Estrogen, Adrenals & Thyroid Hormone Case Study: Functional Medicine Podcast Series

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Welcome to a special series on the Capital Integrative Health Podcast! I am your host, Dr. Andrew Wong, and this is a podcast dedicated to exploring the root causes of both disease and wellness. I am a co-founder of Capital Integrative Health, a clinic with a mission to create a revolution in healthcare by educating, leading, and inspiring people towards optimal health and true well-being. We’re excited to offer you this series as an insightful look into functional medicine and walk you through case studies that exemplify how we think about and approach care with our patients. These cases are de-identified and names used are placeholders.

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Dr. Andrew Wong 

Welcome friends to a special series on the Capitol Integrative Health podcast. I'm your host, Dr. Andrew Huang. And this is a podcast that is dedicated to exploring the root causes of both disease and wellness. I am honored to be a co founder of Capitol Integrative Health Clinic in Washington DC area with a mission to create a global revolution in health care by educating, leading and inspiring people towards optimal health and true well being.

One of the key modalities we utilize in our clinic to help patients and be of service is functional medicine. We're excited to offer you this series is an insightful look into functional medicine, otherwise known as root cause resolution medicine. And walk me through case studies that emphasize how we think about and approach holistic care with our patients. And today's case, an episode we're going to be talking about hormone health, and walking through a patient we're gonna call her name Alicia, she's 40 years old.

And she's had two pregnancies and deliveries. her menstrual irregularities began after her second child was born five years ago. Now her menstrual irregularities are that she has irregular periods. Sometimes she has heavy periods, sometimes you're late, she can't really tell. She does have some pain at times to kind of premenstrual cramping as well.

She's been using a birth control pill for several years, but then discontinued that about six months ago due to concerns about their impact on her overall health.

Alicia also suffers from anxiety that's related to a traumatic accident in her late teens. So again, her menstrual cycle has become irregular with variations in her cycle length and flow. And she has noticed increased mood swings ranging from irritability, anxiety and occasional episodes of sadness as well.

She has had low energy and difficulty getting out of bed in the morning, and she's noticed Unexplained Weight Gain particularly around her midsection, her abdomen and hips despite maintaining a relatively healthy diet. She has low libido to the chagrin of her partner and herself. And she's noticed the loss of the outer third of her eyebrows. So that's this part right here. Eyebrows.

terms of lifestyle for her diet, she eats a vegetarian diet, she does eat some eggs, she occasionally includes things like imitation meats, and pre made meals and packaged foods. From a stress perspective, she's a stay at home mom, which is a full time job. And she also has difficulty managing your childcare and household needs in busy family schedule.

From a movement perspective, she does walk daily, and she also takes a Zumba class once a week.

So Alicia is a very typical 40 year old, she has a lot of responsibility, she has her kids that are growing up, she's shuttling them around to different activities. She has a partner and you know, trying to meet the needs of her of her husband as well. She also has a

busy home life with all the responsibilities that that a person would have taken care of kids taking care of the household,

taking care of the finances, taking care of the house work and all of that. So, you know, this is a very typical person. And then on top of that she has another job, which is self care. Now we all know that really the most important patient, you know, for all of us is patient zero, which is ourselves. So so how does a person like this that is really caring for all these other people, you know, care for herself? I think that's really the first question I would ask Alicia is, hey, Alicia, how are you caring for yourself? You know, what are you doing to take time for yourself? Now she is on a taken Zumba class, she does walk daily. A lot of times what I see a lot of times is people are exercising, or they're doing things but they're not doing it to take care of themselves are doing it because they want to look like SELF magazine, glossy cover model or something where there they want to look like they're friends or they want to go to the beach and look good. So we really want to emphasize here that if if she's doing some self care activities like walking, or Zumba, or any sort of stress management, she's doing it not to punish herself or not to please others, but to really take care of herself. And I think that's the first thing I would really ask this person in this kind of situation which again, I think we've all been in this situation. What do you do to really take care of yourself? What do you do that that brings you joy and and peace and life and a little bit of a respite from kind of what she's been tasked with doing in her life and taking care of her household and managing her family. So that's that's really I probably spend a long time you know, a fair amount of time, you know, talking about this.

And then I would also ask her about the birth control pill, so she was on a birth control pill for several years, several years. We know that birth control can cause a number of hormonal imbalances. It can decrease endogenous meaning internal product

Shouldn't have different hormones like estrogen and progesterone, it can also increase something called sex hormone binding binding globulin or sh B G. That is what I would describe to patients like this, as a taxi cab driver taxi cab driver takes people around, or I should say nowadays, Uber or Lyft, but takes these other hormones around like testosterone, and estrogen, puts them in the cab or puts them in the Prius, let's say, and basically shuttles them around and binds them so that the body cannot use its own hormones. The hormones are not what are called bioavailable. So I think the birth control can actually for some people really imbalanced their hormones. And that will be important to understand what those concerns were for, for her. And then we can talk about lab work in a minute. I'd also ask her about the

the traumatic accident in her late teens, because we know that a lot of a hormone balance does depend on stress management and resilience. And if someone has a long standing stress or history of

significant stress, like a trauma, and that's causing anxiety with that, what happens is, there's something called the fight or flight response. And if that is turned on, in a in a long standing way, where it's just kind of on all the time. So if you think about it, if someone is, you know, if that's on all the time, it's kind of like if your light in your house was on all the time, and it was like super bright, and you couldn't turn it off, you know, you're gonna eventually get headaches and fatigue, and you're gonna go crazy, right? If you're if you can't turn the light off, so you want to turn that stress light off, you know, once in a while so your body can recover, it's your Mind, Body Spirit can recover. So she suffers from this anxiety, we know that anxiety can affect hormonal balance. So we want to ask her about that as well. I would also ask her about the unexplained weight gain. So she maintains a relatively healthy diet, we can talk kind of more about that, what what what that really means. I think from a nutrition perspective, and this is a non judgmental podcast at all.

There is there is I think certain people that eat more vegetables on a vegetarian diet, let's say we're a plant for diet, which I do think is healthy to eat and a lot of plants. And then there's people that are eating more more carbohydrates, things like maybe, you know, bread, pancakes, rice, potatoes, and they call that a vegetarian diet, it's really a carpet terian diet. So I don't know if I would say that exactly, to every person like that. But having having a situation where if she is thinks she's eating healthy, because she's on a vegetarian diet, but she's more on a carpet terian diet, those carbohydrates are going to increase insulin, which is another hormone that's secreted by the pancreas, that's going to lead to basically fat storage and weight gain. So I think that would be a piece of the puzzle there. I'd love to hear a little bit more about the outer third of her eyebrows. Now I know people that paint their eyebrows also. So you can you can paint your eyebrows and kind of gloss over that. But we don't want to gloss over symptoms, right? We want to we want to go from, you know,

glossing over symptoms to actually addressing symptoms, so and disease processes. So those eyebrows, you know, I might ask her to if she wants, you know, she might she might not like me after I say this, but I might say hey, Alicia, don't paint over your eyebrows anymore. Let's let's see if they can get better. You know, without without that without that.

Without that makeup, I struggled for what what exactly makeup. That is because I don't put makeup on myself. But in any case, if she has an outer third eyebrow last and then I am looking at thyroid there and we'll talk more about the lab tests or that that could be a sign of low thyroid.

It would be interesting to see you know how long she's had these menstrual cycle irregularities. Another thing that happens around the age of average of about mid 30s, like 35 Is that progesterone starts to decrease that's one of the first hormones to decrease in premenstrual women is progesterone. And this can this can result in sometimes irregular cycles that can result in some imbalances in hormones, because estrogen progesterone, kind of are like the yen or you're young, or I guess maybe two kids on a seesaw is what I often say to is that estrogen and progesterone kind of balance out each other so that if progesterone is a little too low, that people could have a relatively

relatively too much estrogen and call it that could cause things like mood swings and things like that. So it'd be interesting to see kind of when she started having irregularities in her period and we can kind of tie that to to lab tests and things like that.

Those are some of the questions I would ask again, focusing on her her lifestyle, her stress levels, the history of trauma, and then maybe when when she started getting the symptoms, it's also important to know that you know, the

The patient, you know, Alicia is going to tell us the answer. I mean, that's another thing in medicine that I just want to give a little bit of a little bit of a soapbox on is that it's really the patient. And it's really the person that's sitting in front of you, that's going to tell you the answer most of the time. You know, most of the time, if you listen to that person, they're going to tell you the answer, because their body kind of knows. And the body symptoms are not, the enemy's body symptoms are our friends, they're actually something's going to tell Alisha, what's going on. So I think it's really important for her to understand that the symptoms are not something that she wants to push away and suppress, and try to paint over. But it's actually something that's a friend, it's an opportunity for her to really understand what's going on with her body. And her body's telling her to give her give her that chance. So lifestyle. From a nutrition perspective kind of always started with nutrition here, looking at some of the things she's doing like premade meals, packaged foods, imitation meets nutrition can affect hormone balance, again, having there's a few things that are that are relevant here. But one is that if there's a a glucose, insulin rise from processed foods, or ultra processed foods, that leads to a spike in glucose, and that can affect hormone balance, it can lead to things like what's called estrogen dominance, where there's too much estrogen and too little progesterone. Sugar would do that. But another thing to remember is that a lot of packaged foods are very high in carbohydrate, so or if it's added sugar, even if it's starches, without added sugar, that's going to turn into sugar pretty quickly in the body. I'd love to hear her her thoughts about and we have our health coaches that that often say this in our clinic, but you know, eating our foods, for nourishment and eating, eating or foods for nourishing ourselves rather than just eating for survival. So we're when we're in survival mode, we're not really eating the food, we're just kind of Wolfing it down, you know, have you ever seen anyone like eat or eat a plate of noodles or you know, eat a plate, ie the, the hot dog champions, you know, they're actually just Wolfing things down as fast as they can and, and, you know, we laugh at that. But we also do that ourselves, right? When we're stressed out, or when we have a lot on our plates. It is busy mom, Alicia, she's juggling her childcare and household needs in a busy family schedule and her partner, and she's expected to take care of herself. And there could be some societal pressures, like I was saying the beginning there. So I'm wondering about how she eats how, how fast she eats, is she mindful of her of her food, and as she chewing that, because that's, that's going to be actually really important on the lifestyle. So I think chewing your food, that could be very important. And then what is she eating, you know, basically, is eating processed foods a lot, if she is there could be different, you know, healthier options for her, you know, maybe maybe starting out the meal with with salads, or with some something maybe easy. If she's like on the go, maybe packing a premade salad that's, you know, healthy and organic, ideally, and she eats that first. And then if she wants to eat something, kind of later, like a chocolate or you know, something like that, she eats that after the salad, and then getting the protein. And so we know that for hormones, you need protein. And it's very important to know that, you know, protein is going to give you the amino acids that help you with mood, and help you with, with with mood and hormone balance to so getting enough protein is very important at every meal, our nutritionist usually say to eat protein and fat at every meal for good hormone health. And I would definitely agree with that as well.

In terms of exercise, she does take a Zumba class once a week, and she does walk daily as well. This is a more general thing. And I think it's not specifically towards hormones. But we do think about you know, strength training, especially to prevent bone density issues down the line for for a 40 year old, you know, she still has a menstrual cycles, and so likely she still has a good amount of estrogen and progesterone and testosterone in the body. But as those hormones inevitably unnaturally decline over time, you're gonna get you know, potentially more of a of an increase in bone density loss, you know, for especially women so, so we're gonna look at, you know, potentially making sure that she's adding strength training to her exercise regimen as well.

And then I would say from a lifestyle recommendation as well, back to that history back to that question about what What gives you joy, Alicia, you know, what is going to give you a sense of a break in the day and relaxation and, you know, nourish you both physically, mentally, emotionally and spiritually as well. So, if that's going outside, walking in nature, maybe walking with a pet gardening, listening to to, you know, music that she loves, or just laying down the floor, if she's exhausted, which it sounds like she may be just laying down the floor and doing a little bit of yoga nidra or shavasana, which is a corpse pose, you know, basically kind of laying down and taking a little bit of time for yourself and adding in some breathwork we know that breathwork is one of the

Best medicines. In fact, there's actually a saying of meditation could be one of the best medications. Meditation is not just about sitting on a cloud and floating on a cloud, which, which it's not really bad anyway. But it's actually being mindful and being mindful of the present moment. And you can access this, Alicia can access this at any time. This is a person who is very busy, like I said, with their kids, or their partner with her household. But even when she's like interacting that way she can, she can kind of stop and and basically pause and breathe while even while she's doing that things that those things. But ideally, I would have Alicia do some breath work, before and after the day, sort of at the beginning of the day before everyone wakes up. And at the end of the day, I usually recommend to Pete for people to do about five minutes of breathing

twice a day. So maybe at the beginning and at the end. And again, there's different types of breathing, but I think for her, I would say there's two types. One is called 555 breathing, which is five seconds, inhale, five seconds, holding the breath, five seconds of exhalation, and doing that for about two minutes or ideally five minutes. And then if she has anxiety, then she could actually shift to a 478 breathing. So that's four seconds and seven seconds of exhale. And and then eight seconds of, I'm sorry, four seconds, inhale, seven seconds of holding the breath and then eight seconds of exhale, because that exhalation greater than inhalation is going to increase her vagus nerve activity. That's the relaxation nerve. That's going to be like, Ah, it's okay. It's okay to slow down. So that that I think will be important and then lifestyle wise, I would say the only other thing is I would ask her about her sleep because we didn't talk about sleep but I'm assuming she's actually not sleeping very well or a lot of times people don't sleep well, premenstrual Lee. This This may be because hormones tend to change and different hormones are affected. For instance, when estrogen drops premenstrual Lee a lot of times serotonin drops and serotonin is a precursor to melatonin, which is helpful for sleep onset. So a lot of these things are related to her menstrual cycle. And also progesterone helps because progesterone can really help with increasing GABA, and GABA is a neurotransmitter brain chemical that actually helps with sleep maintenance. So both estrogen and GABA, and melatonin all these different hormones are really important for sleep. So we want to ask her about her sleep. And depending on what she says about him having trouble falling asleep and having trouble staying asleep, we might give her some different lifestyle recommendations, or even nutraceutical recommendations, or hormone recommendations for that.

So testing, definitely, from a hormone perspective, we're kind of looking at the big three. So if you imagine a pyramid of, you know, adrenals, thyroid and sex hormones, definitely we want to look at all of those, we'd look at her, her DHEA we'd look at her cortisol levels, we look at our sex hormones, which include things like estrogen, progesterone, testosterone, and then our friendly taxicab driver, the sexual and binding globulin.

And then I think from a perspective of thyroid, again, looking at the full thyroid panel, because all those are, you know, interconnected, all these hormones are connected. I would also from a hormone perspective, look at fasting insulin, insulin is that hormone again, secreted by the pancreas, that's going to really be helpful in

and getting glucose into our cells, but also if it's too high, over time, chronically can lead to, again, fat storage and weight loss resistance and everything like that. So I think these are some of the hormone tests that we'd recommend. We would also I think, recommend some some other other things related to anxiety, especially things like vitamin D, omega three fatty acid levels, which is omega check, look at vitamin B 12, as well and folate. So there's that there's something called methylation, which I think for purposes of this, there's some genetics involved and epigenetics involved, which is the way that our genes are affected by our environmental inputs. And there's certain vitamins that are needed to help with a process called methylation. And the reason I'm mentioning this is because if she suffered some anxiety, she may have some under methylation. And so we went check various vitamins including B, 12, and folate and potentially B six as well. So there's a lot of different vitamins that can be checked there. But those are some of the big ones. I think from a low energy perspective, another thing that is happening a lot of times is we overlook Iran. Now when we talk about iron, iron is a mineral, but iron is a key component of hemoglobin. So hemoglobin, basically the red blood cells, that's going to carry oxygen to all other leashes, cells and tissues. So if she's having low iron, which he might have, if she's having heavy or irregular cycles, then iron is going to be a really important thing to test. So typically we're going to check a four iron panel that's going to be iron that's going to be iron saturation. It's good

going to be total iron binding capacity. So that and then a complete blood count will be a full iron panel. So I think all these things are very, very helpful for her.

And then otherwise, you know, testing, we can look into the functional testing. So from a hormone perspective, there's actually a hormone metabolism test called the Dutch test. Now, Dutch, I always joke that it's not, we're not talking about the Netherlands here, although I've been there, and it's a nice place to go. There's a lot of water in the Netherlands, by the way, but the Dutch test is actually an acronym that stands for dried urine testing for comprehensive hormones. So this is a test that looks at dried urine samples and hormone metabolites and levels of things like estrogen and progesterone and testosterone. But also things like cortisol and DHEA. It also looks at different estrogen and testosterone and progesterone metabolites. So the way we look at hormones, sometimes it's sometimes it's kind of like a pinball machine, you start with that kind of ball somewhere, but then it'll kind of travel and you might not know where it ends up. So we want to understand, especially with estrogen, where that estrogens ending up in the body, estrogen does tend to get detoxified by the liver, the liver is the main detox organ, as you probably know, and the liver is responsible for hormone detoxification. So hormones are very good for us. But then at the end of the day, they have to be detoxified. So that they're that they can be excreted so that the byproducts of the say estrogen or different hormones can be excreted, successfully. So, so this is going to tell you about all those different hormone metabolites, and kind of what's happening in the body that way. And I think these are, these are some of the tests that we would start with for, for Alicia.

So practitioners that that we think this patient would be benefit benefiting from I think, certainly, she would want to see her GYN and you know, do regular pelvic exams and pap smears and you know, things like that, we'd want to make sure that she ideally sees a functional specialist that is, that is expert in hormones, you know that to do some of these kind of more advanced tests that we're talking about here.

I think she would also be really benefiting from seeing a trauma therapist, especially, you know, she had anxiety that's related to a trauma accident, right? Not all anxieties related to trauma, but a lot of trauma does cause anxiety, depression,

PTSD, you know, a lot of different things. So, I think getting to the root of that on the mental health side will be really important to to do as well. And then depending on what's going on with her, you know, diet, I mean, eating a vegetarian diet can be really healthy, but again, making sure that she's getting enough fats and proteins, sending her to a functional nutritionist, or naturopathic doctor that's really well versed in these types of,

of, you know, care plans is going to be very important, I think, and kind of changing her lifestyle for the better. Because I think this case is really a lot of times about lifestyle. And sometimes nutraceuticals can be very helpful, especially for her sleep, depending on what's kind of going on there. And then her hormone levels as well.

So top top three most important steps this patient needs to take. First of all, the biggest thing for her is to slow down, is to slow down, smell her coffee, smell the roses outside, take some deep breaths, do a little bit of yoga, do a little bit of breathing, basically take time for herself, understand, maybe write down in a journal, maybe write down in a notepad, whatever she likes to do. And then try to figure out, you know, she needs to figure out wants to figure out what is going to bring her joy, what's going to bring her some relaxation during the day, that's going to help her body take a deep breath and just kind of relax and recover and rejuvenate. So that's, that's really the biggest thing for her. Everything else will flow from that. So if we give her a bunch of treatment plans to do, and she's still running around like a chicken with her head cut off, that's not her fault. That's just the systematic effect of her day. So planning her day out a little bit. And getting the support from a partner getting support from her kids, depending on how old they are. They could help her out with that as well get get them some independence as well, right? Because because you know, teaching kids to do stuff themselves is going to really set them up later in life and in a good way. So I think that's one of the first things I would say working on her diet to make sure she's getting enough protein to fats to support the hormone balance would be really important. And then I think for her I would get some lab testing we wouldn't we would want to see kind of where the blood levels are where the urine testing levels are there for the hormones.

Certainly, that outer third of the eyebrow is a potential giveaway for thyroid. So we want to focus on that and that could be one of the first things you could do. That would be very easy to do on on bloodwork. Mostly just to know that most of the time for hormone testing, we do want that to be a fasting test. So you know if you if you're listening to this and you have a provider, you know that's something to mention to them as well. So I hope this

So it was really helpful for you and we all have hormones, we all want the hormones to work in concert with each other. We all want them to work like, like a symphony rather than than a chaotic, you know, chaotic series of notes. So, hope your hormones are working together in a very symphonic way. And looking forward to seeing you on the next episode, where we're going to talk about brain health. Thank you so much.

Thank you so much for joining us today for this episode of Capitol Integrative Health podcast. A quick reminder that the information we share on this podcast is meant for educational and informational purposes only. It's not a substitute for professional medical advice, diagnosis or treatment. We highly recommend that you speak to a qualified health care provider before making any medical or healthcare decisions. This episode please take a few moments to subscribe and leave us a review. Your reviews help us reach more people and continue to offer innovative insights and information to better optimize your health and wellness.