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Applied nutrition for hormone dysfunction

By Kyla Williams DipION, BSc, MSc

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Summary

• The role of hormones in the body

• Sex hormone imbalances and symptoms such as acne, PMS, infertility (male and female hormones)

• Factors impacting hormone levels in the body

• Diagnostic testing

• Nutritional protocol for balancing hormones – diet, supplements, lifestyle

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The endocrine system

• Hypothalamus – Gonadotropin-releasing hormone• Pituitary gland – luteinizing hormone, follicle-stimulating hormone• Thymus – Important during puberty for immune health• Pineal gland - Melatonin• Testes - Testosterone• Ovaries – Oestrogen, progesterone• Thyroid – T3, T4, calcitonin, metabolism• Parathyroid – Bone development• Adrenal glands – Cortisol, adrenaline, blood sugar balance, distributes stored fat• Pancreas – Insulin, blood sugar balance, digestion• GI tract – Ghrelin, gastrin, motilin, leptin, serotonin

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The roles of hormones in the body

• Metabolism

• Cardiovascular health

• Immune health

• Brain function, mood, motivation, learning, sleep etc.

• Bone density

• Appetite control

• Reproductive health

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Sex hormones – what can go wrong?

• Reproductive health– Infertility– Fibroids– Endometriosis– PCOS– Ovarian cysts– PMS, mood fluctuations– Low neurotransmitter production– Period pains – Acne– Hair loss / excess hair growth– Reduced muscle mass– Reduced libido

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Endometriosis

• Womb lining tissue outside of the womb

• Common on the ovaries, lining of pelvis, behind uterus and top of vagina

• Causes painful / heavy periods

• Pain in lower abdomen

• Tissue will thicken and shed each month, causing pain, swelling, fertility problems (if ovaries or fallopian tubes are damaged)

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Polycystic ovary syndrome (PCOS)

• Polycystic ovaries (cysts – underdeveloped sacs containing fluid unable to release egg – usually lots of small harmless cysts)

• Ovaries not regularly releasing eggs• High level of testosterone

• Symptoms:• Irregular periods or no periods• Difficulty getting pregnant• Excess hair growth on face, chest, back and arms• Weight gain• Thinning hair

• Consider: increased risk of type 2 diabetes, high insulin levels

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Ovarian cysts

• If a follicle does not release an egg or discharge its fluid as normal, it can swell and become a cyst

• If an egg is released, corpus luteum can also fill with fluid• Cysts are usually harmless but can cause pain if large – naturally go over time• Pathological cysts – abnormal cell growth (not related to menstrual cycle) can grow

very large, block blood supply to ovaries / burst – can be surgically removed

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Fibroids

• Non-cancerous tumours in or around the womb

• Heavy periods, painful periods, abdominal / back pain, constipation, painful intercourse

• Can cause infertility

• Associated with oestrogen levels

• Common in overweight women

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Female hormones

• The hypothalamus, pituitary gland and ovaries control female hormone production

• Oestrogen (estrones, estradiols, and estriols)

• Progesterone

• Follicle stimulating hormone (FSH)

• Luteinizing hormone (LH)

• Testosterone

• Melatonin

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Hormone production Hypothalamus

GnRH

Pituitary

FSH

Ovaries

Oestrogen

LH

Ovaries

Progesterone

Follicular phase Luteal phase

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Imbalanced female hormones

• When hormones are not cleared from the body at the end of a menstrual cycle: Low FSH (pituitary gland not stimulated enough if low hormones)

Low oestrogen (follicles produce low oestrogen due to low FSH levels)

Low LH (as oestrogen surge is not high enough)

Low progesterone (due to low LH production)

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Progesterone deficiency - women

• Very common

• Symptoms most likely:– PMS, insomnia, painful breasts, unexplained weight gain, anxiety, headaches,

infertility

• Consider:– Liver support to clear hormone levels at the end of the cycle – to stimulate FSH– Stress levels (stress reduces progesterone)– Fibre intake

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Oestrogen deficiency - women

• Common in menopausal women aged 45+

• Symptoms most likely:– Night sweats, hot flushes, vaginal dryness, painful intercourse, memory

problems, feeling lethargic

• Consider:– Liver support– Oestrogenic foods – fermented soy– Oestrogenic herbs – black cohosh

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Oestrogen dominance - women

• Common at age 40-50• Not enough progesterone to balance levels of oestrogen• You can have low / medium oestrogen + low progesterone = oestrogen dominance

• Symptoms most likely:– PMS, insomnia, painful breasts, unexplained weight gain, anxiety, headaches,

infertility (low progesterone symptoms)– Bloating, weight gain, heavy bleeding, migraines, anxiety, mood swings, tender

breasts (high oestrogen symptoms)

• Consider:– HRT – dose too high?– Liver detoxification– Fibre intake

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Excess testosterone - women

• Symptoms most likely: – Acne, excess hair growth on face and arms, high sex drive, PCOS, thinning hair

on the head, ovarian cysts, unstable blood sugar levels, infertility

• Consider:– Fibre intake to clear excess testosterone out of the body– Alcohol intake which may impact testosterone levels– Stress levels

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Male hormones

• Testosterone - testes

• DHEA - adrenal

• Cortisol – adrenal

• Melatonin – sleep hormone

• Oestrogen – small production in liver, adrenal glands

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Testosterone deficiency - men

• Common over 50 yrs

• Symptoms most likely:• Muscle loss• Enlarged breast tissue• Low sex drive• Fatigue• Erectile dysfunction

• Consider:• Increase muscle-building exercise• Consume plenty of zinc• Support adrenal function

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Excess oestrogen - men

• Symptoms most likely:• Hair loss• Irritability• Breast enlargement• Weight gain – especially around thighs / hips / buttocks

• Consider:• Needs to be balanced with sufficient testosterone• Support liver detoxification• Support digestion• May increase risk of prostate cancer (1)

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Balancing male hormones

• Support adrenal function – manage stress

• Reduce alcohol

• Weight loss (if high BMI) increases testosterone levels (2), weight training

• Limit refined foods from the diet

• Support liver function if excess oestrogen

• Consider BPA and other chemicals

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Medical treatment options for hormone imbalances

• Contraceptive pill–Oestrogen + progesterone–Progesterone only

• Side effects:–Digestive complaints–Low sex drive–Weight gain

• Hormone replacement therapy (HRT) during menopause–Oestrogen + progesterone (most common)–Oestrogen only (after hysterectomy)

• Testosterone replacement therapy – for men

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Symptoms identifying possible hormone imbalances

• Acne, excess hair growth – excess testosterone (for women), PCOS, blood sugar

• Excess weight around hips, thighs and buttocks – oestrogen dominance (for men and women)

• PMS, anxiety, painful breasts, weight gain, headaches – progesterone deficiency

• Bloating, heavy bleeding, anxiety, mood swings, painful breasts – oestrogen dominance, stress levels

• Insomnia – Low melatonin, high cortisol, progesterone deficiency

• Heavy / painful periods – Inflammation, endometriosis, cysts

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Symptoms identifying possible hormone imbalances

• Painful intercourse – endometriosis, fibroids, ovarian cysts, oestrogen deficiency, inflammation (for women)

• Night sweats, hot flushes, vaginal dryness, low sex drive – consider menopause, oestrogen deficiency (for women 45yrs+)

• Lack of energy, reduced libido, erectile dysfunction, memory problems – testosterone deficiency (for men)

• Hair loss, breast tissue enlargement, muscle loss – excess oestrogen, testosterone deficiency (for men)

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Diagnostic tests available

• Urine hormone testing (hormone metabolites)

• Blood testing (free and bound hormones)– Single blood draw

• Saliva testing (free hormones)– Several saliva samples throughout the day and month

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Factors impacting sex hormone levels

• Liver function / chemical and heavy metal toxicity / alcohol intake• Digestive function, fibre intake, etc.• Blood sugar balance• Inflammation (omega-6 AA: omega-3 EPA ratio)• Nutritional status (deficiencies)• Exercise and BMI• Stress (cortisol, adrenal function)• Sleep quality

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Chemicals to avoid in products / the environment

• Xenoestrogens – chemical which block / mimic hormones• Reduced fish populations in high E2 (Oestradiol) areas ( 3)• Parabens (in cosmetics and soaps)• Phthalates (chemical used to carry fragrances)• BPA (chemical used in plastic) disrupts menstrual cycle (4)

• Cleaning products• Washing powder• Cosmetics (sun cream / make up / moisturisers etc)• Perfume / air fresheners• Toys• Plastic food containers (don’t heat food in microwave in plastic – use glass)• Cooking utensils

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Chemicals to avoid in food / water

• Pesticides (non-organic food) may reduce testosterone in men and increase oestrogen in women (5)

• Aspartame and other artificial food ingredients (xenoestrogens)

• Mercury, arsenic, lead, cadmium - reduce sperm count (4)

• Non-fermented soy (not ideal for those with oestrogen dominance)– Isoflavones in soy may mimic activity of oestrogen hormone (6)

• Gluten may exacerbate a permeable gut lining if digestive problems are present

• Fluoride in water and other chemicals – filter water reduced fertility in rats (7)

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Source of chemical oestrogens in drinking water

(8)

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Alcohol consumption

• Additional stress on the liver

• Alcohol has been shown to decrease testosterone in men (9)

• Reduces sperm quality (10)

• Worsens symptoms relating to insulin resistance (such as PCOS)

• Reduces quality of sleep

• 3-4 units maximum per day, and rest days for the liver

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Liver support

• Antioxidants to support liver function

• Cruciferous vegetables

• Fibre intake to clear hormones

• Ensure protein intake is not too high – stress on the liver

• Remember that liver support does not have to include a strict ‘detox diet’

• Herbal supplements such as milk thistle

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Digestive health

• Fibre intake to regulate excretion of excess hormones

• Soluble fibre intake has shown to reduce risk of breast cancer (11)

• Soluble vs insoluble fibre

• Kefir or other fermented foods

• Prebiotics – chicory, artichoke, asparagus, banana

• 2-3 bowel movements per day ideal to prevent reabsorption of hormones in the large intestines

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Balance blood sugar levels – improve insulin sensitivity

• Cut out all refined carbohydrates and sugary food

• Include protein with each meal

• Foods in their natural form i.e. whole fruit rather than fruit juice

• Help to reduce weight to healthy BMI

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Fat intake for inflammation and hormone production

• Anti-inflammatory diet including omega-3 EPA and DHA from oily fish

• Other omega-3 rich foods – grass fed meats, nuts and seeds – hormone production

• Balance omega-6 to omega-3 ratio. Infertile men have lower omega-3 levels (12)

Inflammatory

dietOmega-

3

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Omega-3 EPA supplements • Omega-3 EPA supplements for controlling inflammation• 1000mg EPA without DHA most effective for inflammation

• Wild anchovies, sustainable source. Cold pressed organic evening primrose oil.

750mg EPA250mg DHA 60mg GLA 1200iu (30µg) Vitamin D3 9mg Vitamin E

1000 mg EPA 10mg Vitamin E

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Specific nutrients to support hormone health

• Vitamin B6 – production of several hormones and neurotransmitters

• Magnesium – neurotransmitter production, commonly deficient in oestrogen dominance. Required to metabolise oestrogen

• Zinc – progesterone production, sperm production

• Vitamin E – progesterone secretion

• Vitamin C – to support adrenal function

• Vitamin D – a hormone itself, sunlight exposure

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Supplements to support hormone balancing

• Evening primrose oil / borage oil – Consider omega-6 : omega-3 balance– GLA excess leading to problems (inflammation and too much in excess over the

long term can lead to oestrogen dominance)

• Inflammation AA:EPA ratio

• Fish oils (EPA concentrate)

• Probiotics

• Nutrients – B6, magnesium, zinc – multivitamin and mineral supplement

• Herbal supplements and cherry concentrate

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Exercise

• Exercise is key for hormone production and balance

– Insulin sensitivity– Testosterone production

• Intensity depending on individual hormone issues

• Resistance training increases testosterone in Both men and women (13)

• Cardio training• Relaxation exercise such as yoga

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Target stress levels

• Suggest relaxation techniques – Meditation– Yoga – Bath– Reading

• Time to relax

• Time away from work

• Pick up hobbies to distract the mind

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Sleep quality

• Recovery and rest required

• Adequate sleep for hormone production

• Dark room

• Quiet environment

• To do lists done, don’t work too close before bedtime

• Balance melatonin levels – Sunlight early in the day and cherry concentrate in the evening

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Herbal supplements

• Black cohosh (possible oestrogenic activity)

• St John’s wort

• Ashwagandha

• Maca root

• Suma

• Inconclusive evidence for herbal supplements (14;15)• Placebo controlled trials do not show significant beneficial effects on hormone

balancing or menopause symptoms

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Summary – Nutrition protocol for hormone balancing

1. Identify hormone imbalances through symptom analysis / diagnostic testing

2. Reduce toxin exposure from the diet / environment, including heavy metals

3. Consider alcohol consumption

4. Support liver function – cruciferous vegetables, fibre

5. Support digestive health – heal a leaky gut, provide probiotics and ensure plenty of fibre in the diet

6. Balance blood sugar levels – improve insulin sensitivity

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Summary – Nutrition protocol for hormone balancing

7. Ensure healthy fat intake and control inflammation for conditions such as PCOS, endometriosis, acne

8. Nutrient rich diet ensuring intake of specific nutrients for hormone health. May require supplementation

9. Exercise – intensity depending on individual hormone issues

10. Target stress levels, suggest relaxation techniques – meditation, yoga etc.

11. Recommendations for improving sleep quality

12. Consider herbal supplements to ease symptoms

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References1. Hu WY, Shi GB, Hu DP, Nelles JL, Prins GS. Actions of estrogens and endocrine disrupting chemicals on

human prostate stem/progenitor cells and prostate cancer risk. Mol Cell Endocrinol 2012 May 6;354(1-2):63-73.

2. Corona G, Rastrelli G, Monami M, Saad F, Luconi M, Lucchese M, et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol 2013 Jun;168(6):829-43.

3. Grund S, Higley E, Schonenberger R, Suter MJ, Giesy JP, Braunbeck T, et al. The endocrine disrupting potential of sediments from the Upper Danube River (Germany) as revealed by in vitro bioassays and chemical analysis. Environ Sci Pollut Res Int 2011 Mar;18(3):446-60.

4. Balabanic D, Rupnik M, Klemencic AK. Negative impact of endocrine-disrupting compounds on human reproductive health. Reprod Fertil Dev 2011;23(3):403-16.

5. Freire C, Koifman RJ, Sarcinelli PN, Rosa AC, Clapauch R, Koifman S. Association between serum levels of organochlorine pesticides and sex hormones in adults living in a heavily contaminated area in Brazil. Int J Hyg Environ Health 2014 Mar;217(2-3):370-8.

6. Jargin SV. Soy and phytoestrogens: possible side effects. Ger Med Sci 2014;12:Doc18. 7. Zhou Y, Qiu Y, He J, Chen X, Ding Y, Wang Y, et al. The toxicity mechanism of sodium fluoride on fertility in

female rats. Food Chem Toxicol 2013 Dec;62:566-72.

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References8. Wise A, O'Brien K, Woodruff T. Are oral contraceptives a significant contributor to the estrogenicity of

drinking water? Environ Sci Technol 2011 Jan 1;45(1):51-60. 9. Valimaki M, Tuominen JA, Huhtaniemi I, Ylikahri R. The pulsatile secretion of gonadotropins and growth

hormone, and the biological activity of luteinizing hormone in men acutely intoxicated with ethanol. Alcohol Clin Exp Res 1990 Dec;14(6):928-31.

10. La VS, Condorelli RA, Balercia G, Vicari E, Calogero AE. Does alcohol have any effect on male reproductive function? A review of literature. Asian J Androl 2013 Mar;15(2):221-5.

11. Li Q, Holford TR, Zhang Y, Boyle P, Mayne ST, Dai M, et al. Dietary fiber intake and risk of breast cancer by menopausal and estrogen receptor status. Eur J Nutr 2013 Feb;52(1):217-23.

12. Safarinejad MR, Hosseini SY, Dadkhah F, Asgari MA. Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr 2010 Feb;29(1):100-5.

13. Vingren JL, Kraemer WJ, Ratamess NA, Anderson JM, Volek JS, Maresh CM. Testosterone physiology in resistance exercise and training: the up-stream regulatory elements. Sports Med 2010 Dec 1;40(12):1037-53.

14. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev 2013;12:CD001395.

15. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev 2012;9:CD007244.

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Kyla Williams DipION, BSc, MScNutrition Technical Advisor kylaw@igennus.com