Recently I interviewed Kate Vasquez, author of the book “Estrogen is a B*tch”, as she discussed estrogen in detail, including the consequences of estrogen dominance, and of course tied it into thyroid health. If you would prefer to listen the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
Today, we are going to be discussing estrogen imbalances, including estrogen dominance, with Kate Vazquez. Let’s dive into Kate’s bio. Kate is a functional medicine physician assistant, founder of Radiant Health, and an award-winning, bestselling author of Estrogen is a Bitch. I hate saying that, but that is the name of the book. Kate helps successful, driven women get rid of PMS and fatigue by balancing their estrogen naturally so that they never notice their period again and can perform their best every day and become the confident leader, wife, and mother they aspire to be. Thanks for joining us, Kate.
Kate Vazquez:
Thanks for having me. When I thought of the title of the book, I was hesitant to use it, too. I don’t know how everybody is going to take it. I explain in the book that we use words like that to create an emotion. The impacts estrogen has on our body, it causes a lot of crazy things to happen. I would never use this term toward someone else. I am just calling estrogen this word, but also helping women to understand what can happen in the body when it’s imbalanced. What can we do to help it come in balance, to help support our hormones? We do need estrogen, and we can make it our best friend. I completely understand and talk about it in the book as well.
Dr. Eric:
As we discussed before starting this interview, I am listening to the audiobook. I have gotten through most of it and am enjoying it. Why don’t you start out by giving a little bit of your backstory? What led you to write this book?
Kate:
My story has led me up to this point and writing the book. When I became a PA back in 2012, I started off in cardiology. I loved the heart and learning about it. After a few months, I realized it was very specialized, and I was forgetting everything. Plus my goal was to help people feel better.
I got into urgent care. I did ER for a short period of time, but I realized it wasn’t for me. It was way too crazy. I worked in urgent care for a long time. At first, I loved seeing people, making them feel better in the moment. If they had a cut, stitching them up. If they had a broken bone, putting a cast on it. I sent them off on their way.
After a period of time, I noticed a common pattern. The same people would come in sick all the time. “Why am I getting sick all the time? Why are these medications not helping me?” I didn’t have the answers for them. I felt frustrated because I wished I could help them, but I didn’t know how. We get into medicine to help people.
Looking back, I was always very active and focused on eating good, healthy food. I always believed adding in nutrition and fitness and lifestyle factors should be part of medicine, but unfortunately it’s not. You and I know. We weren’t taught these things. We dove into nutrition briefly. When we are practicing, we don’t have time to dive into these things. But these things are so important. They are the foundations of our health.
I don’t remember how I came across Dr. Mark Hyman. One day, I was listening to him talk about functional medicine, how it is the medicine of why. Looking at all the different systems and how they are all integrated. This is what I want to do. I was so excited to hear that and realized for the first time, I can practice medicine the way I felt like it should be practiced. I dove in and got my certification through the Institute of Functional Medicine and started my practice.
It was crazy because at the time, I had my own health issues as well. It started when I was a child. In elementary school, I started having headaches all the time. Doctors would tell me, “She just needs to eat more snacks.” When I got older, I was told it was stress. I was the only one in my immediate family who had migraines, and no one could pinpoint why.
When I went through puberty, I got acne. I figured it was genetics because my dad had it. I was put on birth control pills, which did clear my skin. A sign of hormonal imbalance. Then I had a lot of anxiety in middle school and high school. It continued on into my adult life. In college, I had a lot of GI issues, constipation and bloating. It was like a domino effect. One thing after the other was happening. In Western medicine, we look at it as separate things, but it was all the imbalances in my body.
When I learned about functional medicine, I learned how to heal my body. I focused on healing my gut, bringing in nutrients I was deficient in. I was so stressed out. I am a Type A personality, a recovering perfectionist. I created a lot of stress in my body. I had to learn how to adapt to stress. Unfortunately, you go to the doctor, and they just want to give you pills. Nobody taught me how to calm my body down, how to get my body back to the parasympathetic state. Of course, when I did testing, my cortisol was through the roof. It’s crazy to look back at all of the things that were happening and how each thing led to the next. The beauty of functional medicine is how to heal my body.
But I was still taking birth control pills. My husband and I weren’t ready to have kids, and he was worried that we would get pregnant as soon as I came off. He took some time, but he finally agreed to let me come off the pills about three years ago.
When I did, after all the work I had done, I was surprised at what happened. My hormones went crazy. I was shocked. I read Beyond the Pill and healed my gut. What is happening in my body? For the first time, I tested my hormones and looked into what was happening. I had low levels of progesterone because my hormones were suppressed for so long. I also needed to support the metabolism of estrogen in my liver. We are supposed to produce estrogen, use it, and break it down and get rid of it. A lot of us produce estrogen, use it, and recycle it, and keep using it over and over again. It tends to build up in our bodies. That is what was happening with me.
I had estrogen dominance, where estrogen became the dominating hormone. When I came off the birth control, for the first time in my life, I had irregular cycles of 35-36 days whereas I had always had regular cycles every month. I also had debilitating menstrual cramps. I also developed breast tenderness and gained some weight. Even though I have always been lean and active, I started gaining weight in my butt, hips, and thighs, which is a classic sign of estrogen dominance.
Once I learned what was happening in my hormones, I worked on balancing them naturally. After 3-4 months, I was successful. I had regular cycles. The PMS went away. I was able to get back to my regular weight. It was so crazy what happened.
I’m sure there are a lot of women out there who think they are doing the right things, eating the right foods, exercising, which I was, too. I had eliminated so many processed foods and sugars, dairy, gluten, all the things that were impacting my gut health. Even though I was eating the right foods and exercising, my hormones still went crazy. That led me to believe there was something more that was missing.
I want women to know if you are in that place, there is hope. There are answers. You just have to find the right person to help you discover what those answers are, why those things are happening in the body.
That was my experience with estrogen dominance. Once I figured that out, I started noticing the same patterns in my clients I was seeing. I recognized this was way more common than I realized. Probably 80-90% of my clients had this. Being able to help support their hormones naturally, it was a game changer for them.
At that point, I discovered I needed to write a book about it. I was thinking about all the effects of estrogen dominance. When estrogen is the dominating hormone, what happens to our body? We are miserable. We are suffering. Estrogen is a bitch. That phrase popped into my mind, which surprised me. I don’t like to use that term, but it’s so true. I’m sure a lot of women can relate to this. From that moment on, I knew I needed to write a book about it to educate women. Estrogen dominance is a medical term used in functional medicine, but most women don’t know what that is. I made it my mission to write this book and educate women.
Dr. Eric:
Thank you for sharing that. It’s important to remind people that even though estrogen can be a bitch, it is very important. You alluded to that while discussing detoxification. Some people have problems detoxifying estrogen. That’s one way people develop estrogen dominance. You will talk about the different types of estrogen dominance.
If you could start out by talking about the different types of estrogen. I’m sure there are some familiar, but I’m sure some are unfamiliar, too.
Kate:
Absolutely. It’s so funny because looking back, in school, I learned we had progesterone and estrogen. When I went into PA school, I realized we had different types of estrogen. There are four types. Our body produces three types. The fourth type doesn’t become present until women are pregnant. That is coming from the baby.
The three main hormones that our body produces are estradiol, estrone, and estriol. Estradiol is known as estrogen 2 or E2. This is our good estrogen. Estradiol comes from estrone, which is E1. The problem is that too much estrone in the body can become the bad or what I call the rebel estrogen. It can cause a lot of problems if we’re not careful. This is why it’s important to assess and look at the metabolization of estrogen in our liver.
The estrone is what produces three different metabolites. One of those is really good to have around because it protects our DNA, lowers our risk of the development of estrogen-related cancers like breast cancer.
The other two metabolites are the troublemakers. If those are high, one of them increases the proliferation, meaning it causes excess exponential growth of cancer cells if they are present. The other metabolite can also damage DNA. When you have these two ganging up, causing increased growth and damaging DNA, that is the perfect storm for cancer to develop. When the third one is high, it will protect our DNA and prevent that cancer from happening. That’s why it’s important to understand it’s not just one type of estrogen. We have multiple. One of them is really good, but the other can be bad if there is a lot of it. If we don’t have enough of the good to protect.
The third one, estriol, we usually have that in small amounts, except when women are pregnant. We have a lot of estriol that gets produced. I love estriol. This one is E3. It has anti-inflammatory and antioxidant effects. It helps to lower inflammation and protect our bodies. When women go through menopause and get on hormone replacement therapy, especially if it’s compounded estrogen, they have estradiol and estriol. A lot of women with autoimmune disorders will notice an improvement because they are now getting this estriol to reduce inflammation. It’s an amazing estrogen to have.
A lot of the time, estriol is not detected on bloodwork. I love doing urine tests to look at those estrogen metabolites, and we can see those three types of estrogen.
Dr. Eric:
I also like to do urinary testing on my patients (not everyone though), especially to look at those metabolites. It can also look at adrenals, the Circadian rhythm of cortisol, and the hormone levels in addition to the metabolites. Depending on what company you use, it might look at some other markers.
With regard to the metabolites, that 2-hydroxy estrone is the good one. Then you have the 4-hydroxy, the 16. When doing urinary testing, with the 4-hydroxy estrone, many times it is elevated, which isn’t a good thing. Sometimes, it does look good. Very rarely is it low. With the 16-hydroxy estrone, I see it sometimes elevated, sometimes normal. It’s not uncommon for me to see it low though. Is there any concern if that gets low?
Kate:
No. It’s good. If we see low levels of 16 and 4-hyrdoxy estrone, that is the goal. If we see slightly elevated 16 alpha or high levels, I always like to think, “What’s going on in the gut, thyroid?” Sometimes overweight women produce more of this metabolite. If I see higher levels of that, what do we need to address? It’s good to see low or below the detection limit of those two metabolites, the troublemakers.
Dr. Eric:
The test I use is the Dutch test.
Kate:
Same.
Dr. Eric:
Dried urine testing. They give a range. In a blood test, sometimes it will be less than such and such. There, they give a range with each of the markers. You’re saying that if it’s below the range they give, there is no concern.
Kate:
Yep.
Dr. Eric:
Very cool. Why don’t you talk more about the different types of estrogen dominance?
Kate:
That was another thing I discovered, too. You can look up estrogen dominance online, and people will provide all the recommendations. I realized we can’t necessarily go by that. There are different types of patterns. Everyone with a specific pattern should be treated differently.
The three types of estrogen dominance patterns I have established: The first pattern is normal progesterone levels to higher levels of estrogen. Talking about the Dutch test, for example, when we see those ranges, progesterone looks normal, but estrone or estradiol is really high, then that’s a sign of the first pattern of estrogen dominance.
The second pattern is low progesterone with normal estrogen. Estrogen may be within normal range, but progesterone is really low. Because of that, it will still create an estrogen dominance effect because estrogen is the dominating hormone. We don’t have enough progesterone in the system to balance that out.
The third pattern is low progesterone and high levels of estrogen. That was the most common pattern that I would see. The least common was the normal progesterone and high. I needed to support the metabolism of estrogen in the liver. Those are the three patterns I’ve seen.
Dr. Eric:
When it comes to symptoms, when someone has low estrogen, hot flashes, night sweats are more common. Can you talk about the different symptoms?
Kate:
Low estrogen, yes. When estrogen declines in menopause, a lot of women will get hot flashes, night sweats, trouble sleeping. They will also have vaginal dryness and sometimes increased urinary tract infections. Estrogen keeps our skin plump. When things are dry, it increases your risk of UTIs. Those are the more common symptoms of low estrogen.
With excess or imbalanced estrogen in the body, that is going to cause irregular periods. Normally, a menstrual cycle should be anywhere from 24-32 days. As long as it’s pretty regular every month and doesn’t vary by more than 1-2 days, if it’s 5-10 days off- If a woman has a 30-day cycle, and then it’s a 36-day cycle, and then it’s a 26-day cycle, that is an irregular cycle, and it is not normal.
Another symptom is heavy periods. If women are using tampons and pads and are changing them more than eight times a day and are soaking through all of them, that is a lot of bleeding. That is another sign of estrogen dominance.
The next sign is PMS symptoms. When progesterone is low, or starts to decline, especially as women will start to go through menopause, they will experience some signs of estrogen dominance, too. Not just women who are cycling but as they start to transition.
When progesterone levels are low, that’s when we get mood swings, anxiety, depression. Progesterone helps us with our sleep as well, so that is why we will experience insomnia.
Then menstrual cramps. What happens is right before we have our period, we release these chemicals called prostaglandins. Prostaglandins do increase inflammation and pain in the body, but it also helps the uterus contract. We have what’s called the endometrial lining, which is just inside of the uterus. It’s very vascular. A lot of blood vessels. When the egg implants, it needs all those nutrients to help the baby to grow. When women don’t get pregnant, we need the uterus to contract to get rid of that lining. Otherwise, estrogen will cause it to thicken over time. That’s what happens with some women. That can also contribute to heavy periods. If women have a lot of estrogen to cause thick endometrial lining, those prostaglandins, when they release, estrogen can cause an increase of more prostaglandins, which causes more of those menstrual cramps. It’s painful and debilitating.
Women, if you have those severe, debilitating muscle cramps, where you can’t go out and do the things you need to do because it’s so painful, you’re curled up in a ball, having to take Advil or Aleve to alleviate the pain, that is not normal. That is usually a sign of imbalanced hormones.
The fourth symptom is breast tenderness. Estrogen does cause the breast tissue to swell. It can cause painful, tender breasts. It can contribute to the development of cysts in the breasts. Women who have fibrocystic breast disease, that is usually a sign of excess or imbalanced estrogen.
Another symptom is weight gain, especially in the butt, hips, and thighs. Estrogen is responsible for the development of our curves when we go through puberty. When women gain weight, and they notice that it’s primarily going into their butt, hips, and thighs, that’s a telltale sign of estrogen dominance.
Those are the common symptoms that women will experience. They can also have fatigue, brain fog, acne, low libido, and even infertility.
Dr. Eric:
Estrogen and thyroid health, what everybody has been waiting for. Can you talk about the relationship between the two?
Kate:
When people have thyroid issues, they don’t necessarily look at the hormones. Estrogen does have a role in impacting the thyroid. When certain people have symptoms of hypothyroidism, and it’s showing on the bloodwork that their free T3 or free T4 is on the low side, that is because excess imbalanced estrogen can create more of the protein called thyroid binding globulin (TBG). When this happens, this protein binds up the thyroid hormones, which is not good. We don’t want that. We don’t want more thyroid hormone bound because the thyroid hormones are more active when they are free. When they are floating around, they can do their thing. When there is a lot of excess estrogen in the body, this protein increases. It’s binding up the free T3 and free T4. A lot of women will start to develop hypothyroidism because of that. That is one of the causes.
I’m sure you’ve talked about all of the different causes of hypothyroidism. Something that doesn’t get addressed is if there is estrogen dominance present. You can work on the gut, remove stress, remove gluten and dairy, and do other things. Are the hormones being looked at as well? I have had some clients not getting better thyroid-wise until we start working on the hormones, too. It’s something to keep in mind if you have thyroid issues.
Dr. Eric:
You mentioned earlier estrogen dominance playing a role with fibrocystic breasts. Something else that is important to mention is that many cases of thyroid nodules are caused by problems with estrogen metabolism. People can address that when they have thyroid nodules. There can be other factors as well. Many times, when you address problems with estrogen metabolism, that can resolve. It might not completely shrink the thyroid nodules, but it will often shrink them completely or at least decrease the size. If not, then of course you can look into other factors that might be responsible for the thyroid nodules. I did want to bring that up.
Kate:
That’s a great point. I didn’t realize until I started doing more research that we have estrogen receptors all over our body, not just in our reproductive organs, our breasts, uterus, endometrium. We also have them in the thyroid. That makes sense. If women are having thyroid issues, and there is excess estrogen present, it is also affecting the thyroid. That is a good point you made. If you have thyroid nodules or issues with the thyroid, hypothyroid symptoms or even hyperthyroid, I’m sure there is a link there, too.
We can talk about estrogen’s role in autoimmunity because women who develop Hashimoto’s have that imbalance or excess estrogen present. That is because one of estrogen’s roles is to regulate our immune system and inflammation. Because we have those receptors all over our body-
We have two receptors called estrogen receptor alpha and estrogen receptor beta. For the most part, when estrogen attaches to a beta receptor, it calms down our immune response and calms down inflammation. When estrogen attaches to more of the alpha receptors, it increases our immune system and increases inflammation in the body. That is another pathway that happens when people develop autoimmune disorders. *audio cut out*
Excess estrogen and hyperthyroidism. Excess estrogen and rheumatoid arthritis, lupus, Crohn’s, and ulcerative colitis. There are estrogen receptors in our intestines. It’s so crazy when you think about it. Women developing a lot of these issues, make sure to look at the hormones, too. Especially look at estrogen and make sure it’s being metabolized out properly, and that excess is not building up in the body.
Dr. Eric:
For those listening who have Graves’, that also could apply to you. Both Graves’ and Hashimoto’s as well as other types of autoimmune conditions, as Kate mentioned. Thanks for sharing that.
Because most thyroid conditions are autoimmune, around 90% of those with hypothyroidism have Hashimoto’s. I should also mention that Graves’ is the most common type of hyperthyroidism. There is also toxic multinodular goiter, which we discussed about the nodules and their relationship to estrogen.
You mentioned estrogen receptors in the gut. Can you talk more about the relationship between estrogen and the gut?
Kate:
Oh yeah. There are estrogen receptors in the gut. The gut is also responsible for estrogen metabolism. In our gut, we have trillions of microorganisms. We have bacteria, some viruses, parasites, and yeast. Everything should be living in community. The problem is when one of those organisms starts taking over and growing and knocking out all the good guys, this is called dysbiosis. When we get that disruption of our microbiome. That is a problem because we have specific gut bacteria that are responsible for helping estrogen to get eliminated from the gut. When we have that dysbiosis, that doesn’t happen.
Plus we have this enzyme called beta glucuronidase. This enzyme is supposed to allow estrogen to go through. It’s supposed to be low. When we have that dysbiosis, it causes this enzyme to increase in our intestines.
What happens is when estrogen is metabolized in the liver, it goes through two phases. Phase one is it’s active. Phase two, it becomes inactive. Then it binds to bile, and it goes to our gut. When it goes to our gut, and we have high levels of that beta glucuronidase, it takes that inactive estrogen and turns it back to its active form. Now the body is like, “We’re not eliminating estrogen. Let’s bring you back in and start using you again.” That is where that recycling comes in. That’s not good. We don’t want that to happen. We want to get rid of the excess estrogen. Our body is constantly producing it.
When it comes to gut health, that is the first thing I do when I work with my clients. Whether they have gut symptoms or not, almost everybody has issues with the gut. That is why it’s so important. Even if you don’t have constipation, bloating, or nausea, still get your gut checked. It can reveal a lot of information. If you have an overgrowth of bad bacteria, if you have that high beta glucuronidase, there are things we can do to address that. Get those good gut bugs back in. Support the metabolism of estrogen, so that enzyme will come back down, and you can get rid of estrogen. Gut health is so important because of that. It is related in helping estrogen to have that balance in our bodies.
Dr. Eric:
One thing that you mentioned in your book is if someone wants to test beta glucuronidase, they can’t just go to a regular medical doctor. If they have a basic stool panel done at LabCorp or Quest or another lab, they won’t test for that enzyme. They will just test for pathogenic bacteria and parasites, just a few of those that might cause diarrhea. If you want to look specifically at that enzyme, then you would want to order a comprehensive stool panel such as GI Effects or GI Map. It’s not a bad idea to take a broad look at the gut in addition to the beta glucuronidase.
Kate:
Absolutely. That was a common question I would get when I started my practice. “Can I just have my doctor order this stool test?” No, it’s not the same. That is because they’re just looking for an acute infection. If you took antibiotics and started having diarrhea, or you went to Mexico and developed diarrhea that wasn’t better after 7-10 days, that is when your regular doctor will order that stool test to find an acute infection. If you have one from E.coli or C-DIFF from the antibiotics, they would treat that with antibiotics if it didn’t get better.
The stool test I am talking about that Eric mentioned, the GI Effects or Map, those are way more comprehensive than what your doctor is going to do. The doctors are going to look for parasites or specific types of bacteria. It’s not looking at a full range of microorganisms in the gut and being able to determine how well you’re digesting food. The comprehensive stool test provides so much more information about the health of your gut. We can still have overgrowth of bad bacteria but without those symptoms. That’s why it’s so important to work with a practitioner that does testing that is more comprehensive to give us the whole picture.
Dr. Eric:
Let’s say if someone does both dried urine testing and a comprehensive stool panel, if they show on the dried urine test elevated 4-hydroxy estrone metabolite, and they show elevated beta glucuronidase on the GI map, it’s fair to say at least part of that estrogen dominance is due to dysbiosis, the imbalances in the gut. If on the other hand, let’s say they have an elevated 4-hydroxy estrone, and that beta glucuronidase looks okay, would you say it’s most likely caused by something else?
Kate:
For both scenarios, if the 4-hydroxy estrone is high, that is looking at phase two metabolism of the liver. Phase two is responsible for methylation. When it goes through that process, it goes through a pathway of methylation where we need B vitamins. We need B12 and folate. A lot of people have genetic mutations of this enzyme called MTHFR, which I had. That was part of my journey.
Dr. Eric:
Same here.
Kate:
Not only doing the hormone testing, but I started looking at my genetics. Had I not been put on birth control, this probably would have happened to me a lot sooner. Because I had come off of the birth control, it finally reared its ugly head. I had the MTHFR mutation. I needed to take in active B vitamins that have the methyl group already in them, the methyl tetrahydrofolate and the methylcholine because most vitamins over the counter aren’t active unless you are working with a practitioner, and you are getting the right companies that already have these active forms. When you have this, your body is not able to convert the inactive into the active forms. You’re taking these vitamins for no reason.
Yes, B vitamins are important for energy, but they are also important for estrogen metabolism. That is a great question. If the gut looks pretty good, and there is no elevated beta glucuronidase, but the bad metabolites are high, we have to look at what we need to do to support the two phases of estrogen metabolism. Sometimes we only need to support phase one, we need to support just phase two sometimes, and sometimes we have to support both phases. That’s why I like to do the tests because it can help me personalize what the person really needs and where that support is needed.
Dr. Eric:
Do you also look to see if the person has a genetic variation of MTHFR or COMT?
Kate:
Yes. COMT is also an important part of phase two. I will do genetic testing. If clients have already done 23 and Me, it is easy for me to pull that raw data and look at those specific mutations. I have recently joined with the DNA Company because they are doing an amazing job looking at those genetics. They even have reports looking at estrogen dominance, which I am super excited about. I already have a couple clients doing this test to dig into their genetics even further because once we can really understand- Genetics are the foundation, and lifestyle factors as well, pulling all those pieces together to support our body and healthy hormones.
Dr. Eric:
Years ago, I did 23 and Me on myself.
Kate:
Same.
Dr. Eric:
Same with my wife. I don’t know if it would be worth us doing it again. I imagine there is overlap with- They just give more information. For the sake of patients, that’s something I want to look into. It’s great to know you’re having a good experience with them.
Kate:
Oh yeah. They showed me all the reports. I love them. It’s what I do. It really helps a person understand their body. It’s not just about what’s happening in the body, but why. If we can have that understanding, there is nothing wrong with you; it’s just how your body is built.
That’s another thing with genetics. Some people don’t want to know what their genetic predisposition is, but in a way, it’s good to know because we can actually influence our genes. We can turn them on and off based off of our lifestyle and environmental factors. If we know that we can actually have the power to influence our genes, wouldn’t you want to know? If you are at risk of XYZ, you can do this and that to prevent these genes from being influenced and increasing your risk. There is so much power in learning.
I wanted to know what my Alzheimer’s risk was. I am a 3/4. I have some risk there. I know if I really focus on my lifestyle factors, consuming whole foods, reducing stress, supporting my hormones, I am going to have a low risk regardless of what my genetics say. I’m not worried because I know I’m doing all the right things.
Dr. Eric:
I want to shift back to birth control. Birth control can lead to problems with estrogen metabolism and estrogen dominance. If someone is taking birth control, and they are not experiencing any symptoms associated with estrogen imbalances, can that still be causing issues?
Kate:
When they are taking birth control?
Dr. Eric:
Yes.
Kate:
They usually won’t experience symptoms while on birth control. What happens is when on birth control, it suppresses all of our hormones. If women are experiencing symptoms of estrogen dominance before they get on birth control, they actually may feel a lot better. The PMS, the heavy periods, the irregular periods, a lot of women will have regular cycles again, lighter periods, no mood swings. Usually, birth control does help with that because it lowers the hormones. The problem is that once women come off, it flares back up again. It usually ends up being worse than when they got on it in the first place.
Dr. Eric:
They also might experience symptoms or signs that they don’t relate at all to the birth control, like gallstones. They might end up having surgery recommended, and the doctor might not even make that connection. Maybe they might not ask. They might go to a different specialist, and they don’t bring up birth control. That’s also something to consider.
Kate:
I had a client coming to me. She was taking birth control. She developed gallstones. I told her, “You need to get off birth control.” She even asked her doctor, “Does birth control cause gallstones?” The doctor said no. It’s in the research and the literature, and it’s even in the excerpt they give you with birth control. It’s there. There is a link between birth control and the development of gallbladder issues.
One of the things that birth control does is it impacts the liver’s ability to produce bilirubin, which is what produces the bile. Bile gets produced in the liver and is stored in the gallbladder. It’s impacting that. Also, the prostaglandins, the synthetic progesterone, is in birth control and slows down the gallbladder’s motility. It’s not squeezing and functioning as it should. It slows down that mechanism. That is why birth control is really impacting gallbladder.
If you have gallbladder issues, and the provider recommends birth control, say, “Wait a minute. Isn’t there a link?” If you didn’t have gallbladder issues, and you developed them while you are on birth control, think about that, and have that discussion with your provider. There is a strong link there.
The long-term impacts of birth control can lead to estrogen dominance. Women get on it for hormonal imbalances, but birth control can make that worse, like what happened with me. I needed to support the metabolism with the genetics. Taking in these synthetic estrogens and not really supporting the metabolism of that definitely contributed to that.
It also impacts our gut health and the lining of our gut. When we think about the intestines, one is so thick and one is so thin, but we have this nice mucus layer that protects it. A lot of things cause insult to our gut barrier. It affects that mucus membrane. We have the barrier that is really tight, the tight junctions to prevent a lot of things from passing through. Only vitamins, water, and minerals should be passing through. When we have that constant insult to our gut lining, like birth control, medications, stress, toxins, and inflammatory foods, it’s going to cause those junctions to open up, and it becomes leaky.
If you look at the studies, there is a link between birth control and leaky gut. That’s what I ended up developing. I had leaky gut when I did the stool testing and discovered that. Why I had to do so much work to heal my gut after that. Also because of those estrogen receptors in the gut, there is a link between birth control and the development of ulcerative colitis and Crohn’s. Birth control’s impact on the body long-term is crazy.
As a PA, and I’m sure as a doctor, you probably weren’t taught all these things, what birth control can do. We know that if someone is smoking or have something that increases clotting, they should avoid birth control because birth control can increase clotting. We learn some of the contraindications, but we didn’t fully understand what birth control is doing to our bodies at a cellular level, its impact, and how that will contribute to issues later on.
I would see women, friends and coworkers, when they’d come off birth control and try to get pregnant. They would conceive but would end up miscarrying. That scared me, too. I don’t want that to happen to me. There was a reason why. Being suppressed for so long, the progesterone levels were really low. When they tried to conceive, it didn’t happen because progesterone wasn’t able to increase to maintain and sustain pregnancy.
There are so many factors when it comes to birth control and its impact on our hormones. For women, I want women to learn about it and have that informed consent. Know this is what is going to happen long-term. If birth control is an option for you, have that conversation with that provider first before going on it.
Dr. Eric:
When it comes to addressing problems with estrogen dominance and estrogen metabolism, you want to take care of what we discussed here. If you have dysbiosis causing the estrogen dominance, you want to address the estrogen dominance, methylation, glucuronidation. All of these are important, some more than others. If you’re taking birth control, we mentioned that.
We didn’t chat about xenoestrogens. You want to try to avoid plastics as much as you can, drinking out of water bottles. Thermal paper receipts are a source. It’s almost impossible to avoid completely eliminating your exposure to plastics but minimize that as well.
Kate:
The xenoestrogens are chemicals that are basically foreign estrogen. They mimic estrogen. They are structurally the same. When we are exposed to all these toxins, they are going to attach to the estrogen receptors in our body. Think like a lock and key. The lock is the receptor, and estrogen is the key. These chemicals look like estrogen, so they will be able to go into the lock. That is a problem. I do believe this is one of the main causes of estrogen dominance.
When I was learning about functional medicine and all these toxins in our environment, I was on the Environmental Working Group’s website, and they did a study on how women use on average 12 products a day and are exposed to 168 chemicals. When I read that, that freaked me out. I was mind-blown. I ran to my bathroom and read all the products I was using. I counted up all the ingredients. I was using over 100 ingredients. It was definitely an eye-opening experience.
I realized I needed to start swapping out all these products and reduce the toxic burden in my home. At first, it was overwhelming. I had to get rid of everything in my home. I realized it wasn’t practical, and it is expensive to do that. I don’t want people to think they have to get rid of everything. At the end of the day, like you said, you do the best that you can. Swapping things out one at a time. That’s what I did. I focused on swapping out my toothpaste, then my shampoo, then my body wash. What are the more common things I use? Swap those out. Then the makeup, then the detergent. Over a period of time, I had more non-toxic products in my home.
I used to warm up my food in plastic food storage containers. I’m sure we all did that at some point, not realizing that the heat was releasing all these BPAs and other chemicals that we probably aren’t aware of yet into our food. That is affecting our hormones and causing disruption and causing estrogen dominance. Swapping those out for stainless steel or glass containers. Then the non-stick cookware, replacing those. If you’re hearing this and haven’t done that yet, focus on one thing at a time.
The cool thing is the Environmental Working Group has this skin deep database. You can look at the products you’re currently using to see which ones are toxic and what you can substitute it for. I also like two apps, Think Dirty and Yuka. Those two apps are awesome, too. They have a scanner in them. You can scan your products. It makes it easier. Instead of trying to guess if something is good for you or not, scan it. It will tell you which ingredients are clean, which are dirty, or half and half. When you go to the store, take the app, and scan all the products in the store to find a better alternative.
Rule of thumb: If you are looking at a product that has fancy scientific names, that is probably a sign you should avoid it. I look for products that have lavender oil, olive oil, shea butter, coconut oil, etc. All natural ingredients. That’s what I’m looking for, not these fancy scientific names for whatever. Thankfully, there are some companies that will use the scientific name of lavender oil, but it should say “lavender oil” in parentheses, so you know it’s a natural ingredient.
Same thing applies to food, too. When we are looking at our food, read the labels. That was another game changer for me when I learned it. I learned about nutrition in undergrad, but I didn’t start reading labels until after PA school. I started reading the labels because I realized the impact that food was having on my health and my gut. I didn’t know what so many of these ingredients were. Fillers, thickeners, preservatives all create inflammation in our body and impact our gut health and affect our blood glucose. There are so many things they do to our body. I thought I was eating healthy, but in reality, I was eating all of these processed foods. I really focused on consuming as much whole foods as possible. Certain things that I would eat that were already packaged, I would make it my own.
Yeah, it is a lot of work, but my husband and I meal prep and plan, so this is a tip. If you don’t like to cook every day, get a partner to do it with you. It’s so much easier to do that. Make a list of 10-15 recipes. Make enough for 3-4 days. When my husband and I cook, we make enough food for four days. We’re only cooking twice a week. That’s a lot more doable than cooking every day. That way, we know what’s in our food. It’s homemade. It’s whole. It’s good for our bodies. That was another thing to do.
Reading the labels on your food you’re eating and products you’re using. Food can contain chemicals as well. Going back to the toxins, they are not only in the products we’re using, but in our food. I always recommend going organic as much as possible. Especially nowadays, prices of everything are going up. If you can’t do everything organic, Environmental Working Group has their clean 15 and dirty dozen lists. Focus on the dirty dozen: kale, strawberries, red peppers. Basically anything with a thin skin, you want to get those organic. Everything that has a thicker skin like avocadoes, bananas, oranges, those you can go non-organic if you need to. That thicker skin, you will peel it off anyway. You won’t eat it, versus blueberries and strawberries where you aren’t peeling their skin. Opt into the organic versions of those. We want to support our liver and gut.
I’ll have people ask me, “Should I do a gut cleanse or liver cleanse?” No, you don’t have to do anything crazy like that. Sure, if you want to drink dandelion tea to support your liver, I’m all for that. Don’t buy $100 of products to do a gut or liver cleanse. If you want to, you can, but just focus on whole foods. Cruciferous vegetables are good for detoxification. Fibers are good so you are going to the bathroom every day.
I don’t know if you were taught this in school, but I remember being told if someone is going to the bathroom every other day, and that’s normal for them, that’s normal. Don’t worry about that. No! I learned in functional medicine, that is not normal. If you are going to the bathroom every other day, every third day, once a week, especially if that has been your normal, that is not normal. You should be going to the bathroom every single day, so you can get rid of these toxins and support your liver and intestines in that detoxification. Reduce the toxic burden on your body in order to help your hormones and overall health.
Dr. Eric:
Broccoli sprouts are important when it comes to estrogen metabolism. If they don’t like broccoli sprouts, you don’t have to eat them. I know they can be important. Any other foods and/or supplements that you recommend to support estrogen metabolism?
Kate:
Oh yeah. Cruciferous vegetables. You want to increase fiber, so a lot of vegetables, leafy greens. Fermented foods, which contain all the healthy gut bacteria for elimination and support healthy bowel movements.
However, I do always like to give a disclaimer: If you feel worse when eating fermented foods, that’s a sign there is issues in your gut. Get your gut checked out. That happened to me. I couldn’t eat broccoli, cruciferous vegetables, fermented foods, even beans when I had gut dysbiosis. I also had what’s called overgrowth of bacteria in my small intestine, SIBO. I had to work on treating that, supporting digestion. Once I healed my gut, I was able to eat these foods again, no problems, no issues. If you are eating these foods and notice you are feeling worse, that is a sign that something is going on in your gut. Those foods are important though.
B vitamins will come from your leafy greens. Those are good for estrogen metabolism.
Foods to support progesterone production are healthy fats, like wild caught salmon, avocado, nuts and seeds. Foods that are high in Vitamin C like red and orange foods, peppers, strawberries, sweet potatoes. Increasing those foods supports progesterone production.
Dr. Eric:
Did you mention any supplements?
Kate:
I hadn’t mentioned them. Thank you for reminding me. As far as supplements, I like diindolylmethane (DIM), which is a compound from cruciferous vegetables in a concentrated form. You’d have to eat 3-4 cups of broccoli every day to be able to get the amount that you would get in a supplement. Go for it if you want, but that’s a lot of broccoli to eat in a day. DIM is really good to support phase one metabolism.
I always give the warning: If you think you have estrogen dominance, you’re having a lot of the symptoms, and you Google it, the first thing they will recommend is DIM. There are a lot of supplements out there that sell blends with DIM and other compounds. You have to be careful. When I talked about the different metabolites, you may not need support in phase one. It may cause things to back up and make things worse if you are not careful, especially if the other pathways aren’t supported as well. That’s why it’s important to do the testing.
If your 2-hydroxy estrone is low, when I see that on the test, I recommend DIM. I will see it go from low to really high. Reading the studies and literature shows DIM increases 2-hydroxy. I have seen it happen in the results with my clients as well. It’s good to reduce the risk of breast cancer. Get the testing first because you can make yourself feel worse if you’re not careful.
B vitamins are really good for phase two. Magnesium, phase two as well. B vitamins are needed for the MTHFR, and magnesium helps support that COMT gene.
If you don’t like to eat broccoli sprouts, you can get them in capsule form. Broccoli sprouts contain sulforaphane, which is a powerful antioxidant to help with phase two metabolism. Increasing broccoli sprouts and getting that supplement can really help.
As far as phase three, there is a supplement called calcium d-glucarate, which doesn’t decrease beta glucuronidase, but it helps to eliminate estrogen from your gut when you have high beta glucuronidase. The only thing to help lower beta glucuronidase is to support the health of your gut. Get rid of all the bad guys causing that dysbiosis. Support digestion, heal the gut lining. That will help that enzyme come down. In the meantime, calcium d-glucarate can help facilitate the elimination of estrogen.
Those are the common supplements I will recommend, depending on what phase needs support.
As far as supporting progesterone, if I see progesterone on the low side, I will also recommend Vitex. It’s an awesome herb to naturally support progesterone. However, don’t take it without getting tested and working with a practitioner. If you have PCOS, that can actually make you feel worse. If you have high LH, which is luteinizing hormone, compared to FSH, follicular stimulating hormone, it should be a 1:1 ratio. But if you have 3:1 LH to FSH, taking Vitex can cause LH to increase even more. That is why you can get worse if you are taking Vitex and have that mismatch and imbalance of LH to FSH. Always get tested before taking any of these supplements. If your LH and FSH is 1:1 and your progesterone levels are low, I love Vitex. That’s what helped me naturally to get my progesterone levels back up.
I mentioned the Vitamin C foods. Taking Vitamin C can be helpful. Our adrenals contain the most Vitamin C. If progesterone is low, what is happening with the adrenals? What does our cortisol look like? We also have to support the adrenals because sex hormones and cortisol are all coming from cholesterol. When our bodies are under stress, our bodies are focusing on survival. We will produce more cortisol and less progesterone. Progesterone happens when we are calm and relaxed. When we are in that state, now our body is thinking about reproduction. When we are in that sympathetic, fight or flight mode, it’s thinking survival. That is another thing I will look at, too.
If progesterone is low, let’s get Vitamin C to support the adrenals and that progesterone production. If cortisol levels are high, let’s get you on some adaptogens. I love different mushrooms and herbs, like ashwagandha, rhodiola, holy basil. Mushrooms like cordyceps and reishi are good for adrenal support as well.
Another thing for progesterone is eating primrose can be helpful. I’ll add that in. B vitamins like B6 are important. We need B12 and folate for estrogen metabolism and B6 for progesterone production. A lot of those nutrients will support progesterone, and the adaptogens will support adrenals. I think that’s about it. I dive into all these in the book as well.
Dr. Eric:
You covered a lot. Thank you so much for sharing. Thanks again for getting together for this interview. Definitely check out Kate’s book, Estrogen is a Bitch. Her website is YourRadiantHealth.com. If they want to learn more about you, anywhere else they should go?
Kate:
You can also find me on Instagram @KateVazquez_PA. I am there most. If you have any questions, don’t be afraid to reach out. I’m happy to answer any questions that you have, especially if they come up after this gets released. The book is on Amazon.
Don’t forget to check out the resources, too. I have some resources in the physical book, but I have a lot more online, which contains a meal plan and so much more.I created methods and programs to help women naturally support their hormones. If you have any questions, please reach out! Send me a DM on Instagram.
Dr. Eric:
Thanks for this interview, Kate.
Kate:
Thanks for having me, Eric.