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Hormones and Obesity

an article provided from ZRT laboratory

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As the incidence of obesity climbs ever higher in the United States and other industrialized countries around the world, so does the number of theories on what are the causes and solutions to the problem. The science becomes ever more specialized as researchers debate the possibility of a genetic predisposition, a lifestyle effect, a socioeconomic effect, or an ethnic component. People struggling to lose weight receive a plethora of dietary advice – eat low carb, eat more whole grains, eat low fat, eat less meat, eat more protein, etc., and no-one seems to agree on the best diet for weight loss. But are we becoming too focused on the details and losing sight of the big picture about how our bodies really work?

Let’s think of the human body. It takes in foods and digests them to supply itself with what it needs to function. A normally regulated body knows when it is hungry and when it has eaten enough. So how does it “know” these things? The whole panoply of bodily functions related to hunger and satiation is orchestrated by chemical messengers that are produced in response to messages from the brain as well as external stimuli that affect us all the time. These chemical messengers are known (and defined) as hormones.
So can it be argued that “my hormones are making me fat”? This blog looks at one family of hormones, the steroid hormones, that have been closely linked with how your body manages to control your weight, and when “out of balance” may result in weight gain. This family of steroid hormones can be grouped into the sex-hormones and adrenal hormones. The sex hormones include the estrogens (estradiol, estrone, and estriol), progesterone, and testosterone. The adrenal hormones include DHEA and cortisol.
Estrogen and testosterone
Estrogens are known as the female sex hormones and testosterone as the male sex hormone. While both estradiol and testosterone in fact have a wide variety of functions in both sexes, women in their youth have about ten times more estrogen than men, and men have about 10 times more testosterone than women. These stark differences in estrogen and testosterone levels in women and men define many of the characteristics that make men and women look and behave differently, including the way our body fat is distributed.
Women tend to have fat stores under the skin (subcutaneous fat), around the hips, and in the breasts. This results in the characteristic female curves that contribute to the characteristic hour-glass figure. When estrogen levels are high, excessive fat deposition occurs primarily around the hips and thighs leading to the typical pear-shaped body type, referred to as “gynoid obesity” or female type obesity.
Normally, healthy men have very little estrogen and subcutaneous fat. When they start gaining weight, it tends to be in the belly, in the intestinal space, and is known as “visceral fat” or “central weight gain”. This results in the characteristic apple-shaped body type, known as “android” (male type) obesity, when weight gain becomes excessive. However, this is also the type of fat that is the most metabolically active and therefore easiest to lose – men generally lose weight more easily than women for this reason. Visceral fat is very easily mobilized in response to adrenalin (the “fight or flight” hormone) and strenuous activity. Think of the hunter-gatherers from which we are descended – the males would store visceral fat preferentially when food was plentiful so that it could be easily used as fuel for the muscles when hunting for the next meal.
The picture is a little more complicated in postmenopausal women, when estrogen levels become very low while testosterone continues to be produced from the ovaries and adrenals. Normally estrogen rules over testosterone at the tissue/cellular level, but when estrogen levels drop at menopause and testosterone levels remain the same this estrogen/testosterone ratio shifts in favor of testosterone dominance. The presence of testosterone that is not counteracted by estrogen, a relative “androgen excess”, tends to promote the male type body fat distribution, and women who tend to gain weight during and after menopause often find that their waistline thickens and they become rather more apple-shaped than pear-shaped. The same effect is seen in women with polycystic ovarian syndrome (PCOS), who over-produce androgens. Studies of estrogen replacement therapy in postmenopausal women consistently show that this can prevent central weight gain, by maintaining a relatively higher level of estrogens than testosterone.
Fat tissue itself is an endocrine (hormone-producing) organ. It contains the enzyme aromatase, which converts testosterone to estradiol and androstenedione to estrone. In obese postmenopausal women, estrone can become the predominant circulating estrogen, rather than estradiol. Estrone is about ten times less potent than estradiol and its presence in the absence of estradiol is a hallmark of menopause.
DHEA
DHEA (dehydroepiandrosterone) is the precursor for the production of estrogens and testosterone in tissues where they are needed, and it therefore circulates in the body in significantly greater quantities than the other steroid hormones. Studies of DHEA supplementation have found no significant effect on body weight, but one of its natural metabolites, 7-keto DHEA, is known to increase the metabolic rate and has been found to help with weight loss.
Progesterone
Progesterone is well known for its ability to balance and optimize the effects of estrogens. With each monthly cycle, estradiol stimulates the proliferation of the breast epithelial cells and those of the reproductive tissues. Progesterone produced in the second half of the menstrual cycle then slows the estrogen-stimulated proliferation, allowing for tissue specialization and differentiation. For the same reason, progesterone is needed to balance estrogen replacement therapy to prevent excessive growth and proliferation of the uterine lining to reduce the risk of endometrial cancer. We know that synthetic progestins are also used for this purpose, but while they effectively suppress endometrial proliferation they have been found to have adverse effects in other areas, notably the cardiovascular system and the breast. Natural progesterone is without these adverse effects, and indeed has many beneficial effects in the body. But some women find that it can contribute to weight gain or bloating. Studies have found that women tend to have an increase in appetite and food intake in the latter half of the menstrual cycle, and during pregnancy, when progesterone levels are higher than usual. An encouragement to eat more in preparation for a pregnancy and during gestation would make sense physiologically, but we don’t need excessively elevated progesterone levels otherwise. Some forms of progesterone replacement therapy may lead to excessive progesterone levels that can increase the risk of insulin resistance, which will promote fat storage rather than utilization for energy. It is important to monitor progesterone levels, as with all hormones, during supplementation to ensure that levels are not out of physiological range and well balanced with estradiol and testosterone. Bloating or weight gain could mean you are using too much progesterone.
Cortisol
Cortisol is an adrenal hormone essential for blood glucose regulation, fat storage and utilization, and control of other body functions like the immune system. Cortisol acts in synergy with many other hormones to help regulate their actions. Cortisol is released from the adrenal glands in response to stressors sensed by the brain. These stressors come in many different forms and include low glucose levels, emotional or physical stress, or invasion of the body by pathogens. Cortisol mobilizes glucose from the glycogen stores in the liver to be used as short-term energy for the muscle. While normal physiological levels of cortisol are essential to survival, excessive levels caused by chronic stressors shut down non-essential body functions, such as the immune system, and by suppressing the production of other hormones, such as sex hormones, growth hormone, and thyroid hormones. When stressors are present for extended periods the system goes awry and we develop a chronic stress condition and persistently elevated cortisol levels. When this happens, the effects of cortisol on blood sugar result in an increased appetite, particularly for carbohydrates (“stress eating”) and storage of more glucose as fat, especially in the visceral area, which has more cortisol receptors than other types of fat tissue. Stress-related weight gain can be treated by finding and reducing sources of stress, as well as relaxation techniques to reduce the harmful effects of stress on the body.
Conclusions
When you understand more about your body and how it is hormonally regulated, it is easier to see that hormones, when in balance, are friends rather than foes. The entire endocrine system includes many more hormones than are mentioned above, which are involved in metabolic processes and other bodily functions that can affect our weight and our overall health. But even taking just the reproductive hormones and cortisol, and a little common sense, we can conclude that:

1. We have changing reproductive hormone levels as we age. In our attempts to replenish hormone levels back to youthful levels, we sometimes upset the balance as we replace hormones to levels outside an ideal range, and we don’t recognize the effects this hormonal imbalance has on weight gain.
2. Weight gain itself affects hormone balance.
3. Our bodies have highly efficient stress responses, but the extreme, prolonged stresses of modern life have created an unhealthy hormonal imbalance (excessive cortisol) that has contributed to weight gain.

It is important not to ignore the elephant in the room, the highly palatable and refined foods that dominate the “Western” diet, which are clearly associated with the obesity epidemic. These are not the foods our ancestors ate.Our bodies have not adapted hormonally to the challenges of regulating fat stores when presented with these foods in excess.
Keeping our hormones in balance while maintaining a healthy diet, following an exercise program, and aiming for a stress-reduced lifestyle is key to optimal wellness and longevity.

References

1. Björntorp P. The regulation of adipose tissue distribution in humans. Int J Obes Relat Metab Disord. 1996;20(4):291-302.
2. McTiernan A, Wu L, Chen C, Chlebowski R, Mossavar-Rahmani Y, Modugno F, Perri MG, Stanczyk FZ, Van Horn L, Wang CY; Women's Health Initiative Investigators. Relation of BMI and physical activity to sex hormones in postmenopausal women. Obesity (Silver Spring). 2006;14(9):1662-77.
3. Pasquali R, Vicennati V, Gambineri A, Pagotto U. Sex-dependent role of glucocorticoids and androgens in the pathophysiology of human obesity. Int J Obes (Lond). 2008;32(12):1764-79.
4. Shi H, Seeley RJ, Clegg DJ. Sexual differences in the control of energy homeostasis. Front Neuroendocrinol. 2009;30(3):396-404.
5. Torréns JI, Sutton-Tyrrell K, Zhao X, Matthews K, Brockwell S, Sowers M, Santoro N. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: study of Women's Health Across the Nation. Menopause. 2009;16(2):257-64.
6. www.endotext.org; Endocrine changes in obesity. (Free registration required)

It's Not Just About the Ovaries

Women are driving the ship of Bio-identical hormone therapy more than ever before.  Honk Honk!!  Let me just pause there for a HIGH FIVE!!  The momentum is gaining to the point that pharmaceutical companies are beginning to strong arm insurance companies in efforts to combat the abandonment of the synthetic regimens of years gone by.  Their wallets are getting thinner because of individualized and customized medicine, that WORKS!! I had a call yesterday from a long standing patient who received a letter in the mail that her custom therapy would no longer be covered by her private insurance plan.  Boo-Hiss!!  Those are fighting words I tell you and there's nothing like telling a peri-menopausal woman that she can't have something anymore that she loves and that makes her feel better.  She simply wanted answers and I don't blame her.  I had my hand up saying the "Amens" right there with her. Remember, I'm a bio-identical hormone user MYSELF.  Truth!  I immediately directed her to call her insurance company and ask them to explain why.  I absolutely love that the new force to be reckoned with in this hormonal balancing field of medicine are a brigade of believers with ranks including stay-at-home moms, executives, laborers, physicians and practitioners (believe me, I have many), stage performers, menopausers, peri-menopausers, and young women who just want some good options in treating their symptoms and needs.  Years ago, I had to do a lot of the fighting myself for people.  Uh, not so much anymore and I love that.   Turn the women loose!!

Hormones are where it's at, my blog friends.  I have never seen so many clear cut studies coming out supporting the role of hormonal balance in overall health, improved mortality, cognitive function, bone health, reduction of other disease risks, and in longevity.  A staff member recently brought in a popular magazine article with the title,  "I knew I shouldn't feel this tired."  The article focused on adrenal fatigue, low DHEA and cortisol, and the impact that it had on this woman's life.  I excitedly read it for myself and proclaimed, "That's what I'm talkin' 'bout!"  (My team is used to me and they know I love that kind of stuff)  I'm especially excited because this is hitting the media and press in every form.  I still have Oprah's magazine in my office from 2009 where she shares her personal story about hormonal imbalance.  From about that time forward, I have seen a tremendous amount of growth and attention to this area of health and wellness.  And, I didn't go back to school because I didn't think this would happen.  I'm now buckling my seat beat and enjoying the new drivers at the wheel of their (and their families) healthcare.  Drive on, ladies!

Today, as an example of the importance of this, I want to highlight one key hormone that can't be ignored for the aging woman.  Progesterone is a BIG player in the female scheme of things, and typically the first hormone to go down, down, down with aging.  Although the ovaries are the powerhouse of production for sex hormones, that decline of progesterone and other hormones can have a significant impact on HEART health.  We can live without ovaries ladies, but we cannot live without our heart.....and we can't deny what the studies are showing us.  It's time to talk hormones and heart disease like never before.

At menopause (avg age of 51), the levels of estrogens, progesterone, and testosterone, secreted by the ovaries, decrease considerably.  In a woman's third decade of life and up to about 50 years old, progesterone can drop by up to 75%.  Whoa!  That should get your attention.  And, if you have had a hysterectomy with ovaries removed, just consider yourself right there on the quick hill of decline with those who are going through menopause naturally.  Here's something you need to know.  Progesterone is not the same as the 'synthetic and pharmaceutical company version' called medroxyprogesterone.  There's an added prefix to that name for a reason and it's because it's not a true replica of what the body produces on it's own.  Add a methyl, get a patent!! Although they sound similar, their similarity ends there.  The methyl group addition at C-6 in the structure (pardon me for the organic chemistry lesson but I think it's important) is ABSENT with progesterone.  Studies show us that this little switcheroo does not provide the benefit that progesterone does to our body. 

Remember that progesterone is a pro-gestational hormone.  It is KEY in sustaining a pregnancy, impacting fertility, regulating menstrual cycles and the list goes on and on.  Conversely, medroxy-progesterone is teratogenic and contraindicated in pregnancy.  Say what??? Are you seeing this picture???  I hope so!  One cannot reasonably be substituted for the other in pregnancy, but also as a general rule in providing hormone replacement therapy (in my professional opinion).  I'll take progesterone, hold the methyl please!!   You must also know that Progesterone is essential in the production of other hormones.  (ie. cortisol, aldosterone, estrogens, testosterone, etc. etc.)  We need ALL of these hormones working on our behalf and progesterone is the necessary start of the steroid production pathway.  Take a look at a hormone synthesis chart and you'll see progesterone near the top.  You will quickly realize (hopefully) that you don't want to use a synthetic substitute!! 

Remember the title of this blog.  It's not just about the ovaries.  It's not!  Heart Disease is the number ONE cause of death in women.  Not cancer!  And, I repeat, not cancer!  In many studies to date, we are seeing evidence that progesterone (NOT medroxy-PG) added to estrogen can have a complimentary role in protecting the heart and other health improving markers.  Cholesterol profiles improve, treadmill exercise times improve, a natural diuretic effect occurs, and blood pressure profiles improve.  Conversely, medroxyprogesterone consistently shows negative effects when tracked in studies.  Now that's getting down to the "heart" of the hormone matter if you ask me. In other matters, progesterone can help re-establish menstrual cycles, provide sedation for those suffering from insomnia, and acts as a anti-anxiety agent to most everyone I talk to in my care.  I can verify that during my days on cycle progesterone therapy, I feel more at ease, less bloated, and sleep without those crummy sweats that tend to creep up in those golden peri-menopausal years.   I don't mind sharing my own experiences because I know that it will help others feel comfortable in getting the help that they need.  But, I'm sure you don't have any aging symptoms going on for yourself, right?  (wink wink)

Hormonal balance is one of the areas of my expertise that I love working in the most.  If you could sit in this office and hear the benefits that women share back, you would easily understand why it's so rewarding.  I'm convinced that it's the right thing to do.  From the young woman struggling with PMS, PCOS, or irregular cycles, to the post-menopausal woman noticing that she's foggy in mind, gaining tremendous weight, and has no energy to perform daily tasks, our team can help give insight to all ages and all stages of aging and guide you through testing.  It's easy and affordable to see how well you are doing on the hormone measuring scales.  I'm not sure why you would wait to be checked if you are suspicious that your problems are a direct result of hormonal imbalance.  Perhaps it's time for YOU to get back to normal. 

To your good hormone health,
Dr. Sonja

Young Women and Hormones

I can't help but use some real patient situations to teach others who might be struggling with some of the same things you will read about in this blog.  In the last 6 months or so, I have noticed a growing patient population of young women connecting to our office for help with their suspected hormonal imbalances.  I love it!!  Why do I love that so much?  Because I feel that many women have suffered for a very long time with endometriosis, missed menstrual cycles, horrible menstrual cramping, infertility, ovarian cysts, premenstrual syndromes, depression, and anxiety, and many other hormonally driven problems.  Menopause is one thing that we link to hormones, but young women also need to know that they don't have to be middle age to experience significant imbalances as well.  Addressing them early in life is critical in health for the long haul.  And birth control pills are not the magic cure-all for the things that ail young women.  Just being honest and the reason customized therapies with bio-identical hormones and natural treatments continues to grow. 

Here's a few brief scenarios of what young women are struggling with out there and I can promise that in a majority of these type cases, hormones are to blame.

Maybe YOU can relate to one of these women???

1.  A young 25 year old woman who had already been diagnosed with Polycystic Ovary Syndrome (PCOS).  She is growing hair in certain places of the body and losing it on her scalp.  She is also struggling with intense weight gain (despite eating very little), experiencing extreme mood swings, missing menstrual cycles, suffering from acne breakouts, and experiencing vaginal dryness.  She sought me out and asked if I would be willing to help her check her hormone levels and to create a regimen of therapy so that she can try for a pregnancy in a few months.  "ABSOLUTELY!!", was my answer.   Get this!  She was diagnosed in her late teens and felt as if her case was hopeless.  Well, it's not! I just shared the lab reports with her yesterday and she now has a plan that is outside of everything else she has ever tried.  We clearly identified reasons!!!  I FULLY expect that she will be successful in starting a family after we get some of these 'reasons' reset for her.  She also needs to be encouraged to address this, because PCOS can cause diabetes and other endocrine diseases if left untreated.  Oh, and BTW, she is in nursing school and just couldn't shake the teachings she was made privy to in her studies. She acted on her knowledge and suspicion that more could be done.  And, yes, more can be done! Yeah for her!!

2.  A 28 year old with depression and anxiety, missed menstrual cycles, weight gain, extreme fatigue, exaggerated stress, and PMS symptoms.  Again, this young women needs to have her hormones evaluated.  Her case wreaks of hormonal deficiencies and a stress syndrome.  Just doing some lifestyle teaching and creating a supplement regimen for her can be incredibly life changing for her.

3.  A 30'ish woman with fatigue, painful intercourse, irritability, endometriosis, low libido, vaginal dryness, stress and lifestyle demands, depression, anxiety, and emotional instability.   This young women has a long life ahead of her and using band-aid coping medicines is not what's best for the long haul.   Again, testing her sex hormones along with her adrenal status, and treating her unique physical needs, can turn her around 180 degrees. 

4.  A young woman with menstrual migraines.  Hormones can be a reason for headaches and noticing their onset and severity near menstrual cycle time, can be a good clue that things need to be checked.  I have plenty of patients in my care who use hormone therapy to minimize or eradicate menstrual headaches.  I also advise on elimination of certain known environmental and food triggers linked to headaches.

If you are a young woman reading this, and if you are "dealing with" any of these problems, you should get tested.  I will be happy to guide you on the process of finding reasons and answers. If you are a mom or grandmother reading this for your young female family members, then please share this information to them.  It's so affordable and so critical to health. 

I'm proud to say that I've been doing customized and creative medicine for nearly 20 years.  I now take care of entire families, circles of friends, and now many physicians and practitioners are joining our patient pool.   Word of mouth is our teams greatest advertisement.  That means a GREAT deal to us !!  It really, really, really does.

To health and happy hormonal balance,
Dr. Sonja