Hormone Foundations

Introduction to Hormone Heroines 0:00

not knowing how or where to start. And our busy lives making those types of changes feel really unattainable for most people. So when you don't know the importance, it's really hard to find the motivation to then do it. And then even if you have the motivation to do it, sometimes life gets in the way. I know it does for me. You and I have a struggle with the stress management aspect, probably more than all the others, but everyone's going to have their own challenges. So sometimes it just feels unattainable and that is why sometimes we would just rather have a quick fix with a supplement or hormone replacement therapy because that sounds like something I could do.

I don't have to change anything about my life to quickly swallow a pill but I think it goes deeper than that too. We're often marketed things as healthy which aren't and can confuse many even more. Do you feel like your hormones have turned against you? Trust us, you're not alone. We're Dr. Serena and Dr. Heidi, and on Hormone Heroines, we explore all the root causes that are behind hormone imbalances, and we teach you how to thrive through them. Join us for real talk, expert tips, and even a few laughs.

Hello, and welcome back to Hormone Heroines. I'm Dr. Heidi. And I'm Dr. Serena. And today we're going to talk about the foundations of health and how it affects your hormones and just overall longevity. All right, so let's get right into it. When we talk about foundations of health, what does that really mean in the context of hormone balance? Well, first, I think we should define foundations of health.

Foundations of Health and Hormone Balance 1:29

So the definition I use for it is foundations of health refer to the core lifestyle, nutritional and physiological principles that support optimal function across all systems of the body. and are central to overall well-being as they influence metabolism, energy, mood, sleep, reproductive health, and the body's ability to adapt to stress. So of course, these things greatly impact our hormone balance because they govern our entire body and its rhythms. So now that we know what foundations of health are, let's talk about the big ones.

Healthy lifestyle choices, always top of the list. Things like regular movement, managing stress, getting quality sleep are essential for hormone balance. When these are off, it can directly disrupt hormone function. For example, chronic stress alone can lead to things like stress-induced anovulation in women, where ovulation simply stops Yep. Nutrition also plays a huge role. Diet rich in whole foods, healthy fats, quality proteins, fiber and key nutrients fuel the body's hormonal processes. On the flip side, eating too little or relying on poor quality foods can throw everything off hormonally.

I always like to bring up the idea of like if you're not eating enough you can't make hormones and often in our society we demonize cholesterol but without cholesterol you're not going to have any hormones so if you're not eating any you're not making hormone your body does make its own cholesterol but you do need to provide the building blocks to make that cholesterol which then turns into hormones so Then other things, part of foundations or health are your detox organs, especially the liver, gut and bowels.

They are critical players. They help metabolize and eliminate excess hormones and prevent the reabsorption of hormones byproducts. These systems aren't working well. it can contribute to hormonal imbalances. So basically, if you're not pooping, you're carrying around toxins in your body. And if you're having those continuously, then those can leak out into your gut. And then that can leak out of your gut. And then that can cause systemic inflammation. Also, if those hormones are reabsorbed back into the body, it can cause different excess of different hormones.

And if they're not processed, correctly or they can be processed into metabolites that are more inflammatory than their original forms. Either way you got to get the toxins out and liver, gut, and bowels are the biggest ones but we can't forget about our skin too because our skin is also one of our biggest detox organs. But finally we can't ignore environmental factors so endocrine disrupting chemicals found in things like plastics, pesticides, personal care products can mimic and interfere with natural hormones and throw the whole system off.

So in summary, all of these things create what I like to call as hormonal harmony and even small disruptions like poor sleep or unmanaged stress can lead to big system problems and big symptoms. So before jumping into major advanced treatments, it's crucial to make sure these basic things are in place. So, speaking of that, why do you think so many people jump straight into supplements or hormone replacement therapy without addressing the lifestyle first? Well, that's such a good question. I think it really plays on a couple things.

One, it has to do with not knowing how important foundations of health are or how much of an impact they can have. not only on our hormonal health, but our overall health as well as not knowing how or where to start. And our busy lives making those types of changes feel really unattainable for most people. So when you don't know the importance, it's really hard to find the motivation to then do it. But then even if you have the motivation to do it, Sometimes life gets in the way. I know it does for me and I know it does for you.

We're not perfect all the time. Yep. You know, both you and I have a struggle with the stress management aspect, probably more than all the others, but everyone's going to have their own challenges. So sometimes it just feels unattainable. And that is why sometimes we would just rather have a quick fix with a supplement or hormone replacement therapy, because that sounds like something I could do. I could dig a pill. I don't have to change anything about my life to quickly swallow a pill, but I think it goes deeper than that too.

We're often marketed things as healthy, which aren't and can confuse many even more, especially around food items. You would think yogurt's healthy, a lot of yogurts are like they are full of sugar they don't have the protein that like normal yogurt should so there's things like that that come up that get in the way of people making these changes because even if they think they are doing something healthy our food system

Why People Skip the Basics 6:22

is broken yeah and we're told Yeah, and we're told things are healthy when they're not. But finally, I think the biggest aspect of it all or like the biggest issue in general is we've been conditioned as a society and from like our medical system, as well as just advertisements. Generally, all of those things reinforce the idea that a pill will solve our problems and we're all so busy and stressed. It sounds like a nice answer, but unfortunately, this method of just taking a pill instead of changing our lifestyles often leads us to needing more and more pills, whether it's medication or supplements.

And to be honest, you just can't out supplement or out medicate a healthy lifestyle. There's no replacement. Yeah. And I think to kind of build onto this, I know we have seen it in our brick and mortar practice that we often get people that come from the conventional side. We are naturopathic doctors. So we were taught more about nutrition and natural ways and supplements and all that, all that fun stuff. And exercise too, which in conventional medical school, there's not that much of. And I find a lot of times that I've been told from our patients is that they don't know where to start because even their doctor who is telling them to go on these things doesn't know where to start, which is not their fault.

They weren't taught it. So I think that's another added level to why people are just jumping to the supplements or the hormones because nobody knows where to start. So if their doctor is saying, hey, this is what's going on with you and they have nowhere to tell you what to do other than give you a medication or a supplement or something like that, then where are you supposed to find that information? Yeah. And there's so much misinformation out there. And honestly, marketing is horrible. I mean, Unfortunately, there's the really great supplements out there, but there's also really bad supplements out there.

They are not all created equally. I think fish oil is a great example of that. You know, some fish oil is literally rancid sitting on the shelf that then you buy and you take, and it is not going to provide you the same benefits of high quality fish oil. We know fish oil is good for you. It has lots of benefits, but unfortunately, just because you start taking it does not mean you're going to get those benefits. So it's super hard to know where to start because even just that aspect of it, you don't know where to get the supplement even if that's the way that you want to go, let alone making all the lifestyle changes, which are way harder to do.

Well, and they don't know, they don't know that they have to do them, right? You know, like, especially in our society, you just eat the food that's available. And even though it's highly ultra processed, has a ton of sugar, has a ton of crap in it. You know, people don't really know better a lot of times because they don't know how crappy our food system is. Yeah but I also feel like a lot of people like do know better but the foods that then are supposed to be healthy aren't and I feel like that's a big problem and to know like to think you're eating healthy and doing the right things like if you were doing them 50 years ago would be the right thing but because of our food system now they're not the right thing like that is like a huge hurdle people cross.

And then also just like the reality of life gets in the way. Like we said, we're not perfect. We have, we know the importance of this and we still struggle to do it too. And so, you know, when you get busy, it's hard to make your food from scratch. It's hard to make time to de-stress. It's hard to make time for movement. All of those things kind of come up. And I think because of all of those people often first go to the supplement or the hormone replacement therapy. I think they're great options.

I just don't think they're everything that people should be doing to really support longevity long-term or like long-term health. Right. Well, speaking of that then, how much do you think nutrition plays a role in balancing hormones? And are there like specific eating patterns or foods that you recommend or avoid? Yeah. So, I mean, in general, I like to individualize my diet recommendations for people because I do not believe it's a one-size-fit-all for any people.

Nutrition for Hormone Health 10:20

Yes, food lifestyle instead of diet because diets, yes, not a nice word. No, but yeah, food lifestyle. So I like to individualize my food lifestyle recommendations for people because there's not a one size fit all. I mean, people have different preferences, whether that's being like vegan, vegetarian, or religious preferences, that's all going to play a role in what you end up eating specifically. and how you attain certain nutritional goals. So it's not one size fits all. But in general, a standard American diet is not the right choice.

No, not for anybody. Yeah, it's one of the worst things you can eat for your health, especially your hormonal health, because high sugar, ultra processed foods, microplastics and other toxins in our foods drive inflammation, which disrupts hormone regulation. And those foods do not provide us with the basic building blocks to make and then process hormones properly so if we're not getting the nutrients we're not making hormones but also if we're not getting the nutrients we can't process the hormones we do have and if we're getting all those toxins in our food then the hormone processing organs that we talked about those detox organs are also backed up trying to get all the toxins out and then they can't process the hormones and then it just it's a whole mess so not to mention all the inflammation that then comes from that that then further disrupts hormones.

So standard American diet is just not the way to go, meaning cutting out ultra processed foods, high sugar foods are pretty much the biggest ones. And then trying to eat as clean as possible. I mean, not everyone can afford organic But I usually recommend trying to fall like the dirty dozen and like the 10 clean. Those change. So you can always Google them and see what like the updated version is. But if you can't afford to buy everything organic, that's usually where I recommend you start. But the other thing with eating is like, okay, we don't want to eat the wrong things, but we also want to eat enough.

And I think women in particularly struggle with this the most because of that old word. It's because of that old word. Yes. that dirty word diet but also because we we feel like we should be eating less to achieve some unattainable body picture and honestly eating less is not going to help you do that you got to eat the right things so not eating the right things as well as not eating enough things so unfortunately disordered eating is all too common in our society especially with women but it is also growing in men as well we can't forget that that more and more women more and more men are also suffering from eating disorders.

But I think the, unfortunately, like the diet trends and stuff impact women more. For example, fasting or intermittent fasting. I'm not opposed to those things. I think they can be used in a really good way and can be super beneficial, but too often I find that people are using them to try like as an excuse to eat less or I'm like, I am doing the healthy thing because I'm fasting or intermittent fasting, but then they end up not getting all of their macronutrients on the time that they're not. And it just doesn't work out for women in a lot of cases.

Like women need to listen to their body if they are going to be doing fasting or intermittent fasting. But in general, I also just, I don't typically recommend it for perimenopausal or menopausal women at all because they need to feed their bodies so often. to prevent any decline due to their declining hormones already or just the struggle to absorb nutrients, and it's not really the best fit for them. But if women are going to do it who are cycling, they also need to time it with their cycle. So if you're going to do any fasting or intermittent fasting, I usually say only do it for the first half of your cycle, which is typically day three to 14. During the second half of your cycle, I don't usually recommend any fasting for them.

It's just a good example of things that I recommend that women especially women don't do when it comes to maintaining hormonal health because not getting enough food impacts you just as much as getting the wrong food. But then to summarize what I like, the general rules that I give people when it comes to nutrition is you need to prioritize whole foods, high fiber protein, healthy fats. So the starting rules I give women is shoot for 35 grams of fiber a day, ideally eating 30 different plants a week.

And just so you know, herbs count, so don't feel like it's not possible. You just gotta be seasoning your food with different things because that helps support larger microbiome diversity, which then also supports generally just overall health because we know from many studies that the larger microbiome diversity you have, the healthier people are. What specific microbes are in there is not as well known, but when we have diversity, we know those people are healthier. Right. Because unfortunately, low fiber diets lower our ability to naturally metabolize hormones to more beneficial or less inflammatory metabolites.

So from basically, like I said, from not pooping to liver function, those things are impaired when you're eating a low fiber diet and not getting enough plants in your diet because those phytonutrients from plants also support many other pathways in the body as well, especially detox pathways. So plants and fiber are important. The other major rule I tell people is you need to be getting at least 30 grams of protein per meal. So that's a minimum of 90 grams of protein per day. However, if you are strength training or in perimenopause and menopause, then those protein recommendations are going up because that is a minimum.

And unfortunately, when most patients walk in the door, they're nowhere close to meeting that. So that's usually where I'd say like, here's a good starting goal. Let's start here. And then lastly, eating our healthy fats. So those are like eating an avocado a day, getting olive oil, but like never cooking with olive oil because that's going to denature it and lose all your benefits. So I tell people to like drizzle all your vegetables with some olive oil after you cook them. Or if it's a salad, you should always be putting olive oil on there.

Also like cold water, wild caught fish is a great way to increase your healthy fats too. And then there's also nuts and seeds or other good healthy fats. So those are kind of the basic starting recommendations. And then finally, if you have any food intolerances, you got to cut those out too, because those are going to cause inflammation. So those are the basic rules. And then the other things is ultra processed foods, sugars got to go and you got to eat enough food. Yeah, and I mean to dive into it more because we don't have enough time during this podcast because we have more to talk about.

I think we will in the future, we will be doing a food. What did we call it? Food lifestyle. Yes, we'll be doing a food lifestyle podcast to go over all of these things and actually break them down a little bit better telling you you know, here are the healthy foods, here are the healthy foods that you think are healthy, but they're actually not healthy, you know, those kinds of things. So there will be a podcast later just on food lifestyle, because there's so many different things that would take hours and hours and hours to go on.

So we're going to move on today. But in the future, there will be a food lifestyle podcast. So moving on though, today, how do sleep and stress levels impact hormones like cortisol, estrogen, progesterone, testosterone, and even insulin? And how can people support their stress response symptoms, especially in our high stress world, which we just talked about? Okay. So like I said, this is the one I struggle with the most, but let's talk about it. I know. All right, so in simple terms, stress, whether it's mental, emotional, or physical, like lack of sleep or poor nutrition, disrupts our hypothalamic, pituitary, adrenal access.

So we're going to call that our HPA access going forward. This controls our stress response. When this system is activated too often or for too long, cortisol levels rise. Elevated cortisol starts to interfere with blood sugar regulation by increasing glucose production, suppressing insulin release, and impairing insulin receptor function. This leads to insulin resistance. This creates more internal metabolic stress. This metabolic stress then feeds back into the HPA access, signaling the body that it's under continued threat.

So then now you've increased your stress levels even further just by being stressed out to begin with, unfortunately. yeah further raising your cortisol levels and this creates that vicious cycle so when you are in the vicious cycle of being stressed whatever the original cause was your blood sugar and metabolic stress that's caused from that elevated stress when it goes on for too long creates further stress and then this also impacts hormone disruption other hormones so we know it affects our cortisol and our insulin but Also, this disrupted stress access doesn't just impact the metabolism as it throws off all of our circadian rhythms, including disrupting sleep weight cycles and further elevating cortisol levels.

That added layer of poor sleep becomes yet another stressor, further breaking down the system. And because the hypothalamus is also the control center for the hypothalamic pituitary, gonadal access and just so you know gonads are your ovaries or your testes so your hypothalamus controls your adrenals also controls your gonads so if it is messed up then it's going to be messing up your hormone production and that yeah all around so it directly affects estrogen and progesterone and testosterone regulation when you are stressed out.

When the HPA access is constantly activated, that HPG access is often suppressed. So this can lead to reduced signaling from the brain to the ovaries or the testes resulting in lower production of estrogen,

Stress, Sleep, and the HPA Axis 20:18

testosterone, and progesterone. So when you're stressed out, you're down regulating those other hormones and causing further metabolic and physical stress and disrupting your sleep, which then disrupts the whole system further. So now let's talk about the downstream effects. because we're on the upper levels, now let's go down. So downstream, elevated cortisol can also speed up hormone metabolism. So it not only suppresses your production of it, it also speeds up the metabolism. So your body may break down these hormones faster than normal, On top of that, cortisol can bind to your other hormone receptors and block the effects.

So blocking estrogen and progesterone from binding to their receptors and then doing their jobs. So even if your levels are normal, so if you were to go get tested and people are like, oh yeah, you're in the normal range for estrogen, progesterone, testosterone, they may not be cell signaling because your cortisol is blocking their receptors. So then they can't tell your cells what they're supposed to be doing. So you may have enough, but they're not able to actually work. Yeah. So they may be down-regulated, but they also may be fine and just be blocked from doing their jobs.

So they can't get in the door to do the work, basically. So altogether, this disruption can lead to menstrual irregularities, fertility struggles, estrogen dominance, and progesterone deficiencies, all rooted in the body's chronic stress response. So while it's tempting to look at hormone imbalances in isolation, they're often a reflection of broader dysfunction, especially in the stress and metabolic systems. So addressing the HPA access, health through sleep, nourishment, blood sugar balance, stress management is essential if we want to support hormone health at its core and hormone balance.

Well, and I think a lot of people also to forget that the gut plays a huge role in that too, right? So like cortisol can really screw up the gut. Cortisol can cause so much inflammation in the gut. It can cause a lot of these problems. And again, it's like, it's like this cycle. It just kind of goes around and around and around and. It's like chicken or egg, who knows which one started first. They're all going to kind of tumble all of the dominoes down and then it just causes a huge wreck. So like speaking of gut though, it's usually overlooked when it comes to hormones.

Although at you and I know that it's a huge, huge part of hormone health. Can you explain kind of the gut hormone connection so that our listeners can understand it? Yeah. So for one, I'll warn you, it's a little bit of a long-winded answer, but also it's not the whole story. Unfortunately, there are just some really good examples to get an idea of the importance. So let's start with that. As you said, the gut plays a central role in hormone metabolism, circulation, and signaling far beyond just digestion.

One of the key players here in the gut microbiome, and more specifically a subset of bacteria sometimes called the estrobolo, these microbes produce an enzyme called beta-glucuronidase, which helps regulate how much estrogen is resorbed into the bloodstream through a process known as enteropathic circulation. So when the gut is in balance, this process supports healthy estrogen levels, but when the gut microbiome is disrupted, what we call dysbiosis, beta-glucuronidase activity can become either too high or too low.

This can lead to too much or too little estrogen being recycled, contributing to hormone imbalances like estrogen dominance, PCOS, irregular menstrual cycles, and worsen perimenopause symptoms. But as I said, estrogen isn't the only hormone affected. The gut is deeply connected to the brain and endocrine system via the gut-brain access, which influences that HPG access we were just talking about and helps to regulate that system. Reproductive hormones like progesterone, testosterone, and estrogen are regulated through that.

And if your gut is inflamed, it's causing that stress, impacting the HPA access and then impacting the HPG access. So when the gut lining becomes inflamed or leaky or the microbiome is imbalanced, this can directly disrupt the hormone production and regulation throughout the entire body. Furthermore, not like I said, it's long-winded. This ties into the chronic stress like we just talked about and further increasing cortisol levels from prolonged stress and can damage the gut lining. So not only did we talk about all the effects cortisol can have before, but high cortisol can damage the gut lining and slow or speed up gut notility and shift the microbiome towards a more inflammatory state.

If you have increased motility, then you're not absorbing your nutrients. If you have decreased motility, then you may be worsening the leaky gut picture. So ultimately that gut dysfunction then becomes another form of stress like we talked about. And then it becomes another vicious cycle of like, well, now I'm causing, I'm stressed. Now my gut's damaged. That stress is impacting a further stress cycle, further damaging the gut. However, there is good news. The cycle can't be broken by supporting gut health through a diverse fiber-rich diet, fermented foods, stress management, quality sleep, and movement.

We can begin to restore balance across the gut, the HPA and HPG access. This promotes healthier regulation. of a wide range of hormones including cortisol, insulin, estrogen, progesterone, and your androgens. So in short, the gut isn't just about digestion, it's a hormonal powerhouse. Nice. Okay, so you and I know testing, right? How can people who are listening to us, how can our listeners find somebody, one who knows what correct tests to do? Are there better tests than others? A lot of functional medicine tests out there, most of them, well, I don't know that any of them are actually covered by insurance and a lot of people can't afford them.

Can blood tests work just as good as like the functional tests or would you prefer one versus the other? You know, I know we get different information and I know what our preferences are, but for people out there, if they can't afford those functional tests, are there other tests that they could ask their provider to run for them? In regards to gut and hormone, if you Yeah.

The Gut-Hormone Connection 26:48

Yeah. So a couple of things. My finances are there. I will run both because I think they give you good information when it comes to hormone tests. So when it comes to hormone testing, you can run blood tests and I usually run it, you know, I get a couple samples during a cycle. Ideally, beginning of the cycle and end of the cycle. Sometimes try to catch ovulation in there, but that can be hard, especially if you're having irregular cycles. If you're having irregular cycles, it can be hard to do in general, but I still think they give us some information.

And I usually test a whole testosterone panel. So not just testing total testosterone or free testosterone, got to test both. And then I also run an estradiol and an estrone because I like to see the balance between those, and then I'll run a progesterone. Sometimes I'll run an AMH, which is most tied to fertility, but it can also be a good inflammation marker, depending on what you're looking at. Especially in women with PCOS, it's good to get like an idea of that. I'll also run, sometimes I'll run an FSH and LH.

I do run those less often, but I will run them on occasion just to see how those are the hormones that are signaled from the pituitary, then tell your ovaries to works. If I'm concerned about things being down-regulated, that would be a good time to run those. And then finally, I will run a CA125. That's most commonly used to track ovarian cancers. However, again, it can be used to look at inflammation in women with like endometriosis and stuff like that. Okay, really quick. I have a question because just in case our listeners don't know, I know we know this, but in general, why are you testing estradiol and estrone?

What's the difference and why would you want to test both? Yeah, so estrone is technically we have three major estrogens that we should talk about. So you have your estradiol, which is most famous for being high during pregnancy. Then you have your estradiol, which is just when people say estrogen, they're usually talking about estradiol because that's the dominant estrogen in women. Then you also have estrone, which becomes the dominant estrogen in perimenopause and menopause. However, estrone is often very inflammatory and I don't like it because it doesn't do all the nice things that estradiol and estriol do.

So that's why I run it even on younger women, because if they have really high estrone, then that tells me they're in a pretty inflammatory state, and I want to work on bringing that estrone down. Also, estrone is really high. It can tell me about how their liver is processing their estradiol. So that is why I'll run both, because I want to see if the estrone is wreaking havoc. Is that causing problems and do we need to bring it down? Is the liver being backed up, clogged up? Is digestion being backed up, clogged up and impacting how that's being processed?

I always run it in perimenopausal and menopausal women because I want to see if they, especially if they're on bioidentical hormones, because I want to see if they are turning all their estradiol into estrone. and monitor all those things. So that's why I run both. Yeah and there's lots of things we can do to fix it too. So there's lots of different ways that we can help it and so it's just a good marker for trying to find out how your body is processing things and how we can make because having estrogen is great but you need to have the right amounts of the right estrogens in those good ratios in order for it to be healthy.

I just wanted to make sure people knew to ask for that because people will go, hey, can you test my estrogen and they'll literally just test the estradiol. Also on that note, I look at the ratio between progesterone and your estradiol and your estrone. I'm not just looking at those separately and being like, oh, they're in range. If your progesterone is technically in range but low and your estradiol is technically in range but high, I'm like, that's still concerning. We still need to look at that and be doing something.

about that. They need to be in balance with each other, so you're looking at that as well when you run those labs. So the blood work labs that insurance covers can give you a lot of information. I use them all the time, so you can always start there. However, if I have the option to, I love other types of functional medicine testing. One I use most commonly is the Dutch test, but I am also interested in looking into more of the salivary testing. that can be done as well. The reason is Dutch testing is urine metabolites.

So I love that one because it tells me how your hormones are getting broken down.

Hormone Testing Options 31:28

And they also do a lot of ratio balancing for you with that. So it tells you like, is too much of your estrogen getting broken down into more inflammatory metabolites or are they going towards a more protective pathway? And it'll do that for estrogen, progesterone and testosterone. So I love that test. It gives a ton of information. And there's also different versions of the Dutch test depending on if you're working on fertility, PCOS, menopause, like whatever you're working on, they have a few different tests.

So you can run different versions of that. And that's why I like that one. But I, the salivary testing, I don't use this often, but I do think it gives a lot of benefit because it looks at your free hormones. So that tells you what are active in the body right now, assuming that your receptors are open, like we talked about earlier. It can give you a more of a picture of how much free hormone is available. Typically, if I have the choice, I will run at least the Dutch test and the blood, but sometimes I'll also run the salivary.

But I like doing both because the Dutch just gives you way more insight, but you can gleam a lot of insight from just the blood work itself. Both are hugely beneficial. I'll usually run both, but if you can't afford the functional medicine test, you can still get a good start with the blood work. Yeah. I think a lot of times in our practice, we end up doing the blood test and the Dutch test at first, and then we'll follow up. If we do put them on hormones or do make some changes, we're not going to make them pay for another Dutch test right away.

Again, maybe the next year we might, six months if they can afford it. usually we'll kind of follow up on the blood test because usually that that's covered by insurance and we can gleam enough to see that that is what we're doing is working or not. Yeah, whether it's by I don't have a hormone replacement therapy or if it's using supplements to try and like you pair the blood work with the symptom picture and you can usually get plenty of data to make judgment calls from that and save people money.

But if they can't afford it, the Dutch test is super helpful, but I don't usually repeat it unless it's been a few years. Yeah. Speaking of all of these things that we do, can you walk us through a case where someone saw major improvements in their hormonal health just by addressing their foundations? Yeah. So I actually have a really good PCOS case. So this girl was in her early and she came into me and she hadn't been diagnosed with PCOS yet. She had a bunch of mental stress and was very, very convinced that that was the whole problem.

You know, she had a ton of anxiety and she did have a history where, you know, there was some like childhood trauma stuff that kind of could have played into it. So there was definitely that history. So it could have gotten overly focused on that. But the reality is what came down to being is that she had PCOS and her hormones were causing her anxiety to be a lot higher. So once we got her diagnosed with PCOS, this is what we did. We cut out her food intolerances because she did have food intolerances.

She was falling into the category where she really was not eating enough. She was not nourishing her body. She had frequent migraines, especially around her cycle, but you know, guess what? She was deficient in magnesium, not drinking enough water and not getting any electrolytes. So she no longer has any hormonal migraines as long as she takes her magnesium, drinks her electrolytes and drinks enough water every day. And she's told me on multiple times. on multiple occasions that when she stops drinking her electrolytes, her migraines come back.

So that was one aspect of that. So also increasing other food. She was not eating enough protein. So she had an estrogen dominance picture because she has no progesterone and high testosterone. And then her estrogen was high. So her estrogens were high. So her estrone was higher than her estradiol, which I never liked to see in a 20-year-old. Or anybody really. Yeah or anybody but like especially in a 20 year old there's not really it's not like biologically you're making more of that like you typically see in older women so you're what you're seeing in that is like she's not detoxing she's not her hormones are not being processed she's under a lot of inflammation so to deal with those things I got her eating more protein I did use a supplement I used evening primrose oil to increase her progesterone which is basically providing a healthy fat.

When we talk about supplements and just jumping to a pill, if you give someone evening primrose oil, you're just trying to increase their healthy fats, which helps progesterone production significantly. So I also put her On green tea, I had her start drinking lots of green tea, which increases her sex hormone binding globulin, which helped bind up that extra testosterone. In practice, I really don't see the increase of sex hormone binding globulin affecting your progesterone and estrogens as much, but I do see it really impacting testosterone.

So green tea is a great way to increase that and you can drink it or you can supplement. We did a little bit of both depending on how she was meeting her needs throughout that. And then the other thing for her was stress. Like stress was a huge reason of why her progesterone was so low. It had a lot to do with job stress, so we were kind of limited on how much she could do at that time. But talking about it and working through it, she was in a place in her life where she wasn't locked into a career.

And I've been working with her for years now, and eventually she was able to change her job, not entire career path, but just get a job that was a little bit more manageable for her. And her progesterone levels definitely increased. However, I will say they didn't increase to the point that I really wanted them to. So I did still put her on progesterone, bioidentical hormone replacement therapy progesterone. And when I did that, suddenly all of her mood systems went away. Nice. Those high anxiety pictures, she had a lot of rumination, trouble with sleep, a lot of irritability and anger.

Putting her on the progesterone, all of those things went away. They got better when we did all the lifestyle stuff and did stress management stuff and when we got her progesterone to come up naturally a little bit by doing the evening primrose oil. and all of those things, but it wasn't enough to get it to like a really optimal level, which is why we did eventually do the biogenic hormone replacement therapy. But that is to say, she came a really long way with just doing the foundational health stuff.

A PCOS Case Study 38:08

Mostly diet and stress management were the biggest ones for her. So make sure she was eating enough food was the biggest thing because she was not. and making enough water and making sure that she was getting enough protein because she was definitely falling into the habits of like she would not eat all day and then she would just eat dinner but then dinner would be a heavy carb meal and then she was basically not eating any protein all day. So we started eating regular meals got protein in her, got more healthy fats in her, and I saw an improvement across the board in all of her hormones.

And I've never had to use forinolactone in her to keep her testosterone down. When the lifestyle stuff alone managed her testosterone level enough to where I have not had to use that. The only medication I ended up having to use in her was the progesterone, and that was mainly to treat the mood stuff. Like her biomarkers looked good, but giving her that progesterone gave her that extra boost to just get completely rid of all the mood stuff that came along with her cycles. Nice, nice. Do you think that, so speaking of like hormone needs and changes, how long has she been on the progesterone?

Well, I've been working with her for at least two years and I think she's been on the progesterone for nine months. Okay. But the first three months we did cycling where we just did the progesterone day 14 through 28. And that's when she was like, I just feel amazing during that part of my cycle. Can I just like, can I take it the rest of my cycle? And I was like, yes, you can. Like if it makes you feel amazing, yes, you can. And is she still having cycles, even though staying on it full time? Yep, she still has cycles.

Actually, her cycles are super regular now because she was one of those that was cycling like once every three to six months when she came in, which is, you know, and she started cycling regularly before we started the progesterone actually. So just with the lifestyle stuff, she started cycling regularly. But, you know, we were, I put her on the progesterone just because she was still having the mood stuff and I've seen it have huge benefits in PCOS with people. Like I said, all of her biomarkers and she was cycling regularly, everything improved with just the foundations of health stuff.

It just gave her that last little boost to basically have a perfectly normal life and not feel like she has anxiety that can cripple her at points in her cycle. Totally understand. You know, the whole perimenopause thing. Speaking of changes in hormones, we know that hormone needs change over time. How should people start to adapt their routines given that our hormonal needs change constantly? It seems like. Yeah. So, I mean, I feel like you can add a lot to this, so feel free. But one of the biggest things is when we head into perimenopause, all the things that we did before that worked may not work for you then.

So when it comes to lifestyle changes, they're going to change. But the Biggest thing is probably nutrition in perimenopause. When your hormones start to dip, like we talked about, your gut can be more inflamed and then that inflammation can lead to having a harder time absorbing those nutrients. I talked about earlier that like intermittent fasting, I typically don't recommend for perimenopause women because they have a harder time getting nutrients out of their food. And so why would we be disrupting their metabolic process or putting stress on their body?

Because when you are fasting, you are in a state of stress. We got enough cortisol in midlife, we don't need more. Yeah, so nutritional aspects definitely change when you hit perimenopause. If intermittent fasting was great for you before, it's probably not great for you now, so let's stop that. Let's increase our protein intake. Let's eat more regularly, smaller, more consistent meals. It's hugely important. Also like when you get to exercise as part of, you know, foundations of health movement is a big part of medicine.

Movement is medicine, but you have to do a lot more of it when you get to perimenopause and you got to do a lot more strength training. to maintain everything that you had before or to get back to where you were before. It just changes immensely as our hormones start to dip because our hormones do a lot for us. They balance us out. They make things easier because they are providing. I like to think of hormones of like the like they just make everything like volumptuous and plump and juicy and just like they keep everything like right.

Yeah, keep everything young and healthy. Yeah, they keep everything right.

Adapting Health Habits in Perimenopause 42:58

And when those start to decline, everything gets harder. But yeah, so nutrition movement, you have to do more of it. You have to work harder at it. But also, hormone dysregulation and perimenopause is, you know, a normal part of life, but it causes a lot of problems. So then I do really think that like, for most women, there's only so much foundations of health you can do when you hit perimenopause and menopause. hormones are probably going to be a huge benefit to you. More than likely, they are going to be that key piece.

But that's to say, if you are doing hormones, you still need to be doing the rest because hormones are not a magic fix, although they can feel like it sometimes. They do not do everything for you. you still have to work harder at it. And to be fair, it is really good to talk to your doctors about this earlier in your perimenopause journey. So if you feel like you're starting to have perimenopause symptoms, I mean, it could take us days to list all of the symptoms that people don't know about. But if you are talking to your doctors and you are trying to get help because you just don't feel like yourself and you feel like you're starting perimenopause or in the middle of it or whatever, it's good to start talking about hormone replacement therapy now because the sooner you start it and get keep your hormones on a more regular basis then you know instead of like you said instead of having to go back and fix it you can keep it at a steady rate and just keep working.

So I think it's important to bring up here just because we're on the topic that perimenopause can start anywhere from 35 to 45. averagely and then it typically lasts 10 years and I think doctors are doing a huge disservice if they are not starting to talk to women when they hit 30 about perimenopause and like how to set up for health. I mean we talk about so many other things for preventative health for other groups of people but like we don't talk about that and I think you should be talking to your doctor as early as 30 about how to prepare for perimenopause and menopause.

Yeah. And I agree. It's not, and I mean, even in our school, you know, being naturopathic doctors, we did get a little bit more of training in that, but still not enough. And we were never told, as far as I remember, anyways, we were never told to start talking to women about perimenopause or menopause. And most of the symptoms that I personally had when I realized that I was in perimenopause, I don't remember those ever being taught to us as possible symptoms for perimenopause. So it's really good to even join groups and listen to podcasts like this.

There's other great podcasts that talk about perimenopause and menopause, but getting started sooner in fixing your foundations of health and then Having all of that come in with your doctor is where it's going to be best so that you're not having to fix a whole bunch of stuff on top of losing all your hormones and trying to just live a healthy lifestyle in the first place. Yeah because being realistically like people in their teens and 20s may not want to do foundations of health like you're you're too young and vital anyways because you're like I can do anything.

That thing can hurt me. So I think it is important for doctors to start really talking about it when people hit their 30s because that is the best time. I mean sooner is better but if you haven't been to a doctor because everything was fine until then People usually show up at the doctors in their thirties and that's when foundations of health should be started. So that way they are part of your habits and lifestyle by the time you really need them. Yeah. So, okay. So just to summarize in general, what are three foundation, foundational things that someone can start doing today, no matter where they are in their journey, whether they're the 20 year old or me, like the 46 year old, what can they start doing today to support their hormonal health no matter where they are in their journey?

Yeah, so my big three when it comes to foundations of health is clean up diet, movement, de-stress. And when I say clean up diet, we talked a lot about that. So I won't belabor that point. You got it. Eat a whole food diet, get your fiber, get your protein, get your healthy fats, eat enough food and don't eat... yeah a good variety and don't eat things that are inflammatory whether that's ultra processed foods sugars or your food intolerances so that's your summary there movement movement is medicine there is no way to get around it you have to move and strength training is probably the biggest thing you can do to support your hormonal health and also your metabolic health because if you're supporting If you're supporting your metabolic health, you're supporting your hormonal health.

If you're supporting those two things, you're going to have more longevity. Not to mention you're supporting all your musculoskeletal system and maintaining all of that health so you can be moving even into future years because that gets harder. Don't move. You're not going to move later. You got to keep moving. Well, and it affects your mental health too, which people don't realize. Yes. But, you know, like they say, an object in motion stays in motion. Joints who are moved regularly are going to stay more mobile than joints who are not moved regularly.

So movement's huge. And then finally, de-stress. And like we talked about, it's our hardest one personally. So I have a couple of things that I do to make it more manageable when I talk about de-stressing. I tell people that let's decide on one non-negotiable thing that we're going to do. Ideally daily, but if it's hard, let's start with just weekly. And these can be things that make you feel better or feel less stressed. It's just something that you're going to do for you on a daily or weekly basis.

And then if you start on a weekly basis, Hopefully we're gonna move it up to a daily basis, but you gotta start somewhere and the easiest way is to just pick one non-negotiable that you're gonna do. Maybe that's setting a consistent bedtime.

Three Daily Foundations to Start Today 48:48

That would be huge, honestly. That is a huge way to de-stress that people don't even think about. So if you're not good at meditating or you don't have time to go for a walk, if you go to bed at the same time every night, that is a huge way to de-stress. I will say I like to read a book before I go to bed. And it's not any medical books or anything because I've read enough of those and I read enough of those during the day, but just something stupid that my brain can kind of just have fun with. And that actually helps me de-stress to get tired enough to go to sleep.

Yeah, so that's your non-negotiable that you do nightly and it doesn't take very long. You're already trying to go to bed, helps you fall asleep. So that's a great example. Other people, it could be like taking a bath. Like some people really love baths. I'm not saying you need to take a bath every day, but like taking a bath a week and giving yourself a little bit of you time is a great place to start. If you're not good at meditating, go for a walk in nature if you have the availability to. Being out in nature naturally de-stresses us.

sparks your mind's own creativity, and it makes you feel calmer. Nature walks are a great way to do that, and also then you're getting a little bit of movement in too, so it's a two for one. Like I said, it doesn't matter, you just pick one that fits for you. If you like mindfulness or meditation practices, right do them we know they work we know they de-stress there's a ton of research that supports it but it could be something as simple as when you go to make your morning cup of coffee or your morning cup of tea you just sit and enjoy that cup before you start the rest of everything else.

And that also means off your phone, no doom scrolling while drinking it, no watching TV. You could be talking to family members. That's fine. But, and I do want to stress this too, is when you go on your nature walk or you take your bath, don't be watching a movie. Don't be scrolling on your phone. Don't be answering emails because like literally that is what I do because I'm constantly thinking, Oh, I got to do all these things. I got to do all these things. I don't when I'm out in nature, but I have seen people on a hiking trail on their phone while they're walking.

And I'm just like, you're totally missing the whole point. And that is actually stressing you more. So you got to make sure that you're doing whatever makes you happy, but you need to stay off your phone and electronics and be present in the moment, no matter what it is that you like to do. Yeah, you don't need any dopamine spikes from your phone dinging at you. Like that is not the point of de-stressing. You got to put the phone down and make a little bit of time for something. And if that is making a little bit of time to talk with your partner in the morning while you have that cup of coffee, that is also a great way to de-stress because that's also building community and that is part of maintaining health as well.

You know, you can still do these things with people. You don't have to be alone. You can still chat, but you're not going to be chatting about what you should be doing or shouldn't be doing or other things that make stress, make time for real connection if you are going to do these with other people. Right, especially. Okay. Well, awesome. Thank you for answering all of my questions, Dr. Srinath. And I hope everybody out there enjoyed this podcast and we'll see you next week. Thanks, bye. Bye. Thanks for watching Hormone Heroines.

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