What about Anxiety?

What about Anxiety?

The Gut-Brain Connection

Infections and other imbalances in the gut result in an inflammatory response in the brain.  The inflammatory cytokine theory is well established in the scientific literature and is being embraced as the number one cause of depression.

But what about anxiety?  (more…)

7 Factors that Affect Cortisol

7 Factors that Affect Cortisol

“But I don’t feel stressed!” I hear this a lot from patients when their body is telling me otherwise either through lab work, radial pulse or other clinical factors.  Explaining that there are many physiological causes of stress often is helpful. Financial or relationship stress is just part of the picture when it comes to cortisol.

1. Gut Health

For example, a gut infection is a major stressor to the body and when we resolve this a lot of energy is freed up.  The next step is to rebalance the HPA Axis after a year of living with a parasite.

2. Nutrients

Dietary factors like consuming pro-inflammatory omega 6’s or restricting calories, nutrients and protein can raise cortisol.  Increasing certain nutrients like magnesium does the opposite.  Similarly, intake of the vitamin A in its bioavailable form regulates the HPA axis.

3. Lifestyle Factors

Commuting and posture are some of the factors that can raise your stress response.  Running too much is another common one along with caffeine. Frequent marijuana use affects both cortisol and prolactin.

4. Sleep, Sleep, Sleep

  • Reduced Sleep  – A loss of sleep for just one night leads to higher cortisol levels the next evening.
  • Poor quality sleep – Poor quality sleep activates the stress response.
  • Staying up late – Cortisol goes up when we are awake during normal sleep times.

5. Other Hormones

  • Thyroid:  “The effect of thyroid hormones on the adrenal axis was not secondary to changes in the level of circulating corticosteroids.”
  • Estrogen: Estradiol regulates the CRH (corticotropin releasing hormone) which is “best known for its role in activation of the mammalian stress response.”
  • Leptin: This study looks at CRH in relation to adiposity and leptin.  Furthermore, “the modulatory role of glucocorticoids could be altered in obesity.”

6. Noise

I was working with a patient the other day and a noise I didn’t notice outside was causing her to feel unsettled.  It reminded me of how we all respond differently to stressors.  Noise can be a significant one for many people.

7. Toxic exposure

This study looks specifically at heavy metals following an oil spill and the affect on the cortisol.  This links back to how there can be physiological stressors that affect our endocrine system and stress response past its limit without us knowing.

I have a couple questionnaires I use to help assess both the stress we know about and the stress we don’t know about.  Applying more than one method to figure out what is going on at the root is key to successful treatment.

4 Steps to Hormone Balance

4 Steps to Hormone Balance

I often hear from female patients that they have been prescribed oral contraceptives without hormone testing.  Perimenopause, low libido and even depression or skin issues can be rooted in an imbalance.  Why not test to see what is actually going on?  In Functional Medicine this is exactly what we do.

Recently a patient came to me with a list of symptoms including anxiety, poor recovery from exercise, insomnia and low libido.  Was it perimenopause as was suggested to her?  I didn’t think so.  After testing we had clear picture of what was actually going on and it wasn’t perimenopause at all.

The Estrobiome:  A Healthy Gut = Healthy Hormones

A new and exciting area of research is around the estrobiome.  The gut deals with getting rid of some of our excess hormones.  Estrogens that enter the gut from the liver may be recirculated if the microbiome is not healthy.  Enzymes like beta glucuronidase are thought to play an important role in whether or not estrogen is recirulated.  In one study, 44% of women with healthy estrogen excretion had higher levels of this enzyme.  We are finding out that treating the gut could mean lower rates of estrogen related cancers overall.

Stress, the Liver & Detoxification

Especially for women with heavier cycles and those who have taken oral contraceptives there is likely an issue of hormone buildup.  Our livers are responsible for clearing hormones through the bile and into the gut.  If stress is high, diet is poor and one is exposed to environmental xeno estrogens then the liver is unable to keep up.  Boosting your body’s natural detox capacity is essential to help with hormone clearance.

Natural Detox in 4 Steps

Step 1: Lower stress by moving your body.  Our liver’s love movement.  Choose activities you enjoy so you are inspired to do them often.  

Step 2: Eat Veggies and Drink Water.  The liver loves veggies!  Increase fibers from root veggies and phytoestrogens from specific plants like flaxseed and yam.  Two litres of water/day is your baseline.

Step 3: Get your hormones and gut tested.  Then you will know what you don’t know!  I can’t tell you how many patients are surprised by their results.  The DUTCH test shows metabolites which is key.  I use stool and breath tests to look at gut health.

Step 4: Appropriate supplementation based on comprehensive lab work makes treatment more effective. Get the support of a trained clinician and get started today.  Each person is unique and we decide together where to start.  Often we focus on the gut or the stress response because both have a significant impact on hormone health.  

The Science of Estrogen Metabolism

I’d like you to understand why its important to see hormone metabolites in your lab work.  I will break down the 3 pathways: 2, 16 and 4.  You’ll see that synthetic and equine sources of estrogens from hormone replacement therapy and birth control are metabolized down the less favourable pathway.  Bio identical hormones and botanicals are received favourably. 

Keep in mind that the liver has 2 Phases of detoxification. The first is hydroxylatin and the second is methylation.  Both need to function well as you will see. 


The 2 pathway is the most favourable and we want to see it used more.  It excretes estrodial and estrone.  Estrone is converted into 2-Hydroxyestrone (2-OHE1) as part of Phase 1 detox which is known as hydroxylation. 2-OHE1 is a ‘good’ estrogen because it doesn’t stimulate cell growth.  When it is methylated into the 2-MeE1 in Phase 2 it becomes cancer protective.  Enough exercise, higher protein diets, and specific supplements can raise 2-OHE1 levels.


Estrogen is also metabolized through is the ’16’ pathway. We need this route however it should be used significantly less than the 2-Hydroxyestrone pathway.  Phase 1 in the 16-Hydroxyestrone pathway is also hydroxylation.  Phase 2 is a reduction phase that produces Estriol which is a weak estrogen.

Higher levels of the 16 pathway are associated with breast cancer, obesity, hypothyroidism, pesticide toxicity (organochlorines), high Omega-6 fatty acids, and inflammatory cytokines.


The last metabolism pathway is the 4-Hydroxyestrone. Estrone is hydroxylated through Phase 1 detox to form 4-OHE1. In Phase 2 it is methylation to form 4-MeE1. When 4-OHE1 is properly methylated to 4-MeE1 it is relatively benign as the 4-MeE1 is easily eliminated and risks are low.

When its not methylated 4-OHE1 builds up.  Then it converts to 3,4-Quinones which are carcinogenic similarly to the 16 pathway.  Women with uterine fibroids may have increased levels of 4-OHE1.  High levels of estrogen across the board are associated with heavy cycles.

Why are so many women affected with hormone imbalance?

The answer is simple.  Most of it is due to environemental factors.  Many chemical substances mimick estrogen.  Stress also inhibits the function of the liver as we’ve talked about.  Lastly, compromised gut health inhibits the proper excretion of the excess estrogens.

More about the Bad Stuff:

  • Xenoestrogens – compounds that have with estrogenic activity including polychlorinated biphenyls (PCBs), bisphenol A (BPA), and phthalates are xenoestrogens. These are chemicals that disrupt normal estrogen balance. Eliminate from your environment along with any industrial raised meat products.  These have added hormones and are pro inflammatory.
  • Contraceptives from equine sources favor the 4-OHE1 pathway as do synthetic hormones.

Some of the Good Stuff:

  • Diindolylmethane (DIM) increases 2-hydroxylation favoring the more healthy metabolic pathway
  • Rosemary and Curcumin
  • B6, B12, Folate, MTHF, TMG
  • Omega-3 Fatty Acids
  • Antioxidants: Vitamin E, A, C, Selenium, NAC, Polyphenols, Flavonoids, Lycopene & Alpha Lipoic Acid
  • Phytoestrogens:  Flax seeds in whole form ground or soaked.  The lignans help with estrogen metabolism.  Kudzu – this is another phytoestrogen.  So are yams.
  • Trimethylglycine (TMG):  a compound found in beet root and other plants and animal foods like choline. It protect cells from stress and act as a source of methyl groups. Betaine hydrochloride is made out of (TMG).  This is a supplement that increases stomach acid which I use to optimize gut health.
  • Sulforaphane glucosinolate (SGS): is a naturally occurring phytochemical found in cruciferous vegetables.  It supports Phase 2 detox and decreases 3,4-quinones.
Tired? Stressed?  Find out what is going on and why is it not adrenal fatigue

Tired? Stressed? Find out what is going on and why is it not adrenal fatigue

Stress is a major contributor to nearly all disease but what is it exactly and how can you recover? Most people understand stress in the form of a time pressure, moving homes or financial worries but there are some physiological stressors that can outweigh these perceived stressors.

Anything that interferes with the body’s ability to maintain homeostasis can be a chronic stressor and will lead to an HPA Axis dysregulation. The major ones I see in clinic are:

Blood sugar issues leading to insulin resistance and metabolic disorders. Missing meals, under/overeating. Circadian rhythm disruption from improper light exposure, lack of real rest, play and sleep. Chronic inflammation from hidden gut infections, an elevated immune response, overwork and allergies.

Why is this not Adrenal Fatigue?

In the scientific literature adrenal fatigue is represented with just a few publications whereas the more accurate term HPA axis dysregulation has over 18 000 research papers. The reason is that this isn’t a case where the adrenal glands are tired and unable to function. In fact often cortisol is normal or high and the imbalance is occurring in how the brain and cells are responding to it. Cellular resistance to cortisol is one way the body responds to chronic stress. This is similar to insulin resistance which many people are familiar with.

Testing for Stress

The brain is the control tower for the HPA axis which stands for the hypothalamus, pituatary and adrenal axis. These glands work together in a series of negative feedback loops which maintain homestasis. When there is a disruption it can be tricky to see what went off track. This is where the right lab work can be helpful. Saliva tests for free cortisol which is the most potent form and has been used to diagnose “adrenal fatigue”. The problem with this test is that 85% of those with low free cortisol have normal or high overall cortisol. This is where the replacement model of supplementing creates more problems. I use a urine lab that looks at the cortisol levels throughout the day. It also shows all the sex hormones and their metabolites which gives important information for treatment.

Chronic stress of any kind creates physiological changes ranging in severity depending on how long its been going on. An important part in recovering health requires long-term stress management. When we are in a heightened level of stress we respond to world differently and can create a cycle of more stress. I promote gradual change because this is what lasts. Shift tracks gradually instead of trying to stop the train and begine making these changes before it derails itself.

Am I going NUTS?

The NUTS acronym can be helpful in understanding stress. Stress usually includes these components:

Novelty: a feeling of a new situation

Unpredictability: a sense of touching something unknown

Threat or perceived threat to either the body or ego: as in chronic illness or the end of a marriage

Sense of loss of control: we actually have little control but we can, at times, control our response

These components exist in activities that are positive stressors as well like: applying for school, going on a date or starting a new job. Recognizing that not all stress is harmful is important. Increase your sense of control by gathering information and making informed decisions. Expand your time horizon or put it in perspective by looking at what’s happening within the context of your whole life. For example having a new baby can mean a lot less sleep but only for a few years. And finally remember to question your thoughts. Say an social event goes poorly and by the end of it your internal dialogue is something like “I said dumb things and I always do…I’m a failure…am doomed to always be alone…etc etc”.

This is an excellent time to check your head, sit down on a cushion and watch your thoughts. Meditation is by far the fastest, yes the fastest, way to transform belief systems and calm the nervous system so new habits and neuro pathways can form.

Symptoms that point to an HPA Axis dysregulation

There isn’t one set of symptoms or stressors that define this kind of imbalance. That being said here is a list of possible symptoms:

poor memory

weight gain or loss

brain fog


cold hands and feet

low libido

frequent illness

hunger that comes quickly with agitation


waking with a rapidly beating heart

trouble falling or staying asleep

postural hypotension

Living a long life with Optimal Health and Vitality

In order to do this we must address the HPA axis and understand our own stress response. I know personally that the more joy and purpose I discover, the more I must look at how I manage my stress.

There will be times when stress becomes unmanagable. When this happens the best action we can take is allow for a period to recover. Listening deeply to the body for guidance is the most important resource. If accessing it on your own is difficult then reach out for support.