Welcome!

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the student program agreement.

Tracy’s health counseling certification is from Columbia University for the Institute of Integrative Nutrition in New York.

She has completed ongoing training and is working on a certification in understanding the root causes of chronic illness with the Institute of Functional Medicine and on an additional Masters degree in Human Nutrition at Bridgeport University.

She holds a Masters degree in Engineering from MIT and a Masters degree in Management from The Sloan School at MIT.

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Take lots of notes! The more often you see these connections, the more readily you will be able to recall them.

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SAFM Deep Dive Clinical Courses2

Hormones DemystifiedPart 4

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the SAFM student program agreement.

Today’s Agenda

A Brief Refresher Perimenopause & Menopause Overt Hormone Supplementation Key Medication Considerations Hormone Testing Considerations Resources for More Learning

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Remember cortisol is a master hormone. Stress – physiological as well as mental/emotional – plays a

large role in our wellbeing.

Hormones vary in response to our environment: to help us Survive (as a first priority) and then Thrive. They

evolve through life.

For women as they age, progesterone and estrogen production decrease and androgens increase. Self-care becomes

more important, not less.

For men as they age, testosterone production decreases, and estrogen can increase if muscle mass, diet, and stress

are not well managed. Self-care becomes more important, not less.

Aging is not an “error” in nature that needs to be “corrected” by massive

intervention to try totake us back to the past.

It is an Invitation to shift our Focus.

So Many Things Can “Go Wrong” with Balance

Hormone Imbalance

Toxins/Chemicals Insomnia Low nutrient intake Infections Chronic Stress Physical Stress/Trauma Worry/Anxiety Smoking Maldigestion/malabsorption Genetic Tendency Refined, inflammatory foods Poor Ability to Detoxify Obesity Social Isolation Food Sensitivities Constipation Hypothyroid function Dysbiosis

The Root Causes of hormone imbalance are also the same Root Causes and contributors to other

dis-ease progression!

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You’re ready to start exercising your hormone insights and knowledge! Check out this Q&A treasure chest case study: https://www.schoolafm.com/ws_qa/case-study-hormone-soup/

Perimenopause and

Menopause

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What Does Nature Teach Us?

A plant is not unhealthy or unimportant just because it stops blooming.

Without the burden and strain of flowering, a plant can dive deeper into the soil to form even stronger roots – ones that will nourish itself, as well as its neighbors. It can spread broader leaves and grow a bit taller than its nearby tribe. Its strength will naturally repel pests that threaten the species. The plant’s power now is channeled into a new role, that is even more important to its kind than reproduction;that is, Survival and Thriving as a Whole.

Nature protects itself through the Vitality of the Unburdened and Wise.

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Resisting the Inevitable?

Menopause is a new beginning – a reinvention - in a woman’s life. The lengthy (5-10 yrs) perimenopause period is a generous window of time that the body gives you to accept and adapt to this transition gradually.It is usually asking for – requiring - changes in many areas of our lives. It will also intensify and pull into a pain point what it’s been trying to persuade us to do for prior decades in the areas of awakening, self-awareness, and self-care.

Our experience of a negative - or even horrifying – perimenopause is based on a major disconnect between the life our body (our soul) is asking us to live and the life we insist on maintaining.

We often act as though Menopause is some sort of unfortunate medical problem that needs to be

managed by a physician. I believe it’s actually a spiritual transformation that

becomes a medical event only when it’s being resisted.

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Menopause Myths and Truths

M1. When women are coming into menopause, they are hardly making any estrogen.• Actually, it’s chaos. Estrogen begins to fluctuate dramatically. Even post-menopause,

levels can be ~20-80% of premenopausal levels (reduction happens gradually over time). Don't assume major reductions.

M2. Hot flashes, nights sweats, and mood swings are symptom of low/no estrogen.• These symptoms are more typically signs of erratic, dropping estrogen. Adrenaline

surges are what actually triggers hot flashes; stress is a huge mediator. WS tip: Women can be quite estrogen dominant and still struggle greatly with these symptoms. ***

M3. Estrogen is the hormone changing the most in menopause.• Post-menopause, the ovaries (and adrenals) continue to make androgens which can be

converted to estrogen (adipose tissue has high expression of aromatase*). Obese women in menopause may make more estrogen than thin women do pre-menopause.

M4. Post menopause, women no longer make or need progesterone. • Progesterone begins to decrease 5-10 yrs before menopause; then ovulation ceases.

Ovaries no longer make any progesterone, and adrenal production can be quite hampered. But progesterone is still critical for balancing estrogen systemically.**

M5. After the ups'n'downs of perimenopause, women have very little estrogenic action.• As endogenous, ovarian estrogens wane, in addition to peripheral conversion of

androgens, there can still be dramatic estrogenic activity due to aromatization of androgens and activity of xenoestrogens.

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428377/ , https://academic.oup.com/humrep/article/21/1/309/570742** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/ , https://www.tandfonline.com/doi/full/10.1080/13697137.2018.1455657*** https://www.ncbi.nlm.nih.gov/pubmed/18499105/ , https://www.ncbi.nlm.nih.gov/pubmed/8636357/

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A New Perspective on Menopause?

Is menopause a woman’s transition from Ovarian control to Adrenal control?* Cortisol rises with age. As luteinizing hormone (LH) rises, urinary free cortisol rises.*** Adrenal DHEA and androstenediol (Adiol) can increase dramatically in response to the

menopause transition (DHEA-S production goes up much more modestly). Effects vary by ethnicity (e.g. lifestyle, genetics, diet – of course!).**

DHEA and ADIOL can promote androgenic and/or estrogenic effects in various women. DHEA can convert into either. ADIOL activates estrogen or androgen receptors.

Higher levels of these upstream hormones can amplify pre-existing dynamics in a woman’sbody based on enzyme and receptor status. E.g. Androgen dominance promoted by insulin

resistance will likely get worse. Estrogen dominance promoted by ERα/ERβ

imbalance or obesity likely gets worse. Ongoing stress exacerbates all imbalances.

Menopause is just turning up the heat onimbalances that have already been at play?

* Great article for patients re: stress impact http://ndnr.com/womens-health/the-relationship-between-adrenal-function-and-menopausal-symptoms-2/** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185242/ , https://www.ncbi.nlm.nih.gov/pubmed/19470626/ , *** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459175/ , https://www.ncbi.nlm.nih.gov/pubmed/11061502/

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Menopause: The Basics

A multi-year transition, not a “switch”. Semantics can be confusing.

Menopause is “official” when women have not had a menstrual period for a full year. 95% of women reach menopause between ages of 44-55. Average age is 50-51 y/o in the US.

Progesterone reduction usually begins 5-10 years prior to menopause. Women may still menstruate but have incomplete or absent ovulation. A key concept most women don’t understand!

Erratic, variable hormones and menstrual experience. Hot flashes, fibroids, heavier menstrual cycles, skipped/inconsistent cycles, worse PMS. Aggregate estrogenic effects often higher while progesterone is progressively lower. Systemic effects may worsen symptoms in seemingly unrelated areas of life e.g. lower cognitive functioning, worsening of allergy/asthma, anxiety.WS tip: omega-3 sufficiency becomes even more important.*

Circulating estrogens do not begin to change dramatically until 1-2 yrs prior to menopause. Thus estrogen dominance is quite common in those 35-50 years old (who may not have experienced it in prior years). Vulnerability to fluctuations in xenoestrogens gets worse, not better.

Especially in thin women, insufficient, net estrogenic effect can have systemic impact e.g. brain fog, higher risk of vaginal or urinary infections (estrogen helps promote Lactobacillus proliferation).

Phytoestrogen support can be helpful for providing stability during this transition. WS tip: BUT start low’n’slow and monitor for individual effects; they can vary significantly.**

Again, consider the amplification of existing balance/imbalance! E.g. gut microbial balance, detox pathways, digestion/absorption. Consider Lactobacillus probiotics.***

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537328/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826215/** Excellent patient overview: https://www.energeticnutrition.com/vitalzym/xeno_phyto_estrogens.html#phytoestrogens*** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826836/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552825/ , https://kresserinstitute.com/gut-hormone-connection-gut-microbes-influence-estrogen-levels/ , https://www.ncbi.nlm.nih.gov/pubmed/28778332

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Navigating the Chaos: Peri/Menopausal Relief

The goals? Balance, balance, balance! Provide stable but not excessive estrogenic support. Have ample androgens, not excess. Allow adrenals to make progesterone. Navigate mindfully this major transition from one norm to the next norm.

o Hot flashes may be driven by dropping estrogen, but they are trigged by adrenaline! Supplements such asl-theanine and glycine powder (great to sweeten evening herbal tea) may help (inhibitory neurotransmitter).

Stress relief. Sleep, relaxation, say “No” more often. Rejuvenation, sex, play, joy, positive self-talk, self-expression, choosing Ease vs. More. Higher SHBG w/low hormones may increase xenoestrogen impact. ##

Low glycemic diet. To normalize insulin and blood sugar and prevent excessive bodyfat, BUT not to promote being obsessive about weight (e.g. “trying to fit in your high school prom dress”).

Self-awareness and Self-care. Less self-medicating e.g. alcohol (esp. red wine!), caffeine. Fix known imbalances e.g. estrogen metabolism/clearance, methylation, gut dysbiosis. Top recommendations of helpful supplements. Nothing works for everyone.*

o 2 Tbsp ground flaxseed daily. Lignans likely protective against breast cancer via promoting high 2-OH metabolites. Remember: helpful too for countering BPH (ground flax, not oil)**

o Vitex 2x/day (e.g. Gaia Herbs Vitex Berry) ~500mg daily, regardless of cycle timingo Maca root powder daily. This is the key item for some! Start slowly e.g 1/2 tsp dose.

Highly stimulatory to some, while others need much more (e.g. 2 Tbsp/dose). #o Other options includes siberian rhubarb, red clover extract, cultured organic soy foods. o Vitamin C supplementation has been shown to increase estrogen and progesterone.###

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764641/ ** http://www.ncbi.nlm.nih.gov/pubmed/17374837 , https://www.ncbi.nlm.nih.gov/pubmed/22925074 , https://www.sciencedirect.com/science/article/pii/S0960076005000749 , https://academic.oup.com/ajcn/article/79/2/318/4690098 , https://www.ncbi.nlm.nih.gov/pubmed/24460407 , https://www.ncbi.nlm.nih.gov/pubmed/25546379 , https://www.ncbi.nlm.nih.gov/pubmed/27849354# https://www.hindawi.com/journals/ecam/2015/949036/ , https://draxe.com/top-5-maca-root-benefits-and-nutrition/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184420/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614644/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614604/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614567/ ## https://www.ncbi.nlm.nih.gov/pubmed/11226833### https://www.fertstert.org/article/S0015-0282(03)00657-5/fulltext , http://www.usa-journals.com/wp-content/uploads/2013/07/Al-Katib_Vol18.pdf

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Navigating the Chaos: Perimenopausal Relief

Welcome-to-Midlife Maca Latte

1 Tbsp coconut oil Organic maca powder (per unique dose) 1 tsp glycine powder 1 tsp inositol powder 12 oz boiling water Vanilla and/or cinnamon to taste Optional*: ½ tsp organic matcha powder

Put all in the blender and whir until frothy. Enjoy as a ritual. Breathe.

* Matcha is an excellent source of EGCG also but this powerful antioxidant also uses the COMT pathway which promotes detoxification ofestrogens. Be sure methylation is ample. And do not use where estrogens are already overtly low and there are persistent hot flashes.

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Hormone Replacement

and Medication Considerations

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Estrogen Replacement?!

Perhaps no other topic in the FM world is more controversial! Passionate disagreement. So many choices! So much confusion! Bio-identical or synthetic? Compounded or prescription or

over the counter? Strong estrogens (E1/E2) or weak (E3) or both? Oral, transdermal, injection, troches? Perimenopausal or menopausal? Personal or Family history of cancer or not? Use upstream hormones (e.g. DHEA) or target specifics (e.g. estradiol)? Replace to return to physiologic or “therapeutic” levels?

Fear-ridden choices! Estrogen = breast cancer? Research increasingly showing roles of increased bodyfat, insulin cortisol, ERα/ERβ activation in cancer.* Back to basics? Crap food, stress, and toxins!

Be open. There is no “right answer”. Beliefs/fear/nocebo factors matter. Quality of life matters. Absolutely critical to optimize downstream dynamics before supplementing with any overt hormone

(e.g. liver health (blood sugar?), methylation (B9/B12), sulfation (B6, Taurine), glucuronidation (B5, glycine, moderate beta glucuronidase), increasing glutathione (e.g. sulforaphane, curcumin), increase2-OH metabolites (e.g. DIM but remember: agents that increase 2-OH also lower overall estrogens)).**

Test; don’t guess. And then Listen! Highly different hormone balances may symptomatically look the same. Also pay attention to symptoms and personal experience. No hormone testing will show the full, collective hormone activity in the body (e.g. remember there are myriad xenoestrogens). Many women with low hormones feel great! And many women with “optimal” levels do not feel well at all.

Balance! Data is not fully conclusive, but it appears that both too low and too high estrogen are associated with higher risk of hormonal cancer. “Want enough for the brain but not too much for breasts.”

It will often take 2-3 months for a woman's hormone levels to stabilize after starting any type of hormone replacement. Remember this re: testing timing when either starting or stopping supplementation.

* https://www.ncbi.nlm.nih.gov/pubmed/16809442 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868918/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388472/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756105/ http://www.ncbi.nlm.nih.gov/pubmed/12927427 , https://www.ncbi.nlm.nih.gov/pubmed/10731634/** https://academic.oup.com/jncimono/article/2000/27/113/934445 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899342/ ,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736808/ , https://www.ncbi.nlm.nih.gov/pubmed/19780897 , https://www.karger.com/Article/Abstract/487639https://emedicine.medscape.com/article/276107-overview and https://www.naturalmedicinejournal.com/journal/2010-03/bioidentical-hormone-replacement-guiding-principles-practice

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Estrogen Replacement Risks: What we Know

For women who have their ovaries, supplementing with oral strong estrogen therapy can be dangerous used alone (or in combination with synthetic progesterone).

o Million Women Study found women using estrogen-alone therapy had 30% increased risk of breast cancer over those who didn't use HRT. Women’s Health Initiative fueled fears further.*

o Puget Sound Study found estrogen-only therapy increased breast cancer risk by 60%.o Several other major studies reveal the same: Menopausal use of estrogen-only therapy increased

risk of breast and uterine cancer significantly in post-menopausal women who experienced natural menopause (no hysterectomy). **

Bioidentical progesterone therapy with or without bioidentical estrogen has not been shown to increase the risk of hormone-mediated cancer. But very limited studies. #

Short-term (~3 yrs) use of estrogen therapy (during perimenopause) was not shown to increase risk of disease (very similar to placebo). ***

Studies are really quite mixed in showing increased risk of other diseases when women without ovaries do not receive supplemental estrogen (yep, bio-individuality matters!).****

Thin women with little bodyfat and strong methylation/clearance may need supplemental estrogen to feel optimal, especially to protect heart health and brain function.

See the Bioidentical Hormone article in the Documents section of this course for many research references. * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127562/ , https://well.blogs.nytimes.com/2016/08/29/new-research-counters-fears-about-menopause-hormones/ , https://www.ncbi.nlm.nih.gov/pubmed/12117397/ ** http://www.ncbi.nlm.nih.gov/pubmed/7435487 , *** https://www.nih.gov/news-events/news-releases/womens-health-initiative-reaffirms-use-short-term-hormone-replacement-therapy-younger-women**** http://women.webmd.com/news/20110425/study-ovary-removal-doesnt-raise-heart-risk# https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383/ , http://www.phulicohanmd.com/articles/Lignieres_Combined-Hormone.pdf , https://journals.lww.com/menopausejournal/Abstract/2012/08000/Oral_micronized_progesterone_for_vasomotor.10.aspx

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Helpful Supplementation Options?*

Estriol. Especially topically, vaginally. Topical estriol for vaginal dryness is safe and well-studied. Perhaps combined with Lactobacillus.

Increasingly, progressive practitioners are supporting this choice for patients recovered from hormone-mediated cancer as well or while using ongoing aromatase inhibitors. **

Bi-Est is a BHT cream with 20% estradiol and 80% estriol. Tri-est is similar but includes a mix of estrone/estradiol.

DHEA or Pregnenelone. Upstream hormones allow body to choose how to metabolize and balance it. But will also exacerbate any existing downstream imbalances. Typically available as topical cream or oral dose; again, oral hormones can worsen/cause gut dis-ease.

Topical progesterone. But beware: the aggregate impact to body levels are not measured effectively in either blood or urine.

Topical bio-identical estradiol and progesterone are increasingly popular to avoid gut impact and first-pass hepatic effect of oral preparations. A variety of formats*** are used to ensure/enhance absorption e.g. alcoholic gels, nanoparticles.

Biorhythmic cycling supplementation changes doses (typically weekly) over 4-wk period to mimic menstrual cycling.****

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* This is a helpful overview regarding hormone supplementation that I recommend you consider if you intend to use this in your practice: https://www.naturalmedicinejournal.com/journal/2010-03/bioidentical-hormone-replacement-guiding-principles-practice** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862044/ , https://www.acog.org/About-ACOG/News-Room/News-Releases/2016/ACOG-Supports-the-Use-of-Estrogen-for-Breast-Cancer-Survivors , https://www.tandfonline.com/doi/full/10.1080/13697137.2017.1421923 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3958523/ , also see course Document on Estriol. *** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912337/ and https://www.ncbi.nlm.nih.gov/pubmed/23627249**** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068872/#!po=47.1429

Progesterone and Progestins

Progesterone (bioidentical) and Progestins (synthetic) are not the same thing and do not affect the body the same way.

The most common synthetic progestin used in replacement is Provera (medroxyprogesterone acetate). Progestins are more potent, have higher binding affinity, do not bind to all receptors that progesterone does, and are metabolized differently from progesterone.

Mayo Clinic researchers found women who switched from progestin to progesterone reported an overall 34% increase in satisfaction and these improvements: 50% in hot flashes, 42% in depression, and 47% in anxiety.

When a woman is pregnant in the third trimester, her body produces 300-400mg of progesterone daily. When not pregnant, a menstruating woman produces 20-40mg daily. But Even small amounts of

progestins taken while pregnant have been shown to cause birth defects. Short-term symptoms may be unexpected (e.g. progesterone cream often makes estrogen

dominance symptoms worse for the first few weeks as estrogen receptors are “primed” by the presence of progesterone; make sure downstream estrogen metabolism is optimized first.).

There is seldom a reason for a woman to use supplemental estrogen without the protection (and benefits) of supplemental progesterone at the same time.

Remember the hormone soup dance! Progesterone has key effects e.g. lowers DHT, simulates TPO enzyme to form thyroid hormone, increases GABA and serotonin action (vs. 5-HT receptor binding), both inhibitory neurotransmitters needed for mood balance and avoiding anxiety.

Women (with ovaries) do not need necessarily more estrogen as they age. They do often need help with (1) detoxifying estrogen, (2) reducing xenoestrogen exposure, (3) reducing stress, (4) optimizing tissue sensitivity to estrogens, and (5) balancing estrogen with progesterone!

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A Few Medication Considerations

All steroid hormone medications suppress endogenous production at sufficient dosage (which varies by individual). Dosage must be sufficient to overcome suppression and restore level to targeted value.

Oral birth control pills (OCP) can deplete numerous nutrients, esp. B6, and contribute to enhanced intestinal permeability. Higher, ongoing exposure to estrogens. Increased risk of inflammatory bowel disease, hypertension, elevated CRP. Increases uptake of copper via increased ceruloplasmin (may contribute to zinc/copper imbalance). ***

Aromatase inhibitors can contribute to lowered metabolic rate and increased insulin resistance. A great reminder of two hormone pearls: (1) Balance is everything and (2) It’s always a Hormone soup dance! Estrogen affects insulin signaling.* After use of these drugs, receptors are extremely sensitive to even low-dose estradiol therapy.*

Spironolactone is a potassium-sparing diuretic. Monitor both potassium and magnesium status, the latter being particularly key for insulin sensitivity.

Phytoestrogens may interfere with efficacy of breast cancer treatment (e.g. chemo)? **A great reminder to consider timing and current therapeutic focus in supporting a client.

Oral estrogen therapy increases SHBG, lowering free testosterone due to binding preference.

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* https://www.hindawi.com/journals/jdr/2015/916585/ , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870856/ , https://www.ncbi.nlm.nih.gov/pubmed/22233684 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391691/ , https://jamanetwork.com/journals/jama/fullarticle/184425** https://www.scripps.edu/news/press/2018/20170111siuzdak.html*** https://www.ncbi.nlm.nih.gov/pubmed/21967158 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179165/ , https://experiencelife.com/article/hormonal-birth-control-aviva-romm/ , https://www.schoolafm.com/ws_clinical_know/video-clinical-tips-part-1-oral-hormone-supplementation/ , https://avivaromm.com/the-pill-what-you-need-to-know/ , and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC473360/ .

Hormone Testing

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Testing Options

Serum, saliva, urine…all have both Value *and* Limitations. None measure xenoestrogens, xenoandrogens, or receptor behavior. Lab data is just one puzzle piece!

Measure progesterone (ideally, along with other hormones) on Day 19-21 for women who are menstruating (typical peak of mid-luteal portion of cycle).

Serum (blood) best for measuring endemic gland/organ synthesis. But one-time measurements are much less reliable due to natural variability within the day.* Free hormone portion only available for testosterone (though SHBG can be measured in aggregate). Saliva and multi-sample urine allow averaging for a more accurate norm.

Multi-sample urine testing (e.g. DUTCH) allows measurement of metabolites. 24-hour urine sample best to avoid diurnal fluctuations in sex hormones (but prevents

seeing health of diurnal curve for cortisol/cortisone – a trade-off). You have the opportunity to order a DUTCH test kit for yourself at a significant

discount. Look on this SAFM course page for discount/ordering information. The lab company website features many excellent video tutorials on hormones and test interpretation. Review these thoroughly and repeatedly before working with this test.

There is also a separate entire webinar on DUTCH testing!** Please take advantage of this, your own lab data, many DUTCH webinars, and some practice via multiple case studies before you ever consider using this (or any type of hormone testing) with patients/clients.

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* Peak male testosterone levels occur in the morning for men up to age 45-50 and are best measured prior to 9am, but then can vary and drop significantly. However, day-to-day variability can also occur. Diurnal variability begins to decrease progressively with age. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501456/** Webinar recordings are available as well as case study data discussed and a follow-on handout with additional DUTCH pearls.

Saliva Test (Genova Diagnostics)23

Urinary Test (DUTCH)24

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Education = Inspiration = Empowerment!

We are not designed to be in a chronic, low-gradeStressed, Toxic, Inflamed, Infected, Malnourished, & Unrested

state and yet still easilyThrive, Grow, Reproduce, be Thin, feel Well,

Eat Anything we want, enjoy perfect BMs, and have Great Sex.

This combination would be Not Natural.

Resources for Deeper Learning

Dr. Lee’s guide is a particularly helpful, clear, and practical book. Symptom lists for various imbalances useful for case investigation, especially if no or scant data available. Great practitioner reference; also helpful for savvy patients.

Dr. Northrup’s tome is an excellent “how to” guide regarding menopause which includes both hormonal and biochemical issues but also a large focus on mental-emotional and social issues related to this transition. Excellent client tool; gentler language and pace.

Dr. Gottfried’s book well investigates the hormone soup dance and gives an excellent self-awareness exercise and cleanse-type experience in exploring what foods and lifestyle habits serve a unique person. More suited for pre/perimenopause. Excellent client tool; assertive pace for engaged/committed client.

Dr. Lam’s book focuses on its titled, key imbalance. Many details and various hormone replacement options. Great reference for practitioners.

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This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the student program agreement.

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Hormones DemystifiedPart 4