When you skip a meal or eat inconsistently in other ways your body has to compensate. Several hormones are involved including insulin, cortisol and thyroid. Cortisol has an important anti-inflammatory function. Insulin is involved and works hard to stabilize the metabolism. Thyroid hormone is affected because the conversion of T4 to T3 depends on a constant source of carbohydrate. Receptors for thyroid are found in most tissues highlighting how crucial it is for many physiological functions. You can see why clinically, one of the first layers I look at is stabilizing blood sugar especially if there is thyroid or other endocrine involvement.
Pain and Hunger
Cortisol is anti-inflammatory. If it is overused cellular resistance can happen which can lead to systemic inflammation or increased pain in the body. If there is an underlying autoimmune condition it is likely to worsen as the tissues that are under attack have less protection. Cortisol spikes at night and may be the cause of recurrent night hunger. A high protein snack before bed can be helpful for both this and insomnia. Adaptogens like ashwaghandha normalize cortisol. However this particular one is a nightshade which is contraindicated where autoimmunity is present.
Testing cortisol and hormone metabolites can be very helpful but blood sugar and gut health have to be addressed. Creating a stable baseline is the starting place. Hormones will sometimes regulate themselves once there’s new baseline. If this doesn’t happen then we have other places to look. I find this process to be empowering process for patients because they are engaged in treatment on a day to day basis that creates change.
Carb Tolerance: Learn to moniter your glucose
Glucose levels can stay high or drop too low. In reactive hypoglycemia there is an excess release of insulin resulting in an intense blood sugar crash. A higher protein diet can help stabilize blood sugar. For those with metabolic issues, a Paleo-type diet is recommended. Some will do better on a lower-carb version of this diet, although that’s not always necessary depending on the individual. As I mentioned earlier thyroid requires a more constant source of carbohydrate.
Studies show an increased frequency of thyroid disorders in diabetics. This is a bidirectional problem, meaning thyroid disorders increase the frequency of metabolic problems, and metabolic problems increase the frequency of thyroid disorders. Metabolic syndrome is associated with inflammation, insulin resistance and hormonal imbalances.
Chronically high blood sugar leads to insulin resistance and inflammation; repeated insulin surges increase the destruction of thyroid gland in autoimmune thyroid disease.
There are a couple botanical supplements that support blood sugar regulation. Eating an autoimmune diet low in goitragens and nitrils is a good starting place. Looking at iodine levels is also relevant.
An autoimmune diet
Improving gut health is key for all autoimmune and gastrointestinal disorders including leaky gut. Thyroid hormones affect the tight junctions and of the small intestine and stomach. Lipopolysaccharide is an endotoxin that comes from pathogenic bacteria. In leaky gut it can escape and trigger autoimmune reactions and inflammation.
Adequate intake of sea vegetables along with fish or brazil nuts offers the iodine and selenium needed to support thyroid function. Sweet potatoes are goitrogenic when raw but cooking them makes them a safe choice along with yams, plantains, taro, yuca, and squash. Fermented veggies are encouraged on a daily basis in small amounts. They can be goitrogenic in high amounts.
The autoimmune diet requires removing a few foods like nightshades, nuts/seeds and eggs in order to seed if the body is reacting to these as they are common allergens.
The cycle: Blood Sugar, HPA Axis and Cortisol
Chronically low blood sugar levels lead to increased cortisol as I mentioned at the beginning of this article. Cortisol is a glucocorticoid meaning its job is to increase the glucose so the brain and muscles have what they need. It also slows digestion, growth, and reproduction meaning prolonged or repeated surges undermine these functions. Interestingly thyroid hormone is required to help clear cortisol metabolites.
Diet, exercise, supplements, and hormone replacement cannot overcome stress-induced hormonal imbalance although each of these do play a role. Stress management is the central player. Stress can impair estrogen clearance, weaken immune barriers in the gut, brain and lungs and create cellular resistance as we talked about.
Stress management is going to be the focus of many articles to come. Using an evolutionary framework is incredibly powerful in terms of reconnecting with our genetic legacy of adapting to new environments. Today’s world requires that we remember how to live as our ancestors did. Being able to regulate stress is part of our birthright.
Activities that include social time and play are ideal. Any kind of movement helps manage stress and hormone balance. Pre-menstrual syndrome (PMS) affects 90% of women at some point. In 25% of these cases clinical intervention is required. I treat a number of women for PMS, fertility, menopause and other hormone related issues using acupuncture and functional medicine.
What is the Replacement Model?
PMS is not well understood but we do know that stress, inflammation and auto-immunity are contributing factors. Excess estrogen relative to progesterone is what occurs and conventional medicine uses a replacement model to treat. This mean birth control is given. In more sever cases antidepressants are also prescribed. Given what we do know this strategy is absurd. Functional psychiatrists are now using diet and lifestyle to treat all kinds of conditions without pharmaceuticals. NSAIDs and other painkillers undermine the gut lining and can lead to more problems if used long-term.
Functional medicine looks deeper than symptomatic changes and treats the underlying cause of imbalance. Mood swings, appetite changes, insomnia, brain fog, headaches, breast tenderness, fatigue, skin issues, back pain, digestive issues are all related symptoms. Any five of these symptoms at once may be diagnosed with PMDD or pre menstrual dyphoric disorder. The medications that are used may temporarily relieve symptoms but were never meant to be used long-term and have a detrimental effect on hormone health instead of supporting the body in finding homeostasis.
How can exercise help and hinder hormone health?
Appropriate amounts of activity and exercise move the liver’s blood promoting a healthy cycle. If you enjoy endurance training, then fat is the best source of energy as it has a slow burn. Protein is key for building and maintaining muscle. Whey protein stimulates insulin for a stable metabolism and increases glutathione for liver function. The best protein supplements will include glycine and come from a grass-fed animal source. Protein powders with pea, soy and egg white are not recommended due to the irritating effect on the digestive system.
The tendency for a lot of active people is to under eat so that why we talk about pre and post workout meals. Muscle repair happens at a slower rate if there isn’t an immediate source of energy to help with recovery time. Thirty grams of carbs and fifteen grams of protein is an ideal pre-workout snack. Fasted exercise means a slower recovery time and maintaining muscle becomes more difficult.
What the right amount of fluid?
Having enough fluid is important. Two litres per day is a good baseline. A reduction of 2% than needed can result in a 20% reduction in performance. For every hour of exercise add an extra half litre. Squeeze in a lemon or add some mineral rich salt. Sodium, potassium and magnesium are important for absorption. Most electrolyte drinks are full additives that our ancestors wouldn’t recognize and some are harmful. Plastic packaging is known to have xeno-estrogens which contribute estrogen dominance.
What about fertility? Introducing the HPA Axis (hypothalamus, pituitary, adrenal)
PCOS or polycystic ovarian syndrome is now the leading cause of infertility in young women with insulin resistance is the main cause of PCOS. Fasting after exercise is especially concerning for women because of this so 30 grams of carbs within an hour post exercise is recommended.
A diagnosis of PCOS is made when two of these are present: elevated testosterone or other androgenic hormones, irregular or absent menses and/or cystic ovaries. Only 60 % of women with PCOS are overweight which indicates there is a high number of women are likely to fall into the category of female athlete triad meaning that they are overtraining and under recovering from exercise.
Exercise can be a healthy stressor but if you don’t feel good after it means you are over doing it given your current metabolic state, HPA axis regulation and overall resources which are all individual. Symptoms related to over training include: depression/anxiety, unintentional weight gain/loss, digestive distress, recurrent injury or illness, muscle strength loss, fatigue, brain fog, loss of cycle or painful cycle.
I will be writing and talking a lot more about the solutions to this kind of dysregulation and how to regain health. Getting enough rest and sleep is key. Varying activity and cross training with low intensity activity like swimming or yoga is ideal. Ensuring enough calorie intake is very important and there are some great online tools for determining ideal macro-nutrient ratios. Protein intake needs to be higher than most people eat which is why supplements are used for training periods or for those wanting to eat a nutrient dense diet without restricting calories. Often when people cut out carbohydrates that are low in nutrients their overall caloric intake drops below what is needed to maintain good health.
Loss of menstrual cycle due almost always relates with the function of the HPA axis and increases the chance of osteoporosis later in life. Contributing factors include low body weight, low intake of calories, too much exercise causing higher cortisol which is related to production of the luteinizing and follicle stimulating hormones.
Preparing for Pregnancy and Parenthood
For fertility, pregnancy and breast-feeding nutrient deficiencies are crucial to look at. Folate is required for new DNA and fetal cell division. Folate absorption is dependant on zinc status and should not be taken in form of folic acid. Neural tube defects have been related to choline deficiency and 86% of women don’t get enough. Egg yolks are an excellent source of choline. Vitamins A, D and K2 are especially important. Retinol from liver is the best way to get Vitamin A. D and K2 need to be taken together. High methionine depletes the body of folate, choline and B12. Ensuring an intake of the animal parts normally reserved for stock and regularly consuming bone broth will create a balance of methionine to glycine. Iodine deficiency can result in mental defects and cretinism. Kelp is a good source of iodine. Any thyroid dysfunction in the preparation stages can be a cause for miscarriage and infertility.
Circadian rhythm and artificial light at night may affect fertility in both sexes and increase miscarriage. Research shows that we need 8-10 hours/night. We also need enough natural light each day. Travel between time zones can affect circadian rhythm and losing just one hour lost in a night can be disruptive and cause inflammation. Parents must be resilient and be cautious with their resources as the early years of a child’s life is full of sleep disruption.
Once pregnancy is achieved no additional calories are required during the first trimester but in the second an additional 200-300/day will be important. The last trimester should be 400-500 extra calories/day above baseline. Breastfeeding requires a similar amount.
A little about Menopause
Menopause is another powerful shift in hormones and symptoms may include insomnia, low libido, vaginal dryness and hot flashes. Avoiding the replacement model for this time is a choice that many women are making. Others are ensuring that any replacement hormones lasts a short period of time because they know this area has not been researched enough.
Some solutions to minimize discomfort are strength training to increase the human growth hormone and the cascade that follows, eating a nutrient dense diet and reducing alcohol and caffeine.
Scientists have found that memories may be passed down through generations in our DNA
According to Dr Brian Dias, from the department of psychiatry at Emory University, said: ”From a translational perspective, our results allow us to appreciate how the experiences of a parent, before even conceiving offspring, markedly influence both structure and function in the nervous system of subsequent generations.
“Such a phenomenon may contribute to the etiology and potential intergenerational transmission of risk for neuropsychiatric disorders such as phobias, anxiety and post-traumatic stress disorder.”
This suggests that experiences are somehow transferred from the brain into the genome, allowing them to be passed on to later generations.
How are blood sugar, cholesterol & the HPA axis involved?
Here’s the good news:
Intermittent fasting is normal part of our genetic and evolutionary history. Times of feast and famine are a part of many if not all cultures. It’s a hormetic stressor, meaning it promotes cellular repair. As a tool for weight, it promotes a metabolic shift that preserves muscle mass. (1) For those with moderate blood sugar imbalances, intermittent fasting may help regulate insulin levels.
Intermittent fasting has shown to reduce cholesterol by 20 per cent. This research indicates a decrease in the ‘bad’ LDL’s while maintaining the ‘good’ HDL’s. Triglycerides decreased up to 32%. Triglycerides are associated with cardiovascular disease and diabetes (2,3,4).
Another study showed increased motor coordination, brain health and oxidative stress in an aging population. On that note inflammation and disease associated with neuroinflammation were also positively affected. These include depression, other mood disorders and Alzheimer’s. (5,6,7) I’m imagining how society would change if most elders were free of disease associated with chronic inflammation. What if we could age with sharp minds, stable moods and free of pain?
When to be cautious?
With all this evidence why am I often cautioning patients and instead encouraging eating at regular times? People tend to miss meals when stress is high or eat at times that undermine healthy organ and metabolic function. There are a few specific situations where intermittent fasting is not advisable. For those with HPA axis dysregulation the stress of fasting can worsen their symptoms. These include the inability to fall or stay asleep, afternoon crashes, poor stress response and slow exercise recovery time. Another endocrine disorder where caution is advised where thyroid issues are suspected . Low glucose levels exacerbate thyroid disease because a constant source is required for the conversion of T4 to T3. Functional tests are available to help assess if you are at risk for this.
Pregnancy is another time to avoid intermittent fasting for obvious reasons. Anyone trying to maximize fertility or with hormone imbalances may want to avoid fasting. However if blood sugar or excess weight are contributing factors intermittent fasting may be helpful. Working with a clinician is a good idea to help assess a treatment plan. Keep in mind that more severe insulin resistance does occur in otherwise healthy individuals and this would be another time to avoid fasting.
Children and teenagers do not benefit from fasting as it can cause problems in the same way fasting during pregnancy is not wise. Both can cause epigenetic stressors leading to insulin or leptin resistance later in life. The young one’s system gears up for weight gain to protect from starvation and times of famine.
Anyone with a history of disordered eating needs to be very cautious and not engage in fasting without adequate support. Orthorexia is a term that refers to obsessive behaviour around food with a tendency to become addicted to special diets. If I hear a patient refer to certain foods as bad or even as poison.
Finally if you experience stomach or abdominal pain upon fasting there may be an infection of pathogenic bacteria like heliopylori or other dysbiosis present that needs to be addressed first. Testing for these is available and may reveal important or even life changing information.
How to do it?
If you fall don’t fall into any of the above categories its best to try intermittent fasting when overall stress is low and when your life makes space for it. Perhaps you are sleeping well and there are no big life changes happening. If you are moving, ending a relationship or having a baby it’s definitely good to wait.
Otherwise here are some approaches to intermittent fasting. Many start by skipping one meal a day or extending the duration of the overnight fast to anywhere from 12 to 20 hours. Others prefer whole-day fasts that involving fasting for 24 to 30 hours, once a week or twice a month. Most of the research on intermittent fasting uses alternate-day fasting, where participants fast for 24 hours every other day, alternating days of eating without restrictions.
What causes estrogen dominance, infertility and andropause or male menopause?
Our endocrine system has several glands, enzymes, hormones that work together in a complex system of negative feedback loops. Pregnenolone is the precursor to many of our hormone pathways. It requires cholesterol and an enormous amount of cellular energy (ATP) to form. There is a limited amount of pregnenolone in the body and that’s if we ensure adequate intake of healthy fats and cholesterol.
Why is it important to know about pregnenlone? Chronic stress high jacks all of our other hormones by stealing from this precious and limited resource in order to feed the cortisol pathway. High cortisol can lead to and vice versa creating a vicious cycle which is why maintaining blood sugar levels is so crucial for stress management.
How does it work in men?
When insulin levels rise an enzyme called aromatase up regulates. This enzyme is converts testoterone (T) to estrogen (E) so in excess can lead to estrogen dominance. In a case like this where T is low and hormone replacement is used then the problem will be exacerbated. Simply replacing low hormone levels with pharmaceuticals also disrupts the feedback system and receptor sensitivity. This leads to a higher need over time and the body will produce less and less.
More on Blood Sugar
In andropause (or ‘manopause’) T can be normal and its the E’s that our out of range again throwing off the equilibrium and creating estrogen dominance.. Clinically I’ve seen patients stabilize blood sugar, change their diet and use acupuncture to effectively bring levels into a normal range within a few months. For women high insulin up regulates an enzyme called 17, 20 lyase increasing T and leading to polycystic ovarian syndrome which is the number one cause of infertility. As E rises it suppresses the follicle stimulating hormone (FSH) from the pituitary gland.
More on Stress
The pituitary gland is the control tower of the HPA axis which stands for hypothalumus, pituitary, adrenal axis. The term adrenal fatigue is more accurately called a dysregulation in the HPA axis. Adrenal symptoms are not always related cortisol levels or rhythms. It can be resistance at the cellular level or dysfunction anywhere along the axis. This is why we do comprehensive lab work and look at the detox pathways of each individual.
I won’t go into the physiology much more because I want to offer solutions and steps you can take on your own. Just before I do this let me highlight that inflammation from any chronic condition, allergy or stress can suppress the hypothalamus and pituitary function. Inflammatory cytokines cause hormone resistance. For example gut dysbiosis increases beta glucosidase causing hormones to re-circulate in the liver. This inhibits proper functioning of the active hormones.
Diet, Exercise and Sleep
A growing number of people are becoming highly sensitive to foods and supplements which indicates a number of things one of which is impaired ability for the liver to detoxify. Reducing inflammation helps to open these detox pathways. Ensuring you have enough omega 3’s in the diet also is effective and also helps with blood sugar stability. Removing foods that are common allergens can help you regain a new level of health. These include gluten, dairy and soy.
Eat real food and limit flour and sugar. High-quality protein can be eaten in small amounts at every meal and plant foods like vegetables and fruit ought to make up the bulk of your diet. Healthy fats need to be eaten at each meal as well. Fats are an excellent source of energy and give you a slower burn than carbohydrates. People aren’t reactive to fats and they help with nutrient absorption. If you are removing grains be careful as a very low carb diet is not recommended for hormone health especially where adrenal or thyroid function is impacted. As far as detoxification we excrete excess hormones through bowels so taking steps to optimize gut flora and motility is important. Resistant starch from twice cooked potatoes or plantain for example are incredible for the large intestine.
Nutrient-dense foods like liver, eggs, fatty fish, leafy greens, and full-fat dairy products provide vitamins and minerals that support metabolic function, detoxification and ovarian health.
A woman with PCOS symptoms could have normally functioning ovaries with no cysts and no insulin resistance, yet still fit the symptomatic profile of the syndrome simply due to gut dybiosis (2) or excess androgens from the adrenals (1). I’m using PCOS to illustrate how hormone imbalance can erupt from all angles.
Balancing the right amount of activity and exercise is key. There are a rising number of active women who are eating low-fat and low carb or vegetarian diets with PCOS. (3,4,5). Maintaining a health weight means a body fat index between 16 and 30%. Not enough food during the day can trigger the stress response. If you have trouble sleeping at night or are losing your menstrual cycle this could be what’s happening (6, 7). Increasing the amount of darkness in your life can boost your mood and your hormones (8).
There are numerous studies on PMS and stress affecting young people and leading to infertility (9,10) This is an area where acupuncture shines and the research agrees (11,12). I often will see a patient once a week for one full cycle and see remarkable changes that are lasting.
9. http://emedicine.medscape.com/article/273153-overview HPA axis
When the Body Speaks
The body generally tells us what we need to know. Often this occurs more readily when we are injured or sick. These interruptions to our daily life force us to tune in and listen to the body. In particular when we slow down our bodies will sync up or entrain to the part of us that is healthy. This mechanism is built-in to our genetics and is similar to what happens between mother and child or doctor and patient. Next time you are in pain notice what happens when your body is still and you will likely find that the inner physician speaks up.
Is it possible to Age Gracefully?
Research has proven a connection between mind and body. Harnessing this understanding along with our genetic history can show us how to live more fully. For two million years of our evolution we lived embedded in our surroundings. Only in the last 0.5% of this time have adapted to agriculture and our current system of industrial food systems accounts for a tiny portion of this. Archaeology indicates that bone health decreased as people began to homestead. The explosion of heart disease, cancer, diabetes and other chronic illness has specifically coincided with modern life. There is a mismatch between how we are genetically adapted to live and the age of agriculture. To live a long, healthy life and age gracefully we can simply look to our ancestors.
What to Eat: it can be Simple
We know that our ancestors ate a wide variety of foods which is what I encourage my patients to do. Enjoy a range of macronutrients such as carbohydrates, proteins and fats. Choose foods with vivid colours and revel in the ritual of preparation. Each person has unique needs which change throughout a life span. What is right for you can be discovered through experimentation although specific diagnosis or guidance can be important at times. For example anyone with thyroid imbalances do better with a more consistent source of carbohydrates which will assist with the conversion of the T4 to T3. Or, for example, anyone experiencing hypoglycemia needs to focus more on protein and to ensure fats are consumed with fruit to reduce blood sugar spikes as well as increase absorption.
Four Steps You Can Take
Once your metabolism is relatively stable it becomes easier to experiment because the need to eat is less urgent. This is how our bodies are meant to function. If you need support to reach this place there are some simple steps that can be taken. First, focus on foods that with high levels of bioavailable nutrients and those that actually support the good digestive bacteria. Microbiota accessible carbs are best and what it basically comes down to is eating more vegetables; for example root vegetables are packed with nutrients that are easily assimilated. Second, remove any foods that hurt your gut lining especially refined carbs and any known allergens. Third, stabilize your blood sugar which will reduce your risk of developing diabetes and dementia later in life. Finally, add extra healthy fats to increase the assimilation of micronutrients. A couple of examples are beta carotene and lycopene which absorb up to eighteen times more so eat your carrots with butter and add a dose of olive oil to your tomato sauce.
Facts About Fat, Protein and Micronutrients
Furthermore it is commonly understood that iron is made bioavailable by adding vitamin c but less known that non-animal sources are only 2-20% available partially due to phytate and oxalates reducing absorption. This accounts for why up to 85% of vegetarians are deficient in this essential nutrient. Other nutrients that are often very low are vitamin D and E, B 6, zinc, calcium and magnesium. This is because animal protein is the most nutrient dense and bioavailable source of many micronutrients. Small amounts of well-sourced meat is a shift from the Standard North American diet and one worth taking. I encourage patients to view meat as a medicine and honour it in the way our ancestors did.
Fish and eggs are also foods we can look to as medicinal. Soft yolks are great sources of choline and lecithin that become more available once you add butter or any other fat. Fish is our only bioavailable source of the essential long chain fatty acids DHA and EPA. Flax and hemp oil contains ALA which is the precursor to these omega 3’s but are lacking the full benefit. Enjoy a wide range of full fats and oils including avocado, macadamia, olive, palm, butter, and lard while avoiding all industrial seed oils including canola, safflower, sunflower etc. Seed oils and refined carbohydrates make up for over 50% of the Standard North American Diet and is linked to nutrient deficiency, diabetes, obesity and heart disease. Fat soluble vitamins like K2 have been proven to reduce heart disease and coronary calcification. When you consider that one in four people is affected by heart disease it is worth ensuring that you are getting enough of this fat soluble vitamin.
I’ll be writing more about fats and oils soon. Please send in any questions or comments.