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HEALTH CONCERN? BioHealth Health Concerns

The Systems Approach to Natural Hormone Balance

Contributing Author: Kalish, Daniel D.C.

Daniel KalishFor two decades Daniel Kalish, D.C. has successfully treated patients with hormone imbalances, food cravings, fatigue, depression, digestive distress, and many other health complaints. Dr. Kalish founded The Natural Path Clinic California, where he led a staff of physicians, nutritionists, chiropractors, psychotherapists, physical therapists, personal trainers, massage therapists and acupuncturists for more than ten years. He currently maintains an active international phone consultation practice with patients and trains physicians in natural medicine. He has designed health programs for countless professional athletes including the world’s top skateboarders, hockey players, elite runners, tri-athletes, golfers, tennis players and world-class weight lifters. Download his ebook Your Guide to Healthy Hormones.

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Emily came to my office with a host of complaints: anxiety, insomnia, decreased sex drive, low energy and stamina, neck and shoulder tension, and the early signs of osteoporosis. She was concerned about what seemed to be a steady decline in her overall health, particularly fatigue after what used to be energizing workouts. A 46-year-old mother of two, she was showing symptoms of peri-menopause, the several-year stage leading up to menopause in which women typically experience a drop in certain hormone levels and some early symptoms of menopause.

Post-workout fatigue is a key indicator of problems with stress hormones, so I ran blood and saliva tests to gauge Emily’s levels of estrogen, progesterone, testosterone, cortisol, DHEA (dehydroepiandrosterone), and melatonin. Her estrogen levels turned out to be borderline low, and her progesterone levels were extremely low. Emily’s symptoms resulted from the abnormal ratio between these hormones. She also had low levels of the stress hormones cortisol and DHEA – common among women who have experienced high stress for extended periods of time.

I treated Emily with bioidentical (plant-based) natural progesterone in a dosage that would correct her imbalance. But I could see that hormone therapy alone would not restore her health, so I prescribed a complete nutritional, dietary, and exercise program to address Emily’s adrenal exhaustion.

Within three nights of starting the program, Emily’s sleep and anxiety had improved. Within a month, her sex drive and energy had returned, and her neck and shoulder pain were gone. But her symptoms began to recur in the second and third months as she let her lifestyle and dietary changes lapse after the dramatic early changes – a common reaction in a culture that demands instant, permanent remedies. Maintaining good health is a daily process requiring an ongoing commitment to positive change, just as diets cannot keep us trim when we let healthful eating habits lapse.

Once she understood the importance of the lifestyle component of the program, Emily returned to her food regimen and earlier bedtime — a surprisingly important part of any successful hormone-balancing program. By the end of the third month, she was symptom-free. She remains so a year into her program, and will continue to do so as long as she sticks to her new food choices and daily exercise.

The Menopausal Transition
Most women experience gradual changes in their menstrual cycle between the ages of 45 and 55 before periods stop completely. During the transitional years of peri-menopause, follicle production in the ovaries drops precipitously. Of the 1 million to 2 million follicles a female has in her ovaries at birth, the reserve has fallen to about a thousand by age 51, the median age for the last menstrual period. In the half year before, estrogen production also shows a steep decline, bringing on many of the symptoms of menopause and associated increase in risk for osteoporosis, heart disease, and breast and endometrial cancers.

Although each woman experiences this phase differently, many report hot flashes, insomnia, depression, fatigue, mood swings, decreased vaginal lubrication, and increased incidence of urinary tract infections, depressed sex drive, and weight gain. The hot flash, described as the sensation of heat accompanied by sweating, flushing, and chills most commonly associated with menopause, affects about 75 percent of American women for an average of four years. This nighttime discomfort often produces anxiety and insomnia. Insomnia is frequently what prompts menopausal women to seek medical help. Falling estrogen levels stimulate a rise in the stress hormone cortisol, which accelerates bone loss, disrupts sleep, and gives rise to many other symptoms.

The same dynamic can affect younger women not yet in peri-menopause when adrenal exhaustion brought on by prolonged stress upsets the hormonal balance, leading to symptoms such as decreased sex drive, weight gain, fatigue, and irritability. Hormone imbalance also can manifest as premenstrual syndrome in younger pre-menopausal women, with menstrual cramping, sugar cravings, hair loss, and sudden changes in mood.

The Three Body Systems
Symptoms such as Emily experienced point to an important principle in dealing with hormone imbalance: There is no simple, single solution for every situation. The hormonal system is tied in to the body’s digestive and detoxification systems, and symptoms in one frequently reflect an imbalance in another. Most female hormone problems are brought on by years of poor lifestyle choices combined with digestive or detoxification issues, and in some cases the problems are complicated by a breakdown in hormone-mediated immune function that manifests as chronic sinus infections, vaginal yeast infections, or low-grade digestive tract infections.

The Hormonal System
Most signs of female hormone imbalance – including PMS and menopausal discomfort – can be traced to the adrenal, or stress, hormones that form the basis of female hormone production. During menopause as ovarian hormone levels lower, the adrenal glands play an even greater role in maintaining hormone balance, so adrenal hormone function is the first place we look for the underlying causes of menopausal symptoms.

The adrenal hormone cortisol, best known for its pivotal role in responding to stress, also promotes the burning of body fat, helps regulate emotions, interacts with the ovarian hormones, and counters inflammation and allergies – all part of the body’s “fight or flight” response to threat. Cortisol levels rise under stress, but if stress continues without enough rest for recovery, as often happens with our modern pace of life, the adrenal glands become exhausted and cortisol levels drop. This has a chain-reaction impact on other hormones.

Estrogen is the hormone that receives the most attention in treating female hormone problems. Often referred to as the female sex hormone, it regulates the menstrual cycle and stimulates cell growth in preparation for pregnancy. Equally important is progesterone, whose diverse functions include protecting against the undesirable effects of estrogen. Progesterone helps maintain sex drive, regulate sleep, prevent anxiety, and burn body fat.

Until recent studies revealed their danger, most doctors prescribed combinations of synthetic estrogen and synthetic progesterone, or synthetic estrogen alone, to try to restore the balance of these two hormones in menopausal women. The hormones were often prescribed in high doses. In fact, Premarin, one of the most popular synthetic hormone replacements, comes in only two dosages: 0.625 milligrams or 1.25 milligrams. Just as one dress size won’t fit most women, neither will one dosage.

Paula was experiencing hot flashes, night sweats, and lethargy in her mid-50s, for which her doctor prescribed a very high dosage of synthetic estrogen. Not only did that fail to relieve her symptoms, it contributed unwanted side effects (not to mention heightening her risk for developing serious illness down the road). Paula came to my clinic when she learned that I was successful in using natural therapies, and made the transition to a lifestyle-based natural program within a year. Today, she feels that she has regained control of her life. Her mood has improved, her energy is high, and she has been able to resume a vigorous exercise program.

Natural therapies offer multiple benefits over synthetic HRT: They are safer and more effective, have fewer side effects, and can be adjusted more easily to fit a patient’s needs. But they do not match the ease of taking a pill. Any natural program must be incorporated into a healthful lifestyle to work. Since hormones affect, and are affected by, the body’s other major systems, all must work in concert to promote good health.

The Digestive System
The digestive system is referred to as the “mother” system because it feeds our body tissues with the nutrients we need to function. Overeating carbohydrates and sweets, poor digestive function, digestive tract infections, and food sensitivities all play a part in throwing the hormonal system off balance. Moreover, nutrition is an important first step in any hormone-rebalancing program, as your body needs key vitamins, minerals, and fatty acids to produce sex hormones. The digestive tract also must work well to properly use all the building blocks for hormonal repair. In the majority of women I have treated over the years, their hormone problems have been connected to a problem in the digestive system.

The recent trend toward low-fat diets has contributed to hormone problems by reducing  the building blocks (fat or cholesterol) used to produce all sex hormones, including estrogen and progesterone. People on low-fat diets often develop a lack of the fats needed to produce sex hormones. Also, for the many women who have undiagnosed sensitivities to frequently consumed foods such as grains and soy, what seems to be a “healthy” diet can contribute to hormone imbalance.

Various dietary stresses are often a large contributor to female hormonal imbalance. Consuming the wrong foods, overeating, skipping meals, and other food-related issues such as obesity will trigger a negative hormonal response. The connection between diet and female hormones is brokered by cortisol, the stress hormone that helps to stabilize blood sugar. If you eat a lot of sweets or refined grains, your blood sugar level becomes unstable, forcing your body to re-stabilize these levels by producing insulin and eventually large amounts of cortisol. Giving in to a craving for sweets at times of stress only feeds a vicious cycle: The sugar throws your hormones out of balance, raising stress levels, giving rise to a craving for sweets. Over time, these fluctuations in cortisol have a profound impact on the sex hormones.

The typical American diet only encourages such an imbalance. We tend to start the day with sugary, high-starch foods such as muffins and sweetened cereal without balancing these carbohydrates with sufficient protein or healthy fat. Adding even a small amount of protein to such a meal can cut insulin levels by half, helping to balance hormone levels. Since each hormone can affect another, changes in progesterone levels can affect insulin; insulin can affect cortisol, and so on. Our hormones act as a constant emergency response team, responding to triggers ranging from excessive intake of sugar and caffeine to constant worrying. Hormones rarely cause problems on their own. In most cases, they react to various types of stress. If we can identify and remove the stress causing the hormone imbalance we have a viable long-term correction.

Food allergies are another important digestive system factor affecting daily and monthly hormone cycles. Sensitivity to gluten (found in many grains) is the most common food reaction triggering hormone imbalance, yet it often goes undiagnosed or misdiagnosed. Those at highest risk are of Northern and Eastern European heritage. If untreated, gluten intolerance can bring low energy, depression, obesity, and diabetes as well as very high rates of osteoporosis.

Sensitivity to soy or pasteurized dairy products is yet another common problem with the digestive system that I see among menopausal women, especially since soy has been promoted as helping to balance hormone levels and is widely used by women experiencing hormone problems. Many women who are adding large amounts of soy to their diets are unknowingly allergic to it. While soy can benefit some women in Asian cultures, it is traditionally eaten as a small part of their diet, in combination with foods that balance out its nutrient profile and prepared in ways that aid its digestion. Soy causes problems for many women in the form of protein powders, protein bars, and other processed food items.

Problems with the digestive system are the most common underlying cause of hormone imbalance in the patients I have treated. In a minority of cases I have found the underlying cause to be with the body’s third major system, the detoxification system.

The Detoxification System
Detoxification pathways remove harmful chemicals generated from normal body functions such as physical exertion and breathing, which generate waste products that also need to be removed from the tissues. Detoxification pathways are also busy removing alcohol and metabolizing (breaking down) medications, chemicals in our food such as pesticides and herbicides, along with pollution we are exposed to in our air and water. If you are taking in more toxins than you can flush out through the liver, kidneys, stool, and skin, you will have a backlog of waste products in the body that can cause a large number of symptoms. If the liver detoxification pathways are unable to handle their burden, you will have trouble metabolizing (breaking down) hormones — a problem commonly seen among women who respond poorly to synthetic hormones.

Consumption of alcohol, sugar, medications, and synthetic hormones over the course of a woman’s life all contribute to clogging the liver detoxification pathways, which are alternately helped by eating healthful sources of protein and vegetables. Vegetarians who eat insufficient protein are at risk for detox problems, as are women who have not eaten sufficient vegetables. Liver detox pathways can be corrected through both diet and supplements.

Improving the Three Systems
All three body systems — hormonal, digestive, and detoxification — can be improved through simple changes in lifestyle and diet. In some cases, these lifestyle changes are enough to resolve problems; in others, nutritional supplements are necessary. In cases where multiple problems may have been brewing for years, lab testing may be needed to pinpoint causes so that a therapeutic, customized diet and supplement program can be designed.

It certainly takes some detective work to diagnose the causes of each woman’s symptoms and to determine the best course of treatment, and it takes determination on the woman’s part to stay with a program and maintain it for the long term. But what better reward is there than good health?