The body and hormones are complex. Way more complex than our minds ever give them credit for. As a health care provider, I will never know everything there is to know about the body. And I would never expect other health care providers to either. I also recognize that I’m a young practitioner, have a ton to learn and there are many doctors, physician assistants and other nurse practitioners out there to learn a lot from. My hope is to never stop learning.
But one thing I have learned in my career so far, is that we over pathologize hormonal issues. We make them out to be conditions that require extreme treatments. And as a healthcare field, we are far too quick in finding a “solution.” Even though I I believe most health care providers are well intentioned and want to keep their patients safe, sometimes (more often than not) that quickly proposed solution can do more harm than good. Because hormonal issues are complex and there is no one size fits all approach.
SO WHAT CAN BE CAUSED BY HORMONAL ISSUES?
Think of things such as…
- hypothyroidism or thyroid issues in general
- hypothalamic amenorrhea
- fertility issues
- “adrenal fatigue” –> this isn’t an actual diagnosis but the term is trendy in the media lately
- anxiety and depression –> because these can be associated with blood sugar and thyroid issues
The list can go on and on and on. The endocrine system is insanely dynamic. And because it is insanely dynamic, we cannot muddle the treatment for “balancing hormones” down to eating xyz foods, exercising xyz way, and taking xyz supplements. There are also many things that go into these conditions, hormones can be one piece of the puzzle.
Unless you have an actual hormone deficiency, no synthetic hormone (like birth control, synthroid, etc) is going to completely fix your hormone issues. No specific eating protocol or exercise routine is going to fix your hormonal issues. And no cocktail of supplements is going to magically ‘balance out’ your hormones.
All these specific solutions and protocols are rarely the answer. Really I want to say they are never the answer, but nothing in life is certain, therefore I hate using the word never. Except when telling people to NEVER diet.
These rules often don’t work because they leave people feeling more stressed about taking care of themselves. More often than not it feels like something else to do or fix. In the short term, regardless of the psychological stress or side effects, we might experience immediate results with these “1-2-3” guides to fixing your health problems. But if we think about our overall and long term health, we know from the research that chronic stress induces subtle chronic inflammation (which leads to a wide array of chronic diseases), suppresses the immune system, causes GI disturbances and symptoms, disrupts thyroid function, and increases insulin resistance. And the list goes on.
SO WHAT IS THE SOLUTION?
Healing hormonal issues is way more elaborate than following a protocol or set of guidelines because we have to account for psychological stress, or in other words, perceived stress. Each person has a different threshold for the amount of perceived stress they can handle. If you surpass your body’s threshold, you begin over activating the body’s HPA axis. Think of your HPA axis as your fight or flight system. When activated in short spurts, this system allows your body to survive. Then the stressor ends and your body returns to homeostasis. But when the HPA axis is activated on a continual basis (because of the high stress, go go go, overly productive world we live in….it causes chaos.
One of the many reasons over activation of your HPA leads to hormonal chaos is because your HPA directly impacts your HPG (hypothalamic pituitary gonadal axis) and your HPT (hypothalamic pituitary thyroid axis). That means your HPA is going to affect your reproductive health (fertility, amenorrhea, PCOS, etc) and your thyroid function. I use these two images below often when explaining this concept to clients.
This first image above shows your HPA and your HPG. Let’s look at the left side and focus on the HPA. The stressor happens, which stimulates your hypothalamus to release CRH, which then acts on your pituitary gland to release ACTH into the bloodstream. That ACTH travels down to the adrenals and signals them to produce cortisol, in addition to other hormones. Cortisol plays a big role in your body’s stress response. This is a very intricate system, but I’m over simplifying this concept so it’s easy to understand.
On the right side let’s look at the HPG. Essentially this is the cascade of hormones that occurs to bring about your menstrual cycle. The hypothalamus secretes GnRH which signals the anterior pituitary to release FSH and LH which act on your ovaries. Your ovaries produce estrogen and progesterone. This is a very rhythmic system that is highly sensitive to stress.
All that cortisol produced by the HPA axis has a direct impact on your HPG axis. It inhibits the release of GnRH which then impacts the amount of circulating LH. You need LH to ovulate. And of course you need to be able to ovulate to have a menstrual cycle. At the same time, cortisol production suppresses the production of progesterone. This causes higher levels of estrogen compared to progesterone, leading to all sorts of hormonal problems in women. Things like PMS, heavy/painful periods, fibroids etc.
The second image above that I show clients illustrates the connection between your HPA and HPT (hypothalamic pituitary thyroid) axis and how cortisol can affect your thyroid health. On the right side is the HPT. Your hypothalamus releases TRH (thyrotropin releasing hormone) which tells your pituitary to release TSH (thyroid stimulating hormone). TSH acts on your thyroid to produce T4, your inactive thyroid hormone. T4 then gets converted into T3, which is your active thyroid hormone. Again, I’m oversimplifying drastically here to make it easy to understand.
Your HPA impacts your HPT. You can see in the picture above that cortisol inhibits both the release of TSH and the conversion of T4 to T3. What you end up with is unhealthy levels of thyroid hormone. Depending on what your thyroid hormone levels are you can experience a lot of unpleasant symptoms the we will get into in another post.
SO WHAT ACTIVATES YOUR HPA?
Your HPA is activated all the time from things like…
- inappropriate exercise – moderate to high intensity exercise has been found to increase levels of cortisol (your stress hormone)
- inadequate energy (aka calorie) intake OR inadequate macronutrient intake (carbs, proteins, fats)
- too little sleep (raises cortisol and increases insulin resistance)
- perceived stress (which includes monitoring your food intake and self esteem and self efficacy)
Let’s focus on perceived stress. Perceived stress could be anything from running late for work, caring for a baby, or spilling coffee on your white shirt to things like meeting a large deadline at work, going through a divorce, caring for a sick loved one, poor body image, low self esteem, paying off credit card debt and also monitoring your food intake. Research shows that simply monitoring what you eat, even without calorie restriction, increases levels of perceived stress.
SO WHAT DOES THIS ALL MEAN?
I have only brushed the surface with a little bit of physiology and how that affects our hormones. There are many, many systems at play here and many symptoms and diseases that are associated with hormonal health. We haven’t even talked about the gut-brain connection which plays a role here too. What I hope you take away, is that these issues are multifaceted with many moving parts. The question to answer is… “What is REALLY causing the problem?” And that is going to be different depending on your own individual story. There is no protocol to follow. It’s about understanding your body and learning how to take care of it best based on your own life circumstances.
I understand that food can and does have a therapeutic affect. But does the physical benefit outweigh the psychological distress of eating a particular way. That is the question that we don’t often account for. There is no supplement or food that is going to alleviate the perceived stress in your life. That takes a lot of mind/soul work and it’s a lot harder to change than your food choices. And that is why you will never see a step by step guide written here on the blog. Because there is no specific set of steps you need to follow in order to be healthy. It’s about learning your body’s emotional, mental, spiritual, relational and physical needs and how to meet those needs that will lead you to long term health. As health care practitioners, we can help guide you there, but only you have all the answers.
So before you go down a rabbit hole of all the things you have to change about your life to “get healthy”…what about taking a step back and pausing to think about what might be really causing the symptoms. And then weighing all the factors at hand. Perhaps you need to doing less and not more. Because while I still have a whole lot to learn, I do know one thing. No matter how green and clean and rainbow filled your plate is, and no matter how regimented your exercise routine is, and no matter how non toxic your beauty products are… if all that is stressing you the ef out…you won’t be heathy at all.
If you’re a dietitian or aspiring RD or interested in women’s health…
And you’re interested in learning more about a non-diet approach to women’s health issues including PCOS, fertility, and amenorrhea, I hope you’ll check out the RD Real Talk round table series hosted by Heather Caplan that I’ll be speaking on again this month. There is nothing that gets me fired up more than combining by RD and NP education to approach women’s health through an IE/HAES lens. Here’s a link with more information. You can listen anytime! You can also purchase a listen only option, or full registration, which includes a 20 minute mentoring call with one of us panelists. Here’s the link to register!