What is going on??

First stage: As we grow older (around 40) our bodies slowly stop being stimulated to produce as much of our sex hormones, primarily estrogen and progesterone. We aren’t meant to have babies anymore and our bodies change to accommodate this fact. Ovulation starts to become intermittent, we might have really heavy or light periods or some of both! Because of these dropping levels of hormones, we get symptoms like hot flashes, sleep problems, mood swings, weight gain and loss of energy. Our brain actually becomes resistant to the estrogen we do have!

Second Stage: (40-45) Pre-menopause

Progesterone is dropping (this stuff gives you that glow during pregnancy) Progesterone is like an anti-anxiety hormone, it makes you feel good and when it starts to go away, we may feel crazy! We experience hot flashes, can’t sleep, and want to kill our husbands! At this stage we usually have higher estrogen than progesterone. It’s important that we keep our progesterone to estrogen (primarily E2 or Estradiol) ratio healthy and watch how we are metabolizing our estrogens (how we rid or recycle them in the body). The DUTCH Hormone test is a good test to assess these levels. Naturally at this point we become estrogen dominant and diet and environmental factors can contribute to this dominance. Not eating enough fiber and being overweight can contribute. Also exposing ourselves to too many fake estrogens or estrogen mimickers like BPA’s, triclosan (toothpaste, hand sanitizer), fragrance in your beauty products, fire retardants, lead, arsenic (can be found in people that eat a lot of rice) mercury (avoid those big fish like tuna), non-stick cookware, pesticides on our food and phthalates in cleaners and beauty products can make the ratios even worse.

Stage 3: (45-50)

Now our estrogen levels start to drop. We experience lower sex drive, vaginal dryness, brain fog, bone loss and possibly depression. Low estrogen can impede the production of serotonin in some women. Low serotonin can affect mood, sleep and appetite. It can also cause constipation. Estrogen is low but higher than progesterone so you have the symptoms from above for estrogen dominance and you also have the symptoms of low estrogen. This may all seem awful and unfair, but menopause is a natural part of the life cycle and if we go in with a positive attitude in the best health we can, symptoms can be reduced. After 12 full months of no cycle you are officially post-menopausal and symptoms mayl go away. The average age for this is 51.

Nutritionally speaking what can we do to combat some of these symptoms?

• Vitamin C naturally boosts progesterone- there are many foods rich in vitamin C (red peppers, kiwi fruit, oranges, strawberries, broccoli, kale, brussels sprouts, cauliflower) you can also supplement.
• Vitamin E (look for a mixed tocopherol) may help to alleviate hot flashes, vaginal dryness and mood swings.
• Magnesium is important in helping reduce hot flashes, and fatigue. It is found in spinach, lentils, oatmeal, bananas, almonds and chocolate.
• Omega-3’s help to reduce inflammation, 2-3 servings of salmon per week or supplementation with a good quality product is recommended.
• A B-complex, specifically pantothentic acid or B5 has been shown to help with stress during this time.
• Maca may act as an endocrine adpatogen (does not contain hormones but may support normal hormone production) helping to balance estrogen levels. 1 Tbsp to start and up to 2-3 a day may help.

Herbs: Remember herbs can act like drugs; they should be used short-term and only from a reputable company like Gaia herbs and other professional supplement companies.   Anything in my recommendations (sign up for a fullscript account with me to see them) are well studied. Also be aware that some classes of herbs can interact with prescription drugs so always check with a health care practitioner before taking.

• Ginseng-another adaptogen that may help with stress and immune function as well as menopausal symptoms.
• Black cohosh contains isoferulic acids which may have anti-inflammatory effects.
• Also plant based phytoestrogens. Other foods and supplements that contain phytoestrogens are tempeh, miso and natto (make sure they are fermented and organic) red clover, daidzen, pycnogenol and genistein. These products can have similar effects (although usually much less) as hormone replacement so make sure to work with someone and get tested if you choose to go this route.

Diet: We’ve all heard it before: cut down on processed food and the white stuff (sugar and refined carbs) but during this time of life it is really important to eat a nutrient rich diet to help with stress, weight (fat is estrogenic and messes with our ratios) and sleep. Also our fatty acid balance is important. Fatty acids are the precursors to prostaglandins (these are things that cause cramps!) that regulate hormone receptor sites. Too much Omega-6 fatty acids and not enough Omega-3’s can increase the production of these prostaglandins, which creates inflammation. But remember it is important to get healthy fats in our diet (olive oil, ghee, nuts and seeds, avocado, coconut oil). Do you know where all sex hormones come from? Cholesterol! Cholesterol is the precursor to pregnenolone the beginning of all sex hormones. Our bodies need healthy fats to make cholesterol. Lastly, for some people reducing their intake of caffeine and alcohol can also help with menopausal symptoms as they both can alter the levels of estrogen, and as we age our bodies hold less water and we become more sensitive to the effects of both.

Exercise the right way! For those with hormone imbalance, intense extended exercise can actually make the problem worse in the short term. Long distance running actually increases the intestinal permeability in your gut, in some this may not be a problem, for others who already have a compromised gut function this can cause major issues, as we will see below. Workouts that include short bursts of heavy lifting may trigger a beneficial hormone reaction.

Heal the gut- GI issues can cause inflammation. Inflammation can suppress the hypothalamus in the brain telling the body to make hormones or suppress the function of the glands actually making the hormones. It can also make you hormone resistant. The receptors on the cells become less sensitive to the circulating hormones and you experience the same symptoms even with normal levels of hormones in your body. Dysbiosis (microbial imbalance) in the gut can increase the production of the estrogen metabolites we want to be lower (4-OH and 16-OH) and decrease the production of the protective (2-OH). The gut really is the center of overall health including balanced hormones. Having dysbiosis during menopause can make the problem that much worse! (We can see markers for dysbiosis on two of the nutrient tests I mention here) and don’t forget 70% of our serotonin is made in the gut. Unhealthy gut=mood imbalances. Healing the gut is a 5-step process that involves removing stressors, replacing enzymes or other things to aid digestion, reinoculating with probiotics and fiber, repairing the lining with supplements and rebalancing our lifestyle in order to keep our GI healthy. If you need help with GI issues please let me know.

Increase your detoxification mechanisms. If we are recirculating estrogen this can contribute to estrogen dominance, they compete with the active hormones and bind at the receptor sites but don’t have the same effect so they are actually blocking the active hormone and disrupting the regulation. We can also look at DNA mutations that predispose people to these detoxification problems (looking at your 23 and me data) this helps us to know where to supplement or support. We can look at detoxification markers on the ION nutrition test mentioned here, we can also look at liver markers on your blood chemistry reports, we can look at symptoms like sensitivity to chemical smells and how you react to medications. Certain supplements can help support the liver like glutathione or liver support supplements. If your estrogen is clearing down the wrong pathway we can give support like the supplement DIM (found in cruciferous vegetables) and/or increase your intake of cruciferous vegetables and things like flaxseeds which contain lingans or phytoestrogens that can help change estrogen metabolism (ps I would not blindly recommend flaxseeds to men without looking at his biochemistry first-men can also do the DUTCH Hormone test!)  The DUTCH Hormone test is an amazing dried urine based hormone test that I think every women should have run.  You can read more about it on their website here.  You can work with me to have this run, please ask.

• You can look under Menopause in my fullscript account to see some of the supplements and herbs mentioned above. I believe in testing instead of guessing but changing your diet, adding some supplementation, exercising appropriately, reducing stress and embracing aging can all be done very easily. If you need help personalizing the right diet for you please let me know.  Fullscript

• In regards to hormone replacement I am supportive of bio-identical hormone replacement. It can be a lifesaver for some women who are not helped with the above methods (but I would try diet/lifestyle/supplements first) you need to work with a doctor who will monitor you every 3-6 months. I would choose a naturopathic or functional medicine doctor who understands all aspects of hormone replacement. If you need help finding one please contact me.

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Blood Glucose Regulation:                                                                        Optimal Range (female)

Glucose                                                                                                            75-86

Hemoglobin A1C                                                                                              4.5-5.5

Insulin – Fasting                                                                                                 2-5

Renal Markers: (kidney function)

BUN                                                                                                                  10-16

Creatinine                                                                                                          0.80-1.10

BUN/Creatinine Ratio                                                                                        10-16

eGFR Non-Afr. American                                                                                   90-120

eGFR African American                                                                                     90-120

Uric Acid                                                                                                            3-5.5

Electrolytes:

Sodium                                                                                                              135-142

Potassium                                                                                                          4-4.5

Chloride                                                                                                            100-106

CO2                                                                                                                  25-30

Metabolic:

Anion gap                                                                                                            7-12

Proteins:

Protein, total                                                                                                      6.9-7.4

Albumin                                                                                                            4-5

Globulin, total                                                                                                   2.4-2.8

Albumin/Globulin Ratio                                                                                    1.4-2.10

Minerals:                 

Calcium                                                                                                            9.2-10

Phosphorus                                                                                                       3-4

Liver and Gallbladder:

Alk Phosphatase                                                                                               70-100

AST (SGOT)                                                                                                       10-26

ALT (SGPT)                                                                                                        10-26

Bilirubin – Total                                                                                                   0.10-0.90

Bilirubin – Direct: (only run if total is high)                                                            0-0.19

Bilirubin – Indirect: (same)                                                                                  0.10-0.70

GGT                                                                                                                   10-30

Iron panel:

Iron – Serum                                                                                                       85-130

Ferritin                                                                                                                30-70

TIBC                                                                                                                   250-350

% Transferrin saturation                                                                                      20-35

Lipids

Cholesterol – Total                                                                    160-200 (particle size most important)

Triglycerides                                                                                                     70-80

LDL Cholesterol                                                                                              <120

HDL Cholesterol                                                                                             55-70

Fibrinogen                                                                                                      200-300

Cholesterol/HDL ratio                                                                                      <4.0

Triglyceride/HDL ratio                                                                                       <2.0

Lipoprotein subfractions:

An expanded lipid profile measuring lipids, lipid sub-fractions, particle size and number and APO (B) companies: (choose one)

Lipoprotein particles – Spectracell labs

Nuclear magnetic resonance testing – Liposcience (NMR)

Berkely Heart Labs test – Berkely heart labs

Vertical auto profile – Atherotec (VAP)

Full Thyroid panel:

TSH                                                                                                            1.3-3

Free T3                                                                                                        3-3.5

Total T3                                                                                                      90-168

Free T4                                                                                                       1-1.5

Total T4                                                                                                      6-11.9

T3 Uptake                                                                                                 27-35

Reverse T3                                                                                                10-25

Thyroid Peroxidase (TPO) Abs                                                                    0-34

Thyroglobulin Abs                                                                                       0-1

Inflammation/Oxidation:

C-Reactive Protein                                                                                    <4.5

Homocysteine                                                                                           5-7

Nutritional Panel:

Vitamin D (25-OH)                                                                                   40-70

Vitamin B12                                                                                           450-800

Hormone Panel:

DHEA-S                                                                                                275-390

Testosterone, Free                                                                                 1-2.2

Testosterone, Total                                                                                 35-45

Estradiol                                                                                                150-350

Progesterone                                                                                         18-27

CBC/Diff:

Total WBCs                                                                                           5.5-7.5

RBC                                                                                                      3.9-4.5

Hemoglobin                                                                                          13.5-14.5

Hematocrit                                                                                             37-44

MCV                                                                                                      82-89.9

MCH                                                                                                      28-39.10

MCHC                                                                                                   32-35

Platelets                                                                                                 155-385

RDW                                                                                                      11.7-13

Neutrophils                                                                                             40-60

Lymphocytes                                                                                          24-44

Monocytes                                                                                              0-7

Eosinophils                                                                                              0-3

Basophils                                                                                                 0-1

How do you compare? If you would like help optimizing your blood work and therefore your health, or learning more about what these markers mean, please contact me. I have male ranges too! (Their ranges are a little different). Most naturopathic doctors and preventative medicine doctors will run all of these. If your doctor says they are unnecessary you can work with me on picking the most important ones, or there are on-line labs where you can order your own blood work. It is not covered by insurance but is very reasonable and after considering how much your co-pay for an appointment is sometimes even less!

My other favorite Functional Medicine tests I recommend people run to see a bigger picture: 

• DUTCH Hormone test – this uses dried urine at 4-5 points throughout a day. Hormones fluctuate a lot so a point in time blood marker may not be as accurate as a daily average. It also provides useful markers not found in blood. Includes sex and adrenal hormones.

• Individualized Optimal Nutrition (ION) test – The ION Profile is a nutritional analysis that measures over 125 key nutrient biomarkers and ratios that can help identify nutritional shortfalls that may be a root cause of complex chronic conditions. The ION Profile evaluates organic acids, fat-soluble vitamins, Coenzyme Q10, homocysteine, oxidative stress markers, nutrient and toxic elements, fatty acids, and amino acids.

• If you suspect food allergies or intolerances run an IgE panel (immediate immune response) and an IgG panel (a delayed immune response)

(remember if your food intolerance test comes back with more than 10 foods you may just have an impaired gut lining).

• A stool test (yep you poop in a cup) can show us the type of bacteria present with ratios, abnormal bacteria, fungi or parasites (If you have parasites your baso, mono and esonophils on your CBC will normally all be elevated) yeast markers, inflammation markers, immune markers, and digestion markers. As these tests use DNA they can also tell us what conventional antibiotics or botanical medicines will work against whatever dysbiosis they find.

• A DNA test – 23 and me has taken away some of the markers I like to look at but still has a lot we can work with. I find it very helpful with eating psychology, weight, mood, and other things like when we can see “why we are the way we are.” A few examples of nutritional related things we can look at: If you are a vegetarian does your body convert ALA (found in flax) to the EPA/DHA that our bodies need and that is only found in animal products? Will a ketogenic diet work for you to lose weight? Some genes predispose us to not doing well on a keto diet. Do you have high homocysteine? We can look at the enzymes used in this pathway and see where we might supplement. Do you clear your caffeine slow or fast? If you are a slow metabolizer and drink coffee in the afternoons you are probably impeding sleep. And so on and so forth there are so many things we can look at and confirm with nutrigenomics!

*Lab ranges taken from Blood Chemistry and CBC Analysis, Clinical Laboratory Testing from a Functional Perspective by Dicken Weatherby, N.D. and Scott Ferguson, N.D. as well as Dr. Weatherby’s blood chem software which I use in my practice to analyze results.  My analysis looks at prevention and nutritional support it does not diagnose.

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