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Host: So our next speaker, Lara Briden is a Christchurch-based naturopath, practicing in Sydney. And she draws on her 20 years of clinical experience as a naturopath with her previous career in science as an evolutionary biologist. So I’m pretty pleased to have an evolutionary biologist here this weekend. And she brings this together to help men and women deal with hormonal health issues. Her talk is on hormonal vitality. So please welcome Lara Briden.
Lara Briden: Hi everybody. I’m excited to speak to this group this afternoon. I work primarily with hormonal conditions. And over the last 20 or so years of practice I’ve noticed that something bad is happening with my patients’ hormonal health. And it’s affecting all of our hormonal systems, including thyroid and adrenal systems. But today we’re going to speak about reproductive hormones.
Our reproductive hormones are powerful agents in our physiology, not just for reproduction but also for brain, bones, muscles and metabolism. For example, we now know that our main estrogen— estradiol—plays a key role in insulin signaling in both women and men. And estradiol is why after you adjust for muscle mass women have enhanced insulin sensitivity compared to men. That reference is there on the slide.
It makes sense that estrogen is a key part of our metabolism when you think about how ancient estrogen is. Estrogen was our first steroid hormone to evolve. It’s been dated back to 450 million years ago when we shared a common ancestor with the lamprey. So you can see I take ancestral health from more of a deep time evolutionary perspective.
So for half a billion years estrogen has been deeply involved in metabolism. It was a big player in physiology long before it was recruited for reproduction or secondary sex characteristics. And it’s not just metabolism. Our reproductive hormones, all of them—estrogen, progesterone, testosterone—are potent regulators of mood. They influence the release of neurotransmitters and some of them metabolize into neurosteroids which interact directly with our brain and nervous system.
And for men, the importance of testosterone is pretty obvious. We all know that men need testosterone for general health, for metabolism and for mood. And for the most part I would argue that men still have testosterone. True, men have real reproductive problems such as sperm count, sperm morphology and prostate enlargement. And true, many of you may not have quite as much testosterone as you would like but you still have some. You have more or less managed to hold on to your main reproductive hormone. But not so for many women.
We are in a very strange time for women’s health. And if we ask the question, how far has women’s health departed from that of our ancestors’? I think the answer would have to be so far as to be almost unrecognizable. There are a few factors, first of all – thank you. First of all, we menstruate a lot more than our ancestors did. They were probably pregnant or breastfeeding a lot more of the time and so had fewer periods. And also there were times when our ancestors did not have enough food to ovulate. Ovulation is highly sensitive to food supply. And that plays a big role in women’s health today.
And the second major – can I say major! — departure of women’s health from our ancestors’, even our very recent ancestors is hormonal birth control. Future generations are going to look back at what we’ve done to women in the last two to three generations and not be able to believe it. We have switched off women’s hormones. Not figuratively but literally switched them off. When we give hormonal birth control we shut down the ovarian function. We switch off estradiol and replace with a pseudo-hormone called ethinylestradiol which has very different effects.
Remember, I said earlier that estradiol improves insulin sensitivity. Well, ethinylestradiol does the opposite. It worsens insulin sensitivity and that’s one of the ways the pill causes insulin resistance. When we give hormonal birth control we switch off a wonderful hormone called progesterone and replace it with an odd assortment of progestins such as drospirenone. And to confuse things we still use the word progesterone to refer to these drug steroids. But they’re not progesterone.
Progesterone is a calming, neuro-protective hormone that metabolizes into a neurosteroid allopregnanolone, which is a potent moderator of the GABA receptor in the brain. Drospirenone which is the progestin in Yasmin birth control does not metabolize into allopregnanolone. It is not help mood or pain. In fact, many, many women report anxiety on the pill.
Earlier this year researchers at UCLA found that women who take hormonal birth control have altered brain structure compared to women with natural cycles. Parts of their frontal cortex are smaller. And according to lead researcher Nicole Petersen, that change in brain structure could be why pill users commonly report anxiety.
Of course we don’t know exactly what is altering the brain. It could be something like drospirenone or it could simply be that pill users have no estradiol and no progesterone, two hormones that are very important for the brain. And progestins are different from progesterone in so many ways. The difference in molecular structures that we saw on the previous slide is a big, big deal. And if you need more convincing that the molecular structure of a hormone matters, then think about this.
Progesterone is structurally more different from drospirenone than it is from testosterone. In my view the pseudo hormones of hormonal birth control are simply not good enough for women. They impair mood, libido and metabolism. And for example in this study—a good one for this group I think—researchers found that women taking oral contraceptives gained 60 percent less muscle mass with exercise compared with women with natural cycles. And that’s primarily because the pill suppresses androgens that we need for muscle gain.
And in the U.S., Australia and probably New Zealand and Canada as well 80 percent of sexually active women have taken hormonal birth control at least once in their lives. And there’s a growing trend to prescribe to girls younger than 15. This is always the part where I start crying. What is that going to do to their metabolism and to their brains and to their mood?
But I am optimistic. I think we have passed peak hormonal birth control. What I’m seeing in social media is a revolution of millennials – thank God for millennials! – embracing non-hormonal methods such as copper IUD and fertility awareness method and condoms. And there are some really good quality condoms coming in future developments and it’s really exciting. And future generations will view women’s health very differently than we do. So that’s my rant on hormonal birth control. Now let’s take a look at some obstacles to hormonal vitality that affect both women and men.
Obstacle number 2: standard American diet. The way that we eat now is not at all friendly to our hormone system to say the least. And I know I’m preaching to the choir here. The standard American diet which also the standard Australian diet and standard New Zealand diet is a diet that creates inflammation. It’s a diet that depletes nutrients. It’s a diet that causes insulin resistance. And it’s a diet that alters our micro biome. Inflammation, nutrient deficiency, insulin resistance and dysbiosis – those four things cause hormonal dysfunction.
Most of the patients I work with eat a lot of inflammatory foods, such as sugar, vegetable oil and wheat. And that inflammation causes hormonal havoc. It impedes hormone production. It hyper sensitizes estrogen receptors and it blocks progesterone receptors. And that’s probably why inflammation correlates very strongly with PMS symptoms for example. Women with higher blood levels and inflammatory cytokines are more likely to report PMS symptoms. And that’s exactly what they found in this University of Massachusetts study.
The standard American diet is deficient in key nutrients that we need for hormonal vitality. It’s deficient from Selene, Iodine, Magnesium and I would say especially zinc, especially for women. I routinely test my patients for their zinc levels and it’s one of the most common deficiencies I see in most young women. Women are zinc deficient, partly because they don’t regularly eat meat or sea food. And also because zinc is depleted by hormonal birth control. How does zinc affect hormones? It promotes the healthy formation of ovarian follicles and Leydig cells in men. It supports symphysis transport and action of hormones such as progesterone and testosterone.
So zinc deficiency causes infertility, acne, menstrual irregularity, rectal dysfunction and period pain. And on the other hand, zinc sufficiency prevents period pain because it down-regulates inflammatory cytokines and prostaglandins. And that’s what they found in a new study published in Australian and New Zealand Journal of Obstetrics and Gynecology. And in this study – it’s the second reference down, they gave a fairly high dose of zinc, 50 milligrams but only for three days per month starting on the first day of the period and they still got results which amazed me when I read the study.
They treated zinc like a drug and they went so far as to state and I’ll quote: “Zinc is more affordable than oral contraceptives or anti-inflammatory medication. “ But trust me it works a lot better to promote long term zinc status with zinc rich foods than lowering progesterone supplements given throughout the month.
The standard American diet causes insulin resistance. It’s mostly because of all the fructose and sugary foods such as soft drinks and desserts I think. But there’s also – it’s important to understand there’s also a lot of fructose in natural foods such as fruit juice and dates. And date balls like these – that’s why I chose date balls – date balls like these are the nemesis of many of my patients’ hormonal systems.
When we’re insulin resistant, most of our tissues such as liver and muscle stop responding properly to insulin. But a few tissues keep responding. Adipose tissue keeps responding to insulin which is why insulin resistance can cause weight gain. Ovaries and testes keep responding even when exposed to high levels of insulin they keep responding. In women all that insulin stimulates the ovarian theca cells to make more testosterone instead of estrogen and progesterone. It also impairs ovulation and leads to polycystic ovary syndrome or PCOS.
And remember, I said earlier that ovulation is highly dependent on food supply. PCOS is one example of that. And in men too much insulin causes the Leydig cells to make less testosterone. And that’s why I test all of my testosterone excess women and all of my testosterone deficient men for insulin resistance and I primarily – oh, no, really? I primarily use a blood test called HOMA IR index which is a ratio of fasting and fasting glucose.
This is – I have to skip over. This is a study on using magnesium….
Okay. The standard American diet has a negative effect on our micro biome. It causes dysbiosis and that’s important because dysbiosis causes inflammation which we spoke about earlier. And remember, inflammation causes hormonal havoc. But there’s another problem. Dysbiosis also causes estrogen excess. It’s because some bacteria have enzyme called beta glucuronidase. And beta glucuronidase deconjugates estrogen which interrupts the process of estrogen detoxification and it puts estrogen back into circulation. And that’s a problem for both women and men and it causes things that I’ll skip over. So I’m running out of time.
So how do we keep our microbiome happy? You know a lot of this; we eat vegetables and we avoid antibiotics as much as we reasonably can.
Antibiotics are obstacle number 3. They cause dysbiosis which causes inflammation and estrogen excess. They also damage our mitochondria. I’m really interested in mitochondria which are the little ancient bacteria inside of our cells. Remember, it’s the job of our mitochondria to make energy. But they have other jobs too. And one of those jobs is to manufacture steroid hormones. When we damage our mitochondria, we damage our hormonal system.
Something I say to my patients all the time is: finding a way to avoid future antibiotics is a key part of your long term strategy for hormonal health.
This is endocrine disrupting chemicals (obstacle number 4). An important statement that was released from the American College of Obstetricians and Gynecologists this year. And they said that the scientific evidence over the last 15 years shows that exposure to toxic environmental agents can have significant and long-lasting effects on reproductive health.
And the Endocrine Society said something similar. They said – I tweeted this – “It’s time for endocrinologists to start advising patients to avoid endocrine disrupting chemicals. “ And they said that based on 1,300 studies. I’m going to … how come it’s already 17 minutes? I was practicing this, I don’t understand. I think I got too passionate.
We’ve got a long road ahead. I’m going to get onto the next; so endocrine disrupting chemicals are obstacle number 4.
Finally, obstacle number 5. Stress has a huge impact on hormonal health. Particularly in women but also in men and it’s not complicated. Our hormonal command center, the hypothalamus talks to the pituitary with gonadotropin-releasing hormone (GNRH) – on my diagram. And GNRH tells the pituitary to tell the ovaries and the testes to make hormones and stress reduces the output of GNRH. And that’s where stress affects fertility. It affects libido and it definitely affects PMS.
And there are other factors – 2 minutes, okay. And here’s a study about PMS and stress. And yeah, in this study they tracked 259 women over two cycles. And they found that women with higher levels of perceived stress hormones were twice as like to report severe PMS. Our premenstrual phase is our stress report card for the month. So if we suffer PMS it gives us an excuse to say “in order to balance my hormones I need to go for that walk or book a thai massage or spend the entire time reading a novel” which is what I do.
So what are the modern obstacles to hormonal vitality?
1.) Hormonal birth control
2.) Standard American diet
4.) Endocrine disrupting chemicals and
And finally, I’m slip in one other thing which I skipped over:
When it comes to gut health and dysbiosis and its effect on hormones it is massive. And so something that I say to my patients daily, hourly, every 30 minutes I’m saying to someone: “we cannot fix your hormones until we fix your gut.”