Functional Hormone Solutions
The hormonal orchestra
I’m just so tired all the time; I don’t sleep well anymore; I can’t seem to lose weight no matter how much I diet and exercise; I feel agitated and anxious.
All these symptoms and others are surprisingly common, yet so often simply put down to just getting older or in women, the menopause. The menopause is frequently blamed, and the prescription pad comes out offering hormone replacement therapy (HRT). What isn’t explored fully is if there is a biochemical explanation and your body has become imbalanced from a hormonal perspective.
The endocrine system comprises of eight different glands: the adrenal glands, pineal, pituitary, thyroid, thymus, pancreas, and the ovaries (female) and testes (male).
These various different glands work in an interconnected way, rather like an orchestra. The conductor of the hormonal orchestra is the hypothalamus in the brain, consolidating signals from the external and internal environment (I often describe the hypothalamus to my clients like an old school telephone exchange operator, managing and redirecting all those calls- or in our case cues and signals) . In turn, the hypothalamus delivers precise signals to the pituitary gland(at the base of the brain stem), which then releases hormones that influence most endocrine systems in the body. Specifically, the hypothalamic-pituitary axis directly affects the functions of the thyroid gland, the adrenal gland, and the gonads, as well as influencing growth, milk production, and water balance and the pituitary gland in the brain. This central axis sends signals to distant parts of the body to control everything in the body. This includes your stress response through the adrenal glands; your blood sugar balance through the pancreas and adrenals; the regulation of your heart rate, blood pressure, body temperature, metabolism and growth via the thyroid gland; and your sexual behaviour and function through the reproductive organs.
The most common hormonal problems - sending quite literally hundreds of people out of balance - that I see in my clinic are: insulin resistance (from excessive sugar consumption), imbalances in sex hormones (such as high oestrogen and low progesterone), and sub-optimal thyroid function (that has, due to poor current diagnostic testing, often been misdiagnosed as “normal”) and overall hypothalamic-pituitary axis dysfunction.
We are dynamic creatures! If a hormone becomes excessive or depleted this begins a chain reaction that doesn’t have an end until the cause of the imbalance is put right. Simply taking a pill for high blood sugar levels, for example, may very well not be the complete answer. What we have to ask is why your blood sugar is rising in the first place!
HP(A/O/T)-D (hypothalamic pituitary- adrenal, ovaries or thyroid dysfunction) and stress
Stress is a word we use and something we feel a lot of the time, and although we inherently know it’s “not good for us”, when I explain to clients is has physiological ramifications - particularly to the immune, endocrine and gastrointestinal systems - they are genuinely surprised.
Stress is, of course, totally natural and our bodies are designed to deal with it very effectively. However, if stress occurs in excess, it is detrimental and can lead to a whole number of far reaching symptoms including insomnia, weight-gain, lowered immunity (particularly prone to picking up infections), gut complaints such as IBS, diarrhoea and reflux, scattered thinking and brain fog, PMS, cravings for sugar, carbohydrates and caffeine, low libido, and fatigue!
It’s really important to note that a stressor can be physical (like running a marathon, coping with inflammation from an infection, or even a latent food intolerance like a sensitivity to gluten) or emotional (like being a new mum, going through a divorce or dealing with conflict at work). This wonderful infographic, adapted from the work of Thomas Guilliams in his book The Role of Stress & the HPA axis in Chronic Disease, beautifully illustrates what stressor are to the master controller - hypothalamic-pituitary axis.
As we can see, the negative effects of stress can be far-reaching. This is because stress causes changes in the body’s chemistry through down regulating the master controller, the HP axis, altering the balance of hormones in ways that can have an impact your entire body. You may have heard of “adrenal fatigue” but a more accurate explanation would be hypothalamic-pituitary dysfunction, where the is chronic down regulation of the HP axis due to the constant demand, and as a result, a host of symptoms start to emerge and hormonal anarchy ensues.
What the adrenal hormones normally do
It is easy to see how, when the stress response is triggered and sustained, it affects blood sugar control, immunity and blood pressure, but it is NOT adrenal fatigue.
What happens when we are stressed?
To understand how hypothalamic-pituitary axis dysfunction develops, a little bit of biochemistry is required. When a stressor is sensed by the brain(hypothalamus), a signalling pathway begins that stimulates the adrenal glands to rally your body’s resources into a “fight or flight” response by increasing production of the hormones adrenaline, noradrenaline and cortisol. Remember that a stressor can be physical or emotional. Like a finely oiled machine, these hormones function to enable you to quickly increase your heart rate and blood pressure and mobilise stored glucose from your liver and muscles into the bloodstream for immediate use. Overall, your hormones heighten and sharpen your senses in preparation for dealing with the stressor - to fight or run away!
This response is highly effective, fast and generates a vast amount of energy. It also takes priority over other metabolic functions that are deemed non-essential activities such as digestion, growth and reproduction. These essentially “shut-down” and therefore don’t function as well. So symptoms and conditions such as hair loss, weight gain, bloating, IBS, reflux, fatigue, PMS to name a few start to occur as different glands( adrenal, thyroid , ovaries) become affected.
When stress becomes a constant in one's life, people start to notice that their sex drive is lower than normal, they are getting bloated after eating a meal or experiencing loose stool. This is not surprising as the systems that govern these functions are literally “on-hold”! Instead, the energy normally fuelling them is being channelled into the muscles, lungs and heart etc ready to take action; fight or flight.
Thriving on stress
This stress response has served us well for thousands of years and when our threats were more physical and immediate. In other words, the stress would be more short lived, and the body would have time to recover and balance be restored. Today, we live in a world of 24 hour stimulation and “stress”. Every day, we are exposed to a number of physical and psychological stressors: a demanding job, the fear of losing our job, 24 hr access to media and graphic information, relationship dynamics, lack of sleep, financial pressures, suboptimal nutrition, dieting, skipping meals, over-exercise, illness or infection. These all signal the adrenal glands to produce the stress hormones - adrenaline and cortisol. The net result is that the adrenal glands are on constant high alert.
These modern day stressors don’t permit us to expend this vast amount of energy by fleeing or fighting and whilst the adrenals can deal with the increased demands short term, therefore there is a negative impact on other systems and glands when the body is exposed to excessive levels of cortisol and adrenaline:
As the stress becomes chronic, this puts an incredible strain on the adrenals themselves and ultimately leads to over all hormonal dysregulation as I describe here:-
Could hypothalamic-pituitary dysfunction be causing your weight problem?
If you answered to yes to two or more of the above, adrenal dysfunction could lie at the core of your weight gain.
Women, especially with adrenal dysfunction, often have a “spare tyre,” or what we call abdominal fat. This happens for several reasons. Under normal circumstances, when we haven’t eaten for a while, our blood sugar (glucose) drops and the brain sends a message to the adrenals to release cortisol. This cortisol mobilises glucose (via glycogen in the liver), amino acids (primarily from muscles), and fat (from fat cells). This prevents hypoglycaemia (low blood sugar) keeping your brain and body fuelled with energy in the absence of food. So cortisol maintains glucose levels in the blood, while insulin helps usher glucose into the cells.
When we have long-term stress, cortisol and insulin remain high in the blood, and the extra glucose that isn’t needed for energy gets stored in the form of fat - primarily abdominal fat. And sadly, abdominal fat doesn’t just “sit there” doing nothing; it’s almost as if this fat is, itself, an endocrine organ that reacts to the stress response, spurring still more abdominal fat deposition because it hosts and releases inflammatory and appetite disruptor messengers itself. So the cycle continues unless we take steps to heal the metabolic imbalance. A good place to start with a lot of weight management and loss is the brain and HP response.
Insulin resistance and blood sugar control
Do you feel exhausted all the time? Are you overweight? Or just starting to gain weight around your midriff? Do have serious blood sugar imbalances, or have elevated cholesterol, blood pressure, and triglyceride levels? Even if just one or two of these points resonate with you, it is highly likely that you need to address your blood sugar and insulin levels.
Your body’s preferred fuel source is glucose, which it needs for energy. Glucose is released from your food and then is carried in the blood to the cells where it’s converted into energy. For the glucose to be able to enter the cells, it requires a transport mechanism. This is where insulin comes into play.
Insulin is a hormone secreted by the pancreas and its purpose is to “unlock” the cells and facilitate the transport of glucose into the cells where it can be converted into energy. As we eat a meal, our blood sugar levels rise. However, carbohydrate-based foods raise blood sugar levels significantly more than protein or fat, and the type of carbohydrate we eat has even more significance. Overly-processed carbohydrate foods such as cakes, biscuits, pizza, white bread and pasta, together with fizzy drinks and alcohol cause a far more rapid rise in blood sugar levels. Wholegrain breads, pasta, rice, fruits and vegetables provide a more slow and sustained release, in the main because of the fibre content still present.
If the body is continuously exposed to high levels of blood sugar from eating these overly-processed types of carbohydrates, then the pancreas has to compensate by secreting excessive levels of insulin to be able to move all this excess sugar/glucose out of the blood stream and into the cells. The body can cope with this state of excess for a period of time, but certainly not indefinitely, and if continued, the insulin receptors on the cells start to become quite literally deaf to the call of this extra insulin, and the “unlocking” process of allowing sugar into the cells to form energy becomes blunted. This is a condition called insulin resistance, and eventually, if left unchecked, will lead to full blown diabetes.
Insulin resistance is part of a health spectrum, also referred to as metabolic syndrome, that includes many all-too-common health conditions:
Female hormone imbalance
The ovaries produce many hormones. Chief among them are oestrogen, progesterone, and testosterone. The ovarian hormones oestrogen and progesterone interact to coordinate a woman’s menstrual cycle during her reproductive years.
The brain produces the hormones luteinising hormone (LH) and follicle stimulating hormones (FSH), which trigger hormone production from the ovaries. When any of the hormones from the brain or the ovaries are imbalanced, symptoms may occur.
Several conditions are well known to be associated with hormonal imbalance including: polycystic ovarian syndrome (PCOS), endometriosis and menstrual irregularities.
Symptoms of female hormone imbalance:
Causes of hormone imbalance
When we are under stress our bodies release increased levels of cortisol, which can reduce the effects of luteinising hormone, oestrogen and progesterone. In addition, when the biochemical pathways are switched to “activate the stress response” it can suppress the signals needed to stimulate ovulation.
Thyroid problems can cause menstrual cycle irregularity, with a complete lack of periods commonly occurring in clients with an overactive thyroid. An under -active thyroid is more associated with irregular cycles and heavier periods.
Significant changes in weight
Both severe weight loss and weight gain can cause menstrual irregularities. Severe weight loss leads to a reduction in the level of oestrogen and decreased levels of luteinising hormone—both needed in the correct balance for hormonal equilibrium. By contrast, fat tissue is full of hormones and in recent years been recognised as a major endocrine organ. One of the predominant enzymes that resides in fat cells is called aromatase which when in excess also results in high levels of both testosterone and oestrogen. Excess in one or both of these hormones causes hormonal imbalance and leads to conditions such as PCOS, PMS, endometriosis, low libido and many more.
The whole picture
Identifying root causes to achieve your optimal health and wellbeing
I use the functional medicine model to assess your health. This means seeking to identify interactions between different systems in the body through comprehensive case history taking, your presenting signs and symptoms and on occasion functional laboratory testing. The goal is to identify and address the triggers and underlying causes of your health problems rather than simply focusing on symptoms.
To book an appointment or speak with a member of my team, get in touch.