Are Hormone Creams the Answer?

So there you are…

Nauseated, the room is spinning.  You are wondering if you will ever make it off of this “I’m-going-to-hell-in-a-hand-basket roller coaster.”  You bend over, hands on your knees, and watch a few more beads of sweat drip into a huge puddle pooling on the floor.  Your hair is soaked, your skin is red, and your entire body feels like it’s on fire.  The bottom of your feet are soaking wet and even your sweat is beginning to sweat.  Are you gearing up to finish the most brutal workout in the history of properly periodized weight lifting?  No, you are not…because you are having the mother of all hot flashes!

This is a very common scenario.  If I had a nickel for every time someone contacted me asking about the use of various types of hormone creams for hot flashes and other symptoms of hormonal imbalance, I would be composing this post from a hammock in a tropical paradise while sipping bone broth and eating lots of tropical fruit (instead I am composing it from my home office, which is not in a tropical paradise – yet- but I am sipping bone broth and eating tropical fruit). 

It is very common to hear in popular medical culture that, “Hormone creams are a great way to balance hormones and help alleviate the symptoms of menopause.”

 

 My question to you is – Is that really true? 

My take on this topic may surprise you; and that is…hormone creams may in fact cause more problems than they solve long-term. 

Hormonal Hell, Fire, and Other Stuff

It has been my experience that in a great majority of cases, women find them themselves suffering more symptoms and creating other more problematic hormone imbalances as a result of the hormone creams they are using.  One of the reasons, among many, for this is that many of these women have never had their hormonal system accurately assessed to any real degree.  On top of that, even fewer of them have taken a serious look at their nutrition and in what ways what, how, and when they are eating may be contributing to the creation of their hormonal hell. 

By far the most common scenario that I see is that many females are placed on progesterone creams, particularly when they are “pre-menopausal” or going through “menopause.”  Personally, I find the term “pre-menopause” to be very peculiar.  Isn’t every female, from the time she is born, technically in a “pre-menopausal” state? 

 

Oh, a quick side note – the body doesn’t magically start with these symptoms at some predetermined, arbitrary age.  The body doesn’t wake up one day and say, “Welp, today we are 40, or 45 years of age…let’s start screwing a bunch of stuff up today!”  That’s not how the body works.   
While progesterone is a critically important hormone and has protective and youth-associated properties to it, often the recommendation to use a topical cream has little to no long-term benefit. 

Why?    

Several reasons:

  • Most of those creams, even when well compounded, contain several or more types of solvents. These solvents actually block some of the absorption of progesterone and also make it very difficult to regulate the dosage that one receives when rubbing on 1 pump or ¼ teaspoon, or whatever the recommendation may be.  
  • Progesterone cycles in terms of its ratio to other hormones in the body as do other hormones. Slapping on a random amount without an accurate assessment of what is really going on with your hormonal chemistry throughout a given 28-35 day duration can only lead to further imbalance in the long run.  Oh, and by the way, this is true whether you are cycling or not.
  • What if one is not deficient in progesterone? It is possible to have hormonal issues and be going through a personal hormonal hell without being deficient in progesterone.  One could simply be dealing with excess estrogen, which does not always include progesterone deficiency.  Taking progesterone when it is not needed will lead to further disruption of the monthly cycle.     
  • If one does not regulate the nutritional factors necessary to optimize thyroid function and estrogen:progesterone balance, one will inevitably super saturate with these creams. I have seen this in more cases than I care to count. 

 

Estrogen Accumulation and Dominance

Typically, it is thought that estrogen dominance is strictly a female issue. This is definitely not the case.  While it is true that many females are challenged with estrogen dominance for a variety of reasons, it is equally as challenging for males.  Estrogen can be allowed to accumulate, which often leads to estrogen dominance, for a variety of reasons.  Please note, there is also a physiological scenario that presents as estrogen dominance when estrogen levels are low, and not normal or elevated (this, in my opinion, does not mean that you need estrogen therapy or creams however).

MANY things can contribute to excess estrogen.  SOME of those things are…

  1. Chronic Stress Response: Any time the energy demand on the body exceeds the supply, the stress response is initiated.  Excess estrogen has been shown by Hans Selye, M.D. to mimic the shock phase of the stress reaction.  As well, as part of the stress reaction/response, the amount and biological effects of estrogen are likely to increase through a number of physiological mechanisms that are beyond the scope of this post.   

 

  1. Dysglycemia (Poor blood sugar control): Having poorly regulated blood sugar levels throughout the day and night will basically exacerbate Number 1.  On a side note, excess estrogen is a glucose waster and will contribute to blood sugar issues if left unchecked.

 

  1. Decreased thyroid function: Excess estrogen effects the binding sites for thyroid hormone. Basically, the more estrogen one has running around in the system, the less effective their thyroid output becomes.  The key point is that adequate thyroid hormone (T3) is required for the effective detoxification of estrogen.  Without it, estrogen is allowed to further accumulate and further decrease thyroid output and this series of physiological events literally perpetuates themselves. 

 

  1. Environmental exposure: Estrogenic chemicals and endocrine disruptors are quite literally everywhere in our environment. From hygiene products to cosmetics to air fresheners and household cleaners – our exposure to estrogenic substances is incredibly high and frequent.  

 

  1. PUFAs (poly-unsaturated fatty acids): The detrimental effect of PUFAs on human physiology is well beyond the scope of this post. That said, one of the largest issues with PUFAs is that they will prevent the binding of estrogen to sex hormone-binding globulin (SHBG), which much estrogen is typically bound to in order to render it “inactive.”  By breaking and/or preventing this binding, PUFAs directly and indirectly increase the biological activity of estrogen.

 

  1. Radiation exposure: Aside from being estrogenic, radiation exposure structurally damages and decreases the function and efficiency of the mitochondria of your cells. This down-regulates energy production at the cell level which is exactly the opposite of what anyone wants and needs in order to create a healthier, better functioning physiology.    

 

  1. Endotoxin: Clinically known as LPS – lipopolysaccharide – endotoxin can actually down-regulate certain detoxification pathways that are utilized in the detoxification of estrogen.  It has been shown that endotoxin can increase estrogen levels by up to 500% in both males and females.  It is easy to overproduce and absorb endotoxin when one has a diet that is high in indigestible foods, such as cellulose and pectin containing foods. 

 

  1. Heavy metals: These, particularly mercury, can affect the binding sites for thyroid hormone. The same can be said for halogens such as fluoride, etc.

 

  1. Overproduction of aromatase: Too much aromatase in the body will convert testosterone into estrogenic hormones and leave both men and women with low testosterone and high estrogen levels.  Blood sugar control and reduction of PUFA in the nutritional regimen are critical here because when blood sugar is not regulated tightly, or if one’s physiology is under the influence of a chronic stress response, this will eventually lead to elevated blood sugar and insulin levels. Remember, PUFAs hyper-stimulate the beta-cells of the pancreas and can create hyperinsulinemia (elevated insulin in the blood).  In the end, the high insulin will lead to an increase in aromatase, thus increasing the conversion of testosterone into estrogen.

 

A key point to be made is that estrogen is not the downfall of the western world (that’s soccer…just kidding, sort of).  It is needed.  It is the ratio of estrogen to progesterone and other hormones that really matters.  Just like all other things in life, it is a matter of balance.  

 

So – what do we do about all of this?

Just because a female has identified herself (accurately) as being estrogen dominant does not necessarily mean that she should start replacing her bathwater with progesterone cream.  The body manufactures progesterone from cholesterol (and LDL actually).  To make a long physiological story very short, cholesterol is converted to pregnenolone and then to progesterone in the mitochondria and cytoplasm of the cells of the body. 

The trick is that the body must have the nutrition on board to support the conversion.  If it does not, cholesterol is allowed to accumulate and much of the body’s protective and youth associated hormones are not synthesized in proportionate amounts to maintain hormonal balance.  Vitamin A (animal source), magnesium, thyroid (T3), zinc, manganese, copper, and other nutrients are necessary for this conversion to take place.  Does that mean that one should look to supplement with these nutrients?  No, not necessarily…

 

Nutrition is Key

For me, the first steps in overcoming or avoiding estrogen dominance/progesterone deficiency are to decrease the intake or exposure to the items on the list mentioned above.  Tight regulation of blood sugar is a critical first step.  Without it, one will be on the proverbial hormonal roller coaster both short and long term.  This leads to further hormonal imbalance in the long run. 

Think of the effective regulation of blood sugar as a three-legged stool.  The three legs of the stool are: (1) Eating the proper foods to support energy production at the cell level (2) eating those foods in the proper macronutrient ratio – carbohydrates:proteins:fats and (3) eating meals at the appropriate frequency for your physiology at this stage in the process of creating health. 

If any one of the three legs of the stool is unstable or missing, the stool is likely to collapse.  This collapse comes in the form of fatigue, weight gain, sleep issues, energy highs and lows, hormonal imbalance, sluggish liver and thyroid function, headaches, irritability, cravings, skin issues, GI upset and dysfunction, inability to lose/gain weight, fertility issues, and on and on the list goes. 

To be honest, it is best to not focus on “end result” hormones such as estrogen hormones, progesterone, and/or testosterone.  Using these hormones as a body spray or skin moisturizer may in fact create more hormonal havoc long-term.  Instead, it is more advantageous to focus one’s efforts on the core of the hormonal challenges/imbalances as they are represented in your thyroid function.  There is actually research that demonstrates that correcting and optimizing thyroid function is more effective at reversing gynecological issues than all other efforts combined!  The focus is on the proper nutrition and lifestyle/behavioral modification to assist you body in enhancing its auto-regulation capacity and recreating its balance.

If one puts in the necessary effort to fully customize their nutritional regimen based on that three-legged stool for say 6 months to a year (and neither of these is a long period of time in the grand scheme of things) and s/he is still dealing with symptoms of hormonal imbalance, then consideration of the proper replacement of the hormone in question could potentially be warranted…but not before that is done.  In my experience, the use of hormone creams is unnecessary in the vast majority of cases. 

Recommended Reading:

 

  1. From PMS to Menopause: Female Hormones in Context by Ray Peat, PhD.
  2. Nutrition for Women by Ray Peat, PhD.
  3. What Your Doctor May NOT Tell You About Menopause by John R. Lee, M.D.
  4. John Lee’s Hormone Balance Made Simple by John R. Lee, M.D.
  5. What Your Doctor May NOT Tell You About Premenopause: Balance Your Hormones and Your Life from Thirty to Fifty by John R. Lee, M.D.
  6. Hypothyroidism: The Unsuspected Illness by Broda O. Barnes, M.D.
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Omega-3’s: Essential…or Not so Much?

This post is not intended to make anyone angry.  However, that is bound to happen in more than a few cases.  My intention with this post, as well as with all of my offerings, is to provoke some intelligent thought.  So here goes…

 

Fish Oil and “essential” Omega-3’s

Everywhere you look today, people are popping fish oils like Skittles in an attempt to “taste the rainbow,” from a health perspective.  Every health food store, supplement line, on-line supplement shop, and pharmacy in the western world has at least 17 different versions of fish oil to sell you.  Omega-3 fatty acids have been given all of the health credit in the world – from improving cardiovascular health, to enhancing brain function and memory, decreasing arthritic pain and inflammation, and supposedly being “essential” to combating pretty much every health issue in the known Universe.  To contribute to the problem, there are tons of medical doctors that continuously have diarrhea of the mouth where the benefits of Omega-3’s are concerned.  With all of the medical community and advertisement dispensing such great advice, if you are not currently taking a fish oil/Omega-3 supplement of some kind, you are clearly not “with the program” right?  

Well, as it turns out, there’s no pot of gold at the end of this rainbow and avoiding these supplements may be a better idea.  Let’s have a look at a few things shall we….

 

I’m going to tell you a TRUE Story…

First, consider the simple fact that the majority of the pro-Omega-3 research has been conducted by the very companies that manufacture and sell Omega-3 supplements.  Not all that different from a pharmaceutical company producing its own research to prove that a given drug is “safe.”  If you happen to stumble upon an Omega-3 or fish oil study that is independently funded that actually backs all of the beneficial health claims given to the supplement, please e-mail me the link as I would love to read that!  To date, I have not personally found one.

 

People tend to know about the inherent dangers and potential inflammatory properties of Omega-6 fatty acids.  Every “health conscious” person is in search of the ever-elusive 1-4:1 (or perhaps even 1:1 depending on who you are reading) omega-6:omega-3 ratio, and as a result take enough fish oil to spontaneously sprout gills and develop the capacity for efficient gas exchange while breathing under water.  Does any of this really have anything to do with being healthy…my feeling is NO…it does not.

Much of what is published in the way of Omega-3 benefits is pretty much a waste of the paper it was printed on.  To quote Ray Peat, PhD, in his article The Great Fish Oil Experiment:

“One way to evaluate published studies is to see whether they tell you everything you would need to know to replicate the experiment, and whether the information they provide is adequate for drawing the conclusions they draw, for example whether they compared the experimental subjects to proper control subjects. With just a few minimal critical principles of this sort, most “scientific” publications on nutrition, endocrinology, cancer and other degenerative diseases are seen to be unscientific. In nutritional experiments with fish oil, controls must receive similar amounts of vitamins A, D, E, and K, and should include fat free or “EFA” deficient diets for comparison.”

In fact, even though one will almost never hear about it, the medical literature is chocked full of the evidence of the ill effects of Omega-3’s.  Omega-3’s belong to a class of fatty acids known as poly-unsaturated fatty acids, or PUFA’s.

 

PUFA’s, when consumed in excess, have been shown to have the following adverse physiological effects:

  • Immunosuppression
    • PUFAs damage the thymus gland and promote immune deficiency.
  • Blocking glucose from entering cells to be used in energy production (Randle Cycle or Randle Effect)
  • Creating hypoglycemia
    • through lowering blood glucose via hyperstimulating the beta cells of the pancreas / hyperinsulinemia
  • Increases the biological actions of estrogen via blocking estrogen from sex hormone binding globulins (SHBGs)
    • Estrogen pulls oxygen from your tissues and organs and is a glucose and vitamin B6 “waster”
  • Suppresses cellular respiration (energy production) and inhibits optimal thyroid function
    • Decreases glucose oxidation and increases lipid peroxidation
    • This slows your metabolism, decreases energy production, and creates a hypo-metabolic state
  • Increases vascular tension
    • This is accomplished through activating something called protein kinase-C
  • Create digestive stress
    • This occurs by inhibiting proteolytic enzymes (enzymes that break down protein) in the gut – remember how essential protein is to our health from Lesson 3. The result is maldigestion, malabsorption, overloading the liver, and creating a huge burden on metabolism.  This has been known since the 1920’s!
  • Inhibits the conversion of glucose to glycogen and favors the production of lactic acid
    • This leads to increased inflammation and is a huge overall burden on physiology
  • Exacerbates the stress/inflammatory cycle directly (through below) and indirectly (via the above)
    • PUFA stimulate the stress hormones, ACTH, cortisol, adrenaline, glucagon, and prolactin, which increase lipolysis, producing more fatty acids in a vicious circle.
    • In the relative absence of PUFA, the stress reaction is limited by the negative feedback of saturated fatty acids which inhibit adrenaline and other adrenal sterols, but under the influence of PUFA, the stress response becomes self-amplifying.

 

 

The above list is by no means comprehensive.  The detrimental effects of PUFA on human physiology are well studied, well documented, and even more not-so-discretely covered up.

 

A known fact about PUFA is that they are extremely heat and oxygen sensitive.  When inside the body, they tend to rapidly oxidize, resulting in rapid lipid peroxidation which will generate very large amounts of free radicals as well as lactic acid.  Excesses of free radicals (molecule or atoms with one or more unpaired electron) and lactic acid are very harmful to the body. These things seem to be largely ignored by mainstream nutrition and popular medical culture. 

 

Not-So-Heart-Healthy After All

 

For all of those who have been snagged hook-line-and-sinker on the supposed cardiovascular benefits of Omega-3’s, consider the following quote from Guy Schenker, D.C., founder of the NutriSpec system:

 

“Many studies have shown that after the ingestion of Omega-3 fatty acids the end products of oxidative lipid damage increase substantially.  Oxidative end products after Omega-3 ingestion are shown to be associated with an acceleration of atherosclerosis development and also increased oxidative damage in bone marrow DNA in rats.”   

 

Again, to quote Ray Peat, PhD from his article The Great Fish Oil Experiment:

 

“The most popular way of arguing that fish oil will prevent heart disease is to show that it lowers blood lipids, continuing the old approach of the American Heart Association’s “heart protective diet.” Unfortunately for that argument, it’s now known that the triglycerides in the blood are decreased because of the fish oil’s toxic effects on the liver (Hagve and Christophersen, 1988; Ritskes-Hoitinga, et al., 1998). In experiments with rats, EPA and DHA lowered blood lipids only when given to rats that had been fed, in which case the fats were incorporated into tissues, and suppressed mitochondrial respiration (Osmundsen, et al., 1998).”

 

Not-So-Anti-Inflammatory After All

As PUFA’s decrease glucose oxidation in favor of lipid peroxidation at the cell level, they actually increase energy demand and encourage the overproduction of lactic acid.  Lactic acid is inflammatory and has to be converted back into glucose using stored glyocogen from the liver (assuming there is a sufficient supply). 

This process in incredibly energy consumptive and does not yield as much energy production as glucose oxidation.  So, in a nutshell, lipid peroxidation is energy inefficient.  Lipid peroxidation also requires more oxygen (as much as 3x more) and can eventually create an oxygen debt at the cell level. None of this is beneficial for the mitochondria of your cells or their ability to efficiently produce energy.  When energy supply does not match energy demand, the stress/inflammatory response is initiated. 

Long story short…PUFA’s contribute greatly to and exacerbate the stress/inflammatory cycle when over consumed.

 

 Not-so-Brain-Healthy After All

It has been known for quite some time that women are 2-3 times more likely to suffer from Alzheimer’s than are men.  Men who do have Alzheimer’s actually have higher estrogen levels than “normal” men.  Why is this important to know?  Recall from earlier that PUFA’s actually increase the biological actions of estrogen (through inhibiting SHBG binding) and the biological function of estrogen is actually to mimic the shock phase of the stress reaction and beyond. 

Again, from one of Ray’s articles Fats: Functions and Malfunctions,

“Another interesting association of the highly unsaturated fats and estrogen in relation to brain function is that DHA increases the entry of estrogen into the pregnant uterus, but inhibits the entry of progesterone (Benassayag, et al., 1999), which is crucial for brain cell growth. When Dirix, et al., (2009) supplemented pregnant women with PUFA, they found that fetal memory was impaired.”

 

Not-so-“Essential” After All

As it turns out, Omega-3’s may not be as “essential” as you have been told.  Many of us have heard that the fatty acids linolenic acid and linoleic acid are “essential” and must be obtained from the diet.  The oil industry has been successful in using public relations to effectively sell the medical community and the public at large on the “essentiality” of these fatty acids since about the 1950’s. 

An interesting point to be made is that by the 1940’s  it was known that PUFA’s caused deterioration of the brain, muscles, and gonads of a variety of animals, yet the push was still for human consumption.  Not long after this, the animals that were fed copious amounts of fish oil ended up with a disease called steatitis (or yellow fat disease). 

Even more noteworthy in my opinion is the fact that animals that were fed a diet that completely lacked these “essential fatty acids” in fact had an increase in lifespan.      

 

Again, to quote Ray Peat, PhD, in his article Unsaturated Vegetable Oils: Toxic. (yes, I quote Ray quite a bit because I feel he is at the forefront of research in this and other areas):

“Essential fatty acids are, according to the textbooks, linoleic and linolenic acid and they are supposed to have the status of ‘vitamins’ which must be taken in the diet to make life possible.  However, we are able to synthesize our own unsaturated fats when we don’t eat the EFA, so they are not essential.  This term thus appears a misnomer.  

The human body has the capacity to synthesize its own protective Omega-9 fatty acid, which is not considered to be essential, from unsaturated fats and glucose when in an efficient metabolic state.  PUFA’s actually inhibit the enzyme systems that are necessary to form the Omega-9 fatty acids. 

Chris Masterjohn, PhD, also has a really good piece of educational literature on the “essentiality” of these oils which can be found here for a mere $15.00:

 http://www.cholesterol-and-health.com/PUFA-Special-Report.html

On another related note, animals that are “essential fatty acid deficient” actually show strong resistance to the shock phase of the stress reaction; which is another mark against these acids as being “essential” and potentially toxic.    

 

In Closing…

From Ray’s article Suitable Fats, Unsuitable Fats:

“The food-derived polyunsaturated fatty acids play important roles in the development of all of the problems associated with aging–reduced immunity, insomnia, decreased learning ability, substitution of fat for muscle, susceptibility to tissue peroxidation and inflammation, growth of tumors, etc., and are probably involved in most other health problems, even in children. If research hadn’t been guided by the economic interests of the seed oil industry, many of those problems would have been solved by now.”

 

Am I saying that if you take fish oil you are going to undergo spontaneous human combustion? No…though I am sure some readers will take it as such.  Hell, as recently as 6 or 7 years ago, before I really began investigating this particular subject, I took fish oil myself, though not nearly as much as the “experts” suggested.  I fell for the hype just like many others in the health, wellness, and fitness industries.  Thankfully, I have evolved beyond that now.  At the time when I started presenting some of these ideas to colleagues and clients I can remember a running joke on the motivational and quote board that we use that would repeatedly say something along the lines of, “Brandon loves fish oil.”  It annoyed me for about a week…and then not so much. 

 

Will anyone actually benefit from Omega-3 and/or fish oil supplements?  In some cases…possibly, but my opinion is…I doubt it.  The average person is far more likely to have a diet that has a high PUFA : saturated fatty acid ratio.  As such, more fish oil is not the health savior it is reported to be. 

Save the money you would spend on fish oil and use it on real, digestible FOOD instead.  Opt for the healthier, more stable saturated fats (butter, coconut oil, lard, etc.) in place of your estrogen and inflammatory enhancing PUFA’s and fish oil.

If you love fish oil, are convinced of their health-enhancing properties, regularly use fish oil enemas, or hold stock in the world’s leading fish oil manufacturers, please feel free to leave your need for validation below.

Thank you for reading!

 

References and Recommended Reading:

 

The Metabolic Blueprint by Josh and Jeanne Rubin (creators) owners of East West Healing & Performance.

http://www.themetabolicblueprint.com 

 

Articles by Ray Peat, PhD related to PUFA’s, Fish Oil and the like:

  1. Fats, functions and malfunctions

http://raypeat.com/articles/articles/fats-functions-malfunctions.shtml

  1. The Great Fish Oil Experiment

http://raypeat.com/articles/articles/fishoil.shtml

  1. Suitable Fats, Unsuitable Fats: Issues in Nutrition

http://raypeat.com/articles/articles/unsuitablefats.shtml

  1. Unsaturated fatty acids: Nutritionally essential, or toxic?

http://raypeat.com/articles/articles/unsaturatedfats.shtml

  1. http://www.nutri-spec.net/index.html
  2. The Daily Lipid with Chris Masterjohn, PhD

http://blog.cholesterol-and-health.com/

  1. The Randle Cycle…more accurately the Randle Effect

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739696/

  1. Omega-3’s and Lipid Peroxidation

http://www.ncbi.nlm.nih.gov/pubmed/9168460

http://www.ncbi.nlm.nih.gov/pubmed/1432259

  1. A new perspective on atherogenesis

http://www.ncbi.nlm.nih.gov/pubmed/16270286