How Chronic Stress Leads to Hormone Imbalance

August 23, 2014 in Categories: , , , by

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When we think about the effects of chronic stress, we think of cortisol.  We think of weight gain, especially around the middle.  We think of headaches and depression and anxiety.  We think of poor sleep quality.  Those of us who are very knowledgeable about health and nutrition think of increased cardiovascular disease risk.

Not many of us think about PMS, low libido, heavy or irregular periods, or amenorrhea.  Or how disruption in sex hormone levels can lead to low thyroid function and osteoporosis.  Or infertility. But those are also consequences of chronic stress for women.

As you’ve probably heard the likes of Robb Wolf and Diane Sanfilippo say “writing a health book is one of the worst things you can do for your own health“.  When I completed my first book, The Paleo Approach, I suffered a complete health crash.  The morning after the book was finally submitted to the printer, I woke up with pneumonia.  I had three infections over the next six weeks.  I gained 20 pounds in the months leading up to finishing The Paleo Approach, and the weight didn’t magically melt off when the book was done.  I was getting plenty of sleep but was still tired all the time, relying on caffeine to get me out of bed.  I was working out and watching myself get stronger, but my weight just kept slowly creeping up.  And when I tracked my caloric intake, it didn’t make sense.  I was getting 1800 calories per day (about what I still get now, but back in January I was gaining weight and now I’m losing it) and getting ample of all the essential micronutrients.  This was a great example of how weight loss does not equal calories in versus calories out, but I wasn’t a big fan of being an example of what can go wrong with your metabolism….

So, I asked for help.

I knew something was broken that diet and lifestyle couldn’t easily fix.  It didn’t help that I went straight from finishing The Paleo Approach to working on The Paleo Approach Cookbook.  So, I found a local functional medicine specialist, Dr. Lynn Flowers, who was an emergency medicine doctor for 20 years (but always interested in integrative and functional medicine) before deciding to open an anti-aging practice.

We ran a battery of tests.  There was lots of good news (normal thyroid, great cholesterol, genetic testing showed no complications with ApoE or MTHFR).  But, we discovered that I had adrenal insufficiency (more colloquially referred to as adrenal fatigue).   I was low in cortisol and DHEA–all day.  Not really a surprise.   I had been burning the candle at both ends for months and it was obvious to everyone in my life that the stress was definitely getting to me. When your stress level is chronically elevated, eventually the adrenal glands (and availability of substrates) just can’t keep up.  Chronically low cortisol is the direct result. [I will be talking about some of the other negative health effects of this stage of adrenal burnout in an upcoming post.]

What did surprise me was that I also had hormone imbalance.  Low testosterone, low progesterone, normal estrogen (but this still creates estrogen dominance because the relative amount of estrogen to progesterone is so high).

So, how did that happen?

What is the link between stress and sex hormones?

And what happens when you’re chronically stressed?

And what happens when your sex hormones are out of whack?

To answer these questions, I first need to describe the Hypothalamus-Pituitary-Adrenal Axis (HPA Axis) and the Hypothalamus-Pituitary-Gonadal (HPG Axis).

The HPA Axis

HPA_axisThe HPA Axis is responsible for the flight-or-fight response.  The hypothalamus (which receives signals from the hippocampus, the region of the brain that amalgamates information from all the senses and can thus perceive danger and make decisions) releases a hormone called Corticotrophin Releasing Hormone (CRH), which signals to the pituitary gland to release a hormone called Adrenocorticotropic Hormone (ACTH), which signals to the adrenal glands to secrete cortisol as well as catecholamines (like adrenalin).

Cortisol has a huge range of effects in the body, including controlling metabolism, affecting insulin sensitivity, affecting the immune system, and even controlling blood flow.  If you’re running away from a lion, all these effects (including the combined effects of catecholamines and some direct effects of CRH) combine to prioritize the most essential functions for survival (perception, decision making, energy for your muscles so you can run away or fight for your life, and preparation for wound healing) and inhibit non-essential functions (like some aspects of the immune system especially not in the skin, digestion, kidney function, reproductive functions, growth, collagen formation, amino acid uptake by muscle, protein synthesis and bone formation).

Cortisol also provides a negative feedback to the pituitary and the hypothalamus.  It’s the body’s way of saying “hey, we got the signal that we’re supposed to be stressed now, thanks, we’re on it!”.  If the stressful event has ceased (the lion gave up and left), this is what deactivates the HPA Axis. Of course, if a stressor is still being perceived (that lion is still there), the HPA axis remains activated.  And this is why chronic stress (deadlines, traffic, sleep deprivation, teenagers, divorce, being sick, being inflamed, alarm clocks, bills, and internet trolls) is such a problem.  All those essential functions suppressed by high cortisol never get a chance to be prioritized.

The HPG Axis

HPG_female_axisThe primary role of the HPG Axis is to control reproduction, however it is also important for development (puberty and aging) and the immune system.

 The hypothalamus releases Gonadotropin-Releasing Hormone (GnRH), which signals to the pituitary gland to secrete two hormones:  Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH).  LH and FSH signal to the gonads produce estrogen and progesterone in women, and testosterone in men.

Because women’s bodies are particularly susceptible to effects of stress on sex hormone levels due to interaction between the HPA and HPG Axes, I’m going to focus from this point forward on the female HPG Axis.

Estrogen and progesterone also signal back to the pituitary gland and the hypothalamus.  Generally, estrogen provides positive feedback, further stimulating the HPG Axis (although there are some mechanisms for negative feedback as well).  Progesterone provides negative feedback, inhibiting the HPG Axis.  In the menstrual cycle, the positive feedback from estrogen prepares the follicle in the ovary and the uterus for ovulation and implantation. When the egg is released,  progesterone production inhibits the hypothalamus and pituitary, blocking the positive feedback from estrogen.  If the egg is fertilized, the fetus takes over production of progesterone (why you don’t ovulate again while pregnant). If conception does not occur, progesterone productions starts to decline, which allows the HPG Axis to be stimulated, causing menses and the whole shebang to start over again.

estradiol_cycle

This is an oversimplification.  There are other hormones at play here.  And all these hormones are controlling dozens of aspects of fertility and menstruation, as well as things like linking back to thyroid function, bone formation, and immune health.  And it’s very important that these hormones cycle in rhythm with each other.  And when one of the players is out of tune, the whole symphony sounds wrong.

The Links Between the HPA and HPG Axes

The HPA and HPG Axes are not isolated endocrine systems.  There’s crosstalk.  Plenty of it. For instance, progesterone activates the HPA axis.  This is probably part of the metabolic controls, shift in immune system, and shift in the body’s resource priorities during pregnancy.  Probably why we also tend to have such strong food cravings in the days leading up to our periods starting.

But the links are more insidious than food cravings.  Cortisol inhibits the HPG Axis at every point.  It reduces the production of GnRH by the hypothalamus.  It reduces the production of FSH and LH by the pituitary gland.  It suppresses ovary function, reducing estrogen and progesterone secretion.  This is because, if you are running away from a lion, reproduction is just not a priority.  The body takes those resources and uses them for immediate survival.

 HPA vs HPG 2

But, what if the lion never stops chasing you?  When you are chronically stressed and especially if your stress level is high (and you aren’t spending time outside, and you aren’t active during the day, and you are staying up late and not getting enough sleep and using caffeine and sugar to get you through the day), it’s basically the same physiologic effect of chronically running away from a lion.  Reproduction (and digestion, and bone formation, and growth, and parts of the immune system, and collagen formation etc. etc. etc.) never get prioritized.

So, if you’re chronically stressed, estrogen and progesterone can be decreased.  But, what’s more, the body converts progesterone into cortisol.  And into estrogen. And testosterone (a hormone that the female body still needs, albeit in much lower concentrations than in men).  Yes, progesterone is a substrate from which cortisol and estrogen and testosterone are synthesized.

The following diagram shows how these essential hormones and their precursers and  intermediaries are produced from cholesterol (yet again, the essential cholesterol!).

hormone 1a

Yes, it’s complex.  Here’s the important part:  cholesterol (the backbone of all steroid hormones) is converted into pregnenolone.  Pregnenolone is the converted into either DHEA or Progesterone.  DHEA is converted into testosterone and estrogen.  Progesterone is converted into cortisol.  Still with me?

When the body is stressed, and it starts using up progesterone to make cortisol.   It needs more progesterone, so it starts using more pregnenolone to make it.  This is called pregnenolone steal.  The HPA Axis is literally stealing the precursor for testosterone and estrogen (because pregnenolone is being used to make progesterone instead of DHEA) from the HPG Axis.  What’s more?  It’s using up all that progesterone to make cortisol.

hormone 2

By the way, this is also how chronic stress leads to low testosterone in men (one of the symptoms of which can be balding!).

There’s some extra complications here.  When DHEA is low, the body tends converts testosterone and what little DHEA is being produced into estrogen.  Environmental estrogens (like the phytoestrogens in soy or flax seed or walnuts, or like the xenoestrogens in some plastics) further increase estrogen.  Nutrient deficiencies and lifestyle factors like type and frequency of activity can further influence exactly what hormones are getting produced and what hormones aren’t.

The Take-Home Message

The take-home message is this:  chronic stress messes up your sex hormones.

How might you know if chronic stress has negatively impacted your hormones?  Symptoms include:  depression, fatigue, anxiety, hair loss, facial and body hair growth, headaches, dizziness, brain frog, poor memory, low libido, vaginal dryness, breast swelling and tenderness, fibrocystic breasts, thyroid disorders, osteoporosis, PMS, dry or wrinkly skin, urinary tract infections, endometriosis, uterine fibroids, weight gain (or resistance to weight loss), water retention, bloating, sleep disturbances, mood changes, irregular periods, loss of periods (amenorrhea), heavy periods, and infertility.

The natural follow-up question is what can you do if you think you have hormone imbalance as a result of chronic stress?  Well, first and foremost:  reduce your stress!  Say “no”, ask for help, get enough sleep (at least 8 hours!), be active (but avoid strenuous activities), have fun, laugh, spend quality time with loved ones, orgasm, spend time outside, learn to meditate, make time for hobbies, and go for a walk.  It’s time to give up caffeine and alcohol (temporarily!).  Support liver health by eating a nutrient-dense diet that includes organ meats, seafood, and plenty of vegetables.  I recommend The Hormone Cure by Dr. Sarah Gottfried and Sexy By Nature by Stefani Ruper as two excellent resources for optimizing diet and lifestyle to restore sex hormone balance.

This is serious stuff, and depending on a variety of factors, diet and lifestyle are sometimes not enough to set things straight. If you are going to consider hormone balancing therapy, know that it will not work if your diet isn’t clean (nutrient-dense Paleo, meaning a Paleo diet with a focus on organ meat, seafood, and vegetables, should suffice) and your lifestyle isn’t optimized (stress is low, activity level is moderate, and sleep is ample).  Get tested and find a skilled medical professional to work with before you start messing around with supplements and taking hormones.

So, where am I now?

I’ve been working on reducing stress, prioritizing activity and sleep, and keeping my diet super clean along with hormone balancing therapy guided by Dr. Flowers for 5 months.  The intense process of creating The Paleo Approach was a learning experience.  And also, it was worth it:  The Paleo Approach is a New York Times Bestseller that is helping tens of thousands of people reclaim their health.  And even better, I was able to take those life lessons and apply them to finishing The Paleo Approach Cookbook.  I just retested hormone levels and adrenal gland function but do not have the results yet.  But, I’m losing fat, putting on muscle, have great energy, my skin looks amazing, my hair is thicker and I have much greater what Dr. Flowers calls sense of wellbeing.  I’m pretty sure I’m not all the way back to normal yet, but I’m well on my way.  And that feels really good!

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Links to Diet

If you’d like to know more about the links between stress and hormones (and how diet might affect these systems), you may find my joint talk with Stacy Toth at the Ancestral Health Symposium 2014 to be interesting.

Do you need help finding a medical professional to work with?

My  consultants, with specialties in dietetics, nutritional therapy, health coaching, and functional medicine, offer a variety of packages, from simple 1-hour consultations where you can ask your questions to full 6-month packages.  They can work with you remotely (via Skype, phone and e-mail), and you can learn more about the individual consultants and services offered here:

I also recommend finding a qualified physician or alternative healthcare provider (many of whom can work with patients remotely) to work with via:

Comments

This was SUCH a helpful post. I appreciate so much your ability to phrase scientific information in a simplistic way that communicates understanding. I am nearly 24 and dealing with some pretty serious hormonal problems right now between low estrogen and progesterone on top of low functioning adrenals and low cortisol. This helps so much for me to understand all the complex connections. It doesn’t help much either that my thyroid levels result in hypo thyroid. I am working with a functional medicine practioner, but your post is so important because it gives me better understanding and that is more valuable than you know!

Wow thank you. Suffering from several issues described, amenohrea being the most severe. Eating super clean, some dairy but trying to quit. My stress originates in the stomach, and it is present ALL THE TIME. i try to meditate etc., but when I am not alone at home and really meditate and concentrate, my stress levels go up like crazy and I can’t slow down.
Any tips on how to incorporate the meditative calmness in stressful everyday living?
Also wondering, if using your consultancy and living in Eurpoe, how would tests and medication be sent and received? Have you worked with anyone in Europe?
Thank you again for awesome blog post.

Ellen

This was very helpful, and exactly the thing I’ve been trying to find more information on. I deal with hair loss on and off, and it started again recently. I’m almost 32, and lately I’ve noticed my previously young-for-its-age skin suddenly getting all sorts of fine lines, as if it’s dry even though I moisturize every day. I have so many food sensitivities that I can’t even eat most meat because I react to the corn and chemicals used in the processing and packaging. But here’s the thing: I get way more sensitive to even small amounts of corn or other problem foods just before and during the first part of my period. I get heart palpitations during my period. My anxiety often goes off the charts during my periods, making me feel downright insane. Yes, there’s the thing you are probably not surprised at: I have an anxiety disorder. I spoke with a dietitian last week, and she agreed that a hormonal imbalance can cause digestive problems, but said there was not enough research to use that in finding a way to treat me. It’s good to read you write about all this, simply because it makes me feel like less of a hypochondriac for noticing all these patterns in my health problems. I didn’t make them up! Yay! I’m so glad someone is looking into it. Reducing stress is a constant struggle for me, and I’ve come a long way, but things are so hard with my diet right now that the restrictions have become a major contributor to my anxiety…and yet I may never be able to heal and loosen the restrictions if I can’t stop feeling anxious. It’s quite the puzzle. I guess I should meditate and try to be at peace with eating only fish and plantains and restricted types/amounts of produce? I’d be very interested in knowing if you’ve run into anything about a hormonal imbalance causing more gut sensitivity.

Have you any idea how discontinuing the estrogen suppressing drug Arimidex® (anastrozole) might impact these systems? I experienced an adrenal crash following my discontinuance of Arimidex after 4 years of the drug (plus an initial year of Tamoxifen). I wonder if there may be some relationship there. I was also under an enormous amount of stress.

Great Post ~ Connecting the breath with relaxation of the neuromuscular system/CNS is critical..Most pp who are dealing or have dealt with autoimmune issues have deep-seated trigger points {especially around the digestive area} that aren’t going away without some significant intervention. {yoga poses with lonnng holds to alter Fascia and trigger point therapy}….Fecal Transplant Therapy is great for C. Diff infection but the numbers drop off significantly when used for traditional autoimmune disorders b/c it can’t address the underlying NM components

Thank you so much for this post! I have the exact same issues right and I also have thyroid disease. I just had a full panel female hormone test done and I am still waiting for results. Like you said it seems the more and harder I workout the more weight I gain! I have hope to lose the 20 lbs I’ve gained and keep gaining :( Your post made me realize I’m not alone and there really is hope! Right now my focus has been alot on clean eating and de-stressing. Thank you!

Thanks so much for this! I have the exact same problems without being able to identify the rootcouse of my stress. I find it really hard to loose weight although I’m following the recommendations for several months. One month is better, another is much worse. It is quite frustrating somethimes. Ketogenic diet made things worse. I’m stuck.

I knew it! Ahem, I mean I knew that my out of whack sex hormones had something to do with cortisol and chronic stress. Last fall I got blood test results showing that my androgens level was sky high so the gynecologist prescribed me BC pills. I wasn’t eager to put more hormones into this already-messed-up-hormones-equation so I asked my endocrinologist if maybe we could do cortisol test. And she laughed at me. She told me that androgens are in no way connected to cortisol. Or stress. Or coffee (as I specifically asked her about coffee). As if my hypoglycemia wasn’t a sign of problems with cortisol. Anyway, so I’m reading The Hormone Cure at the moment and I am not sure what to do. I really do not want to take BC pills (especially knowing that the main hormone is CMA, which is progestin and might cause even more harm) and I wish I could bring this issue to my doctor, but I can’t as none of them reads English and none of them truly listens to me (and while seeing a different doctor might be a good idea, I’ve already seen three of them. One said it was genetics, other told me to take BC pills and the third one couldn’t care less). The outer results of hyperandrogenism are terrible (alopecia and facial hair) but the constant fatigue and brain fog worries me even more.
Either way, thank you for the post and I hope to hear about your progress in the future.

Thank you so much for this post. All I could say is that you might have been reading my emails on this subject. I started the Paleo diet on 7/20 (I’m doing level III). I’m 49 years old. I have not seen the drastic changes in my body and health that Dr. Loren Cordain’s book and others talk about. I still have pain in my muscles and joints. I’ve lost just under two pounds and about 1.5 inches overall. I still wake up tired every morning and I am having severe bloating around PMS time. I was losing more weight on WW. I take Bikram yoga classes 4-5 times a week, walk the dog every day and hike 6-10 miles every other weekend. I’m trying to stay encouraged, but it’s hard!
Thank you again.

Crystal,

For individuals with high cortisol, I’ve learned bikram or hot yoga elevates your stress as the heat in the room contributes to the ‘run from the lion’ fight. If you are chronically fatigued, exercises such as walking, restorative yoga, and some weights would be beneficial.

This explains so much! I wish I had known about all of this in my 30’s when I was fighting endomitriosis, PMS, infertility, etc, but I am thankful to be learning about it now in my late 40’s. I am following your guidelines, eating super clean, and managing my stress without feeling guilty about it (much anyway). I fully expect my 50’s to be the best, healthiest decade of my life so far!! You rock Sarah!!

Thank you for writing about this. And please, KEEP WRITING ABOUT IT. I know every person is different, but it’s really encouraging to learn about someone who has found answers and is on the road to recovery. How did you alter your lifestyle/eating/supplementation? Are you doing bioidentical hormone therapy? How long before you noticed a difference? What is your ultimate goal working with Dr. Flowers? Once you help your body find balance, will it just take care of itself (as it should)? Or will you have to continue supplementing and working with a doctor?

Best of luck to you on your journey! And thank you, again.

Adrenal insufficiency is a load of horse sh*t. Do you have any evidence for it? I’m an independent researcher and if you had studies to back up this claim I would surely appreciate it. The adrenal glands are pretty capable of enlarging and producing more cortisol. It’s like saying that if men have low testosterone then they have testicular insufficiency. Not quite..we know that men with low testosterone usually have fine testicles.

Progesterone converts to cortisol and you have low progesterone, among other hormones. Your low hormones are like a result of prolonged production of cortisol instead of these other hormones, among other reasons.

I see no evidence for adrenal insufficiency, which is a pretty rare disease.

I await your response.

My annoyance was directed at the whole adrenal concept, not Sarah herself….But I agree, it was posed rudely and I apologize for that.

I also appreciate the thoroughness of Sarah’s posts, so seeing adrenal insufficiency in the midst of a quality site, overall, through me off balance.

I’m open minded, though, and if there is evidence for it, I would love to hear it.

There seems to be a high incidence of people who go paleo and develop “adrenal fatigue”…why is that? It makes me wonder if perhaps the diet is incompatible with today’s modern city-bound lifestyle. Whilst our bodies may not be adapted to eat grains etc, perhaps they are also not adapted for modern day levels of stress. Food for thought.

I lost 124 lbs 4 years ago from eating the paleo carb lifestyle. I’ve suffered from all these symptoms for years. I was recently diagnosed with primary Addisons disease and am now steroid dependent because my body no longer produces cortisol. I’ve started gaining weight since being on hydrocortisone and fludocortisone (steroids) and it doesn’t seem to matter what I do I gain weight. Paleo and low carb no longer seem to be working. Any ideas?

This resonates deeply with me. I’ve had health issues for many, many years–but never thought anything of it. I suffered from chronic yeast infections, I experienced mono two years after I had “recovered” from it, and was bed ridden for 3 months the second time. I also had eczema growing up and even had small patches of the rash in my adulthood. Also grew up in an abusive environment which I now realize the stress has probably affected me very early on. Almost two years ago, I decided to go vegan. The first year was great, my acne cleared, my eczema cleared, my metabolism seemed to be working wonderfully, and I was building muscle and gaining strength. Shortly after becoming vegan I partied a little bit, (in my early 20s) and experimented with “molly” if any of you are familiar with it, I found out it can directly impact your adrenals… so from this pattern, my new doctor was able to identify what my issues were when….

It came out of nowhere. I took some molly last May, and had a very bad reaction to it (probably because it was some other drug, but I would strongly advise staying away from all unnatural drugs). Then for a few months after, I suffered panic attacks, severe anxiety, and my legs felt weak when I walked. I still pushed through and was able to keep gaining strength at the gym. Around this time I noticed I was always hungry (even when full), began craving sweet and salty foods, and chocolate, etc. My vegan diet seemed to not be satisfying me as it had in the past. Then, one day in September after starting a new semester at grad school (2 classes while holding down a full time job in a corporate environment), SEVERE fatigue and musculoskeletal pains had hit. I’m talking so tired that my husband has had to cook and clean for me for months, I get so dizzy that I get nervous driving or taking showers alone. I immediately recognized the symptoms as what I thought was another “mono/epstein barr relapse”. I figured it would go away as it had in the past, but this time I was overwhelmed as I was working full time and trying to finish grad school… I knew I needed answers… My primary care physician ran some pretty routine blood work and suggested I eat more spinach as she knew I was a vegan and my iron was a tad low. Lucky for me, I had always supplemented with a methylated b-complex, so my Bs were at the highest end of the range. When the results came back “good” (and negative for autoimmune disease), she shrugged it off and told me to basically just deal with it (that’s not frustrating at all….). On top of all of this, I noticed that since becoming vegan my periods were very, very painful, and were becoming less regular (always 5 days late). I even had a cyst that sent me to the ER. I thought it was strange, because I had given up birth control years ago and never had menstruation issues.

Lucky for me, I found a functional medicine doctor who is a big advocate of paleo eating. I told her I was not willing to give up veganism (I had fallen in love with the fundamentals of the lifestyle even though it clearly was not working for me). She was patient with me, tested me anyways (blood, saliva, and hair mineral analysis), and sent me home with some articles about the dangers of vegan and vegetarian diets. I couldn’t deny the research I was presented with, and almost immediately began the conversion back into an omni-diet. When I got my results (still waiting on the saliva) she told me the following:
-Cholesterol was too low and most likely so low that I was not able to produce hormones, leading to estrogen dominance (probably explains my painful periods and cyst)
-Omega 3s were critically low (even though my diet consisted of hemp and flax, it was not enough)
-Found out I have the MTHFR gene
-I have copper toxicity and aluminum toxicity (vegan diets are high in copper, coupled with my MTHFR gene that makes it harder to naturally clear metals and abundance of trace minerals like copper. I also gave up fluoridated toothpaste and aluminum deo years ago!)
-my adrenal glands were shot, so adrenal fatigue/insufficiency—also thyroid insufficiency (also making it harder to clear the copper and aluminum)
-extreme mineral deficiencies, a very low sodium potassium ratio

A high stress lifestyle, mixed with some bad personal choices (veganism and drugs), and genetic weaknesses (MTHFR) was a recipe for disaster for my body. I now have to begin a nutritional balancing program and it will probably take me a year to get better. It is SO true that chronic stress is just horrible for you. Sometimes I kick myself for my poor choices, but I have to avoid despair and remain positive that I will get better. I was winded because I hope others can relate to my experience and not give up. Follow the author’s advice; find a doctor who will test you for all of these things—and manage your stress!

WOW, I have 7 more weeks to early retirement but it feels like i need to stoo working now. T1 diabetic for over 46 years and low income. My doctors now basically told me I’m pretty much on my own cz we don’t have the money so I’m really in hopeless situation. Does an one have any suggestions?

I would love to know what regime your dr put you on for hormone therapy. I’ve struggled with infertility, massive periods, irregular cycles for all my life and recently a 30 lb weight gain is the cherry on top. My gyne suggested a hysterectomy or an iud. Neither of which I’m eager to pursue. My ND has suggested a progesterone support based on my labs… but I am worried it won’t help and the investment will be for nothing because i’ve tried so many things already. I’m considering an endocrinologist as a last resort but really want to tackle this naturally if I can.
Thanks for writing this article. It’s exactly what I needed to read right now :)

Amazing info, Sarah. This article really spoke to me, and the info you provided in the video blew me away. I’ve been searching high and low for research on whether following a ketogenic diet would be ok with my thyroid, cortisol, and wonky hormone issues. Your informative content may have saved me from further suffering. THANK YOU!

I feel like this is me. After my youngest child was born with Down syndrome he needed his heart repaired. I could not nurse him like my heart wanted to so badly. But after he was 4 months old and had his OHS, I started nursing him. 9 months later I went back to work and he was sick. A lot. We struggled. I was dairy and gluten free for him but so very high in sugar because I craved the energy. I was miserable. I was getting about 4-5 hours of broken sleep a night, nursing him, and going to work and taking care of 2 other kids. My marriage was a stressor because of all the stress with kids and work and poor health and lack of sleep. I eventually resigned from that job. I had GI problems galore. It has been 3 years and I am now embarked on a ketogenic “diet” and must get 8 or preferably 10 hours of sleep a night. It is hard when you also run your own business (I quit one job and built another). I find I struggle with saying no and taking time for myself. I work hard at that. I also take Estrofactors for estrogen detox :) I would be very interested in hearing what some other options could be. My GI is only good with little to no carbs, including fiber. Paleo was frankly just not enough to feel better. I don’t mind eating this way but I wish I had a bit more of a carb tolerance and could just be done dealing with GI issues. I too gained 20 lbs in a month! I was depressed, angry, sick, and miserable. I was also trying to run a half marathon when I gained that weight. Oh if only I knew! Now I lift 3 – 4 times a week and might run 1-6 miles a week, depending on if I feel like it (I used to feel obligated). I’m back to about my normal weight and my energy is okay with a lot of thyroid supplements. Thanks for sharing this, I wish I would have known better 4 years ago and would have been healthier BUT I don’t think I would have ever changed the way I ate, and for that I am so grateful. There are blessings abound in my life and eating healthy is a main one right now!

What does it mean when your DHEA is actually THROUGH THE ROOF? & your testosterone is high? I’ve been experiencing hairloss for 6 years, was diagnosed with Hashimotos and low thyroid. I’m trying to understand where the adrenals and cortisol fit into the high DHEA and testosterone puzzle. Thank you!

If your ACTH is also low, it is not Adrenal Fatigue. I sometimes wish the phrase was never invented. Secondary Adrenal Insufficienciency is a diseases recognized by the AMA and requires emergency Cortisol dosing and a bracelet be worn at all times. If your cortisol is low by the medical standards range, you are putting yourself in serious danger and have put yourself in the hands of a dangerous physician. In case of emergemcy, if a person truly has low cortisol, your body is unable to compensate. This is true for both a primary and secondary insufficiency. If you have surgery, the same would hold true. Do not find out the hard way. People are so confused about Fatigue and Insuffieciency and they are entirely different. People wit fatigue complain of all this weight gain. Believe me, if your Adrenals are under active with low cortisol you are as skinny as can be. And when first hit with it, it is like an alien has taken over your body with weight loss. That is reall insufficiency. If your doctor has not warned you to wear a bracelet and carry an emergency dose for trauma, unless your cortisol is within normal range but low by alternative doctor standards, your doctor is ill equipped to handle this illness. I hope anyone who reads this and has low cortisol and low ACTH or low cortisol and high ACTH sees this and takes proper care.

I think this is going to be very helpful. Joint instability runs in my family, and I’d been okay until recently when a stressful event made my joints all loose again and I re-injured my shoulder, then the other shoulder, then both knees, and even my jaw was sliding out just from talking! Trying not to despair, I’ve been running through everything I’ve learned going on the AIP, then discovering I had problems with histamines and salicylates, then adding back in eggs, chocolate, non-nightshade seed spices, and small amounts of properly prepared beans and legumes this last spring (I know, you’d say that’s not a good idea, but I can’t eat coconut, winter squash, or sweet potatoes, and many are saying the soaking, sprouting, and cooking–especially pressure cooking of most beans and legumes should make them safe. I’ve got to eat something, and they seem to sit fine with me in moderate amounts.) I just ran into some information that collagen disorders like EDS may worsen or improve depending on a woman’s cycle, and varying amounts of estrogen and progesterone. I remembered this article here, and between the two, it seems very plausible that my extreme stress caused my collagen issues to flare by creating a hormonal imbalance. This restores my hope for regaining my former health (again, as this sort of thing has happened before), though it once again throws uncertainty on how bad things are going to get once I hit menopause. Here’s hoping for more medical advances by then! Thank you so much for all your research.

Great article. I too have been suffering with imbalance of hormones which were diagnosed as Peri-Menopause. Coincidently it all began after having my third child and having a lot of stress happen in my life. I support a clean, healthy lifestyle but have resorted to bioidentical progesterone treatment. I am very curious how your hormone results are more recently and also would love more information on the Hormone Balancing Therapy that you mention.

Is Primary Aldosteronism a form of adrenal fatigue? I see aldosterone on your chart above. My mother just got this diagnosis and they want to put her on Spironolactone. I am trying to get her to try Paleo first but her blood pressure is high because of the diagnosis but they are telling her they don’t know why? I searched in my copy of The Paleo Approach to see if you mention it there but it was just mentioned in the stress management or lack thereof chapter. I know my mom is not stressed by true stress she is retired and lives a robust and relaxing lifestyle. I am wondering if maybe food related. She drinks a lot of coffee which I know affects adrenals. We live in Atlanta also so will try to convince her to see Dr. Flowers.

Thank you for this extremely helpful post. I wonder how this translates during pregnancy and for labor and birth. As a childbirth educator I see the link between high stress levels in pregnancy and difficult births; pre-eclampsia, prolonged early labor, “insufficient” contractions

Can anyone illuminate?

It’s not something that Sarah has addressed specifically, but I would say it DEFINITELY applies as pregnancy, labor and birth are pretty big (albeit natural) stressors on the body and it can be hard for some women to recover postpartum. -Kiersten

Hi I have been told I have pcos but am healthy weight but suffer terrible stress and just recovered from anorexia. I honestly think I miss a period sometimes when I am too stressed. Yet the doctor said stress wouldn’t cause it or my eating disorder. He gave me no advice or why I have it. I don’t have cysts or insulin resistance. I think I just sometimes miss my period due to anxiety and stress and eating issues. This info u have provided has made me more positive after a day of crying thinking i had pcos and would gain weight ,grow hair etc.Do you think that stress could be the cause of missing a period and hormone imbalance for my case?

I think it absolutely could be contributing to your hormonal imbalance. If you’re uncomfortable with the support (or lack thereof) that your doctor is giving you, you can always try seeing a new doctor. Sarah has had a lot of success combatting her stress induced hormonal imbalances with a functional medicine practitioner. You can read more about her experience in her post on her personal battles with stress. -Kiersten

Thanks for bringing this altogether for me in an approachable and straightforwad manner. It’s such a refreshing change to seethe whole DHEA and cortisol thing presented so clearly. Anmd no, I will not be taking a DHEA supplment as a preventative as I was advised.
Thanks,
Bren

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