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TRANSCRIPT
Balance Female Hormones at Every Stage
A TCM and Functional Medicine Approach to Estrogen Dominance,
Menopause and Progesterone Deficiency
By: Cathy Margolin L.Ac. Dipl OM
More than 20 million women in the
United States are between
45 and 55 years
Hormone therapy common for menopausal symptoms,
Also widely used to protect post-menopausal women from:
• Heart Disease
• Osteoporosis
• Cognitive Decline (aka dementia)
Estradiol Preserves Key Brain Regions In Post-
Menopausal Women at Risk For Dementia
When initiated estradiol regimen, (HRT) within a year of menopause ,with estradiol prevented
degeneration in key brain regions of women who were at heightened dementia risk.
Stanford University School of Medicine
Women who had started an stayed on the regimen, had
increased metabolic activity in a number of brain regions,
David Rubinow, MD, PhD, former head of the division of behavioral endocrinology at the National Institute of Mental Health.
Rubinow, now professor and chair of psychiatry at the University of North Carolina-Chapel Hill, said the findings are "absolutely
consistent with a large volume of evidence from basic studies in laboratory dishes and in animals" concerning estradiol's
protective role in many tissues.
What does balance look like ?
Recognizing symptoms
What is “Good Health”?
Major Hormones vs Minor Hormones
MAJOR
Cortisol
Insulin
Estrogen
Adrenalin
MINORSHBG
(Sex-Hormone-Binding-Globulin)
Progesterone
All the others
Estrone (E1) vs Estradiol (E2)
• Fat cells make estrone E1 • Ovarian cells predominately make Estradiol E2
• E3 primarily during pregnancy & metabolite of E2
After menopause – estradiol E2 is formed in small amounts in the ovary but in larger amounts in the periphery, produced by aromatase enzymes of testosterone in the ovaries or via 17-Hydroxylation of estrone (in the periphery)
Zhu BT. Functional role of estrogen metabolism in target cells: review and perspectives. Carcinogenesis. 1998; 19(1):1-27.
Estrogen Interplay and Primary Functioning
Estrogen strongly influences intracellular signals but we can learn to flip the signal switches in our favor.
Focus on Hormones
Estrogen TestosteroneProgesterone
TSH Cortisol
Sex Hormone Binding Globulin
SHBG production in the liver responds to the amount of circulating estrogen and testosterone in the liver with higher SHBG
With higher estrogen and lower levels of testosterone increasing production of SHBG
Increased SHBG is seen in conjunction with hyperthyroidism (>T4) cirrhosis of the liver. Failure of estrogen metabolism, estrogen dominance, low progesterone, (high cortisol), pregnancy (>estrogen) and hormone therapy.
Sex Hormone Binding Globulin
Rises in response to rising estrogen levels in order to help the body regulate. Amount of SHBG (produced in the liver) that binds bothEstrogen & testosterone is a major determinant of the amount of circulating estrogen and testosterone
Estradiol SHBH Testosterone
Any action that increases SHBH will automatically reduce TestosteroneSHBH is independently inversely associated with poor glycemic control. The more people get into metabolic syndrome, the less SHBG they have & more Estrogen becomes bioavailable - a self-perpetuating cycle.
FACT
Estrone (E1 ) from fat cells up
regulates Cortisol...
AND High Cortisol up regulates Estrone.
Zhu BT. Functional role of estrogen metabolism in target cells: review and
perspectives. Carcinogenesis. 1998; 19(1):1-27.
The vicious circle is a catch 22.
What do we address first?
Interrupt The Cycle Create Hormonal Balance
Balance
“The regulation and metabolism of estrogen is potentially more important than that of adrenal,
or ovarian hormones, because estrogen’s potency and
domination over other hormones. “
Michael Greer, MD. OBGYN – Pioneer in Functional Medicine
THE RULE OF
Estrogen Dominance & Progesterone Deficiency Defined
Estrogen Dominance - An Elevated Estradiol to Progesterone Ratio Estrogen dominance. Term coined by Dr. Lee in his first book on natural progesterone.
It describes a condition where a woman can have deficient, normal or excessive estrogen, but has little or no progesterone to balance its effects in
the body. Even a woman with low estrogen levels can have estrogen dominance symptoms if she doesn't 't have any progesterone.
Estrogen Dominance (the yang)
The symptoms and conditions associated with estrogen dominance are: Acceleration of the aging process Allergies, including asthma, hives, rashes, sinus congestion Autoimmune disorders such as lupus erythematosis and thyroiditis, and possibly Sjoegren's disease Breast cancer Breast tenderness Cervical dysplasia Cold hands and feet as a symptom of thyroid dysfunction Copper excess Decreased sex drive Depression with anxiety or agitation Dry eyes Early onset of menstruation Endometrial (uterine) cancer
Irregular menstrual periods Irritability Insomnia Magnesium deficiency Memory loss Mood swings Osteoporosis Polycystic ovaries Premenopausal bone loss PMS Prostate cancer (men only) Sluggish metabolism Thyroid dysfunction mimicking hypothyroidism Uterine cancer Uterine fibroids Water retention, bloating Zinc deficiency
Progesterone is an early precursor molecule in the adrenal and ovarian steroid cascades and can be converted into
estrogen, cortisol, aldosterone & testosterone in different tissues
3 Sources of Progesterone • Produced in small amounts in the adrenals throughout life• Produced in large amounts following ovulation from lining of mature egg called,
the corpus luteum• massive amounts by the placenta during pregnancy
Progesterone (the yin)
Metabolism of Estrogen in Liver
Primary metabolism of Estrogen is through Phase I or Hydroxylation
Phase II = Methylation
Final Excretion - Urine & Feces
Estrogen Can Be Dangerous
Estrogen in phase one has three possible fates.
It can be metabolized into a 2 -OH estrogen
- A 4-OH estrogen
or a 16-OH estrogen
1 in Every 8
Breast Cancer Survival & Prevention
Mayo Clinic on HRT
According to The Mayo Clinic, HRT, which includes medications containing female hormones to replace the ones the body no longer makes naturally after menopause, used to be a standard treatment for women with severe symptoms. In the largest clinical trial to date, a combination estrogen-progestin pill was found to increase the risk of certain serious conditions, including blood clots, heart disease, stroke, and breast cancer. This type of therapy also may make a woman's breasts appear more dense on mammograms, making breast cancer more difficult to detect. When undergone for more than a few years, HRT has been confirmed by multiple studies to increase the risk for breast cancer.
http://www.acog.org/Womens-Health/Menopause
High Fat Meals Lower Testosterone Levels
Fact: Eating high fat meals/foods reduces free testosterone hormone levels for up to 4 hours.
Why: The fat estrogens attack to fill all hormone receptors.
NEW CALORIE EQUATION
This equation is now based on incomplete information.
More appropriate:
Recognizing Causes of Imbalance
Xenoestrogens –undiagnosed threats to our health
[Chunyang Liao, Kurunthachalam Kannan. Concentrations and Profiles of Bisphenol A and Other Bisphenol Analogues in Foodstuffs from the United States and their Implications for Human Exposure. J Agric Food Chem. 2013 Apr 24. Epub 2013 Apr 24. PMID: 23614805
It was only last year that it became apparent that global manufacturers of consumer goods that formerly used BPA were switching to the equally toxic (and environmentally more persistent) bisphenol BPS. Consumer Alert: BPA-Free Goods Still Contain Toxin Bisphenol.BPS is increasingly being used to displace BPA in global paper currency and thermal printer paper, and is now found in human urine samples at levels as high as BPA. The new study discovered that the second most prevalent bisphenol analogue found in foodstuffs was BPF, which accounted for 17% of the total BP concentrations versus 42% for BPA.
Concentrations and Profiles of Bisphenol A
Breast Cancer Risks & EstrogenicityRecent studies have shown a significant difference in estrogen metabolism by gut bacteria from equol producing and non-
producing study participants.
http://www.fhcrc.org/en/labs/phs/projects/cancer-prevention/projects/gut-bacteria-isoflavone-estrogen.html Identification of the gut
microbiome involved in equol production and estrogen metabolism will help us understand the role they play and how they influence the
composition and estrogenicity of circulating estrogens as related to breast cancer risk.
Actually, research done on the metabolism of the birth control pill as far back as 1984 said: “The results suggest that the intestinal
bacterial flora plays a significant role in estrogen metabolism.” So really this is old news. One theory today is that some bug species/
microbiome produce enzymes that increase a woman's lifetime estrogen exposure, and potentially, her risk for estrogen-related
cancers. Experts in this field of "estrobolome, the complete set of bacterial genes that code for enzymes capable of metabolizing
estrogens within the human intestine.
Why is this important, because in women.. estrogen is the key that unlocks many many doors, pathways of hormonal activity that
drives the female body. It has been long known that estrogen, a vital hormone for human health, is processed in the liver, and that
some of it enters the gut, where it interacts with each person's unique microbial community.
J Steroid Biochem. 1984 Jan;20(1):217-29.
Studies on the role of intestinal bacteria in metabolism of synthetic and natural steroid hormones.
Adlercreutz H, Pulkkinen MO, Hämäläinen EK, Korpela JT.
“Whether weak or strong, the estrogenic response of achemical, if not overcome, will add extra estrogenic burdento the system. At elevated doses, natural estrogens andenvironmental estrogen-like chemicals are known toproduce adverse effects. The source of extra or elevatedconcentration of estrogen could be either endogenous orexogenous. The potential of exposure for humans andanimals to environmental estrogen-like chemicals ishigh.” D. Roy, 1997
Foods – Chemical AdditivesPesticides Water BPA’s
Cell research has shown that glyphosate may act as an endocrine disrupter exhibiting estrogenic-like carcinogenic effects within the parts-per-trillion range.
Michael S Majewski, Richard H Coupe, William T Foreman, Paul D Capel. Pesticides in Mississippi air and rain:
A comparison between 1995 and 2007. Environ Toxicol Chem. 2014 Feb 19. Epub 2014 Feb 19. PMID: 24549493
Reference link: http://www.mdpi.com/1099-4300/15/4/1416
“Glyphosate, the active ingredient in Roundup®, is the most popular herbicide used worldwide.” Residues are found in the main foods of the Western diet, comprised primarily of sugar, corn, soy and wheat. Consequences are most of the diseases and conditions associated with a Western diet, which include gastrointestinal disorders, obesity, diabetes, heart disease, depression, autism, infertility, cancer and Alzheimer’s disease ….”
Estrogenic Contributing Drugs
Hormone Therapy
Dr. Lee’s 3 Rules • Only for Women who need them • Bio-Identical not artificial• Dosage (reconsider annually)
Body Care Products/Chemicals
Arsenic to phthalates to nano-technologyWe can avoid or minimize exposures to some of the worst
culprits in our environment: cigarette smoke, flame
retardants, harsh cleaning products, personal care products,
pesticides and chemical food additives, etc.(spray tanning, bug sprays)
Toxins in our World
Chemicals in Cookware
Cleaners
Household products
Money & Receipts
Gut bacteria - Why do they matter?
A very quick summary of one study: Scientists took a group of mice with peanut allergies and gave them the gut bacteria Clostridia, a bacteria found commonly in humans. After administering it, they
found that the mice no longer had food allergies. Researchers recently discovered Clostridia, a big group of bacterial. With them, no allergies, without them yes allergies. Immunologist
Cathryn Nagler. Allergies may have a lot to do with our antibiotics-happy culture. Anti-biotics used on farms could be another culprit.
Microbial Cloud Variety Of BenefitsMicrobial cloud – we see them through their effects on our body. We need a field guide to what they are doing to our
lives and our bodies. We are them and they are us.
Microbiome begins in vaginal canal/colonized with microbes of mother/ C-section leads to mis-colonization
Microbial community helps metabolism
Gut bacteria inhibits estradiol & estrone glucuronidation
Microbial community determines our immune system - helps in fighting off pathogens
Helps in determining our odor
What happens when we’re germ-a-phobic. Anti-microbial soaps, anti-biotics in our food,
Risks for obesity, auto-immune,
Poo-tee, veterinarians… tea from poo fecal transplants very successful very effective, curing systemic c-differencialdisease. Happening now for Crohns disease,- Illuem transplant
Microbial community is an organ.. Anti-biotics are changing our health history.
“The safest way to increase your microbial
biodiversity is to eat a variety of polysaccharides”Stanford Researcher - Dr. Rob Knight
What herbs are high in polysaccharides?
Astragalus (Huang Qi)
Echinacea
Medicinal mushrooms
Aloe Vera Leaves - (leaves not necessarily present all juice extracts)
Microbial Biodiversity with Polysaccharides
Huang qi is one of many Qi tonifing herbs its effects well known and studied and according to Kerry Bone in Prinicipals and Practice of Phytotherapy, it “restores, strengthens and balances the body’s immune response, increases vitality and strengthens cardiac function.” (And we know the immune system resides in the gut we are not surprised that Chinese medicine has known this for centuries. (
And as Dr. Bone says, it is the naturally occurring polysaccharides in huang qi that have the immune enhancing and immune - regulating properties. (interestingly aqueous extracts of huang qi yield higher polysaccharide content than alcohol extracts)
Echinacea Root : (not whole plant or flower) Immune enhancing, treats upper respiratory tract infections,
Probiotics Definition pro = "for" + biotics "life“= FOR LIFE
What is a probiotic? Probiotics are live microorganisms (in most cases, bacteria) that are similar to beneficial microorganisms found in the human gut. They are also called “friendly bacteria” or “good bacteria.” Probiotics are available to consumers mainly in the form of dietary supplements and foods. NIH
NIH has defined probiotics by a strict criteria:1. The organism must be a normally occurring organism in the digestive tract.2. In order to consistently trigger a healthy boost in immune function the organism must be supplemented in concentrations higher than what normally occurs in the digestive tract.3. The organism must be able to survive in the digestive tract as well as in the environment.Interestingly enough there are almost no probiotics in the marketplace that meet all three of these criteria!
More Good News About PRO-Biotics
Remarkably, two common probiotic strains, Bifidobacteriubreve and Lactobacillus caseii, have been found in animal research to help the body detoxify BPA’s by reducing the intestinal absorption of BisphenolA through facilitating increased excretion.
A : This ubiquitous toxicant -- linked to over 40 diseases -- found in thermal printer receipts, paper money, n canned food liners, dental composites, and of course plastics, is a powerful endocrine disrupters now found in everyone's bodies.
Kenji Oishi, Tadashi Sato, Wakae Yokoi, Yasuto Yoshida, Masahiko Ito, Haruji Sawada.Biotechnol Biochem. 2008 Jun;72(6):1409-15. Epub 2008 Jun 7. PMID: 18540113
Probiotics Not Enough ResearchPostgrad Med J 2004;80:516-526 doi:10.1136/pgmj.2003.008664
Probiotics and human health: a clinical perspective
“There is unequivocal evidence that administration of probiotics could be effective in the treatment of acute infectious diarrhea in children and the prevention of antibiotic associated diarrhea and nosocomial/community acquired diarrhea. Encouraging evidence is also emerging for the effectiveness of probiotics in the prevention and management of pediatric atopic diseases, and the prevention of postoperative infections. There is also strong evidence that certain probiotic strains are able to enhance immune function, especially in subjects with less than adequate immune function such as the elderly. Efficacy of probiotics in the prevention of traveler's diarrhea, sepsis associated with severe acute pancreatitis, and cancers, the management of ulcerative colitis, and lowering of blood cholesterol remains unproven. In addition to firm evidence of efficacy (for a range of conditions), major gaps exist in our knowledge regarding the mechanisms by which probiotics modulate various physiological functions and the optimum dose, frequency, and duration of treatment for different probiotic strains.”
Duke University - Our appendix… may be a "safe house" for beneficial bacteria living in the gut.
http://www.dukehealth.org/health_library/news/10151
Researchers hypothesize the appendix acts as a safe house for good bacteria. Possibly to “reboot” the digestive system after a bout of dysentery or cholera.
Duke University Medical Centre in North Carolina researchers say that following a severe bout of cholera or dysentery, which can purge the gut of bacteria essential for digestion, the appendix acts as a reserve for good bacteria to emerge. –
“As an idea it’s an attractive one, that perhaps it would be a nice place for these little bacteria to localize in, a little cul-de-sac away from everything else,”
The gut is populated with different microbes that help the digestive system break down the foods we eat. In return, the gut provides nourishment and safety to the bacteria.
Creating Balance
AcupunctureFoods,
PrebioticsHealthy Gut Micro-Biome (colonies of bacteria)
Herbal Formulas
Harmonize Digestion Herbal formulas – harmonize digestion - sooth the liver - clear heat - move Qi
Si Jun Zi Tang – Liu Jun Zi Tang - Xiao Yao San - Jie Wei Xiao Yao San
Gut bacteria & the inhibition of estradiol & estrone glucuronidation• Look at good fats – coconut oil research & anti-estrogen effects of fat• Phyto-estrogens & soy dilemma• Green tea research & estrogen
Phytoestrogens are a diverse group of non steroidal
plant compounds (generally phenolic) with structural
similarity to estradiol, and therefore estrogenic effect, or
anti-estrogenic effect by blocking receptor sites.
Most common:panax ginseng (ren shen),
red clover, kudzu (ge gen),
pueraria mirifica, angelica (dang gui), fennel (hui xiang), anise (hui qin),
glycyrrhiza glabra
(gan cao); soy isoflavones, wild yam, lignans (flax, EPO)
Phytoestrogens for Estrogen Balance
Supports “Oestrogen function in the body” Support “female organs” Contains Steroidal Saponins (may increase cholesterol levels in bile)
Treats: menstrual migraines, spasmodic conditions Dioscorea is a source of diosgenin used as a precursor for the
chemical synthesis of progesterone (dioscin hydrolyzes to diosgenin) Oestrogenic effect and possibly anti-cancer effect
*Herbal sources of diosgenin often are yang tonics (Hu Lu Ba, fenugreek, Ba Ji Li, tribulus) Dioscorea Villosaused in studies Mexican Wild Yam is Dioscorea Barbasco – raw materials for natural progesterone & estrogen creams .K. Bone, S. Mills, Principals & Practice of Phytotherapy 2nd ed. Churchill Livingstone, Elsevier
Wild Yam – Dioscorea - Shan Yao
Natural vs Synthetic Progesterone
Synthetic Progestins are chemically formulated from natural Progesterone..
But are NOT chemical equivalents.
Not convertible by body toother steroid hormones
Natural Progesterone is converted by Adrenals into corticosteroids that• aid in regulating blood sugar metabolism• Promote bone formation,• Enhance thyroid hormones• Block estrogen side effects• Create efficient utilization of fat for energy
Dr. John R Lee MD Menopause & Estrogen – Natural Alternatives to Hormone Replacement Therapy 1996
Dr. Peat on Progesterone
Micronization has been shown to enhance absorption (apply to thin skin areas , wrists, back of knees, ankles, nipples)
Oil base best for lymphatic system
Preferable for long term replacement therapy say American Journal of OBGYN
Progesterone has adverse on lipo proteins
Under influence of estrogen, body retains extra water .. One reason we crave salt
1951 progesterone produced evidence of regression of cervical cancer tumors (National Cancer Journal #115)
Lack of progesterone interferes with adrenal corticosteroids which is how we respond to stressVitamin E for everything – thyroid dysfunction, estrogen dominance, progesterone deficiency
Most USP Progesterone is extracted from Soy! Is is GMO Soy ???
Food is Medicine - Foods for Estrogen Elimination
1. Cruciferous vegetables – what the studies say
2. Paleo Diet vs Vegetarian Diet
Aromatase inhibitors block estrogen production from hormone precursors - Phyto-estrogens
Biochanin A - Red clover, soy, alfalfa sprouts, peanuts, chickpeas
Genistein - isoflavone fromgenesta tinctora,fava beans, soy, lupin, kudzu, coffee, flemingia vestita, flemingia macrophylla -binds to and activates estrogen receptor
Green tea -
Grape Seed Extract -
Aromatase Inhibitors
Supplements to Accelerate Endocrine “Balance”
1. Calcium-D-glucarate2. DIM3. Probiotics4. Enzymes5. Protein supplements6. Thyroid / Iodine rich foods7. Saccharomyces Boulardii - supplement/Great Lakes Gelatin,
Collagen Hydrolysate8. Good fats – coconut oil research & anti=estrogen effects of fats
DIM – Indole 3 Carbinol - Diindolymethane
I3C is one of several potent compounds found in cruciferous vegetables such as broccoli, cauliflower and Brussel sprouts
I3C & DIM function by modulation of hormones and the activation of genes (i.e. mitochondria)I3C dosage should be based on weight
• up to 179 lbs: 200 mg daily• 180-239 lbs: 300 mg daily• Over 239 lbs: 400 mg daily
2 month protocol minimum
Lifestyle modifications
• Acupuncture to balance hormones• Physical exercise component• Bowel patterns & re-circulating estrogen• Sleep as a habit• Hygiene & the beauty industry – Xeno-estrogens on our skin
Pharmaceutical Replacements
1. HRT Replacements – Herbal formulas & acupuncture
2. Birth Control Pill replacement options
3. Prozac & Zoloft, Anti-depressants side-effects and alternatives
Life Style Actions To Balance Hormones
Conversations & studies behind the healing arts• Yoga • Meditations • Qi Gong • Tai Qi • Qi Nei Tsang
Gailand L. Applying Person-Centered Diagnosis to the Problem of Chronic Fatigue. 7th International Symposium on Functional Medicine, 2000. Institute forFunctional Medicine, Gig Harbor, WA
• High fiber, high veggie, lower fat/animal product, 30-50 mg fiber daily
• Juicing with dandelion root, turmeric, cilantro, apple, beet, celery, lemon, ginger
• Pre-biotic foods to improve digestion
• Ground flax seed for lignans (2 Tbs) - Cruciferous vegetables (kale)
• Supplements: Magnesium – B Complex including B12 and DIM – (only if needed)
• Exercise – Exercise – Relaxation & Movement
• Clean out house & personal care products – no parabens products
• Remove an HRT – Oral Contraceptives
• Detox more extreme estrogen dominance with Calcium D-glucarate, glutathione
• Add herbs high in Polysaccharide – Reishi or other medicinal mushrooms – Huang Qi
(astragalus & Echinacea)
Where To Start
FOOD IS THE MOST PERVASIVE INFLUENCE ON HUMAN HEALTH
Questions
