functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
given without concomitant progesterone
supplementation regardless of whether or not the
patient has had a hysterectomy. Balancing with
adequate progesterone is not only important to
prevent endometrial cancer, but will also protect
the brain, the heart and the breasts iv
. Estrogen
doesn’t refer to a single hormone, but is rather a
group of hormones that differ distinctly in molecular
structure as well as in physiologic role. The
human body produces three primary estrogens:
estrone, estradiol and estriol. Estradiol is the
most biologically active of the three, and therefore,
one of the most commonly prescribed; however, it
is best when given in combination with estriol v
.
Estriol (E3) is the weakest of the estrogens;
though it binds to the same estrogen receptors, its
action is significantly weaker. Because of this
property, the presence of estriol can work to
govern the proliferative effects of estradiol by
competing for receptors vi . A combination of
estradiol (E2) and estriol (E3) is often referred
to as biest or two estrogens. The third estrogen,
estrone, is not recommended for hormone
replacement, as many of its metabolites are
carcinogenic.
Though there is much individual variability in
estrogen levels, progesterone levels are almost
always low in the peri and post menopausal
population vii
. It is the relative loss of progesterone
compared to the decline in estrogen that causes a
number of symptoms including breast tenderness,
menstrual irregularities, mood changes, depression,
tearfulness, foggy brain and more. The
disproportionate loss of progesterone (termed
‚estrogen dominance‛) begins in the latter stages
of a woman’s reproductive cycle, when the luteal
phase of the menstrual cycle begins to
malfunction viii
. Because the corpus luteum is the
primary source of progesterone, when there is no
ovulation, there is very little progesterone
produced.
The term ‚estrogen dominance‛ can be confusing
at times because it is less related to the amount
of circulating estrogen and more related to the
ratio of estrogen to progesterone in the body.
Symptoms of Estrogen Dominance include:
� Mood Swings
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� Irritability
� Depression
� Irregular Periods
� Heavy Menstrual Bleeding
� Hot Flashes
� Vaginal Dryness
� Water Retention
� Uterine Fibroids
� Decreased Libido
� Headaches
� Fatigue
� Weight Gain: Hips, Thighs and Abdomen
� Sleep Disturbance (Insomnia, less REM
sleep)
� Breast Tenderness/Fibrocystic Breasts
� Bone Mineral Loss (Osteoporosis)
� Short-term Memory Loss
� Lack of Concentration
� Dry, Thin, Wrinkly Skin
� Thinning of Scalp Hair
� Increased Facial Hair
� Diffuse Aches and Pain
Hormone imbalance, and particularly estrogen
dominance, is not a condition that is limited to the
menopausal population. In a cycling woman,
progesterone is the hormone that should be
dominant during the second half of the menstrual
cycle ix . There are many factors that can affect
the ability of the corpus luteum to produce
adequate progesterone including stress, diet and
the use of exogenous hormones, such as birth
control pills. The hormones found in birth control
pills are not the same as progesterone produced
by the body. Synthetic progestins differ
significantly in molecular structure as well as in
action x . While natural progesterone decreases a
woman’s risk of breast cancer and cardiovascular
disease, synthetic progestins increase it. The
most famous study illustrating this fact is the
Women’s Health Initiative, a large multi-armed
research project that followed over 16,000 women
for an average of 5.2 years and concluded that
the participants who had been taking the progestin
medroxyprogesterone acetate had a statistically
significant increase in rate of breast cancer,
2012