Meet Lisa. Lisa is beautiful by almost any set of standards. Not too skinny, not pudgy, not frumpy at all, she has olive skin and big brown eyes. Like most women (all women?) she has some very particular complaints about her body and the way she feels. She doesn’t like her boobs (not perky enough), she feels like her ankles and calves are “way too thick” and most troubling to her are bouts of cystic acne and some intermittent discomfort in her gastro-intestinal tract, lovingly referred to as her “gut” from here on out. She’ll skip having a bowel movement for 1-2 days and then sometimes has loose stools. She often feels bloated and as if her food isn’t being digested properly. Her biggest concern is her skin. Lisa’s breakouts are painful and it takes a long time for the red marks to fade. Like all my patients with skin issues, they want results fast! Everyone has their health challenges but people with skin problems have to wear them right on the surface for the world to see!
(skin, gut, hormones, it's all related)
That this is not normal, not pooping every day, is news to Lisa. She has noticed that milk and dairy products contribute to her sluggish gut function but she has not made any other dietary connections. Her periods are “normal” she says. What she means by this is that she has some PMS with irritability, breast tenderness and bloating but no terrible cramping or super heavy bleeding. Her constipation is also much worse the week before her menses and she can get headaches that week as well. She has never taken more than some ibuprofen for the headaches but they are bothersome.
- Constipation, bloating and occasional loose stools
- Acne breakouts
- Mild/moderate pre-menstrual symptoms (PMS) including breast tenderness and headaches
I think many women feel if they aren’t debilitated by their period, laid up in bed for 1-3 days, that everything is normal. Almost all women experience some indication that their period is coming but it shouldn’t be a source of anxiety or dread every month. Nor should it only be tolerable if you are scarfing down Advil by the bucketful for a few days. That’s a good way to end up with more gut problems in the future. Periods actually can be pain-free and maybe even helpful as a time to go inward and reflect, getting in touch with your inner voice. It may sound cheesy but there really can be a more inward focus for the days one is bleeding. The menstrual blood is also an extraordinary way women can eliminate toxins from their bodies. It’s our monthly completely natural detox!
Lisa forgot to write on her intake form that she’s been taking oral contraceptives for a number of years. She’s 34 years old and married but “on the fence” about having children. Lisa is not, not by far, the sickest patient I’ve ever seen. Nonetheless, she has some real complaints that her other doctors don’t have much to say about. She’s been given “the pill” and that’s about all. She wasn’t given any other options to address her concerns. This is why so many people are seeking help from naturopathic physicians.
Lisa’s pertinent history
- On oral contraceptives (exogenous estrogen) for 8-9 years
- Taken antibiotics for acne intermittently over last 10 years
- No high blood pressure, history of clotting problems or episodes of major depression
- Family history: one aunt with breast cancer in her 50s, mom and sister in good health
- Lisa is Type A+ blood type
Let me tell you a little bit about the connections between a healthy gut and your hormones. Many people are now aware that in our digestive tracts reside humongous amounts of bacteria, estimates range in the 100 trillion area. That’s more than the number of cells in our bodies. Some of these microbes are “friendly” some not-so-much friendly. This balance of good and bad bacteria is like an inner ecosystem, or inner garden, if you will. In medicine we refer to this garden as the microbiome and it is an area of medical research that is blowing up right now! For years, naturopaths have said that the true road to healing must begin with the gut and now it seems we are being vindicated. Well, unsurprisingly no one is really giving us credit. But the revolution is happening, and it’s definitely not being televised by most of mainstream medicine.
(a pretty "sea garden" akin to your inner garden)
If we have imbalances in the gut flora, if the good guys are depleted and the bad guys are robust, then we have what many naturopathic doctors refer to as dysbiosis. In some cases this means any number of pathogens; “bad” bacteria, yeasts, viruses, are growing out of control, regardless of whether or not we have plenty of the good guys around. In addition, the presence of heavy metals like mercury, cadmium and lead can interfere with healthy balance of gut flora.
Most of the research has been done with regards to diversity in the microbiome. Like any ecosystem, there is strength in having a diversity of organisms. In fact, almost all the research done on the hormonal connection show that women with active breast cancer have far less diversity in the microbiome and therefore don’t clear excess estrogens from their bodies effectively. The more estrogen circulating, especially pro-inflammatory estrogen metabolites, more risk for developing aberrant DNA replication and risk for tumor development.
The action of methylation plays an important role in this process of eliminating dangerous estrogens. If methylation status is less-than-optimal, there is a greater likelihood of inflammation in the gut. What is methylation, you ask? Without a major lesson in biochemistry, let me say that when methyl groups (we are talking molecules now) attach to certain parts of your DNA they help the cells replicate themselves more accurately and that is really what anti-inflammatory action is all about. When your cells can’t make good copies of themselves, they get wonky, inflamed, and more likely to turn cancerous. Cancerous mutations are often (not always, but often) nothing more that chronic inflammation left unchecked by the body.
When we have adequate amounts of beneficial bacteria they secrete enzymes in the gut to help eliminate excess hormone. These same enzymes help reduce inflammation and thereby help stave off leaky gut, which is when the inflammation gets bad enough to create micro-tears in the lining of the intestines. This allows proteins of all kinds; foods, environmental exposures such as pollens, dust and molds, as well as bacterial by-products, to enter into systemic circulation. This means systemic problems like allergies, chronic hives and eczema can develop—through auto-immune mechanisms. I will discuss this more when I write about thyroid health. For now, think of bacterial balance as one way to protect your whole body. Indeed, our gut flora is our first line of defense!
Key learning: gut flora and hormones
- You want to be able to break down (metabolize) estrogen properly because some estrogen metabolites are more inflammatory and are a risk for developing cancer.
- Methylation is one important mechanism to control inflammation—bacterial balance controls whether estrogens are pro-inflammatory or anti-inflammatory.
- You want to be able to eliminate estrogen by-products/metabolites from the gut and certain bacteria aid in this process whereas pathogenic bacteria make your estrogens get recycled!
- You need adequate amounts of beneficial bacteria and low amounts of pathogenic bacteria, yeast and virus to keep healthy types of estrogens forming and eliminating “excess” estrogens at the same time.
Back to our friend Lisa: she’s only 34 but she’s been taking estrogen in the form of birth control for 8 or 9 years. She has also used antibiotics for her skin for long periods of time. The antibiotic use can create dysbiosis long after discontinuing their use and “the pill” can encourage yeast overgrowth. Although the acne breakouts are less frequent, she is still getting them about once monthly and that tells me her skin is trying to eliminate instead of her gut doing it’s primary job of eliminating. In addition, taking the pill will deplete the body’s stores of folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc! A number of these nutrients relate directly to skin health, as well as many other parts of the body including the nervous system, the adrenals, the circulatory system and the liver.
Because Lisa has disrupted her gut flora and she’s got some extra estrogen intake in the form of oral contraceptives, she is very likely in trouble with eliminating the estrogens her body is exposed to. Unless she has a very healthy diet and plenty of antioxidants, low levels of inflammation and optimal thyroid function, I would expect that her digestive complaints and her skin issues are directly related to her hormonal health. When I asked her more about her dietary habits I found room for improvement even though she is eating a fairly healthy diet.
What I recommended is that she increase the amount of healthy fiber in her diet in the form of leafy green vegetables (especially spinach) and fruits rich in bioflavonoids like bell peppers, berries, grapefruit, lemon/lime, peaches, cherries and many more. The proper types of plant fiber can greatly increase the digestive capacity and along with a key supplement or two, she should be eliminating excess estrogen far more readily. And equally as important, she needs to move her bowels more regularly! Improving eliminations is the first goal I have with many of my patients. If you continue to read my articles this is something you’re going to hear from me time and time again.
Lisa’s dietary recommendations
- Healthy fiber to move bowels more regularly and bind potentially dangerous estrogens.
- Lignans in flax seed are one of the most effective phytoestrogens to help move excess estrogen out! 1 teaspoon of ground flax per day is sufficient.
- Bioflavonoids as anti-oxidants and staving off pathogenic bacterial overgrowth.
- Essential Fatty Acids as modulators of inflammation and especially black currant oil is great for the skin.
- Green tea as potent methylator!
- Avoid commercial cow’s milk and commercially-raised animal protein, especially those poor chickens!
The supplements I recommended to her are a form of calcium, called Calcium D-glucarate, that can bind the excess estrogen and help it move out of the body through the gut. I also recommended drinking 1-2 cups of organic green tea for methylation. Green tea has super potent methylation properties and is like “anti-cancer in a cup” I say to patients all the time. I like to use herbal anti-microbials for 1-2 months to kill off some of the bad bacteria before putting the good bacteria in. The good guys, called probiotics, have become super popular in recent years and for good reason. The amount of healthy bacteria in your gut affects so many systems in the body and now I hope you understand that gut bacteria help your hormones too!
Lisa made great progress over the first 3 months we worked together. Month #1 her bloating virtually disappeared and she was eliminating more regularly but still not consistently every day. Month #2 her gut felt even better and her PMS symptoms were moderately improved. Overall her energy is better and her skin looked almost flawless so she’s cautiously optimistic about that! We can focus more on hormones in the future if she is interested in getting off the pill. If not, staying on a regimen of high-quality nutrients will be essential!Lisa’s supplement essentials
- Calcium D-Glucarate to keep estrogens from re-circulating in the body.
- Herbal Anti-Microbials for 1-2 months to kill off bad bugs! (I use several different products and the 2 Biotics Research ones must be used together)
- Blood-type specific pre- and pro-biotics after the course of herbal anti-microbials (natural antibiotics)
- Anyone taking oral contraceptives should be on a good B-complex and mineral complex due to the nutritional depletions I mentioned earlier.
- Black currant oil is rich in omega 3 fatty acids and has an affinity for the skin.
If you want to purchase any of the products mentioned in this article they are all available in the Ginger Nash shop and links are provided below. Buying from my site ensures the highest quality, best forms and most fresh of natural supplements! We never have more than a few bottles of anything on hand and all products have been “vetted” by me personally and proven to be effective clinically in my practice of 20 years.
Would you like my TOP 5 resources for keeping your gut flora healthy? Purchase any 2 products from the links below and sign up for my list here, I’ll send you a one-page hot tip and resource guide! Thanks for learning!
Detoxical: eliminating excess estrogen
Itaru’s Green Tea: super-duper potent methylator!
Black Currant Oil: essential fatty acid specific to skin
Active B-complex: best forms of all B-vitamins
Spectralyte: combination of essential electrolytes and minerals
Polyflora O, A, B, AB: blood-type specific probiotics
Canda Clear Four: wonderful anti-yeast, anti-bacterial and support for leaky gut
Dys-biocide: awesome killer of "bad" bacteria (use in conjunction with FC-cidal)
FC-cidal: awesome partner in killing with Dys-biocide (above)
Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1804-13.Oral contraceptives and changes in nutritional requirements.Palmery M1, Saraceno A, Vaiarelli A, Carlomagno G.
J Steroid Biochem Mol Biol. 2010 Aug;121(3-5):538-45. doi: 10.1016/j.jsbmb.2010.03.068. Epub 2010 Apr 9. A new approach to measuring estrogen exposure and metabolism in epidemiologic studies. Ziegler RG1, Faupel-Badger JM, Sue LY, Fuhrman BJ, Falk RT, Boyd-Morin J, Henderson MK, Hoover RN, Veenstra TD, Keefer LK, Xu Xi
Associations of the Fecal Microbiome With Urinary Estrogens and Estrogen Metabolites in Postmenopausal Women Barbara J. Fuhrman, Heather Spencer Feigelson, Roberto Flores, Mitchell H. Gail, Xia Xu, Jacques Ravel, and James J. Goedert
Food Nutr Bull. 2015 Mar; 36(1 0): S76–S87. Environmental enteric dysfunction: An overview Rosie J. Crane, Kelsey D. J. Jones, and James A. Berkley
Clin Epigenetics. 2016; 8: 17. Published online 2016 Feb 16. doi: DNA methylation and hormone receptor status in breast cancer. Elizaveta V. Benevolenskaya, Abul B. M. M. K. Islam, Habibul Ahsan, Muhammad G. Kibriya, Farzana Jasmine, Ben Wolff, Umaima Al-Alem, Elizabeth Wiley, Andre Kajdacsy-Balla, Virgilia Macias, and Garth H. Rauscher