When your hormones get in the way of your health
Over the past several years I have seen so many women struggling with the same types of symptoms. Fatigue, constipation, mood swings, palpitations, night sweats, irregular periods and PMS, headaches, breast swelling and tenderness, loss of sexual desire, skin changes, insomnia, fuzzy thinking, anxiety/nervousness, depression, bloating, etc… etc… Not every women that comes into my clinic has all of these symptoms at one time but I found that the majority of my female patients were suffering from many of them on and off at different times through out the month.
I started to look into the underlying reasons as to why all of these symptoms keep plaguing women. I began to see some very interesting connections between sex hormones, stress hormones, thyroid hormones, and blood sugar regulation. I found it fascinating how a dysfunction in any one of these systems would create a problem in the others, and even more fascinating that by correcting the ones that were out of balance we began to correct all of them. The key was to find out which systems were most affected and causing the biggest problems with the rest.
By approaching and treating their symptoms in this matter I saw some dramatic changes in the overall health of these women because we were finally getting to the heart of the matter!!
It’s another typical day in the clinic, seeing patients of all ages, male and female for a wide variety of health concerns. Everything from little 6 month-old Maddie covered in eczema to 70 year old George recovering from bowel cancer. Then I see my new patient Mrs. M. She is in her late 30’s, exercises occasionally, eats a fairly balanced diet, appears to be happily married but is still having a laundry list of health concerns.
She has troubles sleeping and never wakes feeling refreshed, she’s fatigued all the time, her motivation and drive have got up and gone, she’s cold…no wait…she’s actually hot and sweaty as well…weird!!! She feels nervous and depressed but doesn’t understand why. Her period is heavy and painful or may decide to skip a month all together. She gets mood swings, irritability, breast tenderness and retains water. Her digestion seems to be “off”, sluggish if anything with lots of bloating and gas and constipated just to make matters worse. And she just can’t seem to get rid of those last 10 pounds. Sound familiar??
I have seen many women coming in with similar symptoms as Mrs. M. They seem to range primarily between 30-50 years old and the vast majority of them between 35-45years of age. So what the heck is going on? Is their something in the water that is making all of these women go through hormonal hell!! Well, let’s follow along with Mrs M and see what was going on.
As we continued on I learned that Mrs. M was very stressed at her job and under constant worry and work pressures. She often skipped meals and she would work right through lunch or eat sugary or caffeinated foods or drinks to keep her energy up….also sound familiar??
After running through our initial consult I asked Mrs. M to get a series of lab tests done to first see how her overall health was doing and if there were any big things that we needed to address. When there is such a large list of symptoms it is very important to narrow things down and figure out what is at the root of the problem. Mrs. M came back a couple of weeks later with lab test in hand letting me know that she was given a clean bill of health and that all her labs were “normal.”
Now it isn’t that I thought her physician was lying to her or anything…I just like to look at the labs myself and see exactly where they fall within their reference ranges. The reference ranges for many lab tests are very broad and aside form the “normal” and “abnormal” readings…there is also an optimal range where most patients find significant relief of their symptoms when attained. So, Mrs. M and I sat down and we went through her lab test. Some of the main ones that I wasn’t too happy with were the following:
- Ferritin (storage iron assessment0 = 14.5 reference range (13 –150)
- TSH = 2.19 reference range = (0.27 – 4.2)
- Free T4 = 11.4 reference range = (12 – 22)
- Free T3 = 2.5 reference range = ( 2.8 – 7.1)
- Vitamin D: = 107 reference range = (79.9 – 250)
Most of her other labs that she had done were pretty good but these ones stood out to me. First of all ferritin is one of the best tests to see where your iron levels are at. It is a storage form of iron and it often decreases before any of the other markers for iron. As you can see the reference range is huge…from 13-150! I mean does it really make sense that two people can both be normal when one of them has 11X’s the iron level of the other!!
This is a massive divide in value. Some labs will even use a reference range from 15-300!! Bottom line is that I almost always find that unless women are above 20 for their ferritin they will have symptoms of anemia such as Low energy, apathy, dizziness, headaches and weakness even if it hasn’t shown up yet on a complete blood count test (CBC). I think optimally women should be around 40 to guarantee themselves that iron deficiency isn’t playing into their symptoms.
Her thyroid panel is a mess in my eyes. It has been shown in the research that TSH or thyroid stimulating hormone should optimally be below 2.0. If it is above 2.0 then you should be concerned of having suboptimal thyroid function. When we actually look at her free T4 and T3, the two major hormones that the thyroid produces. T4 is the major hormone that gets converted into T3, the active thyroid hormone that has all the benefits. Mrs M was below “normal” for both of these hormones. She has an obvious hypofunctioning of her thyroid that she was told was “normal” with nothing to worry about. Clinical or subclinical hypothyroidism could also be responsible for many of her symptoms. Weight gain and difficulty losing weight, cold hands and feet and general feeling of cold, constipation, fatigue and lethargy, poor stamina. These two hormones can make a massive difference in peoples symptoms by just getting them up from a low-normal to a normal/upper-normal level.
Vitamin D is a great test to get checked, especially for anyone living in North America. It has been estimated that up to 85% of North Americans have insufficient levels of Vitamin D. I have checked vitamin D on many people over the past couple of years for this reason and Mrs M was actually one of the highest levels that I had come across, unfortunately it still wasn’t optimal.
All of the health benefits that you may have heard about surrounding vitamin D happens when we get to a level of 125 nmol/L. When we are below this number our vitamin D is primarily used to regulate calcium and phophorus levels. Once we get to our optimal levels of 125-175 nmol/L we are able to wreak all the benefits of vitamin D and increase our prevention of cancers, heart disease, stroke, depression, and strengthen our immune system. Mrs M was at 107 which is far better than most people I see but she still needed a little bit of tweaking to reach her health potential.
After reviewing her labs we began to put everything as too how she ended up in this situation. She has no history of hypothyroidism in her family and she isn’t a vegetarian so how could she be this low in iron.
First of all of the four groups of hormones that I talked about thyroid seems to be affected pretty severely by all of them. As soon as stress becomes prolonged it starts to interfere with your thyroids ability to convert T4 to active T3. Skipping meals and eating sugary snacks will wreak havoc on her blood sugar levels and insulin. This will create peaks and valley sin her blood sugar crashing her energy and stressing her adrenals even more. When your body is under constant stress digestion starts to get shut down leading to changes in pH, beneficial gut bacteria and absorption of vital nutrition including iron.
Mrs M although currently not on the BCP had been on it for many years prior. This in combination with many environmental “xenoestrogens” that she was exposed to set her up for having estrogen dominance…an imbalance between her levels of estrogen and progesterone. Excess estrogen also interferes with thyroid function by increasing the amount of thyroid binding globulin that prevents you from being able to use the thyroid hormone your body is craving. To make this even worse…her high cortisol (stress hormone) competes for binding sites with progesterone…further exacerbating her estrogen dominance. It’s all one big cycle that starts to unwind as soon as you start to pull a couple of big logs out of the fire.
The key is to put together a plan that starts to normalize these 4 groups of hormones. It’s not just about supplementing its about taking back control of your health. There are significant lifestyle, nutritional and supplemental strategies that when applied to your specific situation can break the cycle and stop the hormonal chaos.
Once Mrs M got on track and followed her individual program we retested her labs, approximately 3 months down the road. They now read as follows:
- Ferritin = 39
- TSH = 1.91
- Free T4 = 15.7
- Free T3 = 3.7
- Vitamin D = 158
Currently Mrs. M has more energy than she has in years, she is at her desired weight, feels motivated and excited, her periods are regular each month and her discomfort and mood swings have decreased considerably. She is having regular bowel movements and her gas and bloating only come on if she overeats or eats very specific foods that she is sensitive to. She finds that if she takes on too much, her energy drops so she still has to be careful about this and take things in stride. She has now been on her program for about 6 months and finds it a welcomed addition to her lifestyle.