Welcome!

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the student program agreement.

Tracy’s health counseling certification is from Columbia University for the Institute of Integrative Nutrition in New York.

She has completed ongoing training and is working on a certification in understanding the root causes of chronic illness with the Institute of Functional Medicine and on an additional Masters degree in Human Nutrition at Bridgeport University.

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

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

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SAFM Deep Dive Clinical Courses2

Hormones DemystifiedPart 2

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the SAFM student program agreement.

Today’s Agenda

Refresher on Key Concepts from Part 1 Estrogen Dominance Interventions

• Endometriosis• Rapid Relief for PMS

Epidemic of PCOS Looking toward Part 3

4

HPATG : an Axis of Interconnectedness5

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

Thoughts

Environment

Stress/Immunity

Metabolism

Reproduction

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

- Charles R. Swindoll

Fundamental Interconnectedness

Hypothalamus& Pituitary

Thyroid

Adrenals

Gonads

G E N E S ILL-NESS

ENVIRONMENT:What we Maximize,

Minimize, and Prioritize

WELL-NESS

InteractiveBiochemistry

Endocrine (Hormones)

Immune (Inflammation)

Nervous (Neurotransmitters)

Digestion(Nutrients)

Metabolism(Energy)

Detoxification(Clearance)

?

Choices

Choices

Functional Medicine: The Big Picture7

InteractiveBiochemistry

Endocrine (Hormones)

Immune (Inflammation)

Nervous (Neurotransmitters)

Digestion(Nutrients)

Metabolism(Energy)

Detoxification(Clearance)

Functional Medicine: Hormonal Connections8

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

receptor status, balance vs.

individual level.

Inflammation increases stress hormones (cortisol)and can affect hormone

receptors, HPATG balance, and thyroid function.

Estrogen has strong impact on

serotoninsynthesis,

transport, and receptors

Specific nutrients are key for hormone synthesis

and appropriate hormone clearance (e.g. sulfation,

glucuronidation, and methylation of estrogens).

Hypothyroid state slows metabolism, detoxification, GI motility/digestion,

and ovulation.

Excessive exposure to xenoestrogens can

overload liver detoxification pathways and increase

estrogenic activity.

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A Typical “Real Life” Patient

A very busy, over-committed woman

Uses aggressive exercise/running for fitness 4 days/week (“can’t live without my exercise!”)

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 from being “crazy”

Lots of carb cravings. Gaining weight.

Constipation

Anxiety

Feels puffy. Using more make-up and beauty products these days.

Too busy to cook. Loves convenience of grocery store prepared foods.

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

10

Putting the Hormone Puzzle Pieces Together

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

Stress impairs T3 thyroid hormone function. Stress impairs immune function, so active viral/bacterial challenges. Simmering immune challenge can increase inflammation, further impairing T4 to T3 conversion.

Using oral birth control pills (OCP) which promote enhanced intestinal permeability and food sensitivities. Yet more inflammation, impairing thyroid function, raising cortisol.

OCP depletes nutrients, especially Vitamin B6*, critical for both sulfation and methylation which would help her body to excrete excess estrogen (and toxins).

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

High insulin level increases testosterone, impairs ovulation, blocks progesterone synthesis, and thus promotes more estrogen dominance (and infertility). Increased retention of copper can promote more anxiety (more self-medicating with food and exercise).

Uses mainstream personal hygiene products. More make-up helps to improve self-confidence after weight gain. Xenoestrogens exacerbate estrogenic activity.

High intake of refined vegetable oils and insufficient omega-3s lead to poor cellular membrane flexibility and function and increased inflammation.

10

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

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It’s the Hormone Soup Dance!

High cortisol Low melatonin Low cellular thyroid function Enhanced intestinal permeability Increased inflammation High insulin High testosterone Low SHBG High body fat High estrogen action (OCP, bodyfat, xenoestrogens) Insufficient nutrients for detoxification Low progesterone. Estrogen dominance. Pro-inflammatory dietary fat intake.

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

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

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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, feel Well,

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 Chronic Stress Physical Stress/Trauma Worry/Anxiety Smoking Maldigestion/malabsorption Genetic Tendency Refined, inflammatory foods Poor Ability to Detoxify Obesity Social Isolation Food Sensitivities Constipation Hypothyroid function Dysbiosis

The Root Causes of hormone imbalance are also the same

Root Causes and contributors to other dis-ease progression!

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Dance of the Hormones

Epinephrine/Norepinephrine

CortisolInsulin

EstrogenProgesterone

ThyroidTestosterone

DihydroTestosterone(DHT)

…in an interactive Soup!

14

Estrogen Dominance

Interventions

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What a Difference a Century Makes!

One Hundred Years Ago Menses begin near age 16. Earlier and more frequent pregnancies Nearly universal breastfeeding. Earlier menopause (~45). Shorter life span (~52 yrs). Typically ~200 menstrual 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. More stress (less progesterone). More xenoestrogens. A major increase in exposure to hormone fluctuations

during a woman's lifetime, especially estrogen.

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

Estrogen Dominance

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

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

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

control pills, body fat e.g. high-glycemic diet, hypothyroid state, 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 ongoing stress/cortisol, luteal insufficiency, natural reduction from age ~35-50, hypothyroid state, menopause, toxic exposure/stress causing anovulation (recent or much earlier in life))

Estrogen dominance can manifest as many common, modern hormone syndromes, diseases, and illnesses. Lots of labels! And a diagnosis is not a Root Cause discovery.

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

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

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Bloating

Water retention/weight gain/ swollen appearance

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

Heavy, lengthy menstrual bleeding, perhaps with many clots

Irritability/Impatience

Anxiety

Headaches, perhaps migraines

Breast tenderness, cysts

Outbursts of rage

Hypothyroid function

Extreme emotional sensitivity

Panic attacks

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

Estrogen Dominance Symptoms in Women18

Root Causes: Excess Estrogenic Input

High-glycemic diet (promotes insulin surges which promotes conversion 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.* WS tip: THIS is the reason to choose local and organic foods. Your clients need a tangible motivation to “get on the bandwagon” with prioritizing organic (e.g. money, availability).

Petrochemical compounds in personal hygiene products, parabens, phthalates (e.g. lotion, soap, perfume, hairspray, make-up, room deodorizer, nail polish, sunscreen**). WS Tip: Most powerful education 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, may cause symptoms depending on clearance. Stress (promotes lower metabolism (e.g. higher reverse T3 and lower free T3 thyroid hormone

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

overproduce estrogen (and no progesterone) – a potentially vicious cycle)

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There is a handy patient handout on xenoestrogens in the Documents for this course. * http://ehp.niehs.nih.gov/1306648/** http://pubs.acs.org/doi/abs/10.1021/es204415a and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834384/*** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385438/ and https://www.ncbi.nlm.nih.gov/pubmed/28918287 and https://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-risk and http://www.ncbi.nlm.nih.gov/pubmed/24666753 and https://experiencelife.com/article/hormonal-birth-control-aviva-romm/ and http://www.saragottfriedmd.com/the-birth-control-pill-7-reasons-why-you-may-want-to-stop-and-how-to-stay-healthy-if-you-dont/

Endometriosis

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

for infertility in this situation are multifactorial e.g. pelvic anatomy distortions, blocked ovulation, impaired hormone synthesis/uptake in tissue. **

Tissue responds to hormonal fluctuations (especially rising estrogen) and can cause severe symptoms, primarily pain and infertility.

Over 50% have chronic pain; over 75% pain during menstrual cycling. 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 reduce recurrence.***

WS Tip: support for reducing estrogen dominance (e.g. decreasing estrogen receptor sensitivity and increasing estrogen detoxification) and excretion can be quite helpful in reducing symptoms.

* 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

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Root Causes: Poor Estrogen Detox & Clearance

Strong/Weak estrogen imbalance(estradiol vs. estrone (80% potency of E2) vs. estriol (<10% of E2) ***

High alcohol intake (increases aromatase enzyme activity, slows estradiol metabolism to estrone, upregulates estrogen receptors, and impairs liver clearance) ****

Caffeine increases 16-OH estrogen metabolites. However, coffee specifically increase 2-OH (polyphenols!). However, increased cortisol/adrenaline makes estrogen receptors more sensitive.#

Low levels of B vitamins or Magnesium (e.g. low stomach acid or digestive enzymes, vegan diet, chronic stress, low vegetable intake, drug use (e.g. birth control pills, diuretics, PPI)

Fatty liver (e.g. from sustained insulin resistance or Type 2 diabetes or with high alcohol intake)

Low bile production, gallstones, or missing gallbladder (sufficient bile is needed to for clear movement of conjugated estrogen into the GI tract, sufficient Vitamin B6 is needed to synthesize taurine to make bile salts)

High levels of beta-glucuronidase* (an enzyme that decouples estrogen from its conjugate and enables reabsorption; can be measured in comprehensive stool test). WS tip: this can be reduced using Calcium D-glucarate, e.g. 500-1000mg, 3x/day** Also helps to clear many estrogen-mimicking chemicals.

Detoxification pathway impairment (e.g. COMT SNPs, MTHFR, Gilbert’s syndrome)

Constipation (poor clearance of toxins from GI tract)

# https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526325/ , http://clincancerres.aacrjournals.org/content/21/8/1877.long* http://www.tldp.com/issue/166/166stop.htm , ** http://www.ncbi.nlm.nih.gov.pubmed/?term=3091283*** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127562/ , see Phytoestrogen clinical write-up in Documents.**** https://academic.oup.com/alcalc/article/35/5/417/206575 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4299758/ , https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-015-0620-1

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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 potentially carcinogenic.* The 2-OH pathway can be increased with cruciferous vegetables and berries, but it will also reduce available strong estrogens. Beware over-suppression of 3A4 pathway; it creates estriol!

Phase 2: Methylation via COMT changes hydroxy metabolites into methoxy ones which have very little binding affinity to estrogen receptors. ** Requires methylation and magnesium! Check homocysteine. DUTCH gives estrogen methylation ratio. In some cases, consider reducing competing substances which use this pathway 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 Map or GI Effects).

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

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922211/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053199/** See two related 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 not have the same action as natural progesterone.) Progestin (synthetic) and Progesterone (USP) are NOT the same!

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

Menopause (There is no ovarian production of progesterone and the adrenal gland may be incapable due to cortisol production priority.)

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

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Root Causes: Other Hormone Imbalance

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

suppresses GnRH and can cause menstrual irregularity or cessation. Excessive estrogen increases TBG and reduces available free thyroid hormones. Women with low thyroid function are significantly more likely to have

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

Elevated levels of cortisol (usually due to chronic stress) can directly contribute to hypothyroidism and can create insulin resistance.

Chronic demand for high cortisol depletes progesterone through coordinated HPATG axis modulation (a double whammy for a woman in her perimenopausal years).

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

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

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

Bifido species or more Bifido, sufficient water, increase EV olive oil) Estrogen detoxification support Regular intake of cruciferous vegetables (primarily

cooked vs. raw if there is a hypothyroid concern). Indole-3-Carbinol (I3C) or DIM supplement but no more than 100mg/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 (vegan diets!), grape seed extract, and chrysin are natural aromatase inhibitors (perhaps helpful for both men and women!).

Increase methylation of estrogens to reduce carcinogenic potential. B-complex to support methylation if needed (feedback from MCV, homocysteine, DUTCH metabolites).

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

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Countering Estrogen Dominance

Countering Estrogen Dominance

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

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

Bioidentical progesterone cream. Overt hormone supplementation is in webinar #3. Chastetree Berry stimulates higher progesterone

secretion, 500-1000mg daily.** Limit excessive alcohol consumption.

Occasional use likely irrelevant. Studies show women social drinkers who drink 2 or more drinks most days are much more likely to 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/ , and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787473/**** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792621/ , https://www.schoolafm.com/ws_clinical_know/reversing-arterial-plaque/ , https://www.ncbi.nlm.nih.gov/pubmed/17010542

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PMS Rapid Relief

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

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

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Countering Estrogen Dominance: Back to Basics

The Environmental Working Group’s website is an excellent resource for clean household and hygiene products and organic food priorities. www.ewg.org/skindeep and http://www.ewg.org/guides/cleaners

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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 of them together & send home samples.

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

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

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

• For short-term, rapid relief of high cortisol and/or catecholamines, 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 very sensitive/allergic (e.g. histamine intolerance).

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

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Countering Estrogen Dominance

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

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

Epidemic of PCOS

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Expanding on Androgens32

Testosterone Troubles

The primary androgen or “male” hormone Critical for libido, bone cell formation, metabolism, muscle retention, overall achievement

drive, fat storage control, and general energy/well-being. Low testosterone levels common in women who also have low DHEA and/or progesterone

(and of course those who have had a hysterectomy). Excess insulin can cause women’s ovaries to produces excessive testosterone (and can

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

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

The 5a enzyme creates dihydrotestosterone (DHT) the strongest androgen.

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

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

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Dance of the Hormones

Epinephrine/Norepinephrine

CortisolInsulin

EstrogenProgesterone

ThyroidTestosterone

DihydroTestosterone(DHT)Many hormones affect one

another directly and indirectly across systems.

In women, excess insulin can promote higher testosterone and

anovulation. Resulting lower progesterone can increase

estrogen dominance.

…in an interactive Soup!

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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 make more

testosterone

Ovarian Cysts

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

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

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

Excessive androgens or estrogens can promote excessive or lasting cysts.

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

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Epidemic of PCOS?

PCOS is affecting more and more young women as a result of high insulin-stimulating diets (high in refined carbohydrates, sugars) and high toxic exposure in modern society (both in utero and life-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 menses and overall higher estrogen levels throughout. Use of contraceptives hormones to “fix” PCOS may make this issue worse long-term.

Typically, women with PCOS do not ovulate, so there is no trigger to produce protective progesterone. Thus, they are more vulnerable to that higher estrogen!

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

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PCOS Biochemistry

PolyCystic Ovarian Syndrome is a sign of hormonal imbalance. #

These ovaries generally do not produce eggs or ovulation consistently. The egg maturity process is impaired, producing many cysts with small, underdeveloped eggs

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

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

Without ovulation, the ovaries do not produce progesterone to balance estrogen. Thus ongoing PCOS can easily cause estrogen dominance.

Lack of ovulation promotes greater GnRH production which triggers more LH synthesis, stimulating greater testosterone production 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 may cause 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/ and http://www.ncbi.nlm.nih.gov/pubmed/9408743*** Givens, “Reproduction and Hormonal Alterations in Obesity” in Dr. P. Bjorntorp's “Obesity”, 1992****http://press.endocrine.org/doi/full/10.1210/edrv.18.6.0318

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The Mighty Pancreas

Life-critical gland with both digestive and endocrine roles

Digestive: producing digestive enzymes and bicarbonate which help to break down foods in the intestines. 99% of pancreatic cells do this.

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

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Insulin

A life-critical hormone released from the pancreas when wethink about eating & when we consume either carbohydrates and/or protein

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

Key Insulin Resistance Concepts Cells absolutely cannot absorb sugars without insulin.

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

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

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From Walter Willett, Chair of Dept. of Nutrition, Harvard University, 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 of Nutrition.

Carbohydrates, Blood Sugar, & Insulin41

Cellular Energy

●In a healthy cell, insulin opens a cell's glucose transporters in the cell membrane. This allows glucose into the cell to be used for fuel.

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

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Pathway to Diabetes

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

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

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

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

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

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

7)Eventually the pancreatic cells begin to wear out and are unable 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 is full-blown Type 2 Diabetes.

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

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Making Things Simple for Your Clients

Eat an Excess of Processed,

Refined Carbohydrate

Foods

Make lots of insulin

Cells resist the effects of

insulin

Excess sugar gets stored as

body fat

Body fat increases insulin

resistanceVicious Cycle

of Insulin Resistance

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

Feel Hungry, Weak, and

Tired

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Excess insulin creates higher body fat, regardless of weight!

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 Menopause Hormone Supplementation Hormone Testing Considerations Resources for More Learning

We highly recommend experiencing this (Part 2) webinar again

before moving on to Part 3.

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Hormones DemystifiedPart 2