Which Comes First: The Hormones or The Gut?

Margaret Floyd Barry

February 18, 2020

A client came in to see me a few months back. Let’s call her Maryanne. She was experiencing crippling pre-menstrual symptoms every cycle: incredibly volatile emotions and crying spells, fainting episodes, extreme bloating and cramping, and acne – all of which would start mid-cycle and escalate to being almost unbearable by the time her period finally arrived. She was miserable. And desperate. 

For our first session together, we did a deep dive into her health history and food journal. She’d had horrible periods since she began menstruation in her early teens. Several doctors had prescribed the birth control pill, but it gave her headaches and she put on a lot of weight with it, so she’d never stayed on it for long. She also hated the idea of being constantly medicated. 

Maryanne’s digestion, on the other hand, appeared to be rock solid. She had regular daily bowel movements, no heartburn, bloating, or any discomfort other than very occasional gas if she ate a lot of cruciferous vegetables or legumes. She ate well, avoiding gluten and refined sugar, and she always sought out organic options. 

At the end of our session I recommended we start with gut healing and food sensitivity testing. She looked at me, confused. Her digestion was great – why start there? 

Anne shared last week that we always start with digestion as the body’s top healing priority, and this client scenario is a great example of when it’s challenging to make the case for starting with the gut. Isn’t this obviously a case of hormonal imbalance? Or wouldn’t it be an endocrine-related issue like something to do with her adrenals, since we know these are intimately connected with hormones? 

A hormonal issue may have its origins in the endocrine system, but without first assessing gut health and addressing anything we find there, the hormonal rebalancing work won’t last very long. Here’s the connection: 

For one, all of our hormones need to be synthesized from nutrients accessed via the diet. If one’s digestive capacity isn’t strong enough, those nutrients aren’t readily available. When we’re talking about reproductive hormones, we’re thinking about fat digestion in particular because sex hormones are steroid hormones and built from fats. 

Next, our body’s ability to process and clear spent hormones is directly connected to two key digestive organs: the liver and the intestines. The liver conjugates all our hormones whether they are endogenous (those our body creates) or exogenous (those we are exposed to from external sources. This is true for intentional hormone replacement therapy or unintentional exposure from xenobiotics hidden in our food and environment). If the liver isn’t functioning properly, the conjugation process will be compromised. 

Once the hormones are conjugated, they leave the body, escorted out through the intestines via the bile (another key digestive player that contributes to peristalsis and emulsifying fats). When there are gallbladder issues or if the bile is thick and sludgy, it will negatively affect those hormones trying to leave the body. Likewise, the enzyme beta-glucuronidase that inhabits the large intestines can proliferate and de-conjugate the conjugated hormones, essentially breaking apart the “packaging” the liver had put them into and allowing those hormones to re-enter the bloodstream. Beta glucuronidase proliferates in a dysbiotic gut environment. 

And so: if Maryanne has any digestive issues that are compromising biliary secretions, liver function, microbiome balance, nutrient absorption or digestion enzyme production, this is going to directly affect her hormone levels and contribute to imbalances. If we don’t start there, we are ignoring a vitally important piece of the puzzle. 

Sure enough, when we tested Maryanne’s digestive capacity with the GI MAP stool test, we found many opportunistic bacteria overgrowing, low levels of the beneficial bacteria, significant amounts of inflammation in her colon, and elevated b-glucuronidase levels. Food sensitivity testing revealed that several foods she was eating on a regular basis were highly inflammatory in her body, exacerbating the hidden digestive issues she had. 

We focused entirely on healing up her gut and removing inflammatory foods, and hadn’t done any hormone testing yet. Her first cycle after we began this protocol, she still had some symptoms, but they were far less pronounced. By the end of our 3 month protocol, her hormonal symptoms had subsided to the point that we decided to hold on any hormonal testing for the time being and to give it another two months to see if things completely improved. And guess what: they did! 

Had we started with hormone testing would the results have been the same? We’d not have identified the gut imbalances that were exacerbating her hormonal issues and so we wouldn’t have addressed critical underlying factors. It’s hard to imagine that her results could possibly have been so profound or so lasting.

Now, it’s important to be clear that starting with the gut doesn’t always assure that you’re going to knock out every other symptom your client is experiencing. Some hormonal issues are more complex and do require direct intervention beyond digestive healing. But when you start with the gut you will often find that other seemingly unrelated issues resolve, and if additional healing layers are required it is easier, longer-lasting, and more effective. 

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