(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


  • 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)






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

    - Charles R. Swindoll

    Fundamental Interconnectedness

    Hypothalamus& Pituitary





    ENVIRONMENT:What we Maximize,

    Minimize, and Prioritize



    Endocrine (Hormones)

    Immune (Inflammation)

    Nervous (Neurotransmitters)







    Functional Medicine: The Big Picture7

  • InteractiveBiochemistry

    Endocrine (Hormones)

    Immune (Inflammation)

    Nervous (Neurotransmitters)




    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


    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.


    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.


    * 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.


  • 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.


    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!


  • Dance of the Hormones






    …in an interactive Soup!


  • Estrogen Dominance



  • 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.


    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.



  • Bloating

    Water retention/weight gain/ swollen appearance

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

    Heavy, lengthy menstrual bleeding, perhaps with many clots



    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)


    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/


  • 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



  • 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/


  • 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.


  • 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



  • 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#


    Countering Estrogen Dominance


  • 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



  • 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


  • 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


    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/


  • • 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/


    Countering Estrogen Dominance


  • 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


  • 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.


  • Dance of the Hormones





    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!


  • 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


  • 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.


  • 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/



  • 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



  • 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.


  • 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).


  • 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.


  • 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.




  • Making Things Simple for Your Clients

    Eat an Excess of Processed,

    Refined Carbohydrate


    Make lots of insulin

    Cells resist the effects of


    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




  • 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.


  • 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


What is the normal age for menopause to start? ›

The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity.

What are the 1st signs of menopause? ›

  • Irregular periods.
  • Vaginal dryness.
  • Hot flashes.
  • Chills.
  • Night sweats.
  • Sleep problems.
  • Mood changes.
  • Weight gain and slowed metabolism.
Dec 17, 2022

Why am I still having periods at age 52? ›

Bleeding can occur in women over 50 after they experience menopause as well. Studies show that this postmenopausal bleeding is usually caused by conditions like uterine fibroids or polyps. It can also be a sign of endometrial cancer, which affects 2 to 3% of women and is most common among postmenopausal women.

What is Menapausal syndrome? ›

A variety of symptoms are reported frequently as being part of a menopausal syndrome. These include hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells.

Does HRT make you look younger? ›

By supplementing your body's natural hormone levels, HRT can help you maintain a more youthful body composition. While this effect is particularly evident in men, research suggests that women can also benefit. HRT is also known to help women maintain softer, smoother skin, resulting in a younger look.

What are the 3 stages of menopause? ›

There are three stages of menopause: perimenopause, menopause and postmenopause.
  • Perimenopause is the time leading up to menopause. ...
  • Menopause occurs when you've stopped producing the hormones that cause your menstrual period and have gone without a period for 12 months in a row.
Oct 5, 2021

What vitamins are good for perimenopause? ›

By incorporating natural supplements for perimenopause into your daily regimen, you can relieve the associated symptoms while also safeguarding your long-term health.
  • Phytoestrogens. ...
  • Calcium. ...
  • Dehydroepiandrosterone (DHEA) ...
  • Vitamin D. ...
  • Bioidentical hormones. ...
  • Vitamin E. ...
  • B vitamins. ...
  • Omega-3s.
Aug 26, 2021

Can you still have periods at 60? ›

Any woman still experiencing a menstrual cycle in her late 50s and 60s should see a doctor. However, it's important to note that each woman's reproductive system is different. Just as each young woman starts menstruating at a different age, menopause comes at a different age for each woman.

Can a blood test detect menopause? ›

The blood test measures a hormone called FSH (follicle‑stimulating hormone). FSH is found in higher levels in menopause.

Why do breasts get bigger in menopause? ›

As oestrogen goes AWOL, breasts go through a process called 'involution' where milk glands shut down and this tissue is replaced by fat. Weight gain also causes an accumulation of fat cells, and some of these camps out in your bra. Many women get bigger all over as their oestrogen stores get smaller.

Is it better to have menopause early or late? ›

While overall later menopause is probably healthier, it is associated with an elevated risk of developing breast, ovarian, and endometrial cancers. The average age for menopause is 51, and the women in this study were close to that number, with an average age at menopause of 50.5.

Can you still be in menopause at 63? ›

When people hear "hot flash," they generally think of menopause. This is the time in a woman's life when her period stops. While women typically experience menopause in the 40s or 50s, a large number of women can experience hot flashes not only during menopause but well into their 60s, 70s, and even 80s.

What are the symptoms of menopause liver? ›

Symptoms your liver isn't coping well include headaches, itchy skin, pain in your upper right quadrant (lower part of your ribs), fatigue, weakness, nausea, easy bruising, swollen ankles, brain fog, skin pigmentation, insomnia, weight gain, constipation, etc. It's important to have an annual liver function test.

What are the best foods for menopause? ›

A whole-foods diet high in fruits, vegetables, whole grains, high-quality protein and dairy products may reduce menopause symptoms. Phytoestrogens and healthy fats, such as omega-3 fatty acids from fish, may also help.

Do you feel better after menopause? ›

In postmenopause, symptoms of menopause may have eased or stopped entirely, but some women continue to have symptoms for longer. The change in your body's hormones however is a sign to keep looking after your health and wellbeing, and be mindful to listen to your body.

Does HRT make your tummy bigger? ›

Many women believe that taking HRT will make them put on weight, but there's no evidence to support this claim.

Why does estrogen make you look younger? ›

Your skin also becomes thinner, because the levels of collagen and elastin also dip along with estrogen. The hormone estrogen is responsible for making skin look younger due to the hyaluronic acid it produces. Estrogen not only affects your skin but also your muscle mass, metabolism, and energy levels.

Does HRT help with belly fat? ›

Hormone replacement therapy (HRT) can affect weight loss in women. In addition to having less abdominal fat, the same study found that women undergoing HRT were almost one whole point lower on the body mass index (BMI) scale, and they had nearly 3 pounds less of fat mass.

Is menopause considered a disability? ›

In some cases, the menopause could be considered a disability under discrimination law. If someone is disabled, their employer must make reasonable adjustments to reduce or remove any disadvantages they might experience because of it.

What is Type 5 menopause? ›

What is Type 5? Type 5 is a general category for women who don't follow the typical path through perimenopause to menopause. Hormonal birth control may mask many of the symptoms of perimenopause, and since the bleeding that comes during the “sugar-pill” week isn't a true period, even that doesn't tell us anything.

What are the 3 hormones lost in menopause? ›

Women will experience hormone imbalance as they enter and transition through to menopause due to declining oestrogen, progesterone and testosterone levels and a rise in control hormones FSH and LH.

Does B12 help with menopause? ›

Vitamins B-6 and B-12 may help support cognitive function, which means the ability to think, reason, and remember. Memory problems, focus, and “brain fog” can occur during menopause. Getting enough of these vitamins may lower the risk of developing dementia over time, whether or not they are experiencing menopause.

How can I increase my estrogen naturally? ›

Top 7 foods and remedies to boost estrogen
  1. Soy and other legumes. Soybeans and soy products are a rich source of isoflavones, one of the most important groups of phytoestrogens. ...
  2. Flaxseeds. ...
  3. Dark chocolate. ...
  4. Garlic oil supplements. ...
  5. Red clover. ...
  6. Vitamin D. ...
  7. DHEA.
Nov 2, 2022

Does zinc help with perimenopause? ›

If you are in peri-menopause, we need zinc to help with the production of FSH and LH. These 2 key hormones help regulate our cycles and stimulate ovarian production of our reproductive hormones.

Can a 65 year old have a period? ›

Postmenopausal bleeding can range from light spotting that is pinkish-gray or brown, all the way to a heavy flow, like a regular period. Most of the time, there is no pain with the bleeding. No matter your exact symptoms, you'll want to get in touch with your ob-gyn right away if this happens to you.

Can you still have a period at 65? ›

Bleeding from the vagina after menopause is unusual. Get it checked by a health care provider as soon as you can. Or see a doctor who's had extra training to find and treat diseases of the female reproductive organs, called a gynecologist.

Why would a 60 year old woman have a period? ›

The most common causes of bleeding or spotting after menopause include: Endometrial or vaginal atrophy (lining of the uterus or vagina becomes thin and dry). Hormone replacement therapy (HRT) (estrogen and progesterone supplements that decrease some menopausal symptoms).

What is the best supplement for menopause brain fog? ›

  • Vitamin D. Vitamin D is a fat-soluble nutrient necessary for immune system function, brain health, and more. ...
  • Omega-3s. Omega-3 fatty acids are well known for their impressive health effects. ...
  • Magnesium. ...
  • Vitamin C. ...
  • B complex. ...
  • L-theanine. ...
  • Other ways to reduce brain fog.
Aug 26, 2021

Can stress cause early menopause? ›

Excessive stress, which leads to elevation of stress hormones, can also negatively affect reproductive ability, including by accelerating menopause.

What blood count indicates menopause? ›

When a woman's FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.

Why do women's breasts get so big? ›

Hormonal Changes: Women develop their breasts during puberty as estrogen increases. Pregnancy and milk production can also cause the breasts to enlarge due to hormonal changes.

Why do older women's breasts get bigger? ›

They Get Bigger

Thanks to the triple whammy of weight gain, swelling from estrogen spiking, and inflammation (which increases in the body in your 40s), you might have a sudden need to go bra shopping.

Do nipples change during menopause? ›

In addition, low estrogen may cause changes in your nipples and areolae. During menopause, you may notice that your nipples start to turn slightly inward. Your nipples and areolae may also start to shrink. However, some studies suggest that hormone replacement treatment may help prevent these changes.

What vitamins delay menopause? ›

Higher daily intake of both vitamin B6 and zinc was similarly linked to delayed menopause. But complicating the matter, the investigators also found that vegetarian women experienced menopause about a year earlier than meat-eaters.

Can you be 51 and still have periods? ›

If you are still experiencing a menstrual cycle in your late 50s or early 60s, make an appointment with your healthcare provider. During your appointment, you may be asked about your menstrual cycle and symptoms. This will help your provider identify if you are in menopause.

What time of day is menopause worse? ›

Hormone levels do not stay steady throughout the day – they rise and fall. For many women, these hormonal changes during the day are worst after the sun goes down, making existing hot flashes more intense or triggering new hot flashes, and night sweats, during the evening and overnight hours.

Can a 70 year old woman go through menopause? ›

Most women in the U.S. typically experience menopause between the ages of 45 and 55. Often referred to as “the change of life,” menopause is when the menstrual cycle ends as the body produces less of the hormones estrogen and progesterone.

Can you still be in menopause at 58? ›

Women in North America will likely experience natural menopause between ages 40 and 58, averaging around age 51. Some women, however, reach this phase in their 30s, others in their 60s. Typically, women reach menopause around the same age as their mothers and sisters.

Do I need estrogen after menopause? ›

It depends on your situation. Not all women need, want or are candidates for estrogen therapy. Estrogen can reduce menopausal symptoms like hot flashes, night sweats and vaginal dryness. If you have a uterus, you'll likely need to take progesterone along with the estrogen.

What organ is affected by menopause? ›

During this transition time before menopause, the supply of mature eggs in a woman's ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases. It is the big drop in estrogen levels that causes most of the symptoms of menopause.

What organ causes menopause? ›

With menopause: The ovaries stop making the hormones estrogen and progesterone. The ovaries also stop releasing eggs (ova, oocytes). After menopause, you can no longer become pregnant.

Is fatty liver a symptom of menopause? ›

Abstract. There is increasing evidence that menopause is associated with the progression and severity of non-alcoholic fatty liver disease (NAFLD). Estrogen deficiency worsens non-alcoholic steatohepatitis (NASH) in mice models with fatty liver.

What is the best breakfast for menopause? ›

Things like oatmeal, full-fat Greek yoghurt, homemade granola and eggs are all good options that help keep your blood sugars stable and release energy slowly to help avoid slumps.

What is the best fruit for menopause? ›

Citrus fruits (oranges, limes, lemons, citrons, grapefruit, kumquats, ugli fruit) were also reported to help reduce overall menopause symptoms.

Is Pineapple good for menopause? ›

Its high levels of vitamin C "help prevent chemical changes to estrogen," says Dr. Crump. Since estrogen fluctuations can lead to hot flashes, eating hormone-regulating pineapples can keep you hot flash free.

What is the average age of menopause? ›

The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity.

What age does menopause end? ›

Overview Menopause

Menopause is when your periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55.

How can I get more energy during menopause? ›

8 Energy Boosters to Beat Menopausal Fatigue
  1. Exercise Daily. ...
  2. Create a Healthy Sleep Routine. ...
  3. Eat the Right Foods — and the Right Amounts. ...
  4. Watch Caffeine, Alcohol, and Nicotine Use. ...
  5. Try Relaxation Techniques. ...
  6. Consider Herbal Remedies. ...
  7. Ask Your Doctor About Medication Options.
Jan 4, 2022

Can you still have periods at 53? ›

Any woman still experiencing a menstrual cycle in her late 50s and 60s should see a doctor. However, it's important to note that each woman's reproductive system is different. Just as each young woman starts menstruating at a different age, menopause comes at a different age for each woman.

Can menopause start at 40? ›

Most women reach menopause between the ages of 45 and 55, with the average age being around 51. However, about one per cent of women experience menopause before the age of 40 years. This is known as premature menopause. Menopause between 41 and 45 years of age is called early menopause.

What triggers early menopause? ›

Causes of early menopause

chromosome abnormalities – such as in women with Turner syndrome. an autoimmune disease – where the immune system starts attacking body tissues. certain infections, such as tuberculosis, malaria and mumps – but this is very rare.

Can stress bring on early menopause? ›

Excessive stress, which leads to elevation of stress hormones, can also negatively affect reproductive ability, including by accelerating menopause.

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