Today’s episode was inspired by the various patients who come to see me with symptoms such as painful periods, heavy bleeding, irregular cycles, with growth such as cysts, fibroids and endometriosis – and also those patients who come to see me with imbalanced hormones (whether estrogen, or low testosterone and so on).
Because Chinese Medicine is a functional medicine – and it views symptoms as the body’s cry for help – it sees symptoms as the body’s message about what is out of balance. Because it does so, it seeks out the root cause of the imbalance so that this can be corrected, rather than just masking the “cry for help” (or dialling down its volume). This means that the acupuncture and the Chinese herbal medicine that I give (for my patients with the symptoms I just mentioned) is highly personalized – it differs greatly from person to person. But what doesn’t differ, is that the lifestyle and dietary tweaks that I recommend as supportive or adjunct therapies are very often common to all of the patients who come to see me for help with these symptoms. This is because in situations of changes to the menstrual cycle – or overgrowth of tissue (as in cysts or fibroids, or the growth of tissue outside it’s physiologically-designated area, as in endometriosis), or various hormone imbalances – very often in these situations, there is an underlying foundation of inflammation, and / or of excess estrogen. Therefore, any lifestyle adjustments are going to aim to reduce inflammation, and / or rebalance the hormones as required. So before we go into these natural health hacks for happy, healthy hormones, let’s briefly talk about sex hormones.
All humans produce in varying amounts, estrogen, progesterone and testosterone. There are various subtypes of each of these hormones, but for the purposes of this discussion, we’ll just stick to the three main, overarching types. These hormones – estrogen, progesterone, and testosterone – affect not only our sexual and reproductive health, and the development of secondary sexual characteristics (such as the growth of breasts, or the deepening of the voice), but they also have wide-ranging effects on the body, beyond the reproductive system. This is because we know now in modern medicine – and Chinese Medicine has been talking about this for millennia – that all of the body’s systems are integrated, and they’re in a constant interplay of communication with each other. Therefore the balance and health of our sexual hormones is going to have knock-on effects throughout the body. The hormones mostly involved in the menstrual cycle are estrogen and progesterone. Estrogen governs the first half of the cycle, and it prompts ovulation, the release of mucus, the growth of breasts and uterine lining, whereas progesterone is released midway throughout the cycle, at ovulation, and it helps to regulate the cycle. It’s important to prepare the uterus in pregnancy, but it is also important for the production of testosterone in people assigned male at birth. So it’s important for everyone, and I love the shorthand that Chinese Medicine terminology offers us when we talk about sex hormones – it’s really beautiful, because it enables us to talk about the many complex biological pathways, and all the different interactions that are going on in the body, in a simple way that’s accessible to all of us.
All of us, regardless of our gender, are a mix of Yin and Yang. Yin and Yang are complimentary opposites, and they’re in dynamic balance with each other; from a biomedical or Western medicine perspective, we’d see this as the state of homeostasis, or the body’s ability to return to balance in a dynamic way, in response to all the ups and downs and events of life. Yin and Yang are complimentary opposites, and each contain at least a seed of the other. There is no 100% Yin or 100% Yang in nature, as the very interplay of the two is what creates life. We can see a visual representation of this idea in the Yin and Yang symbol: we see that one half of the circle is Yin and one half is Yang, but each contains the seed of the other, and each is constantly changing into the other as well. We see that flow, or that cycle of life happening, visually represented. When we look at the root of the Chinese words for Yin and Yang, and when we look at the Chinese characters for them, we see that Yin describes a shady / shadowy part of the mountain (or the Northern side of the mountain, because it’s stemming from the Northern hemisphere); whereas the Yang character describes the sunny side of the mountain (or the Southern side of the mountain). In general, we see more activity in nature during the day, while night time is a time of rest and renewal. In biology, this translates as Yin describing the more material, dense and dark aspects of our biology – the more solid aspects like body tissues, body fluids, bones, flesh, and so on, while Yang is the dynamic, functional and active aspect.
When we think about things in this way, low Yang might manifest as low function in a particular area – it might be hypothyroidism, or depression or fatigue. Excess Yang might present as a hyperfunction in a particular area or body system, such as in hyperthyroid, or manic behaviour, or an inability to wind down. Excess Yin is an excess of substance: in Chinese Medicine, we see a relative Yin excess in cases where there might be fluid accumulation, swelling or an overgrowth of tissue – as in excess flesh or lumps like fibroids, cystic breasts and tumours.
Yin is associated with the traditionally feminine qualities, and Yang is associated with the masculine qualities, and when it comes to sex hormones, we view estrogen as more Yin in relation to the Yang of progesterone. This is because estrogen encourages growth and the proliferation of substance: it encourages more material density, and we see estrogen as being essential to fertile mucus and breast growth, it leads to ovulation – and excess estrogen can manifest as weight gain around the abdomen and hips. Meanwhile, progesterone is more concerned with boosting function – that’s more of a Yang aspect. We can see a very clear visual representation of this Yin and Yang relationship between estrogen region and progesterone, when we look at a BBT, or basal body temperature, chart. For anyone who’s ever tracked their temperature throughout the duration of their cycle, generally we’ll see that there is a fluctuation in the basal body temperature from day to day and throughout that time. The first half of the cycle is governed by estrogen, and generally has a lower body temperature, because Yin talks about the shady side of the mountain (and it’s dense and dark), Yin is associated with cold, whereas the second half of the cycle, which is governed by Yang – which is warm and dynamic and sunny – generally has an elevated temperature. We have a boost of progesterone throughout this second part of the cycle, and this is why optimizing progesterone levels is so important in fertility work, as the presence of Yang is what allows for the spark of new life. It’s also important for us in balancing menstrual and hormonal health, because progesterone keeps estrogen in check – so Yin and Yang are constantly balancing each other. And as we touched on at the beginning of this podcast, elevated estrogen is often underpinning many of the symptoms that we’re talking about today.
So why are estrogen levels so commonly elevated? in fact, they’re so commonly elevated that some people have talked about an estrogen epidemic that affects all of us. Now there are many factors that contribute to elevated or excess estrogen levels, so we’ll run through each of these in a little bit of detail.
The first one is quite an obvious one, and that is hormonal contraceptives, because very often they flood the body with much-higher-than-what-is-physiologically-normal levels of these hormones, which then leads to a disruption of the healthy balance of hormone levels. Another factor that is so important to hormone health is gut health, and the balance of gut bacteria (the microbiome). In recent years, modern science has aligned with what Chinese Medicine has been talking about for millennia: gut health being the foundation of all of our health. We’re now learning just how important gut health is in the treatment or regulation of many common conditions, and it’s just as important in the balancing of healthy hormones. We know a lot about the microbiome – that’s the whole population of bacteria and microbes that live in and on our bodies, and they outnumber our cells roughly 10 to one! So there’s definitely more of them than us, and they can be helpful to us when we live synergistically with each other, and when they’re in balance. In addition to the microbiome, there’s also the estrobolome, which is the body of microbes or bacteria that help in the metabolism, or processing, of estrogen. When the gut bacteria is healthy – and our estrobolome is in order – then we can process excess estrogen and excrete it in order to maintain healthy hormone balance. Therefore, anything we can do that will support gut health will also support hormone health.
Another factor that can disrupt estrogen levels as xenoestrogens – this just translates as foreign (“xeno-“) estrogens, and we see these in plastics and BPA. BPA is present in many packaged foods in plastic bottles, or anything that comes in plastic containers. This is why it’s so important to use glass containers, and to not heat up foods in plastics, as it can leach some of these BPAs into the food. Unfortunately, BPA is also really prevalent in all of the register receipts that we have, so every time we touch those, we’re also coming into contact with BPA – so we can see just how rife these are in our modern life!
In addition to xenoestrogens, we also have phytoestrogens (“phyto-“ meaning plant) – these are estrogens present in plants and they’re present in large amounts in soy. When eaten traditionally, or as part of a traditional diet, this isn’t an issue because often, in traditional Asian diets, a large proportion of that soy was fermented, which affects its digestibility, and its effect on the body. When we’re talking about fermented soy, we’re talking about foods such as miso paste, soy sauce and tempe, as opposed to unfermented soy products like soy milk and tofu. In small amounts, soy is not an issue to our bodies, but the problem is that soy is one of the largest commercial crops in the world, and is so prevalent in any kind of packaged or processed food. If you start looking at ingredients, you’ll notice that very often there’ll be soy flour listed, or soy protein; Vegetable oil is very often hiding soybean oil, so it’s not so much that soy is “bad”, but it’s the amount of soy that we’re eating (or that we’ve been exposed to over the course of our lifetimes) is just too excessive for our bodies to balance.
Another factor is estrogens in the water supply. Now, some people claim that this is due to the widespread use of the contraceptive pill and hormonal contraceptives, but some other research that I’ve read recently, suggests that up to 70% of the estrogens that we find in the water supply is due to industrial waste, and dairy and soy production. Whichever way you look at it, there are estrogens in the water supply at a higher level than what our bodies are physiologically designed to handle, so that is yet another contributing factor that’s boosting our estrogen load.
Speaking of load, there’s also the factor of higher toxic load that most of us are subjected to. This is a consequence of living within modern society, that has us surrounded by environmental pollutants, by packaged foods, and by a daily rhythm and lifestyle that doesn’t necessarily support the movement, and exposure to fresh air and sunlight, that would then encourage excretion of toxins. And it’s also contributed to by a lot of the synthetic substances that surround us – (14:02) – these are commonly called “endocrine disruptors” because they disrupt the endocrine system (the hormone system), and therefore they disrupt estrogen balance as well. These are things that unfortunately are all around us, like phthalates and parabens. Phthalates are often found in synthetic fragrances, so when you walk down the detergent aisle in the supermarket and you feel a bit queasy, you’re being hit with a massive phthalate load. Parabens are found in many commercial skincare formulations, and because the skin is our largest organ of absorption, the stuff that we wash with and put on our skin every day is going to accumulate in our bodies, and contribute to toxic load.
Another major contributing factor is unfortunately stress – this is something that has become so commonplace as a result of the pace of our modern life. Unfortunately, when we’re stressed and when we’re pumping out stress hormones like cortisol and adrenaline, our body will steal the common building blocks of these hormones, which is called pregnenolone, in order to manufacture more adrenaline and cortisol in response to that stressful situation. What that does is that it robs the body of the building blocks to make progesterone, which we need (as we learned) to balance estrogen. We call this situation “pregnenolone steal”. It’s so important to manage stress – not just from the pregnenolone perspective – but also because we’re dealt a double whammy on the hormone front, as the stress hormone cortisol will block our progesterone receptors as well (thereby reducing the efficacy of progesterone in the body).
As we’ve seen, the factors that contribute to elevated estrogen are factors that affect all of us, not just those with menstrual or reproductive system imbalances. And it’s a concern for all of us, because elevated estrogen has been linked with an increased incidence of autoimmune disease; it’s been linked to certain cancers and it’s been linked to thyroid disorders and to candida overgrowth. Now, understanding these different factors that can contribute to elevated estrogen gives us some clues on lifestyle medicine tweaks that we can make, that will help us to rebalance excess estrogen levels.
One of the first – and most important – of these is looking after our gut health. This is going to have benefits for any symptoms that we’re experiencing, because as we’re discovering, our gut health really underpins so much of our general health, and has an effect on our energy levels, moods, sleep, hormone levels and so on. Therefore, looking after the gut is essential. I’ll be going into much more detail in future episodes of this podcast on gut health – and optimizing gut health, and the unique Chinese Medicine perspective on how to boost our digestion, and assimilate nutrition and so on. So stay tuned for that!
Another tweak that we can make, to really support rebalancing of hormones, is to reduce the toxic load on our bodies. That’s having a look at where in your daily life can you possibly make choices that will support your health, rather than overburden your body in it’s attempt to excrete all of those toxins. This can be simple things, like making sure that we’re using glass or steel containers instead of plastics – just throw out all your plastic containers, and definitely don’t ever heat up food in plastic containers, because as I mentioned earlier, this leaches those xenoestrogens (foreign estrogens) into your food, and then allows them into your body. It’s also maybe having a look at all of the different products that you have for body – personal care – and throughout the home. We’re so fortunate now that we have natural, and less disruptive, products available – even in supermarkets – so we can get rid of those products that have synthetic fragrances, which might be disrupting our hormones and those that have parabens, which we’re absorbing and again, further disrupting our hormones. Look at the soap you use, the detergents, the deodorant, any beauty products that you use – all of those can be cleaned up over time to really support your body towards greater health. On that note as well, we can move towards wholefoods and preparing more of our foods from scratch, so that we’re less reliant on packaged foods that might have a preponderance of soy products (and that have hidden soy products that aren’t labelled as such), and that have chemicals, or other digestive disruptors, that add to the toxic load.
Limiting processed foods. If you can, definitely opt for filtered water: this is going to reduce the toxic load from the water supply, and any estrogens that are already present in that water supply. Where possible, choose organic foods – or at the very least, choose foods that have been minimally sprayed with pesticides and other toxins. If choosing to go fully organic isn’t currently an option, you can choose produce from the “Clean Fifteen” list. The Clean Fifteen is produced by the Environmental Working Group (EWG), and it’s updated yearly to reflect the 15 fruit and veggies that are the least contaminated by common pesticides. And in contrast to the Clean Fifteen, we’ve got the “Dirty Dozen” and they’re the fruit and veggies that are the most affected by pesticide use, and the best to avoid if you’re not going organic for those vegetables.
In addition to choosing clean veggies, it’s best to avoid meat that has been treated with hormones, because this will be passed onto us. Choosing organic where possible – and grass fed – because this will change the fat profile of the animal, making it healthier for us. While we’re on the topic of food, there are so many amazing foods that support the metabolism and the excretion of estrogen. The real superstars in this area are the leafy greens: So these are the veggies like broccoli, kale, bok choy, cauliflower, and Brussels sprouts. These guys are amazing at helping the body to excrete excess estrogen. Other superstars are onion and garlic – these guys support the liver. The liver is our major organ of detox, and these guys support the liver’s function of excreting toxins, and they will be supporting excretion of estrogen.
With excretion, it’s important to have regular elimination – making sure that you have enough veggies that provide fiber in your diet for removal of that estrogen – and for daily bowel movements – is going to help in remove all of those toxins too. From a Chinese Medicine perspective, because estrogen is Yin, we can balance Yin by choosing foods that are more Yang, like warm and well-cooked foods that don’t drain the body’s Yang reserves (the body’s energy or metabolic potential). We can balance estrogen by avoiding Yin foods – Yin foods are cold and dense, and they’ll encourage growth and fluids: these are foods like dairy and sugar, and this is why we call ice-cream “Triple Yin death”! It’s cold, it’s sweet, it’s dairy, and it can damage the digestion. Choosing foods that are more Yang, and more warming, like, ginger, tumeric and certain spices which are full of antioxidants (which explains how they work from a biomedical perspective), is going to help in excreting excess estrogen, and maintaining a healthy gut balance.
The final lifestyle tweak that I suggest to patients looking to balance their hormone health is managing stress, and very often this will be in the form of meditation. Meditation is amazing and so beneficial for literally every aspect of health to the point that the amazing functional doctor, Dr. Mark Hyman recently said on a podcast that if meditation was sellable and patentable, every doctor would be prescribing it for every ill because it really is that amazing! It helps the body get out of its own way with healing – it switches on those healing superpowers that I touched on in Episode One. Meditation might be a way of managing stress, while for other people it might be movement, particularly rhythmic movement that links moving with breath – so that might be walking or swimming, yoga, Tai Chi. As stress is characterized by being in that “fight or flight” mode, or that sympathetic nervous system mode, any activity that encourages us to switch over to “rest and digest” mode is going to foster healing and rebalancing.
Anything that brings you joy, or what Dr. Kelly Brogan refers to as “signals of safety”, will allow the nervous system to switch over. This might be quality connection with a loved one. It might be deep breathing – particularly with the focus on the exhale, which encourages parasympathetic tone. It might be prioritizing activities that engender positive emotions like love and joy and happiness. It might be giving back to the community, or it might be a hobby that gets you into the flow state, whether it’s baking or crochet or cycling, or whatever floats your boat! We need to be making more time for fun – and for stress management – in our lives.
Tucking in under that umbrella of managing stress is the importance of sleep. It’s very important for our hormone balance to get adequate and restful sleep – and sleep at the right time, because our bodies follow circadian rhythms. There’s different peaks, and the release of different hormones, at different times during the day. If we can aim to be asleep before 10 o’clock, we can get into a deeper sleep than if we stay awake beyond that time and catch our second wind (when often we have trouble falling into a deep and restorative sleep) So good sleep is important for stress management, and also for regulating hormones and managing inflammation.
We will be getting more into inflammation, and its impact on hormones and menstrual and reproductive health, next week. This week we’ve looked at the effect of estrogen, and the many lifestyle factors that contribute to elevated estrogen – and also the simple lifestyle tweaks that we can make to support our bodies in rebalancing hormones, and regaining more optimal health.
EWG Clean Fifteen
EWG Dirty Dozen
BBT (Basal Body Temperature) Chart, showing cyclical body temperature variations
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