Sarah LoBisco, ND, IFCMP

3. Digging Deeper Than Hormone Levels and Getting to the Root of Imbalances

We have seen a bigger picture of the complexities of testing for levels of hormones and that many interfering factors determine hormonal production and metabolism in the body.

Some of these influencers include:

• lifestyle
• stress^15-17
• individual variances in detoxification/metabolism⁸
• food and nourishment (“diet”)
• toxic exposure
• the microbiome
• relationships and social connections
• blood sugar balance¹⁸

Although all important to address, reviewing every one is beyond the scope of this series; however, I will demonstrate with 2 examples (stress and blood sugar) that missing one could be a cause of perpetual and distressing symptoms in women.

Stressed Out Hormones

Stress is a “biggie” for most women with hormonal issues.^15-17 Chronic, long-term stress can impact steroid hormone synthesis and induce a suppression of the menstrual cycle. Interesting, whereas chronic stress can typically deplete reproductive hormones;^15-16 the effect of acute stress is likely influenced by a woman’s current estrogen levels.¹⁷

One of my favorite tools for modulating the stress response, and indirectly hormones, is essential oils. This is due to their psychological, biochemical, and physiological properties. I discuss this more in this video.

The Not So Sweet Truth of Blood Sugar on Hormones and the Thyroid

Chronic, fluctuating hypoglycemia (low blood sugar) and sustained high blood sugar (hyperglycemia) are underappreciated causes of reproductive issues in women.^18-21 This is due to the many effects of insulin and glucose on the body.

For example, insulin and sex hormone binding globin (SHBG) have an inverse relationship.^21-22 This means that women who have high levels of insulin, to deal with chronically elevated or fluctuating blood sugar levels, will have lower levels of SHBG.

SHBG preferentially binds to androgens over estrogens to protect women from too high levels of testosterone. This makes women with poor blood sugar control more estrogen dominant in relationship to androgens, leading to an imbalance in hormones. Furthermore, imbalanced blood sugar has a distinct connection to the thyroid. One article that reviews the connection of hypoglycemia to hypothyroidism states:

Hypoglycemia is basically a mismatch between insulin (whether exogenous or endogenous) and glycemic levels (whether produced by meals or parenteral nutrition). The excessive insulin levels may be due to excessive dosage, increased bioavailability, or enhanced insulin sensitivity. The inappropriate increase in insulin levels leads to a fall in blood glucose levels, which in turn stimulates a series of physiological protective mechanisms. These include a release of glucagon, adrenaline, cortisol, and growth hormone; among others.[1] These physiological responses are linked with symptoms,…¹⁸

Women being treated by steroids or hydrocortisone for “adrenal fatigue” should also be aware that glucocorticoids interfere with thyroid hormone signaling and can cause an effect of the pituitary to suppress its signaling hormone, TSH.^22-23  This means that these women may be getting a double whammy on the thyroid if they have blood sugar issues due to the connection between insulin and cortisol.

Doctors and patients may not be aware of this connection or dismiss this important factor if one is eating a nourishing diet; however, sugar levels aren’t just the result of food intake. External factors, such as stress,^24-25 environmental exposures,^26-27 and/or gut health^28-29 also contribute.

Bottom line:  If your doctor, endocrinologist, and/or OBGYN isn’t asking about your stress levels or measuring your blood sugar and insulin, you may want to ask them to.

A Whole-Person Approach to Hormonal Balance & the Conclusion

In my practice, I use a whole-person approach to hormonal balance.  If a woman I am working with has hormonal issues, we will address lifestyle factors, look at all her symptoms, consider testing and its caveats, and evaluate the root cause of the imbalance. This is always the approach I prefer to use before considering any supplemental hormones by her prescribing physician.

I also remind the women I work with to try to be patient. Although we wish for their symptoms to vanish as quickly as possible, one month of personalized lifestyle, supplement, and dietary suggestions won’t heal what has been imbalanced since puberty. It is an ongoing process and takes tweaking as things shift. For complex cases, it can take about a year to balance out all the complexities and interactions in of the body systems that influence and are influenced by hormonal production.

This is why I, and other naturopathic and functional medicine doctors, spend at least an hour with every client, every visit. If you want to learn more to learn more about naturopathic and functional medicine and my methods of working with clients, click here.

I hope you’ve gleaned some information for yourself and possibly education you can bring to your physician to help you achieve optimal hormonal harmony.

Wishing you all the best!

References:

1. Fishman JR, Flatt MA, Settersten RA. Bioidentical Hormones, Menopausal Women, and the Lure of the “Natural” in U.S. Anti-Aging Medicine. Social science & medicine (1982). 2015;132:79-87. doi:10.1016/j.socscimed.2015.02.027.
2. Martin K, Barbieri R. Treatment of menopausal symptoms with hormone therapy. UptoDate. 2018. Available at: https://www.uptodate.com/contents/treatment-of-menopausal-symptoms-with-hormone-therapy. Accessed September 10, 2018.
3. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause 2017; 24:728.
4. Barnabei VM, Cochrane BB, Aragaki AK, et al. Menopausal symptoms and treatment-related effects of estrogen and progestin in the Women’s Health Initiative. Obstet Gynecol 2005; 105:1063.
5. Moreno, M. Premenstrual Syndrome Treatment & Management. EMedicine. Medscape. September 01, 2016. Available at: https://emedicine.medscape.com/article/953696-treatment. Accessed September 11, 2018.
6. Hodges RE, Minich DM. Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. Journal of Nutrition and Metabolism. 2015;2015:760689. doi:10.1155/2015/760689.
7. Trabert B, Schwartz SM, Peters U, et al. Genetic variation in the sex hormone metabolic pathway and endometriosis risk: an evaluation of candidate genes. Fertility and sterility. 2011;96(6):1401-1406.e3. doi:10.1016/j.fertnstert.2011.09.004.
8. Aschebrook-Kilfoy B, Neta G, Brenner AV, et al. Common genetic variants in metabolism and detoxification pathways and the risk of papillary thyroid cancer. Endocrine-Related Cancer. 2012;19(3):333-344. doi:10.1530/ERC-11-0372.
9. com. Steroid Pathway. Provider Resources: Product Information Sheets. Available at: https://dutchtest.com/wp-content/uploads/2017/10/Streroid-Pathways.pdf. Accessed September 10, 2018.
10. com. Testing Matrix. Provider Resources: Product Information Sheets. Available at: https://dutchtest.com/wp-content/uploads/2016/02/Testing-Matrix-1.pdf. Accessed September 11, 2018.
11. Ottoson UB, Carlstrom K, Damber JE, von Schoultz B. Serum levels of progesterone and some of its metabolites including deoxycorticosterone after oral and parenteral administration. Br J Obstet Gynaecol. 1984 Nov;91(11):1111-9.
12. Tavaniotou A, Smitz J, Bourgain C, Devroey P. Comparison between different routes of progesterone administration as luteal phase support in infertility treatments. Human Reproduction Update. 2000; 6(2): 139–148. http://hormonebalance.org/images/documents/Tavaniotou%2000%20Vag%20prog%20sup%20to%20oral%20LPS%20HR.pdf
13. Zargar-Shoshtari S, Wahhabaghei H, Mehrsai A, Wen J, Alany R Transdermal delivery of bioidentical progesterone using dutasteride (A 5α-reductase inhibitor): a pilot study. J Pharm Pharm Sci. 2010;13(4):626-36. https://journals.library.ualberta.ca/jpps/index.php/jpps/article/viewFile/9065/7650
14. Mercola J. DUTCH — The Most Informative Hormone Test Out There. Mercola.com. May 8, 2016. Available at: https://articles.mercola.com/sites/articles/archive/2016/05/08/dutch-hormone-test.aspx. Accessed September 11, 2018.
15. Berga SL, Loucks TL. The diagnosis and treatment of stress-induced anovulation. Minerva Ginecol. 2005 Feb;57(1):45-54.
16. Tarín JJ, Hamatani T, Cano A. Acute stress may induce ovulation in women. Reproductive Biology and Endocrinology : RB&E. 2010;8:53. doi:10.1186/1477-7827-8-53.
17. Schliep KC, Mumford SL, Vladutiu CJ, et al. Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study. Epidemiology (Cambridge, Mass). 2015;26(2):177-184. doi:10.1097/EDE.0000000000000238.
18. Kalra S, Unnikrishnan AG, Sahay R. The hypoglycemic side of hypothyroidism. Indian Journal of Endocrinology and Metabolism. 2014;18(1):1-3. doi:10.4103/2230-8210.126517.
19. Diabetes Teaching Center at the University of California, San Francisco. Blood Sugar & Other Hormones. Diabetes Education Online. Available at: https://dtc.ucsf.edu/types-of-diabetes/type2/understanding-type-2-diabetes/how-the-body-processes-sugar/blood-sugar-other-hormones/. Accessed September 10, 2018.
20. Daka B, Rosen T, Jansson PA, Råstam L, Larsson CA, Lindblad U. Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden. Endocrine Connections. 2013;2(1):18-22. doi:10.1530/EC-12-0057.
21. Strain G, Zumoff B, Rosner W, Pi-Sunyer X. The relationship between serum levels of insulin and sex hormone-binding globulin in men: the effect of weight loss. J Clin Endocrinol Metab. 1994 Oct;79(4):1173-6.
22. Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab. 2009 Dec; 23(6): 793–800. doi:  1016/j.beem.2009.08.003
23. Gamstedt A, Järnerot G, Kågedal B, Söderholm B. Corticosteroids and thyroid function. Different effects on plasma volume, thyroid hormones and thyroid hormone-binding proteins after oral and intravenous administration. Acta Med Scand. 1979;205(5):379-83.
24. Marcovecchio ML, Chiarelli F. The effects of acute and chronic stress on diabetes control. Sci Signal. 2012 Oct 23;5(247):pt10. doi: 10.1126/scisignal.2003508.
25. Wing RR, Epstein LH, Blair E, Nowalk MP. Psychologic stress and blood glucose levels in nondiabetic subjects. Psychosom Med. 1985 Nov-Dec;47(6):558-64.
26. Lim S, Cho YM, Park KS, Lee HK. Persistent organic pollutants, mitochondrial dysfunction, and metabolic syndrome. Ann N Y Acad Sci. 2010 Jul;1201:166-76. doi: 10.1111/j.1749-6632.2010.05622.x.
27. Pizzorno J. Is the Diabetes Epidemic Primarily Due to Toxins? Integrative Medicine: A Clinician’s Journal. 2016;15(4):8-17.
28. Upadhyaya S, Banerjee G. Type 2 diabetes and gut microbiome: at the intersection of known and unknown. Gut Microbes. 2015;6(2):85-92. doi:10.1080/19490976.2015.1024918.
29. Brunkwall L, Orho-Melander M. The gut microbiome as a target for prevention and treatment of hyperglycaemia in type 2 diabetes: from current human evidence to future possibilities. Diabetologia. 2017;60(6):943-951. doi:10.1007/s00125-017-4278-3.

Photo by rawpixel on Unsplash

Read part 1 of this 2 part series here:

3 Considerations for Getting to the Root of Hormonal Problems: A Naturopathic and Functional Medicine Perspective

---

Sarah LoBisco, ND, IFCMP, is a graduate of the University of Bridgeport’s College of Naturopathic Medicine (UBCNM). She is licensed in Vermont as a naturopathic doctor and has received her certification in functional medicine through the Institute of Functional Medicine (IFM), which is accredited by the Accreditation Council for Continuing Medical Education (ACCME). She holds a Bachelor of Psychology from State University of New York at Geneseo and is also certified in Applied Kinesiology. Dr. LoBisco currently incorporates her training in holistic and conventional medicine through writing, researching, and through her independent consulting work with individuals and for companies regarding supplements, nutraceuticals, essential oils, and medical foods. Dr. LoBisco speaks professionally on integrative medical topics and has several journal publications. “Dr. Sarah” also enjoys continuing to educate and empower her readers and clients through her blogs and social media. Her main blog can be found at dr-lobisco.com.