As more information is learned on the prevention of coronary artery disease, it becomes increasingly clear that women should be considered at similar risk as men, and should undergo equally as aggressive preventative measures. Coronary artery disease is the leading cause of death in women, accounting for 38% of deaths among women, according to the American Heart Association.

Read Articles from Dr. Oberg…

I’ve been getting a lot of questions recently about hormones and food. For example, “should I eat [or avoid] soy because it contains phytoestrogens?” “how much estrogen am I consuming if I eat conventionally raised dairy products?” “is additional estrogen good for my brain?” “does extra estrogen exposure add to my risk for breast cancer or blood clots?”

These are complex questions that have been investigated, with conflicting data, in many research studies. Studies of populations that eat lots of phytoestrogens (such as the high soy food consumption in Japan), women have lower risk of breast cancer and blood clots. However, when rats are given large amounts (30X a dietary amount) of isoflavones (an estrogenic component of soy), cancer risk goes up.  To quickly review the data, I turned to one of my favorite sources, Michael Greger, MD at nutritionfacts.org.  He’s a colleague from my research days and a trusted authority who does a much better job of blogging than me! Listen to his review here  His review of the research confirms – soy FOOD is an excellent quality protein that is more protective than harmful and the risk of true allergy to soy is < 0.5%. Further, it increases bone density!  So…unless soy is undigestible for you, the health benefit of a few servings per week is a good idea.

On the flip side of the estrogen conundrum is the question about how important is it to avoid the xenoestrogens in factory-raised cow products (dairy and meat). Again, Dr Greger has done the homework and his report is here. In short, the estrogens from cow products is at least 10-fold that of soy. Further, it is bioidentical and basically has no redeeming benefits.  Not to mention, the additional hormonal burden you are eating, such as high levels of the stress hormone cortisol that is present in animals under stress, such as cattle.

If you are looking for a way to incorporate dietary principles such as these in an easy, practical way, check out vegan Chef Madelyn at Zest. She makes and prepares vegan meals for San Diegans that are so delicious and nutritious, I frequently “prescribe” them for my patients!

Hormonal health is all about balance – but achieving the right balance can be a challenge, particularly for women at midlife. Long before menopause, this dynamic is found in women whose estrogen and progesterone balance is off kilter. The wide range of resulting symptoms can be debilitating, and women can find themselves battling heavy periods, disruptive PMS, fatigue, weight gain, and many more symptoms.

How can balance be restored for optimum well-being? Let’s take a look at how hormones influence your health and how a healthy lifestyle can help.

Hormones’ Role In Your Health

Your body contains over 50 different types of hormones, and they all act as chemical messengers to other parts of the body. Hormones are secreted by endocrine glands, including the:

• Pituitary gland

• Pineal gland

• Thymus

• Thyroid

• Adrenal glands

• Pancreas

• Testes

• Ovaries

When hormones are released by endocrine glands, they travel to specific receptor sites, where they “lock in” and transmit a message to perform a specific action.

What does this mean in practical terms? Your hormones control almost every function in your body, including:

• Maturity and growth

• Metabolism of food items

• Hunger

• Sleep

• Sexual function and reproductive health

• Mood

• Cognitive ability

• Stress response

• Appetite

Hormones also work in tandem with each other. A good example is the relationship between progesterone and estrogen, two hormones produced by the ovaries that work together to regulate the menstrual cycle.

The Link Between Estrogen and Progesterone

Estrogen and progesterone have complementary functions. Estrogen is the more energizing of the two and helps with memory, libido, mood, sleep and many other functions. It helps protect bone density, youthful skin and hair, mental sharpness, and healthy cholesterol levels. Estrogen levels rise in the follicular phase, which is the first half of the menstrual cycle, up to the point of ovulation.

Progesterone is produced after ovulation occurs (the period called the luteal phase) and has a more calming function. Progesterone levels peak about midway through the luteal phase, then drop off before menstruation occurs. This sudden drop can contribute to symptoms of premenstrual syndrome (PMS). Progesterone helps regulate the effects of estrogen on the body. It plays a role in the growth of the uterine lining during menstruation, and helps regulate the timing of menstruation.

As you see, both hormones play vital functions in a woman’s body, but they must be balanced. Having inadequate levels of progesterone is not only problematic on its own, but estrogen doesn’t function as well with low levels of progesterone. When your levels of estrogen and progesterone aren’t balanced, estrogen dominance can occur.

Estrogen Dominance: When Hormones Go Off Kilter

Without the balancing influence of progesterone, estrogen’s influence on the body can lead to troubling symptoms. This is often the first pattern to occur because the ovaries fail to make enough progesterone to balance the estrogen. Women who previously hadn’t experienced trouble with their periods may find themselves bleeding far heavier than before. They may struggle with PMS or wonder where their wild mood swings came from. The symptoms of estrogen dominance include:

• Heavy periods

• Menstrual cramps

• Fertility issues

• Blood sugar problems

• Weight gain, particularly around the belly

• Thyroid problems

• Higher risk of developing autoimmune diseases

• Bloating

• Fatigue

• PMS

• Mood disorders, including anxiety and depression

• Anger management issues

• Increased risk of breast, uterine, and ovarian cancers

What Causes Estrogen Dominance?

Many factors can lead to estrogen imbalance, and it’s not uncommon for a woman to experience more than one cause.

• Problems in other parts of the body can contribute to estrogen dominance, including poor liver function, since the liver helps eliminate excess estrogen.

• Other hormones also influence estrogen and progesterone production, particularly insulin and cortisol, so when those hormones are disrupted, the effects can cascade.

• Chronic stress can lead to harmful hormonal fluctuations.

• A poor diet can also lead to hormonal problems, because magnesium, zinc, protein, and B vitamins help to metabolize estrogen. In addition, since fat cells produce estrogen, obesity can contribute to excess levels.

• Normal age-related fluctuations in hormone levels can create imbalances, particularly during the perimenopause years. Women experiencing polycystic ovary syndrome (PCOS) are also vulnerable.

• Interestingly, sometimes estrogen dominance isn’t caused by estrogen itself. Xenohormones are compounds that mimic the properties of estrogens. They can be absorbed by the body and trigger estrogen production, leading to further imbalances. Many common products contain xenohormones, including plastics (watch out for plastic food containers in particular), pesticides, factory-farmed meat, car exhaust, and emulsifiers found in shampoo and other beauty products.

How To Balance Estrogen and Progesterone

1 – Reduce stress.

Stress, particularly the chronic stress so common in our modern lives, impacts cortisol production, which in turn impacts other hormones, including progesterone. Stress reduction techniques such as meditation and yoga can help regulate stress and hormone levels. Sometimes, a simple attitude shift in attitude can slow the “flight or fight” response that produces cortisol. To do this, try considering a stressful event in a more positive light – perhaps as an opportunity to prove your strength.

2 – Get enough sleep.

Hormonal imbalances can cause sleep disturbances. At the same time, you need adequate sleep to maintain healthy hormonal balance. If this seems frustrating, it is! Start with the obvious sleep habits – no blue light, cool, dark room, empty stomach. If that isn’t enough, try listening to guided meditations or binaural beats using headphones. Low dose melatonin, herbal teas like SleepyTime and NightyNight, and Magnesium malate are some things you can try as well. If that doesn’t work, come talk to me or another healthcare provider.

3 – Maintain a healthy liver and gut.

Your liver metabolizes estrogen, so it’s imperative to maintain optimum liver health by reducing exposure to toxins and minimizing alcohol. In addition, your gut microbiome also plays a role in estrogen regulation. Probiotic supplements, fermented foods like kimchi and sauerkraut, and drinks like kefir help maintain the “good” bacteria in the microbiome. Fiber consumption triggers the production of more bacteria, so increase your fiber intake with a focus on whole grains and produce. High amounts of fiber can also lead to more bowel movements, which helps eliminate excess estrogen.

4 – Eat for hormone health.

The traditional Western diet of highly processed, high-sugar foods is linked to higher estrogen production. In contrast, a Mediterranean diet has been shown to reduce estrogen levels. The Mediterranean diet centers around whole grains, brightly colored vegetables, olive oil, and fish. Green, leafy vegetables like kale and spinach are particularly beneficial.

Protein is essential for the production of amino acids, which are the building blocks of hormones. Some evidence shows that vegetarian sources of protein are the most effective in regulating estrogen – but the most important factor is to avoid meat from animals exposed to pesticides and artificial hormones.

Omega-3 fatty acids help regular insulin and cortisol production and reduce inflammation, which has a beneficial effect on estrogen. Foods high in omega-3 include chia seeds, avocados, many nuts, and fatty fish.

Dr. Erica’s hormone balancing App can be an easy way to eat this way. It includes menus, shopping lists, recipes, and more!

5 – Improve hormone receptivity with exercise.

Some research shows that regular exercise can make your body more receptive to the messages carried by hormones. Plus, exercise can help reduce excess body fat, which carries estrogen.

6 – Consider replacement.

The decision to start hormone therapy should be an informed one, with many factors to consider, including a woman’s age, health priorities, and health history. Those who try it often consider it a game-changer, but it isn’t for everyone.

If you do choose hormones, it is important that they are bioidentical hormones compounded for you in your unique optimal dose. Dr. Erica is California’s only Menopause Method certified/endorsed prescriber. This method involves formulating your hormones in an organic oil base. Traditional hormone replacement therapy (HRT) is synthetic, and standard bases contain parabens and preservatives.

If you recognize any symptoms of hormonal imbalance, we can help! Reach out to get a comprehensive assessment of your hormones and a customized plan for rebalance. You don’t have to live with an imbalance of hormones!

Sources

Paterni I, Granchi C, Minutolo F. Risks and benefits related to alimentary exposure to xenoestrogens. Crit Rev Food Sci Nutr. 2017;57(16):3384-3404. doi:10.1080/10408398.2015.1126547

Layman DK, Anthony TG, Rasmussen BB, et al. Defining meal requirements for protein to optimize metabolic roles of amino acids. Am J Clin Nutr. 2015;101(6):1330S-1338S. doi:10.3945/ajcn.114.084053

Sánchez-Zamorano LM, Flores-Luna L, Angeles-Llerenas A, Ortega-Olvera C, Lazcano-Ponce E, Romieu I, Mainero-Ratchelous F, Torres-Mejía G. The Western dietary pattern is associated with increased serum concentrations of free estradiol in postmenopausal women: implications for breast cancer prevention. Nutr Res. 2016 Aug;36(8):845-54. doi: 10.1016/j.nutres.2016.04.008. Epub 2016 Apr 26. PMID: 27440539.

Cano A, Marshall S, Zolfaroli I, Bitzer J, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Hirschberg AL, Kiesel L, Lopes P, Pines A, van Trotsenburg M, Lambrinoudaki I, Rees M. The Mediterranean diet and menopausal health: An EMAS position statement. Maturitas. 2020 Sep;139:90-97. doi: 10.1016/j.maturitas.2020.07.001. Epub 2020 Jul 15. PMID: 32682573.

https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3574573/

Gorbach SL, Goldin BR. Diet and the excretion and enterohepatic cycling of estrogens. Prev Med. 1987 Jul;16(4):525-31. doi: 10.1016/0091-7435(87)90067-3. PMID: 3628202.

Sánchez-Zamorano LM, Flores-Luna L, Angeles-Llerenas A, Ortega-Olvera C, Lazcano-Ponce E, Romieu I, Mainero-Ratchelous F, Torres-Mejía G. The Western dietary pattern is associated with increased serum concentrations of free estradiol in postmenopausal women: implications for breast cancer prevention. Nutr Res. 2016 Aug;36(8):845-54. doi: 10.1016/j.nutres.2016.04.008. Epub 2016 Apr 26. PMID: 27440539.

What is Candida you might ask?

Candida albicans is a yeast, a type of fungus which grows within the mouth, intestines, and skin. In small amounts, this fungus is harmless to our body and leads to no symptoms.

The problems arise, however, when there is an overgrowth of Candida, which leads to infections. This is typically referred to as Candidiasis, which can be caused by a variety of factors:

• Antibiotics: Sometimes antibiotics are necessary to fight an infection or kill unwanted bacteria in the body. However, antibiotics can also kill good bacteria, such as those responsible for controlling Candida levels. This causes Candida to grow out of control and can lead to serious symptoms.

• Diet: The diet you consume has a significant impact on regulating levels of both good and bad bacteria in your gut. Sugar, refined carbohydrates, and alcohol are all substances that Candida feeds on, so overconsumption promotes Candida overgrowth.

• Immune Weakness: People who have weakened immune systems are more likely to experience Candida overgrowth. At-risk populations include the elderly, infants, and those with HIV/AIDS or other autoimmune disorders.

• Diabetes: Type 1 or Type 2 diabetes increases your chances of experiencing Candida overgrowth.

• Stress: A healthy immune system can regulate your body’s good and bad organisms. Sometimes, however, stress can lead to a shift in the balance between Candida and healthy bacteria. When we are stressed, the immune system’s ability to fight off infections is weakened.

What Are The Symptoms Of Candida Overgrowth?

How can you tell if you have Candida overgrowth in your body? Here are the tell-tale signs to look out for:

• Brain fog and Fatigue: This is one of the most common symptoms associated with Candida overgrowth and is likely due to nutritional deficiencies that accompany the condition. It also happens that having a weakened immune system leads to both fatigue and Candida, so the effects can be multiplied.

• Oral Thrush: When there is too much Candida in your mouth, white, bumpy patches will appear on the tongue, inner cheeks, or throat. This is a tell-tale visual sign of Candida, and is most common amongst the elderly, newborns, and those with weak immune systems.

• Digestive Issues: The balance of good and bad bacteria in the gut plays a large role in digestive health. As mentioned, small amounts of Candida can be present in the body and cause no problems. However, Candida overgrowth may cause various unpleasant gut-related symptoms, such as bloating, constipation, and diarrhea. Recent studies have connected Candida overgrowth with several gastrointestinal disorders such as Crohn’s and ulcerative colitis.

• Yeast Infections and Recurring UTIs: Candida naturally exists in the vaginal tract, but an overgrowth can lead to vaginal Candidiasis, also called a yeast infection. Symptoms include redness, swelling, itching, painful intercourse, and a thick, white discharge from the vagina. Vaginal yeast infections are quite common, occurring in 75% percent of women at least once. Candida overgrowth can also cause urinary tract infections (UTIs). This tends to occur amongst the elderly and immunocompromised populations. UTIs can cause burning while peeing, a more frequent need to urinate, dark and cloudy urine, and discomfort in the lower abdomen.

• Joint pain: When a Candida infection is left untreated for too long, the fungus can enter the bloodstream. This then affects the joints and can lead to arthritis. Candida can also affect the bones, causing infections or osteomyelitis. Bone and joint infections caused by candida are uncommon but can be difficult to eliminate when they do occur.

• Hormonal imbalance: Scientists have noticed a correlation between increased estrogen levels and the overgrowth of Candida. The by-products of Candida, which can spread beyond the digestive tract, mimic estrogen, which can cause serious hormonal imbalance.

Natural Treatments For Candida Overgrowth

Treating Candida involves a thorough health assessment from your healthcare practitioner, followed by a strict elimination diet and Candida protocol as next steps.

Since food plays a crucial role in regulating healthy levels of bacteria in the gut, one of the main ways Candida overgrowth is treated is through diet. This means reducing consumption of sugars and carbs which Candida thrives on. High-lactose dairy products can also encourage Candida to grow and should be avoided.

Along with eliminating foods that can trigger Candida, focus on foods that have been proven to fight it and promote the growth of good bacteria. Try incorporating the following into your diet:

• Garlic. Garlic has an antifungal property called allicin, which is known to fight against candida yeast.

• Coconut oil. Due to its high lauric acid content, coconut oil can also reduce Candida.

• Pomegranate. More research needs to be done, but initial research has found that the plant compounds found in pomegranate are helpful in reducing Candida.

• Curcumin. Test tube studies show that curcumin has the ability to reduce the growth of Candida yeast and may even kill it.

• Probiotics. Probiotics promote the growth of healthy bacteria in the gut and protect against candida. Lactobacillus is the recommended probiotic for fighting Candida overgrowth. Be sure to speak with a healthcare practitioner to guide you in the right supplements to choose for your condition.

Don’t let a Candida overgrowth run you down! It’s important to get the proper assessments in order to get to the root cause and a tailored plan to cleanse your body of it for good – we can help!

Sources

Irving G, Miller D, Robinson A, Reynolds S, Copas AJ. Psychological factors associated with recurrent vaginal candidiasis: a preliminary study. Sex Transm Infect. 1998 Oct;74(5):334-8. doi: 10.1136/sti.74.5.334. PMID: 10195028; PMCID: PMC1758140.

Kumamoto CA. Inflammation and gastrointestinal Candida colonization. Curr Opin Microbiol. 2011 Aug;14(4):386-91. doi: 10.1016/j.mib.2011.07.015. Epub 2011 Jul 28. PMID: 21802979; PMCID: PMC3163673.

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Vaginal yeast infection (thrush): Overview. 2019 Jun 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK543220/

Cheng G, Yeater KM, Hoyer LL. Cellular and molecular biology of Candida albicans estrogen response. Eukaryot Cell. 2006 Jan;5(1):180-91. doi: 10.1128/EC.5.1.180-191.2006. PMID: 16400181; PMCID: PMC1360257.

Khodavandi A, Alizadeh F, Harmal NS, Sidik SM, Othman F, Sekawi Z, Jahromi MA, Ng KP, Chong PP. Comparison between efficacy of allicin and fluconazole against Candida albicans in vitro and in a systemic candidiasis mouse model. FEMS Microbiol Lett. 2011 Feb;315(2):87-93. doi: 10.1111/j.1574-6968.2010.02170.x. Epub 2011 Jan 10. PMID: 21204918.

Shino B, Peedikayil FC, Jaiprakash SR, Ahmed Bijapur G, Kottayi S, Jose D. Comparison of Antimicrobial Activity of Chlorhexidine, Coconut Oil, Probiotics, and Ketoconazole on Candida albicans Isolated in Children with Early Childhood Caries: An In Vitro Study. Scientifica (Cairo). 2016;2016:7061587. doi: 10.1155/2016/7061587. Epub 2016 Mar 14. PMID: 27051559; PMCID: PMC4808662.

Pai MB, Prashant GM, Murlikrishna KS, Shivakumar KM, Chandu GN. Antifungal efficacy of Punica granatum, Acacia nilotica, Cuminum cyminum and Foeniculum vulgare on Candida albicans: an in vitro study. Indian J Dent Res. 2010 Jul-Sep;21(3):334-6. doi: 10.4103/0970-9290.70792. PMID: 20930339

Kumar A, Dhamgaye S, Maurya IK, Singh A, Sharma M, Prasad R. Curcumin targets cell wall integrity via calcineurin-mediated signaling in Candida albicans. Antimicrob Agents Chemother. 2014;58(1):167-75. doi: 10.1128/AAC.01385-13. Epub 2013 Oct 21. PMID: 24145527; PMCID: PMC3910804.

Mailänder-Sánchez D, Wagener J, Schaller M. Potential role of probiotic bacteria in the treatment and prevention of localised candidosis. Mycoses. 2012 Jan;55(1):17-26. doi: 10.1111/j.1439-0507.2010.01967.x. Epub 2011 Jun 14. PMID: 21672043.

Good bone health requires more than just calcium – it requires a combination of key nutrients to build strong, non-brittle bones, activity stresses the bones in a healthy way, and balance exercises to ensure you don’t fall!

INCORPORATE THESE KEY FACTORS:

Calcium, magnesium, and trace minerals

1200-1500mg total calcium from food and supplements.

Calcium + D increases BMD by 1-3%, reduces fracture 30%, likely more with all trace minerals

We like Bone Up (Jarrow) & Botani-Cal (New Mark)

Vitamin D3

Dosed based on lab tests to reach serum 50-70ng/dl.

Increases BMD 1-3%

Strontium citrate

200-250mg – this is different than prescription strontium ranelate (SR) which is available Europe.

SR reduced fracture ~50% and increases BMD 3-7%

Vitamin K2

45mg (MK4 preferably, MK7 is an acceptable, less well studied form).

Increases BMD 3-5%, reduces fractures significantly; one study of MK4 showed 90% reduction.

Weight bearing exercise

Weighted exercise vests, walking with a small backpack with weights, or weight training in the gym all put healthy stress on your bones, causing them to remodel into stronger, less brittle bone. Weighted walking vests can be found on Amazon. Start with 6lbs and work up.

Good balance

Osteoporosis isn’t much of an issue if you don’t fall! If your balance isn’t great, start with well supported activities like chair yoga. T’ai Chi, Qi Gong, and Yoga are all excellent options to build balance.

AVOID BONE DEPLETING FACTORS:

Medications – Proton pump inhibitors, glucocorticoids,

Smoking – Depletes bone

Sedentary behavior – Minimize bed rest; begin physical activity and rehabilitation as soon as possible following surgery or illness.

Excess alcohol intake – Depletes bone

GET EDUCATED:

Read Lara Pizzorno’s book “Your bones” (2011)

Explore the FRAX tool to estimate your personal risk. https://www.shef.ac.uk/FRAX/tool.jsp

Please also see my companion blog post, Are Bioidentical Hormones Right for Me?

IF FURTHER TREATMENT IS NEEDED, DISCUSS THE RISKS AND BENEFITS SPECIFIC TO YOU:

Bio-identical hormone replacement therapy (estradiol, estriol, testosterone)

Reduces fractures, increased BMD 1-8%, Very slight ncreased risk of breast cancer, CVD, blood clots and stoke. Progesterone and DHEA appear to have no bone-related effects.

Bisphosphonates

Alendronate (Fosamax), Ibandronate (Boniva), Risedronate (Actonel), Zoledronate (Zometa, Aclasta)

Over 5 years, increases bone density 3-5%, decreases fractures 40-60%.

Overtime, decreases bone remodeling. This leads to adverse effects such as brittle-ness and osteonecrosis, cavitations, atypical fractures

Safe use requires a “drug holiday” after several years; 3-5 years on, 3-5 years off may be wise.

Selective estrogen receptor modulators (SERMs) i.e. Raloxifene (Evista)

Decreases fractures up to 35%, decreases breast cancer risk

Side effects consistent with estrogen-blockade – hot flashes, vaginal atrophy, cognitive function

Parathyroid hormone – Teriparatide (Forteo)

Best for glucocorticoid-induced osteoporosis, those who haven’t tolerated other therapy, or at high risk. Decreases fractures up to 70%, increased bone density 1-6%. It is given 3m on, 3m off for a max of 2 years. Lots of contraindicated conditions – ask your doctor. Must monitor calcium, PTH, and 25(OH)D

Calcitonin

Decreases fractures 30%, increases bone density 2%. Increases risk of malignancy, cannot be used long-term.

Denosumab (Prolia)

A monoclonal antibody treatment that affects bone remodeling. May be most appropriate for bone loss associated with auto-immune & inflammatory conditions like IBD.

To learn more, or to discuss which approaches are most relevant to you, schedule a consultation with Dr. Oberg.

http://emedicine.medscape.com/article/330598-treatment#d9

http://www.naturalmedicinejournal.com/journal/2014-08/bioidentical-hormone-replacement-therapy-postmenopausal-osteoporosis

http://www.bmj.com/content/351/bmj.h4183