Part 3: PMS and Estrogen Dominance
Just because PMS is common, does not make it normal. PMS is defined as any physical or behavioral symptom that significantly impairs your daily life during the 2 weeks before your cycle starts. It commonly includes alterations in pain levels, energy, mood, and motivation. PMS is greatly associated with hormonal imbalances such as estrogen dominance, low progesterone, nutrient deficiencies, inflammation, as well as serotonin and GABA dysregulation (two of your relaxing brain neurotransmitters). This is why some women are prescribed SSRIs (serotonin reuptake inhibitors) to aid in the management of PMS. Some potential causes include high estrogen, low progesterone, hypothyroidism, heavy metal toxicity, cortisol dysregulation, endocrine disruptors, inflammation, stress, gut dysbiosis, infection, illness, or nutrient deficiencies. Key strategies for being a PMS conqueror include:
Focus on color: Fill up on all the colors of the rainbow in your fruits and vegetables to increase the amount of antioxidants and polyphenols in your diet. This will not only help you achieve optimal nutrient status, but combat inflammation, which is a heavy contributor to PMS problems.
Power up the cruciferous veggies: These superpowered veggies can help you to detoxify excess estrogen. They contain indole-3-carbinol, which converts to DIM in your body, which helps to push your estrogen through Phase 1 of estrogen detoxification. Broccoli sprouts are another fantastic addition to your diet, as they contain high amounts of sulforaphane. Sulforaphane helps to combat free radical damage and inflammation in your body, as well as helps to move estrogen through phase 2 detoxification.
Fix your fats: Focus on consuming healthy fats such as avocado, fatty fish such as salmon, eggs, olive oil, nuts, and seeds. These foods contain rich sources of essential fatty acids (omega-3s and omega-6s) that you can only get from your diet. Lack of essential fatty acids puts you at risk for heavy PMS as well as a whole host of hormonal chaos. These fats are anti-inflammatory and work to combat inflammation in your body, which can decrease PMS symptoms. Try to reduce processed vegetable oils that are easily susceptible to oxidative damage and rancidity, which can cause inflammation in your body. These processed vegetable oils include corn, canola, soybean, sunflower, and cottonseed.
Cut the crap: Avoiding excess added sugars, alcohol, and removing your own food intolerances is crucial to decrease inflammation, which can make PMS a demon. A great goal for sugar is under 10g added sugar per serving for a food, with a total of around 60g per day of sugar total. Reading nutrition labels will allow you to get a better idea for what is in your food and focus on the quality. Note- natural sugars from fruits are always welcome. Eat them to your heart’s content! Try to keep your alcohol consumption to 2 drinks per week, though I suggest minimizing this as much as possible. Common food intolerances include gluten, wheat, eggs, nuts, dairy, and soy. Only restrict what you need to and work with a registered dietitian to make sure you are on the right path for a sustainable nutrition plan that is best for you.
Focus on fiber: Fiber helps you to naturally detoxify your estrogen and helps to feed your gut microbiome by feeding your good gut bugs. You need a healthy microbiome for optimal metabolism, mood, and immune function. There really isn’t anything your gut can’t impact. Make sure to utilize different sources and types of fiber based on your needs. A messed up gut can contribute to heavy PMS and pose a threat to your overall health, so make sure to prioritize your fiber.
Drink your water: Your body is approximately 60% water. Dehydration leads to dizziness, headaches, increased hunger, cravings, and can even be life-threatening. Aim for at least 1 gallon of water per day. Being properly hydrated can positively impact your energy, mood, and metabolism. Set a timer on your phone to drink water if you struggle with getting it in. You can also try flavoring your water naturally with fruit.
Balance your blood sugar level: An imbalance of blood sugar in your body can leave you hit with hanger. Ever noticed periods of shakiness, sweaty palms, anger, irritability, and brain fog? That’s a sign of low blood sugar. Going up and down in a blood sugar rollercoaster can heighten your PMS. Especially if you are progesterone-sensitive. Be mindful of your carbohydrate sources and choose whole grains if possible. Always pair your carbs with a fat or protein to help stabilize your blood sugar and avoid skipping meals or going more than 4 hours without eating.
Remove endocrine disruptors: these chemicals will disrupt your hormonal symphony and wreak havoc on your health. Hands down, they can cause and worsen PMS.
Supplement Smartly: Supplements can be highly beneficial to help reduce your risk of PMS and decrease inflammation. Any nutrient deficiency will wreak havoc on your health, so ensuring to supplement smartly is critical. My favorite supplements for PMS include: There are many other herbs, vitamins, and minerals that may help to decrease symptoms of PMS. Make sure to always speak with your dietitian or medical professional before starting or stopping a supplement.
Manage Stress: High stress levels and lack of self-care will lead you to PMS problems. Focus on ensuring you have proper stress reduction practices in place, practice healthy sleep hygiene, and make sure to allow yourself periods of rest and relaxation. Stress is one of the most common culprits leading to PMS problems.
Estrogen Dominance:
If you have estrogen dominance you may experience: painful periods, heavy periods, bad PMS or PMDD, tender breasts, mood swings, migraines and headaches (especially the week before your period), abnormal weight gain, bloating or water retention, acne, and fibroids. There are many reasons you can become estrogen dominant. These include: endocrine disruptors, nutrient deficiencies, poor diet (high in added sugars, refined carbs, and alcohol being the most common diet culprits), heavy metal toxicity (especially copper toxicity), high histamine levels, excess aromatase activity (your conversion from testosterone to estrogen in fat cells), poor liver health, defects in estrogen detoxification (can be Phase 1, 2, or 3), high insulin levels, Hypothyroidism Infections (such as Epstein Barr Virus, Lupus, Lyme disease, or even mold), gut dysbiosis, inflammation, low progesterone, hormonal birth control or post birth control rebound, and obesity or high body fat levels.
The Estrogen Dominance Solutions:
Fix your diet: Reduce the amount of added sugars and refined grains in your diet that don’t provide you with enough vitamins and minerals and may cause blood sugar imbalance. Focus on whole grains, a variety of fruits and vegetables, and healthy sources of dietary fat. If you can, choose organic over conventional meats, as they have been shown to be higher in essential fatty acids.
Reduce alcohol: Alcohol can disrupt both your hormones and liver function. If you are going to drink and have estrogen dominance, stick to 1-2 glasses of wine per week. I suggest eliminating alcohol if possible.
Reduce environmental toxins: Reducing endocrine disruptors will reduce inflammation, help to balance your hormones, and support your liver (helping to reduce its toxic burden).
Focus on Fiber: Aim to consume at least 25 g fiber per day with 35-45 g being an even better range. Adequate fiber intake helps you to detoxify and eliminate excess estrogen. It also helps to reduce the levels of intestinal beta-glucuronidase activity that can cause havoc with your phase 2 estrogen detoxification (preventing it from being excreted).
Promote a healthy gut microbiome: This is where fiber plays a major role to help your good gut bugs produce short-chain fatty acids, B vitamins, and vitamin K. Why is this important? They help modulate your immune system, protect your gut lining, reduce inflammation, combat pathogens, promote healthy cholesterol levels, and enhance your mood and cognitive function. Other adjustments to help promote a healthy gut include diversity in the plants in your diet, reducing intake of artificial sweeteners, and removing food intolerances.
Prioritize sleep: Lack of sleep will disrupt both your hormones and adrenals. Focus on getting at least 7-8 hours of sleep per night. Make sure to have a healthy sleep routine, which includes blocking blue light at least 2 hours before bedtime, stopping electronics 30 minutes before sleep, sleeping in a cool, comfortable environment, and avoiding high strenuous exercise before bed.
Focus on self care: You need to fill up your cup to be able to pour out into others. Lack of self care will wreak havoc on your mental, physical, and emotional health.
Supplement smartly: Just like with PMS, supplements can help you in rebalancing your hormones and fixing nutrient deficiencies. With estrogen dominance, the author likes to see her clients do a DUTCH test to look at their Phase 1-3 estrogen detoxification. Why? There are certain supplements that can downregulate or upregulate specific pathways. For example, DIM and Indole-3-carbinol help to push you down Phase 1. If you have trouble with phase 2 and phase 3, then you can’t get rid of your estrogen, and taking these supplements can make your estrogen dominance worse.
Reduce Inflammation: Inflammation will upregulate cytokines and prostaglandins in your body, causing increased period pain, body aches, and increase the risk of heavy menstrual bleeding. Inflammation also further increases aromatase activity in your body, which converts your testosterone to estrogen. This can further drive estrogen levels higher. You can reduce inflammation by following all the previous tips suggested, plus making sure to incorporate omega-3 fatty acids, reduce caffeine intake, and add anti-inflammatories such as curcumin (the active component of turmeric), Boswellia, or cat’s claw in your life. If you carry excess body fat, losing weight will also help to decrease aromatase activity and decrease inflammation.
Exercise for energy: Yes, you read that right. Your exercise and workouts should not drain, but instead energize you. Focus on finding a fitness routine that you enjoy and that you can stick to. Moderate intensity weight training is a great option, as it will help to increase insulin sensitivity and preserve lean muscle mass. These include yoga, power walking, and small amounts of running or high intensity cardio. Be cautious on the runs and cardio because if you have adrenal imbalances, this can cause even worse hormonal chaos.
The Three Estrogen Phases/Liver detoxification:
There are three main phases of estrogen metabolism in your body. These phases follow your body’s natural detoxification process. Our bodies do great things for us including the detoxing of drugs, environmental toxins, hormones, chemicals, water, air, and even the food you eat is mostly performed in your liver, but detoxing also occurs through your digestive tract, kidneys, skin, and lungs. Each phase requires specific vitamins and minerals to power various enzymes that transform toxins (and estrogens) in your body from their fat soluble forms to water-soluble forms, allowing them to be excreted through your bile, urine, and feces. Your liver is critical to maintaining a healthy immune system, metabolism, and digestion. It plays the superhero role of detoxification. Without your liver, you cannot convert food into energy, make immune system molecules, or process and eliminate medications or environmental toxins. Let’s dive into the three phases of liver detoxification. Phase 1 detoxification involves a process called “bioactivation” and is largely performed by hepatocytes, aka the cells of your liver. During this phase, a series of reactions occur including oxidation, reduction, hydrolysis, hydration, and dehalogenation. During these reactions, Cytochrome P450 enzymes (CPY450) convert fat soluble toxins and various “materials” mentioned, including estrogen, medications, environmental pollutants, and waste materials into more water-soluble metabolites. Your diet can ensure that this phase is performed properly. Antioxidants in your diet are the true superheroes that come in to prevent damage from the reactive intermediate This includes something called glutathione, which can be considered your master antioxidant. These super hero antioxidants include: Riboflavin (Vitamin B2), Niacin (Vitamin B3), Pyridoxine (Vitamin B6), Folic acid, Vitamin B12, flavonoids, Vitamin A, ascorbic acid (vitamin C), and tocopherols (vitamin E). Nutrients such as selenium, copper, zinc, manganese, Coenzyme Q10, thiols (found in cruciferous vegetables), and silymarin (better known as milk thistle) also play a role. An easy way to help ensure Phase 1 detox is achieved is to get a wide variety of nutrients in your diet with lots of colorful fruits and leafy greens and to help your liver by lowering your overall toxic burden, including limiting exposure to environmental toxins, not overloading your body with supplements or medications, and eating a balanced healthy diet. Please note- there are also many substances, nutrients, and drugs that can influence the function of the CYP enzymes that are in charge of Phase 1. This can be from the inhibition or induction of their activity, and can greatly influence how you detoxify, CYP Inducers include: soy, curcumin, garlic, fish oil, rosemary, resveratrol, chicory, and astaxanthin. CYP Inhibitors include: raspberries, blueberries, black currants, pomegranate, peppermint, quercetin, daidzein, grapefruit, and dandelion. Just like Phase 1, Phase 2 requires specific nutrients in order for the enzymes within each reaction to perform optimally. You need to get through Phase 2 in order to get to Phase 3, where the toxins and estrogen in your body can be fully excreted. These nutrients include glycine, taurine, glutamine, N-acetylcysteine (NAC), cysteine, and methionine. They also require choline, inositol, and sulfur-containing compounds such as MSM and Sam-E. Adequate protein intake is required (as many require Phase 2 nutrients come from protein), as well as dietary fat, which is needed to mobilize the required fat-soluble vitamins used. Though diet plays a key role for ensuring adequate nutrients to perform Phase 2, just like in Phase 1’s enzymes, problems can arise if there are “roadblocks” affecting any of the methylation steps. Glutathione is your master antioxidant and works to combat free radical damage, protect your tissues, and enhance your immunity. Phase 1 and 2 detoxification are like a bathtub. Phase 1 involves the filling of your bathtub, while Phase 2 involves draining. You have to get Phase 2 to occur in order for the “water” in Phase 1 to get out. If both Phase 1 and Phase 2 occur, then Phase 3 can happen. The final step in Phase 3 estrogen detoxification involves the neutralization of metabolites and excretion through your bile, feces, or urine. Both constipation and lack of bile flow are additional contributing factors to estrogen dominance. Therefore, it’s essential that you focus on getting adequate fiber intake (in general 25-45g per day), prioritize your gut health, and be kind to your liver.
Diet Modulators of Estrogen Metabolism: from Metagenics
Production to support body function and phase 3: flaxseed, flavonoids, zinc, soy, calcium-d-glucarate, dietary fiber, prebiotics, probiotics
Systemic pool to circulate: fiber, flaxseed, soy
Receptor Sensitivity and binding: Isoflavones, lignans, indole-3-carbinol, DIM, hops, curcurmin, B6, rosemary, resveratrol
Detoxification for Phase 1-3: cruciferous veggies, I3C, rosemary, isoflavones, curcurmin, vitamin A, E, and C, NAC, green tea, alpha lipoic acid, flavonoids, superoxide dismutase, folate, B vitamins, glycine, magnesium, adequate dietary fat and protein
