiastic about anything. For those who sleep excessively and feel a lack of self-confidence it may be due to lack of dopamine, not serotonin.
What Weakens Dopamine?
Chronic stress and a dysregulated cortisol response make it harder for the body to produce it. Low estrogen or thyroid hormone also weaken this neurotransmitter. In fact, hypothyroidism can look a lot like low dopamine. Tyrosine is the the precursor to both thyroid hormone and dopamine. This is an amino acid that I use a lot in clinic because it is safe and effective for those with Hashimoto’s thyroiditis and depression.
Pleasure & Movement
Dopamine can help you access pleasure and euphoria. This means people can desire more of it leading to addiction. Levels in the brain and body are increased by thrill-seeking activities, caffeine, sugar, recreational drugs, gambling, sex, food and devices. If you require constant access to any of these you may have a dopamine deficiency. On a physical level, this neurotransmitter affects motor control and movement.
Replenish Your Dopamine
Recovering from deficiency in a natural way is possible. Here are six ways you train your self back into a state of balance. I always start with diet and lifestyle alongside any supplementation.
Sleep, real rest & downtime: By real rest I mean time unplugged either meditating, reading or connecting with a loved one. Insomnia is a major contributor to dopamine deficiency. Your brain needs this time to restore dopamine levels.
Tyrosine: I mentioned supplementing with tyrosine already. Start with 500mg in the morning. You can go up to 1500mg per day and split the dose into two if you experience afternoon crashes. Some people just need more and others need less. Take a day off every week.
Foods rich in tyrosine and its precursor L-phenylalanine: turkey, chicken, wild game, walnuts, yogurt, and yes, dark chocolate! You can also supplement with l-phenylalanine if tyrosine didn’t help as much as you wanted.
B-vitamins: especially B6 in the P5P form (pyridoxal phospate). This helps the hypothalamus and pituitary communicate effectively so that they are producing the right amount of dopamine.
Strength training: Building muscle increases the human growth hormone and dopamine. Circuit training, resistance training and HITT (high intensity interval training) are smart ways to increase dopamine. Aim for about 40 minutes three or four times per week.
Meditate: this simple practice whether it is 5 or 20 minutes a day cultivates well-being like nothing else. It is simple and intelligent.
Feeling Happy All Year
Chronic high stress and elevated levels of cortisol cause both dopamine and serotonin to drop. Each small step we take towards lowering stress ripples out. Notice how you feel after a short meditation or a half an hour of strength training. We can set off a cascade that allows us to feel more calm, connected and satisfied. We are less likely to shop, smoke, drink and overeat. Our physiology is able to function with more ease and we can experience more pleasure. Our thoughts don’t take over and send us into negative self-talk as easily.
The hormone testing I do now includes a dopamine assessment. This morning I was reviewing this test with a patient who has had more challenges than most beginning in childhood. Her dopamine response is excellent which didn’t surprise me. The resiliency and satisfaction that she experiences speak louder than any of her challenges. May we all experience this kind of pleasure.
Every tissue in the body adores and wants some estrogen. Estrogen protects us from disease. It nourishes our brain and keeps our bones strong. And damn girl, estrogen is what makes women curvy! We build muscle in our legs and butts more readily than men because of this wonderful hormone. During a regular menstrual cycle estrogen will spike around ovulation giving us extra energy while suppressing our appetite. Estrogen doesn’t cause abdominal weight gain.
People get down on estrogen but it’s not estrogen’s fault! Environmental toxins and pharmaceuticals like birth control contain ‘bad’ estrogens which can accumulate in the body. These can be recirculated or metabolized down pathways that lead to problems. There is a trend to ‘detox estrogen’ as a way to lose weight. Please don’t fall for this! We need estrogen. We love estrogen. Estrogen is sexy. Treating your hormones without proper testing and guidance is not recommended. It can create more problems.
Progesterone Just Says ‘Eat!’
Seems like progesterone gets all the love. It’s true, progesterone is pretty awesome too. We need all of our hormones to work together. Progesterone spikes before your period. This is why you may feel extra hungry. It’s a good time to nourish yourself with iron rich foods so I don’t mind this cue. It makes sense. Progesterone doesn’t get a bad reputation the way estrogen does. Why is this? Is it because of how estrogen dominance and insulin resistance in men causes a certain type of weight gain? Well, women are quite different than men.
Progesterone can dip due to high stress. When this happens it can contribute to estrogen dominance in women. Estrogen might not even be high but the ratio is what matters. We have come to equate estrogen dominance with weight gain but it’s not that simple. The kind of weight that is concerning for women’s health has a specific pattern. It looks like higher testosterone paired with insulin resistance and an aggressive androgen metabolism.
Estrogen: the Move & Seek Hormone
Around ovulation women tend to have more energy. It’s a great time to test your limits in the gym or attend a social event. This phase has been coined ‘move and seek’ by researcher Martie Haselton. As estrogen is hitting its peak we tend to want to move our bodies more and seek more contact. This fertile window creates a surge of inspiration for moving and mating. Makes sense, doesn’t it?
Symptoms like breast tenderness, heavy or clotted cycles and fibroids are linked with excess estrogen in the body. In men, this can look like weight gain, erectile dysfunction, breast development or moodiness.
So where does your estrogen go once your body is done using it? Estrogen does a lot of great things for our bodies, like protect us from cardiovascular disease for example. Problems arise when our body isn’t able to get rid of it properly and it recirculates.
Where Your Estrogens Go
The short answer is that you detox your estrogen based on two main factors. Lifestyle and genetics. These influence one another. Now as we begin to dig in, keep in mind that there are three parts to detoxification & this is a process your body is undergoing all the time. Gently supporting your overall health supports this process. Doing fast, hard cleanses does not.
First, the Liver!
In phase one of detoxification your estrogens get turned into 3 different kinds of metabolites. The metabolites are called 2-OH, 4-OH and 16-OH. The 2-OH is the protective pathway but even too much of this can inhibit neurotransmitter production. What we are looking for a a ratio that prefers the 2-OH pathway. Broccoli, kale, cauliflower, broccoli sprouts, and brussels sprouts encourage this pathway. There are supplements as well but please do not start using them unless you know it’s phase one that needs support. I’ll explain why.
If you begin taking DIM when its actually your phase two that is sluggish then you will feel worse. Both phases need to be optimal in order for the symptoms of PMS, heavy cycles or painful cycles to let up. Supplementing without testing can also lower estrogen levels overall. If they aren’t high then this can cause other problems. With hormones it really is about the balance.
Next, Packaged Up!
Keep in mind that in phase one, all of these metabolites are reactive to oxygen meaning they have the potential to damage DNA. The goal of phase two is to neutralize the 2-OH and the 4-OH in a process called methylation. Basically this process makes the metabolites water soluble so that they are in a form that can be safely excreted. Magnesium helps the enzyme COMT in this process. If excretion doesn’t happen then the reactive metabolites will recirculate and end up in the 4-OH pathway. Magnesium is a safe to supplement for most people.
With testing we can see if you methylate your estrogens well or not. Nutrients like SAMe, methionine, choline, tri-methyl-glycine (TMG) and methylated B vitamins support methylation. Having food with a balance of amino acids is a good start. Before supplementing testing is ideal. To support phase two check your make-up, skincare and household cleaners for chemicals. Avoid pesticides & herbicides. Reduce alcohol.
Last, Move ‘Em Out!
Interestingly, we need to begin treatment with this last phase in most cases. Phase three is all about how we excrete these estrogens once they are ready to go. This happens in the gut. If you colon isn’t working properly then recirculation will occur. Inflammation can inhibit this phase. Flavonoids like those found in broccoli sprouts, dark chocolate & green tea support phase three.
If your gut bacteria is disrupted and you are producing too much of an enzyme called beta glucaronidase then phase three won’t work. This is because this enzyme can take the estrogens that are ready for excretion and push them back into circulation. You can be estrogen dominant because your gut health and microbiome causes reabsorption where the 4-OH pathway is likely to be preferred. Good gut testing will show if beta glucaronidase is elevated. If it is then we can help with a supplement called calcium d-glucarate. But again, do not take this without testing.
What you can do is eat a whole food diet with plenty of prebiotic fibres and fermented foods. Drink two litres of water a day and avoid environmental toxins as much as possible. We know that by simply living a lifestyle that is cleaner can expand your lifespan by 13 years. Quality of life improves as well.
Why Estrogen Gets a Bad Reputation
Often women share with me that they are concerned about breast cancer because of a family history. By looking at the metabolite pathways some of these fears are alleviated. When it comes to hormones we really can’t guess where the imbalance is because there are so many factors. By optimizing the detoxification pathways and preventing recirculation we can take steps to decrease the proliferative estrogens. 4-OH is why estrogens get a bad reputation. 16-OH is weaker but also can contribute to symptoms.
None of this is an alternative to cancer treatment. A friend whose wife recently fought breast cancer shared what he learned. She had a family history and was screened regularly so it was caught early. They treated immediately. He noticed that the women who were diagnosed at the same time and who waited did not have good outcomes.
Going back to how lifestyle and genetics work hand-in-hand allows us to feel empowered. It is also what evidence-based medicine knows. The choices we make do have a major influence in how our genetics get expressed in this lifetime. This doesn’t mean that when someone is diagnosed it is somehow their fault. It’s shocking that this cruel idea even exists but it does. Please enjoy this precious life and be kind to those who are up against cancer. Touching into our mortality can fuel our love for the time we have and align us with how best to spend it.
Below are 4 of the most common period problems along with the 5 steps that can help. First, let me explain what I hear women talk about often when it comes to their cycle.
1. Heavy Periods
If your periods are long, or heavy it is called menorrhagia. You may be surprised to hear that iron deficient anemia is one of the causes of heavy cycles. Talk about unfair! I see this a lot especially in women who are vegetarian or have an absorption issue. They are already low in iron and then they lose an excess amount of blood each cycle making the problem that much worse. Hypothyroidism can be a contributing factor and is often missed. I see this every week in my practice as well.
Fibroids and another type of growth in or around the uterus can also cause heavy bleeding. Endometrial hyperplasia is the fancy way to say the endometrium is growing too much. Both of these are linked with estrogen dominance. I’ll talk more about that in a minute.
2. Irregular Period
Some women don’t know when their cycle will come or how heavy it will be. There are a few reasons this can happen but the most common one is because of a metabolic disorder called PCOS. At the root of PCOS is a blood sugar imbalance combined with poor androgen metabolism which causes hair growth on the face, chest and abdomen.
3. Painful Periods
Extremely painful periods where you are doubled over in pain and perhaps even vomiting could be caused by endometriosis. This autoimmune condition is difficult to diagnose because surgery is required. I often find painful periods can be alleviated within a month by specific diet and lifestyle changes. In my practice, I recently had three young women who suspected endometriosis. Two recovered from painful periods quickly while one decided to go through with surgery. In each case we worked on underlying causes but the woman who had surgery arranged to have the overgrown tissue removed. I trust the decisions my patients make. Surgery isn’t an easy choice but it can offer relief like nothing else can.
Nonsteroidal anti-inflammatory (NSAIDs) are used to treat the pain. These specifically blocks hormone-like chemicals called prostaglandins which cause the cramping in your uterus. They also harm the gut health and delay ovulation resulting in lower progesterone levels. This can lead to estrogen dominance. Estrogen dominance is where there is more estrogen and lower levels of progesterone. This can cause heavy cycles. painful cycles and worsen PMS.
4. Missed Periods
Amenorrhea is when your period has been absent for more than three months. This can happen in athletes who are pushing their bodies very hard. This has been termed the female athlete triad meaning energy is low, there is no period and bone density is impacted.
Early menopause can also cause this although women often think this is happening and their labs say otherwise. Probably the most common cause of missed periods is due to discontinued use of hormonal birth control or straight up pregnancy.
Traumatic brain injury, malabsorption disorders like celiac disease or inflammatory bowel disease, pituitary tumors, and thyroid illness also need to be ruled out.
5 Steps to Help Your Period Problems
1. Track Your Cycle
Start tracking your cycle and symptoms so that you can understand if there’s a pattern or clues your period is giving you. There are more and more excellent tools for doing this easily now. Tracking can help you identify problems early before they become bigger issues.
2. Stress & Blood Sugar
Cortisol production will go up when you are stressed and dampen your progesterone. Estrogen dominance comes next. High stress means cortisol is going to keep you up at night giving you less time to recover. Include fat and protein with each of your meals as this will help with your insulin and blood sugar levels so that the rest of your hormones can get back into balance.
2. Lab work
If you’re experiencing period problems then definitely consider lab testing to understand what the root cause is for you. I always look at blood sugar, thyroid and ferritin. Then I do cortisol testing which includes a complete picture of how its regulating throughout the day. The sex hormones and their metabolites help us see a full picture of what may be causing the imbalance or symptoms.
4. Magnesium, Evening Primrose Oil & Turmeric
Magnesium inhibits prostaglandins and helps with methylation. If you get headaches with your period, magnesium can work wonders. You can increase your intake up to 600 mg the week before your cycle.
There is research supporting the use of evening primrose oil for the treatment of PMS and menopausal symptoms. For PMS and painful periods begin on the first day of your cycle until ovulation. Taking 1500mg for these first two weeks supports what the body is already doing. I use seed cycling for PMS for balancing hormones for similar reasons. During menopause you can take a lower dose during the whole month. Evening primrose oil is helpful for skin, hair loss and fertility.
Turmeric is an anti-inflammatory and supports healthy liver detox which is where your hormones get metabolized. Turmeric can reduce pain driving prostaglandins and supports healthy estrogen levels.
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.
This is a question I often get from patients. It’s an imbalance of hormones beginning with our stress hormones and involving insulin. 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.
Sleep, Inflammation & PCOS
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). All of these factors will contribute to increased belly fat. Abdominal weight gain is a real concern for health for all of these reasons.
My doctor tells me “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, you will lose belly fat as a side benefit. HIIT targets several of the key factors contributing to 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 or Cardio?
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 belly fat.
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.