All things hormones from a hormone nutrition expert
Naturally, a lot of hormone-related questions come up since I work in women’s health. I am so fortunate to have connected with Melissa Groves, a fellow dietitian and an amazing resource on how nutrition plays a role in hormones. She is a wealth of knowledge, and like me, believes in following the evidence to help make women’s lives better and healthier. I am sure that if you take the time to read this, you will learn something from her.
LM: What made you want to become known as the hormone dietitian?
MG: When I first started working as a dietitian, I was working in the office of a functional medicine RD, and I was assigned all of the weight loss clients who came in. Anyway... when women would come in and they were literally doing everything "right," eating well, exercising regularly, etc, I discovered that there was almost always a hormonal reason why they couldn't lose weight. Either their thyroid was low, cortisol was high, they had PCOS, high estrogen or testosterone levels, etc. I started realizing how many women's health "problems" stem from hormonal cycles and wanted to learn all I could about it. So when I opened my own practice, I wanted to keep helping these women figure out how hormone imbalances were keeping them from living their best life. And I feel really passionate, especially about helping women with PCOS — they've been mistreated by the conventional medicine community for so long, told to "just lose weight," etc. I felt like they needed someone on their side who first of all believed them, and second, could actually help them.
LM: When a person says that a certain food is good for “hormone balance”, what exactly to they mean?
MG: Ugh, I've heard some crazy ones. Someone on Instagram recently told me she eats a sweet potato every day for estrogen balance. (That's not a thing.) To me, what it means is a food that either contains the nutrients necessary to support hormone production (such as Brazil nuts, high in selenium for supporting thyroid hormone production) OR it means a food that helps you break down a hormone and excrete it properly (that controversial "D-word," detox). For example, cruciferous veggies like broccoli sprouts, cauliflower, etc, help support your liver pathways that are involved in breaking down estrogen. Ground flaxseeds contain lignans that help bind to estrogen in your gut so you can eliminate it in your stool. But basically, eating high fiber in general is going to help you eliminate excess estrogen so your estrogen & progesterone are more in balance. I think that's what most people mean, haha.
LM: Many dietitians do not believe in a detox diet, but mention certain foods like cruciferous vegetables as detoxifying. That can be confusing to some people. What does detoxifying foods mean to you?
MG: Yes...I've seen those posts that go something like "you have a liver, you have kidneys, therefore you detox." I think that's problematic. First, there are several gene SNPs that negatively impact a person's ability to detox properly (for example, COMT affects estrogen metabolism and MTHFR affects methylation). So you may be at a genetic disadvantage when it comes to ability to detox. Plus, we're just exposed to so many more toxins at this point in history than we ever have been before. Our livers are pretty freaking amazing, but I'd also say they're pretty busy at the moment! I remember reading in Nutrition 101 class that when you drink an alcoholic beverage, for example, your liver STOPS all of its other functions (regulating blood sugar, etc) in order to prioritize clearing your body of the toxin alcohol. So if we're constantly dealing with toxins from our environment (food, water, air, health & beauty products, cleaning products, etc.) our livers may be too overwhelmed to handle day-to-day tasks like breaking down excess estrogen. So, to me, foods that are detoxifying contain nutrients and phytochemicals that support the liver to do it's job. There's no magical food, tea, supplement, etc, that's going to make you detox, though. It's still your body's job.
LM: Other than a hormone test (like a DUTCH test), is there any other ways that women can tell that they are dominant in either estrogen or progesterone?
MG: Is progesterone dominance a thing? Most ladies would kill for more progesterone, haha. We ONLY make it when we ovulate, so if that's not going well, then progesterone's going to be low (either no ovulation or poor egg quality). Signs that progesterone is low are spotting before your period starts, lower or zig-zaggy temps after ovulation on your BBT chart, and short (<11 days) luteal phases. If we don't do a full DUTCH test, you can check your levels at your OB/GYN or RE (should be 7 days post-ovulation to get an accurate number), or there's a newer FDA-approved home test called Proov, that's pretty affordable, which I've also used and recommended.
Estrogen dominance is more common - there are 3 ways this can manifest: 1. You have outright high estrogen levels. 2. You have normal estrogen levels, but it's going down the "bad" pathways (this is what I use DUTCH to determine). 3. You have normal estrogen but low progesterone. Signs of excess estrogen include sore breasts after ovulation, heavy, thick, clotted periods, painful periods, "early" ovulation (before day 14), PMS or PMDD.
LM: Vitex (chaste berry) seems to be a go-to for general "hormone balance", yet it has a specific role in the body. Do you agree that vitex is a general "hormone balancer" and can be taken for infertility, PMS, and menopausal symptoms? Why or why not?
I do NOT recommend this across the board and I think it's currently being used way too widely. It's really a potent herb, and I don't think you should use it if you're not working with a healthcare practitioner. Where I DO recommend this is 1. if you're not ovulating and you DON'T have PCOS (or have lab levels that show that your LH is not high). 2. Where low progesterone is an issue, from ovulation to period ONLY. I think it can be helpful in peri-menopause, but in combination with other herbs (like black cohosh, etc.)
LM: Why is it important for women to seek help from a hormone expert instead of a general dietitian?
I'd say one of the biggest surprises in my practice has been how many dietitian clients I've had. The reason for this is that we all can't know everything about every topic. I certainly don't know anything about pediatric nutrition or nutrition for kidney disease or cancer, for example. I'd turn to an expert in that topic if I needed it.
Specializing in hormone issues allows me to go really deep and stay up to date on the current research, so I can better serve you versus a general dietitian. I think other dietitians may mean well, but maybe they just haven't had the training or kept up with the latest research in hormones and fertility.
Think about it the way you think about doctors...you may go to a general surgeon for something like an appendix removal. But you bet your @&$ you're going to want the best neurosurgeon in your area if you need to undergo brain surgery!
LM: Many women suffer from long cycles after going off of birth control. Understanding that everyone's body is different, do you have any general tips for getting cycles back on track?
First, give it time. Depending on how long you've shut down your body's own systems by being on the pill, it can take a while to start up again and re-establish that communication between your hypothalamus/pituitary and ovaries. I'm very skeptical of any hormone testing or diagnoses (eg, PCOS) that are made in the first 6 months of going off the pill. Your body hasn't even had a chance to do its own thing yet.
My top tips for regaining your cycles naturally at this point are to nourish yourself (3 nutrient-dense meals per day, plus a snack or two as needed, and make sure to include plenty of fat so you can actually make hormones), get enough sleep (aim for 7-9 hours), don't overdo the exercise (I'm talking 5 days a week "crazy cardio" bootcamp-type classes, etc.), and work on stress management. If it's been over 6 months and you still haven't cycled regularly, consider working with a hormone specialist (like me) to guide you in what else to try. PLEASE don't jump right to the "big guns" recommended on the internet, like vitex, DHEA, etc. You may do more harm than good.
Thank you Melissa for an incredible interview. You covered a ton, and I am sure that many people appreciate your insight. If you want more info from this incredible clinician, make sure to follow her on IG @the.hormone.dietitian or visit her at her website.