(PDF) Disease Begins in the Gut Part 1 · 2019. 5. 7. · Nearly universal breastfeeding. Earlier menopause (~45). Shorter life span (~52 yrs). Typically ~200 menstrual cycles. Today Menses - DOKUMEN.TIPS (2023)

Welcome!

This presentation is copyrighted by Purpose Inc. with all rightsreserved, available for student reuse strictly subject to the termsoutlined in the student program agreement.

Tracy’s health counseling certification is from ColumbiaUniversity for the Institute of Integrative Nutrition in NewYork.

She has completed ongoing training and is working on acertification in understanding the root causes of chronic illnesswith the Institute of Functional Medicine and on an additionalMasters degree in Human Nutrition at Bridgeport University.

She holds a Masters degree in Engineering from MIT and a Mastersdegree in Management from The Sloan School at MIT.

Online Q&A bulletin board within this course is available toyou for follow-up at any time on questions specific to this coursecontent. Make use of this tool to expand your (and others’)learning. Please understand we cannot accommodate detailed clientcase reviews on the Q&A boards.

Take lots of notes! The more often you see these connections,the more readily you will be able to recall them.

Plan to review this course material again, at least once more –preferably twice more. Remember: Repetition breeds Retention.

If you ever have any technical trouble with your SAFM membershipor site access, please don't hesitate to contact our team at[emailprotected]

SAFM Deep Dive Clinical Courses2

Hormones DemystifiedPart 2

This presentation is copyrighted by Purpose Inc. with all rightsreserved, available for student reuse strictly subject to the termsoutlined in the SAFM student program agreement.

Today’s Agenda

Refresher on Key Concepts from Part 1 Estrogen DominanceInterventions

• Endometriosis• Rapid Relief for PMS

Epidemic of PCOS Looking toward Part 3

4

HPATG : an Axis of Interconnectedness5

H = Hypothalamus (neural & immune tissue)P = Pituitary(neural & endocrine tissue)A = Adrenal (endocrine tissue)T =Thyroid (endocrine tissue)G = Gonadal (endocrine tissue)

Thoughts

Environment

Stress/Immunity

Metabolism

Reproduction

“Life is about 10% what happens to you and about 90% how youreact to it.”

- Charles R. Swindoll

Fundamental Interconnectedness

Hypothalamus& Pituitary

Thyroid

Adrenals

Gonads

G E N E S ILL-NESS

ENVIRONMENT:What we Maximize,

Minimize, and Prioritize

WELL-NESS

InteractiveBiochemistry

Endocrine (Hormones)

Immune (Inflammation)

Nervous (Neurotransmitters)

Digestion(Nutrients)

Metabolism(Energy)

Detoxification(Clearance)

?

Choices

Choices

Functional Medicine: The Big Picture7

InteractiveBiochemistry

Endocrine (Hormones)

Immune (Inflammation)

Nervous (Neurotransmitters)

Digestion(Nutrients)

Metabolism(Energy)

Detoxification(Clearance)

Functional Medicine: Hormonal Connections8

Hormone “effect” is more than hormone level. Total vs. free,

receptor status, balance vs.

individual level.

Inflammation increases stress hormones (cortisol)and can affecthormone

receptors, HPATG balance, and thyroid function.

Estrogen has strong impact on

serotoninsynthesis,

transport, and receptors

Specific nutrients are key for hormone synthesis

and appropriate hormone clearance (e.g. sulfation,

glucuronidation, and methylation of estrogens).

Hypothyroid state slows metabolism, detoxification, GImotility/digestion,

and ovulation.

Excessive exposure to xenoestrogens can

overload liver detoxification pathways and increase

estrogenic activity.

9

A Typical “Real Life” Patient

A very busy, over-committed woman Uses aggressiveexercise/running for fitness 4 days/week (“can’t live without myexercise!”) Feels exhausted and unrested in the morning.Self-medicating with red wine, chocolate (“for the antioxidants!”),mocha lattes, and

gluten-free baked goods (“because gluten is the bad thing”).

Using oral birth control pills to keep menstrual periods frombeing “crazy” Lots of carb cravings. Gaining weight. ConstipationAnxiety Feels puffy. Using more make-up and beauty products thesedays. Too busy to cook. Loves convenience of grocery store preparedfoods.

9

Many Signs and Contributors to Hormone Imbalance – None of whichare Uncommon!

10

Putting the Hormone Puzzle Pieces Together

Overwhelmed. Anxious. Aggressive aerobic exercise makes thisworse. High cortisol. Impairs melatonin overnight. Poor sleep.Possible low cortisol awakening response.

Stress impairs T3 thyroid hormone function. Stress impairsimmune function, so active viral/bacterial challenges. Simmeringimmune challenge can increase inflammation, further impairing T4 toT3 conversion.

Using oral birth control pills (OCP) which promote enhancedintestinal permeability and food sensitivities. Yet moreinflammation, impairing thyroid function, raising cortisol.

OCP depletes nutrients, especially Vitamin B6*, critical forboth sulfation and methylation which would help her body to excreteexcess estrogen (and toxins).

Self-medicating with too much food overall and too much refinedcarbohydrates in particular. Insulin resistance (high-carb snacks +stress) drives more fatigue, carb cravings, and weight gain. Bodyfat makes estrogen.*** Obesity decreases SHBG.**

High insulin level increases testosterone, impairs ovulation,blocks progesterone synthesis, and thus promotes more estrogendominance (and infertility). Increased retention of copper canpromote more anxiety (more self-medicating with food andexercise).

Uses mainstream personal hygiene products. More make-up helps toimprove self-confidence after weight gain. Xenoestrogens exacerbateestrogenic activity.

High intake of refined vegetable oils and insufficient omega-3slead to poor cellular membrane flexibility and function andincreased inflammation.

10

* https://www.ncbi.nlm.nih.gov/pubmed/21967158 , **https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782930/*** For moreinformation about bodyfat as endocrine tissue, see related item incourse Documents.

https://www.ncbi.nlm.nih.gov/pubmed/21967158https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782930/

11

It’s the Hormone Soup Dance!

High cortisol Low melatonin Low cellular thyroid functionEnhanced intestinal permeability Increased inflammation Highinsulin High testosterone Low SHBG High body fat High estrogenaction (OCP, bodyfat, xenoestrogens) Insufficient nutrients fordetoxification Low progesterone. Estrogen dominance.Pro-inflammatory dietary fat intake.

Is it any wonder that she struggles with being in anEstrogenDominant state?

Again, this is Not an atypical scenario. Your expertise in thisarea is NEEDED.

11

And this is all going to get worse

once she is in perimenopause!

12

False Expectations?

We are not designed to be in a chronic, low-gradeStressed,Toxic, Inflamed, Infected, Malnourished, & Unrested

state and yet still easilyThrive, Grow, Reproduce, be Thin, feelWell,

Eat Anything we want, enjoy perfect BMs, and have Great Sex.

This combination would be Not Natural.

So Many Things Can “Go Wrong” with Balance

Hormone Imbalance

Toxins/Chemicals Insomnia Low nutrient intake Infections ChronicStress Physical Stress/Trauma Worry/Anxiety SmokingMaldigestion/malabsorption Genetic Tendency Refined, inflammatoryfoods Poor Ability to Detoxify Obesity Social Isolation FoodSensitivities Constipation Hypothyroid function Dysbiosis

The Root Causes of hormone imbalance are also the same

Root Causes and contributors to other dis-ease progression!

13

Dance of the Hormones

Epinephrine/Norepinephrine

CortisolInsulin

EstrogenProgesterone

ThyroidTestosterone

DihydroTestosterone(DHT)

…in an interactive Soup!

14

Estrogen Dominance

Interventions

15

What a Difference a Century Makes!

One Hundred Years Ago Menses begin near age 16. Earlier and morefrequent pregnancies Nearly universal breastfeeding. Earliermenopause (~45). Shorter life span (~52 yrs). Typically ~200menstrual cycles.

Today Menses begin near age 12 (or even 10). Fewer (if any)pregnancies Less/shorter breastfeeding. Later menopause (~52).Longer life span (~83 yrs). Typically ~400 menstrual cycles. Morestress (less progesterone). More xenoestrogens. A major increase inexposure to hormone fluctuations

during a woman's lifetime, especially estrogen.

16

With appreciation to Dr. Bethany Hayes, MD for her leadershipand inspiration to so many healthcare practitioners.

Estrogen Dominance

Hormonal health is primarily about Balance vs. absolute levelsof any one hormone at any point in time

The most common hormonal imbalance challenge for women beforemenopause –and a notable number of men - is estrogen dominance.

Most common contributing Root Causes include at least one ofthese:o Excess estrogen (e.g. hormones in food,estrogen-potentiating chemicals, birth

control pills, body fat e.g. high-glycemic diet, hypothyroidstate, hyperinsulinemia)

o Inability to detoxify/excrete estrogen (e.g. low B vitamins,low-nutrient diet, fatty liver, constipation, caffeine intake,imbalance of strong vs. weak estrogens)

o Insufficient progesterone (e.g. high or ongoingstress/cortisol, luteal insufficiency, natural reduction from age~35-50, hypothyroid state, menopause, toxic exposure/stress causinganovulation (recent or much earlier in life))

Estrogen dominance can manifest as many common, modern hormonesyndromes, diseases, and illnesses. Lots of labels! And a diagnosisis not a Root Cause discovery.

e.g. Premenstrual syndrome (PMS), Polycystic Ovarian Syndrome(PCOS), Premenstrual dysphoric disorder (PMDD), PremenopausalSyndrome (PS), highly-symptomatic perimenopause or menopause,Endometriosis, Fibrocystic Breast Disease (FBD), Breast/Uterinecancer.

Easy-to-follow, credible resources for your patients andclients:https://www.energeticnutrition.com/vitalzym/estrogen_dominance.htmlandhttps://drknews.com/hormonal-imbalances-estrogen-clearance-vital-healthy-hormone-function/and estrogen dominance.

17

https://www.energeticnutrition.com/vitalzym/estrogen_dominance.htmlhttps://drknews.com/hormonal-imbalances-estrogen-clearance-vital-healthy-hormone-function/

Bloating

Water retention/weight gain/ swollen appearance

Strong premenstrual symptoms (PMS) e.g. abdominal cramps

Heavy, lengthy menstrual bleeding, perhaps with many clots

Irritability/Impatience

Anxiety

Headaches, perhaps migraines

Breast tenderness, cysts

Outbursts of rage

Hypothyroid function

Extreme emotional sensitivity

Panic attacks

Excess weight in lower torso, hips, buttocks, thighs (pear-shapevs apple shape – which is associated with androgen dominance andinsulin resistance).

Estrogen Dominance Symptoms in Women18

Root Causes: Excess Estrogenic Input

High-glycemic diet (promotes insulin surges which promotesconversion and body fat storage of surplus sugars)

Birth Control Pills (promotes ongoing exposure to estrogen)****Hormones in mass-produced animal food sources (e.g. poultry, beef,dairy) Pesticides/Insecticide/Fungicide (from sprayed foods,household use) and chemical solvents

(e.g. nail polish remover, home cleaning products, POPs***).Exposure to certain pesticides increases risk of endometriosis.* WStip: THIS is the reason to choose local and organic foods. Yourclients need a tangible motivation to “get on the bandwagon” withprioritizing organic (e.g. money, availability).

Petrochemical compounds in personal hygiene products, parabens,phthalates (e.g. lotion, soap, perfume, hairspray, make-up, roomdeodorizer, nail polish, sunscreen**). WS Tip: Most powerfuleducation you can give in this arena? “Your skin is a giant mouth.Don’t put anything on it that you wouldn’t eat!”

Hormone replacement (esp. high-dose or estrogen only e.g.Premarin) Body fat (adipocytes convert androstenedione &testosterone into strong estrogens - and can store it).

WS tip: with bodyfat loss, stored estrogen is released, maycause symptoms depending on clearance. Stress (promotes lowermetabolism (e.g. higher reverse T3 and lower free T3 thyroidhormone

conversion) and excess calories stored as fat) Ovarian cysts(elevated testosterone and/or xenoestrogens can promote cysts; thencystic ovaries can

overproduce estrogen (and no progesterone) – a potentiallyvicious cycle)

19

There is a handy patient handout on xenoestrogens in theDocuments for this course. * http://ehp.niehs.nih.gov/1306648/**http://pubs.acs.org/doi/abs/10.1021/es204415a andhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834384/***https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385438/ andhttps://www.ncbi.nlm.nih.gov/pubmed/28918287 andhttps://academic.oup.com/humrep/article/31/1/190/2379972 ,https://www.niehs.nih.gov/health/topics/agents/endocrine/****http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/the-contraceptive-pill-and-cancer-riskand http://www.ncbi.nlm.nih.gov/pubmed/24666753 andhttps://experiencelife.com/article/hormonal-birth-control-aviva-romm/andhttp://www.saragottfriedmd.com/the-birth-control-pill-7-reasons-why-you-may-want-to-stop-and-how-to-stay-healthy-if-you-dont/

http://ehp.niehs.nih.gov/1306648/http://pubs.acs.org/doi/abs/10.1021/es204415ahttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834384/http://pubs.acs.org/doi/abs/10.1021/es204415ahttps://www.ncbi.nlm.nih.gov/pubmed/28918287https://academic.oup.com/humrep/article/31/1/190/2379972https://www.niehs.nih.gov/health/topics/agents/endocrine/http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/the-contraceptive-pill-and-cancer-riskhttp://www.ncbi.nlm.nih.gov/pubmed/24666753https://experiencelife.com/article/hormonal-birth-control-aviva-romm/http://www.saragottfriedmd.com/the-birth-control-pill-7-reasons-why-you-may-want-to-stop-and-how-to-stay-healthy-if-you-dont/

Endometriosis

Endometrial-like tissue growth that occurs outside the uterus(verified laparoscopically) Endometriosis is present in ~50% ofwomen with unexplained infertility. Infertile women are 6-8 timesmore likely to have endometriosis vs. fertile women. Causes

for infertility in this situation are multifactorial e.g. pelvicanatomy distortions, blocked ovulation, impaired hormonesynthesis/uptake in tissue. **

Tissue responds to hormonal fluctuations (especially risingestrogen) and can cause severe symptoms, primarily pain andinfertility.

Over 50% have chronic pain; over 75% pain during menstrualcycling. About 25% of patients are asymptomatic. *

Many root cause theories: high estrogen exposure(xenoestrogens?), impaired immune system (autoimmune activation?),chronic inflammation (causing cell DNA damage?)

Hormone therapy is common treatment just to reduce symptoms.

Conventional treatment: Endometrial ablation can reducerecurrence.***

WS Tip: support for reducing estrogen dominance (e.g. decreasingestrogen receptor sensitivity and increasing estrogendetoxification) and excretion can be quite helpful in reducingsymptoms.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/ **http://www.ncbi.nlm.nih.gov/pubmed/2961844/***http://humrep.oxfordjournals.org/content/16/12/2676.long

20

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/http://www.ncbi.nlm.nih.gov/pubmed/2961844/http://humrep.oxfordjournals.org/content/16/12/2676.long

Root Causes: Poor Estrogen Detox & Clearance

Strong/Weak estrogen imbalance(estradiol vs. estrone (80%potency of E2) vs. estriol (

Folate

Estrogen Clearance: Devil in the Detail22

Phase 1: CYP enzymes create hydroxy metabolites (2-OH, 4-OH,16-OH) which are estrogenic; 4-OH and 16-OH are potentiallycarcinogenic.* The 2-OH pathway can be increased with cruciferousvegetables and berries, but it will also reduce available strongestrogens. Beware over-suppression of 3A4 pathway; it createsestriol!

Phase 2: Methylation via COMT changes hydroxy metabolites intomethoxy ones which have very little binding affinity to estrogenreceptors. ** Requires methylation and magnesium! Checkhomocysteine. DUTCH gives estrogen methylation ratio. In somecases, consider reducing competing substances which use thispathway e.g. quercetin, EGCG, and stress (catecholamines!).

Phase 3: Address constipation and dysbiosis (comprehensive,functional stool test may give beta glucuronidase level e.g. GI Mapor GI Effects).

Don’t work on something “upstream” until you are sure you haveoptimized what’s downstream first!

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922211/ andhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053199/** See tworelated clinical write-up in course Documents.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590855/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922211/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053199/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590855/

Root Causes: Insufficient Progesterone

Birth Control Pills or other Progestin-containing remedy(Suppresses natural progesterone production. Progestin does nothave the same action as natural progesterone.) Progestin(synthetic) and Progesterone (USP) are NOT the same!

Luteal insufficiency or Anovulation (PCOS, from insulinresistance, ovarian follicle damage from toxins/xenoestrogens,often earlier in life, perhaps inutero.)

Menopause (There is no ovarian production of progesterone andthe adrenal gland may be incapable due to cortisol productionpriority.)

Natural reduction through perimenopause (From age 35-50, awoman's estrogen production from ovaries goes down by 35%.Progesterone decreases 75%.) WS tip: Women in their 40s are oftenshocked to hear this; education is key. For many women, netestrogenic effect (xenoestrogens!) is actually increasing whileprogesterone is decreasing.

23

Root Causes: Other Hormone Imbalance

We have an epidemic of hypothyroidism, especially in women. Lowthyroid function (higher TSH) increases the level of Prolactin*,which

suppresses GnRH and can cause menstrual irregularity orcessation. Excessive estrogen increases TBG and reduces availablefree thyroid hormones. Women with low thyroid function aresignificantly more likely to have

PCOS.** Patients with PCOS are over three times more likely tohave autoimmune thyroiditis (Hashimotos).***

Elevated levels of cortisol (usually due to chronic stress) candirectly contribute to hypothyroidism and can create insulinresistance.

Chronic demand for high cortisol depletes progesterone throughcoordinated HPATG axis modulation (a double whammy for a woman inher perimenopausal years).

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719326/** Laywrite-up but excellent Reference summary:http://hypothyroidmom.com/pcos-and-thyroid-health/***http://www.ncbi.nlm.nih.gov/pubmed/15012623

24

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719326/http://hypothyroidmom.com/pcos-and-thyroid-health/http://www.ncbi.nlm.nih.gov/pubmed/15012623

Low glycemic, nutrient-dense diet.Lose body fat. WS tip:L-carnitine (500mg, 2x/day) may help if fat metabolism is alimiter.

For most, reduce/eliminate caffeine (esp. if not coffee).Eliminate dairy products & conventionally-raised meatproducts.* Clean up personal/household products Stress reduction(meditation/yoga, sleep 8 hrs, primary food, stop talk therapy?)Eliminate constipation (magnesium citrate, probiotic with eitherbalanced Lacto and

Bifido species or more Bifido, sufficient water, increase EVolive oil) Estrogen detoxification support Regular intake ofcruciferous vegetables (primarily

cooked vs. raw if there is a hypothyroid concern).Indole-3-Carbinol (I3C) or DIM supplement but no more than100mg/day and ramp slowly

Modulate estrogen balance. Ground flaxseed. ** Curcumin,Rosemary, Resveratrol, Red Clover or Kudzu. If needed, estriol (E3)support (available OTC and online).

Reduce estrogen conversion. Ground flaxseed, zinc (vegandiets!), grape seed extract, and chrysin are natural aromataseinhibitors (perhaps helpful for both men and women!).

Increase methylation of estrogens to reduce carcinogenicpotential. B-complex to support methylation if needed (feedbackfrom MCV, homocysteine, DUTCH metabolites).

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524299/ **https://academic.oup.com/ajcn/article/79/2/318/4690098#

25

Countering Estrogen Dominance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524299/https://academic.oup.com/ajcn/article/79/2/318/4690098

Countering Estrogen Dominance

Iodine reduces estrogen receptor sensitivity in breasts anduterus with fibroids *** e.g. kelp sprinkles, seaweed snacks, wholeseaweed (e.g. Arame). Daily intake. Higher iodine supplements (e.g.3mg/day) will be necessary for some with fibrocystic breast but usewith caution in hypothyroid individuals (superphysiologic dosescontraindicated for most Hashimotos) and Ramp Slowly (over 2-3 wks)to allow body time to adjust; will take up to 3 mos for dramaticprogress. Black cohosh also effective at eliminating uterinefibroids.

Fibrocystic breast tissue can promote benign calcifications. Awake-up call to not only addressestrogen dominance but also bettermanage calcium in the body: ensure optimal magnesium status(ideally RBC Mg in upper third of RR) and increase Vitamin K2 fromfood (e.g. grass-fed butter, egg yolks, fat from grass-fed orpastured meats) or supplement (MK-4 and/or MK-7 form).**** WS Tip:See the interconnectedness with things like arterial plaque whichis also calcium-laden. The body responds toinjury/infection/inflammation in tissue by putting down protectione.g. calcium in a plaque. In this case, estrogen dominance itselfcan attract immune system “repair” in overwhelmed tissue.

Bioidentical progesterone cream. Overt hormone supplementationis in webinar #3. Chastetree Berry stimulates higherprogesterone

secretion, 500-1000mg daily.** Limit excessive alcoholconsumption.

Occasional use likely irrelevant. Studies show women socialdrinkers who drink 2 or more drinks most days are much more likelyto have abnormal menstrual periods or anovulation.*

*http://pubs.niaaa.nih.gov/publications/arh26-4/274-281.htm , **http://www.med.nyu.edu/content?ChunkIID=21649***https://www.ncbi.nlm.nih.gov/pubmed/15239792/ ,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2452979/ , andhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787473/****https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792621/ ,https://www.schoolafm.com/ws_clinical_know/reversing-arterial-plaque/, https://www.ncbi.nlm.nih.gov/pubmed/17010542

26

http://pubs.niaaa.nih.gov/publications/arh26-4/274-281.htmhttp://www.med.nyu.edu/content?ChunkIID=21649https://www.ncbi.nlm.nih.gov/pubmed/15239792/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2452979/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787473/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792621/https://www.schoolafm.com/ws_clinical_know/reversing-arterial-plaque/https://www.ncbi.nlm.nih.gov/pubmed/17010542

PMS Rapid Relief

Reduce (ideally stop entirely!) caffeine, alcohol, dairy foods,and refined carbohydrates

Magnesium – magnesium glycinate or Epsom salt baths ChastetreeBerry – typically beginning mid-cycle B-complex support – ongoing,daily intake w/a meal (not dinner). Evening primrose oil – toreduce prostaglandins (esp. for cramps) Ground flaxseed – 1-2Tbsp/day

27

Countering Estrogen Dominance: Back to Basics

The Environmental Working Group’s website is an excellentresource for clean household and hygiene products and organic foodpriorities. www.ewg.org/skindeep andhttp://www.ewg.org/guides/cleaners

28

There are many excellent resources online for using simple,clean ingredients for homemade beauty and cleaning products.*

An excellent topic for a group wellness class; make a few ofthem together & send home samples.

* https://wellnessmama.com/5801/diy-beauty-recipes/

http://www.ewg.org/skindeephttp://www.ewg.org/guides/cleanershttps://wellnessmama.com/5801/diy-beauty-recipes/

• Sleep is vital. Teach about Sleep Hygiene. Support withcalming herbs or tea in the evening hours. Amino acid support maybe needed (e.g. tryptophan, 5-HTP, taurine, NAC, GABA -many postson SAFM site with keyword “sleep”).

• Adaptogenic herbs* can help normalize HPATG function,including cortisol. But they are only for short-term support; theyare not a long-term solution. Keep in mind that cortisol secretionmay change over time (esp. from hyper to hypo levels if root causesare not also being addressed)!

• For short-term, rapid relief of high cortisol and/orcatecholamines, use calming herbs e.g. ashwagandha, holy basil,passionflower, chamomile, magnolia, l-theanine, bacopa, kava,valerian, hops. Rhodiola (but may be stimulating to some). WS tip:choose a combination vs. individual herbs unless a person is verysensitive/allergic (e.g. histamine intolerance).

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560823/ andhttps://examine.com/supplements/theanine/

29

Countering Estrogen Dominance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560823/https://examine.com/supplements/theanine/

Show Clients pictures of what will Help their WellnessOr betteryet, offer them a cooking class

(or at least samples of supportive food while they learn abouthormones in a group program)!

Epidemic of PCOS

31

Expanding on Androgens32

Testosterone Troubles

The primary androgen or “male” hormone Critical for libido, bonecell formation, metabolism, muscle retention, overallachievement

drive, fat storage control, and general energy/well-being. Lowtestosterone levels common in women who also have low DHEA and/orprogesterone

(and of course those who have had a hysterectomy). Excessinsulin can cause women’s ovaries to produces excessivetestosterone (and can

promote excess estrogen in men). Excess androgens in women causeacne, PCOS, facial hair, infertility, irritability.

Testosterone tends to increase in women in perimenopause &into the menopausal years. Converted to metabolites by 5a and 5benzymes.

The 5a enzyme creates dihydrotestosterone (DHT) the strongestandrogen.

Excess DHT in women can promote head hair loss, acne, high bloodpressure, irritability,excessive body/facial hair, trouble losingweight, and anovulation due to PCOS.

High free testosterone, high DHT, and/or high DHEA might be atplay in promoting PCOS dynamic in women.

33

Dance of the Hormones

Epinephrine/Norepinephrine

CortisolInsulin

EstrogenProgesterone

ThyroidTestosterone

DihydroTestosterone(DHT)Many hormones affect one

another directly and indirectly across systems.

In women, excess insulin can promote higher testosterone and

anovulation. Resulting lower progesterone can increase

estrogen dominance.

…in an interactive Soup!

34

The picture can't be displayed.

The picture can't be displayed.

The picture can't be displayed.

An insulin-surging diet causes a women’s ovaries to makemore

testosterone

Ovarian Cysts

Are normal. Formed at every attempt at ovulation. Ovaries almostalways have small functional cysts in them (small,

typically 1-3 cm). * Larger cysts may arise quickly and may bepainful but are nearly

always self-resolving. In some cases, they need to be removed.*Follicular – evidence of ongoing follicle growth that has failed todischarge its eggs, as normal. Thin-walled.* Luteal – the corpusluteum. May occasionally cause mild bleeding upon ovulation.

Excessive androgens or estrogens can promote excessive orlasting cysts.

* Northrup, C. “Women's Bodies; Women's Wisdom”, p. 212.

36

Epidemic of PCOS?

PCOS is affecting more and more young women as a result of highinsulin-stimulating diets (high in refined carbohydrates, sugars)and high toxic exposure in modern society (both in utero andlife-long).

High insulin causes ovaries to make testosterone.

“Skinny fat girls” and Muffin tops

Women with PCOS are more likely to get hormonal cancer.*

It's a hormonal double whammy!

High insulin drives high body fat which spawns earlier mensesand overall higher estrogen levels throughout. Use ofcontraceptives hormones to “fix” PCOS may make this issue worselong-term.

Typically, women with PCOS do not ovulate, so there is notrigger to produce protective progesterone. Thus, they are morevulnerable to that higher estrogen!

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683463/

37

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683463/

PCOS Biochemistry

PolyCystic Ovarian Syndrome is a sign of hormonal imbalance.#

These ovaries generally do not produce eggs or ovulationconsistently. The egg maturity process is impaired, producing manycysts with small, underdeveloped eggs

Research points to two primary drivers to PCOS: (1) high levelsof circulating insulin (insulin resistance)** 50% of women withPCOS

have excess body fat; those with high waist-to-hip ratio aremuch likely to have PCOS. *** (2) endocrine disruption andsubsequent egg damage due to hormone-mimicking chemicals(xenoestrogen toxicity) . ****

Without ovulation, the ovaries do not produce progesterone tobalance estrogen. Thus ongoing PCOS can easily cause estrogendominance.

Lack of ovulation promotes greater GnRH production whichtriggers more LH synthesis, stimulating greater testosteroneproduction in the ovaries.

As much as 50% of women's androgens are produced in the ovaries(vs. the adrenals) both pre- and post-menopause. High androgens maycause increased body hair (e.g. face, nipples) and head hair loss.High insulin makes androgen receptors more sensitive.

#http://www.sciencedirect.com/science/article/pii/S001502820302853X**http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726844/ andhttp://www.ncbi.nlm.nih.gov/pubmed/9408743*** Givens, “Reproductionand Hormonal Alterations in Obesity” in Dr. P. Bjorntorp's“Obesity”,1992****http://press.endocrine.org/doi/full/10.1210/edrv.18.6.0318

38

http://www.sciencedirect.com/science/article/pii/S001502820302853Xhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726844/http://www.ncbi.nlm.nih.gov/pubmed/9408743http://press.endocrine.org/doi/full/10.1210/edrv.18.6.0318

The Mighty Pancreas

Life-critical gland with both digestive and endocrine roles

Digestive: producing digestive enzymes and bicarbonate whichhelp to break down foods in the intestines. 99% of pancreatic cellsdo this.

Endocrine: producing insulin, glucagon, and other key hormones.~1% of pancreatic cells do this.

39

Insulin

A life-critical hormone released from the pancreas when wethinkabout eating & when we consume either carbohydrates and/orprotein

(1) “escorts” sugar out of your blood and into your cells whereit can be used for cellular energy production(2) promotes (limited)storage of carbohydrates as glycogen(polymer chain of glucose) bythe liver(3) stops the use of fat as an energy source (whenelevated)(4) hormonally triggers additional fat storage in the body(often creating “the muffin top”)is reduced in secretion as bloodsugar falls (because sugars have moved into cells and out of theblood).

Key Insulin Resistance Concepts Cells absolutely cannot absorbsugars without insulin.

Adding more and more insulin won't reduce blood sugar IF sugarcannot get into the cells

While insulin is present in the blood, insulin-resistant cellsmay not get energy and cannot run effectively (because usage of fatfor fuel is blocked).

40

From Walter Willett, Chair of Dept. of Nutrition, HarvardUniversity, 2009.

High Glycemic: the way it often is. Low Glycemic:

the way it can ideally be.

Graphs with appreciation to Dr. Walter Willet, Harvard School ofNutrition.

Carbohydrates, Blood Sugar, & Insulin41

Cellular Energy

●In a healthy cell, insulin opens a cell's glucose transportersin the cell membrane. This allows glucose into the cell to be usedfor fuel.

●In an insulin-resistant cell, insulin receptors are inefficientat binding with insulin. Thus less glucose makes it into the cell.And more sugar is stored as fat.

42

Pathway to Diabetes

1)Typical American diet causes large spikes of blood sugarmultiple times daily.

2)Blood sugar cycling and higher levels of insulin cause energyswings and cravings for more refined carbohydrate foods

3)Your cells become “insulin resistant” i.e. sick & tired ofhaving to process and bring on board so much sugar. WS Tip: Insulinresistance is exacerbated by increased body fat, oxidative stress(e.g. toxins), low magnesium, inflammation, and intake of transfatsand high amounts of inflammatory fats. Insulin resistance typicallybegins 5-10 years before other diabetic manifestations.*

4)Our overall stress level plays a part too. High levels of thestress hormone cortisol impair cellular uptake of glucose andessentially cause insulin resistance.

5)Blood sugar remains high. The pancreas works harder and harderto secrete even more insulin - to force the cells to acceptsugar.

6)Meanwhile, your cells are suffering from low energy AND yourorgans and cardiovascular system are suffering from too much sugarAND your body is storing more and more fat.

7)Eventually the pancreatic cells begin to wear out and areunable to produce enough insulin to manage the level of sugars.Supplemental insulin becomes necessary IF the diet is not changed.But no healing is possible without dramatic change. This isfull-blown Type 2 Diabetes.

*http://www.ncbi.nlm.nih.gov/pubmed/9274899

43

http://www.ncbi.nlm.nih.gov/pubmed/9274899

Making Things Simple for Your Clients

Eat an Excess of Processed,

Refined Carbohydrate

Foods

Make lots of insulin

Cells resist the effects of

insulin

Excess sugar gets stored as

body fat

Body fat increases insulin

resistanceVicious Cycle

of Insulin Resistance

* A good article for clients, explaining the vicious cycle ofinsulin resistance and fat storage:http://www.diabetesincontrol.com/articles/64-/4559-

Feel Hungry, Weak, and

Tired

44

http://www.diabetesincontrol.com/articles/64-/4559-

Excess insulin creates higher body fat, regardless ofweight!

And body fat makes Estrogen.

Looking Toward Part 3

Webinar #3 Support for Countering PCOS Estrogen Receptors,Phytoestrogens, and

Individuality Male Hormone Balance Perimenopause and MenopauseHormone Supplementation Hormone Testing Considerations Resourcesfor More Learning

We highly recommend experiencing this (Part 2) webinar again

before moving on to Part 3.

46

This presentation is copyrighted by Purpose Inc. with all rightsreserved, available for student reuse strictly subject to the termsoutlined in the student program agreement.

Thank You for Joining Us!

Hormones DemystifiedPart 2

Welcome!Slide Number 2Slide Number 3Today’s AgendaHPATG : anAxis of InterconnectednessSlide Number 6Slide Number 7Slide Number8A Typical “Real Life” PatientPutting the Hormone Puzzle PiecesTogetherIt’s the Hormone Soup Dance!False Expectations?So ManyThings Can “Go Wrong” with BalanceDance of the HormonesSlide Number15What a Difference a Century Makes!Estrogen DominanceSlide Number18Root Causes: Excess Estrogenic InputEndometriosisRoot Causes:Poor Estrogen Detox & ClearanceSlide Number 22Root Causes:Insufficient ProgesteroneRoot Causes: Other Hormone ImbalanceSlideNumber 25Countering Estrogen DominancePMS Rapid ReliefCounteringEstrogen Dominance: Back to BasicsSlide Number 29Slide Number30Slide Number 31Slide Number 32Testosterone TroublesDance of theHormonesSlide Number 35Ovarian CystsEpidemic of PCOS?PCOSBiochemistryThe Mighty PancreasInsulinCarbohydrates, Blood Sugar,& InsulinCellular EnergyPathway to DiabetesMaking Things Simplefor Your ClientsSlide Number 45Looking Toward Part 3Slide Number47