Adapted from episode 82 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD with guest Kyrin Dunston, MD, OBGYN, host of the Hormone Prescription Podcast and pioneer of female hormonal justice. After discovering the hidden cause of midlife weight gain and fatigue in women, Kyrin lost a life-changing 100 lbs. and fixed her adrenal issues. She is fellowship trained in Anti-Aging, Metabolic and Functional Medicine and has practiced this exclusively for over a decade. She is also the founder of Her Hormone Club, an end to end all inclusive membership providing women access to state of the art natural hormone therapy treatment throughout the US and the Midlife Metabolism Institute, providing educational and coaching programs for women at midlife to fix their hormones, their metabolism and their health.
Lindsey:
Well, of course, as a host of a podcast on hormones, I wanted to start with a general overview of the various hormone systems in the body and how they interact with the gut microbiome. After that, we can dig deeper into some of them.
Kyrin Dunston, MD:
Sure! I always say there are seven main metabolic driving hormones. There are actually hundreds of hormones. Hormone just means chemical messenger. You’ve got many, many of them throughout the body and they’re brothers and sisters to neurotransmitters. They’re a part of your nervous system and most people don’t realize that. The majority of them originate in the brain. It’s just that they travel a long distance through the blood in order to get their message across, whereas neurotransmitters travel a short distance across a neuronal synapse to get their message across, but they’re part of your nervous system. I like to tell people that because most people don’t know that, and it really gives them some perspective.
Even though I went through OB GYN training, and we’re supposed to be the experts on women’s hormones, we were always kind of taught, and hormones were treated as if they were this accessory pack – like women’s hormones, that’s a little accessory pack you women have that confers reproductive capacity on you, right? It’s kind of like that black bag, you take down from the back of your closet when you have to go to the black tie dinner once a year at Christmas. What I discovered is that nothing could be further from the truth. They’re really fundamentally and foundationally a part of who we are as women, and that’s because they’re a part of our nervous system. I like to emphasize that because otherwise, I find that men and women alike relegate hormones to that “other” category. That’s that other thing you have to deal with. No, it’s like you have to deal with your brain cells in your brain. You also have to deal with your neurons.
The seven main metabolic driving hormones, I always say are insulin, thyroid, cortisol, DHEA, estrogen, progesterone and testosterone. They really set the tone for the level of your metabolic rate, how you process the calories, macronutrients that you eat and what you do with them. Do you store them as fat, do you burn them as fuel and your basic biologic processes. Your sleep-wake cycle, your energy level and your weight is a basic biologic process. Most people just think of it as, “I don’t like how I look in the mirror, it’s unwanted fat.” When you really think about it, what is excess fat if not excess fuel storage? Your body has the fuel it needs to operate and your main fuel source is glucose, or sugar. You use that up usually within a few hours until you dip into your stores, which is fat. When you have a weight problem, you have a fuel storage problem. Most people don’t think about it like that. That’s a basic biologic process. If you can’t burn your fuel, then you can’t make energy and the currency of energy in our body is ATP. You’re tired and a lot of times sleep disorders are coupled with that too. These are the things that drive it.
Now how does it interact with the microbiome, which is your thing? Basically, we’re donuts. We have a big hole inside of us and that is our gastrointestinal tract from top to bottom, and the surface area is as large as two doubles tennis courts. And we’re taking the external environment, food, and we are putting it inside of us, seemingly inside of our bodies. But really, that too, is outside of us, even though it’s inside of us. Hopefully that makes sense, kind of like a donut. Our biggest interfaces with the external environment, and one of our body’s main jobs is security. Everybody knows how important security is if you’ve tried to log on to any program on the internet lately or your bank account. Remember how two-factor authentication has become a thing because security can be easily breached on the internet? Well, it’s the same with your gut. Most of your gut lining is only two cell layers thick and you’re taking the external environment and putting it inside this tube in your body, and it’s contacting all this surface area. Security has to be very high and it is at the highest level in your body all along your gastrointestinal tract. There’s something called GALT, Gut Associated Lymphoid Tissue, which is little patches of lymphocytes all along. And your immune system is mostly clustered in your abdominal cavity around the gut, because it is security; it is your body’s military system designed to protect you against foreign invasion.
Now, what does this have to do with your hormones, Kyrin? Well, it has everything to do with your hormones, because your hormones’ number one job is also security and survival. If your body can’t survive, you’re done. Any living thing prioritizes survival and security. You as a human are no different. You’ve got your security system, which is part of your survival system in your gastrointestinal tract, and you’ve also got your adrenal glands right there in the mix on top of your kidneys, which produce cortisol, which is your survival hormone. It works hand in hand with the immune system to balance your hormones. Have you ever heard a woman say, “Oh, I was stressed out and I missed a period.” That is because your body will sacrifice periods. Your body really does consider reproduction an accessory function although the hormones that it uses to create that reproductive cycle are not accessories. They’re vital for many processes – number one I’ll mention is brain function, but it will sacrifice a period and a reproductive cycle for survival and immune system function. That has to do with gut health.
Now, the microbiome, which I’m sure your audience knows very well, represents trillions of bacteria that live in the gastrointestinal tract and are essential for our survival; we’re back to that security and survival. We cannot live without these bugs in our gut and those bugs directly speak to our immune system and indirectly speak to our cortisol stress hormone. They’re really having this three-way conversation. And it’s much bigger than three ways because other hormones are involved and other systems in the body. You’ve got to have the right members in the bug council in the gastrointestinal tract to send the right messages and have the right conversation. If you have abnormal bugs that shouldn’t be there, too many of certain good types, parasites, fungi or other unwanted visitors that are having a very negative conversation, it’s kind of like the UN – there are certain countries and I am not a government expert, but there’s certain countries that aren’t part of United Nations. If they show up speaking in a language no one understands and they don’t really know how the UN operates, it’s going to be a not so nice conversation. It’s the same in your gastrointestinal tract. You need to have enough of the right ones and you don’t want the wrong ones to have the conversation. This directly works with your cortisol. I call her Queen cortisol. She is the queen hormone and she will be served at all costs, because you cannot live without her. Your body will take down all the other systems in order to preserve your survival, reproduction being number one. Your gut health, your microbiome, is directly and intimately involved through your hormones (very much through your cortisol), but we could also talk about estrogen, which I think we’re going to get into. I don’t want to go on too long if you want to interrupt me and ask something else.
Lindsey:
Yeah, let me let me interject with a question. I’ve actually seen a number of clients with really big gut problems following a period of high stress, but also following steroid medications such as prednisone. I’m wondering if you’ve seen the same or if you understand and can explain the mechanism of how that happens.
Kyrin Dunston, MD:
Oh, yeah. So when we as physicians give people exogenous from the outside corticosteroids, (that’s what cortisol is, and it falls under that category of hormone) it’s because your own cortisol isn’t working properly. We do that for conditions that are usually inflammatory (things like asthma exacerbations). For example, I had an injection in my knee once for bursitis or when I used to have back problems they would inject steroids. Maybe some people have had that or if you get bad bronchitis, they might give you steroids. They’re very common. In fact, I like to say in mainstream medicine, the two drugs of choice are antibiotics and steroids. When in doubt, antibiotics and steroids. But that’s a key indicator that your own queen cortisol is off the job, not doing a good job. Usually, the first places you should look are gut dysfunction and immune system dysfunction, because they’re going to be a part of that.
When you give a human steroids, cortisol or prednisone, or whatever it is, you basically give them a high dose of cortisol higher than their body usually makes. That will serve a few functions. One is anti-inflammatory, and it works to shut down the inflammatory response in the body. Bronchitis, that’s chronic, if you have all that inflammation mucus going on, get a steroid and it cuts down the inflammation because it tells the immune system, “Go have a seat, I’ve got this.” Unfortunately, it also temporarily shuts down your own cortisol production. You were saying that they have problems after this. What’s the mechanism? Because cortisol is your stress hormone, it has beneficial aspects and it has deleterious aspects. You can’t get one without the other.
Anyone who’s ever taken steroids knows, yes, it’s going to cut down inflammation. I remember, when I first moved down to the south, I had never heard of fire ants. I was from the north. A patient came in one day with her ankles swollen. I said, “What happened?” She said, “I stepped on a bed of fire ants.” I’m thinking, “What in the world is a fire ant?” I had to get an education in what fire ants were and learn that the treatment of choice is steroids. Everybody knows steroids cut down inflammation and pain. It does that. But you also get the deleterious side effects. What are they? Number one, it’s going to jack up your blood sugar. What happens when your blood sugar gets increased artificially? Well, sugar is inflammatory and sticky so you get the decrease in the short term inflammatory response, but in the long term, you’re driving up sugar. If people are on chronic steroids, oftentimes they become diabetic. I had a lot of people or had dogs. I had a dog that has that. She had been on chronic steroids and she became diabetic. Well, that can damage all the cells in your body because of sugar in the body that’s too abundant.
Sugar is sticky, right? Think of a sticky bun. Why is it sticky? It’s because it has sugar that’s been heated. Sugar that’s in your bloodstream, and in your body is no different. It’s heated to body temperature. It’s warm. It’s sticky. It’s inflammatory. It sticks to all your cells. It can fix to the cells in your kidneys or even fix to cells in your blood vessels. There could be long term damage. Why does it mess up the microbiome in the short term? A lot of these bacteria in the gut, especially the unsavory ones that you don’t want, consume sugar. When sugar is higher and plentiful, they will proliferate and propagate. If you’ve got a lot of sugar, you’re feeding your unsavory bugs. You get a disbyotic picture, and especially if there’s Candida, or fungi. They love sugar, right? If anyone’s ever made bread, what do you need? Just add warm water, sugar and yeast and you put it in the dark, (and it is dark, moist and warm in your gut already) and you add sugar, phew! You get that nice yeasty concoction you make bread out of. Well, that can happen in your gut and it’s not a question of, “Do we have Candida?” We all have Candida! It’s around. It’s in us. It’s everywhere. When the conditions are right, and there’s too much sugar, then you’re gonig to have too much. It fosters a dysbiotic picture.
Lindsey:
That’s an awesome and thorough answer that helps me understand and explain to clients. So I personally reversed my Hashimoto’s thyroiditis by both changing my diet and by eliminating gluten and dairy and most added sugar, and just by healing my dysbiotic and leaky gut. I imagine you must see a lot of patients with Hashimotos. In your experience, is there a best order of operations for reversing this type of condition and have you seen patients who’ve been on thyroid meds like Synthroid who’ve been able to come off of them?
Kyrin Dunston, MD:
Great question about Hashimoto’s. We can actually lump some other autoimmune conditions in there because they’re all caused by the same thing. I know some people are thinking, “What are you talking about Kyrin?” Most people don’t realize that all autoimmune conditions have the same root cause and most physicians don’t understand that either. But what does autoimmunity mean? It means auto, yourself, immunity. Your own immune system is attacking you. What causes that? In mainstream medicine, we’re up in the leaves, in the branches of the health that is our tree. We’re trimming this leaf, and over in another branch, right? And one branch we’re over at the neurologist getting those lesions in our brain looked at in an MRI because we suspect we have MS. For urinary leakage, we’re over at the gynecologist at another branch. Nothing’s related in mainstream medicine.
The truth is, if you go down the trunk of the tree into the roots and soil, all diseases have the same root causes. Every disease has a driver, and every disease should have a brake, that is not present (and that’s why it’s happening). Your body naturally will heal itself. Anyone who’s ever cut themselves knows that. Do you need to do anything when you cut your hand other than put something over it to protect it? Your body naturally heals. Well, your body will do that for everything. It naturally has innate healing mechanism. So every disease has to have something that’s the foot on the accelerator, accelerating dysfunction. And every disease has a lack of a break because you should have a break in your body on disease. So with autoimmune disease, what’s the accelerator? The accelerator is inflammation, most of which comes from the gastrointestinal tract.
Like you said, Lindsey, you remove gluten and dairy, heal your gut. That’s aim number one with Hashimoto’s, or any autoimmune disease. You go immediately to the gut. I love the gut and unfortunately, she is the source of most of the inflammation because we treat her like a trash can, not the temple that she is. If you treat her like a trash can, guess what you’re going to get back – trash. Autoimmune disease has its foot on the accelerator gut and no brake. What the brake on autoimmune disease should be is your cortisol stress hormone. We just talked about how, when your own steroids or cortisol fail, you go to the doctor, they give you whatever steroid and they give you pills – and that becomes the brake. You only need that brake when your own brake isn’t working and your own brake is your body’s natural cortisol.
Every autoimmune disease has gut dysfunction and cortisol problems at its root cause. When you fix those, you can reverse autoimmune disease. Fix the microbiome and remove food sensitivities, which may not be allergies. I’m not talking about if you go to any board certified allergist. They’re going to tell you that there’s no such thing as a food sensitivity. That’s not true. Science knows way more than you’re going to find at your mainstream doctor’s office. Go take a visit to somebody who can help you. Your allergist doesn’t believe in that as if it weren’t science. It’s science. It’s not religion. You can be sensitive. Your immune system has many different branches, just like our military. Your immune system is your military. We’ve got Army, Navy, Coast Guard, we’ve got seals, we’ve got… I don’t even know all the branches of the military.
Lindsey:
Air Force, Marines.
Kyrin Dunston, MD:
Marines, right? Well, your body is the same. We’ve got IgG, IgM, IgA, we’ve got cell-mediated immunity and mast cells. We have different types of lymphocytes, all with numbers. We’ve got CD 4, CD 8. We’ve got so many branches in our immune system, it probably outstrips the military. When your immune system is attacking itself, it’s not doing it for no reason. It’s because it’s been triggered into that. It’s like if America started bombing ourselves, right? Well, everyone would say that’s insane. What caused that? It’s the same in the body. Your immune system is throwing bombs on you. Why? What caused it? So we were talking about food sensitivities. You have many different ways you can be sensitive to a food.
Mainstream medicine pretty much only recognizes that if they inject you in your arm and you get IgE sensitivity, that’s an allergy, right? That’s not true. It can be so many other things. You’ve got to get tested for both sensitivities. I love to test. Test, don’t guess. You can energetically test. There’s so many ways you can figure out what foods you are sensitive to, but gluten and dairy have to go for Hashimoto’s. And I think for all autoimmune conditions. After that you go to work on the cortisol. Why aren’t the adrenals functioning properly? You’ve got to support and nurture and love them and give them what they need. I have had plenty of patients. If you ask most doctors, “Do people ever get rid of autoimmune disease?” They’re going to say, “No, it’s progressive and you’ll have it forever.” That’s just not true. I see people all the time who have Hashimoto’s antibody, whether it’s thyroid peroxidase, anti-thyroglobulin, or both, and they don’t have any Lindsey.
Lindsey:
Right. That’s, that’s my situation.
Kyrin Dunston, MD:
Right? And so, it happens regularly. Now, your other questions, do they get off thyroid medicine? Let’s take that one. The problem with Hashimoto’s is that these antibodies are destroying thyroid tissue, if you catch it early enough, and I’m a big proponent of checking auto thyroid antibodies, early and often on everyone, because they’re so common in women. I’ve seen plenty of people with an optimized TSH an optimized T3, T4, reverse T3 who actually had auto antibodies. If you can catch someone who’s in that stage before, you can fix their gut and their cortisol and they don’t ever have to get Hashimoto’s. Their antibodies can go away. I love it when I find someone like that. That’s before there’s anatomic damage to the thyroid.
Now, once you’ve had these antibodies long enough, they’re in there destroying your thyroid and causing anatomic damage. Once you have an anatomic problem, it’s much harder to reverse. There’s a spectrum of how health disorders occur. You don’t just wake up one day and have no cartilage in your knee. It doesn’t happen that way and everybody knows that. You had great cartilage and it got eaten away by inflammation and pressure until you didn’t have any anymore. All disorders happen that way. You just don’t know it or see it. They happen on a spectrum and they start on a functional disorder spectrum. That’s why we say we practice functional medicine. We’re working on the function before you see any anatomic problem and it’ll start as a small functional problem. That’s why I’m a proponent of checking auto antibodies in women early because if you can catch it, it’s just functional, then there’s no anatomic damage, you could fix it.
Lindsey:
Let me stop you for a second on that. When you’re checking the auto antibodies are you doing this by default with every person you see or is this something that you do when you see gut issues or something that would indicate to you that they might have something going on?
Kyrin Dunston, MD:
I only work with women with health problems so at all of my people get it.
Lindsey:
Okay. Got it
Kyrin Dunston, MD:
I don’t do just regular screening care. I don’t do physical exams, pap smears or any of that. I only see women who have problems. If you’re a woman and you are a man and you have health problems, in my opinion, the thyroid is so vastly affected.
Lindsey:
Just to specify you’re saying that women need it in particular, because the majority of Hashimoto’s occurs in women?
Kyrin Dunston, MD:
The majority of thyroid disorders occur in women. It’s like 80/20. 80% in women and 20% in men – the majority of Hashimoto’s and the majority of thyroid disorders. The thyroid is so fundamental to our health. It determines the rate at which we burn calories, which means it determines the rate at which we make energy, which means it determines the rate at which we do anything, because if you don’t make ATP for energy, you can’t fix anything in your body. If there’s ever a health problem, as a part of that health problem at its cause, is an energy production problem, because you don’t have the energy to fix it (as mentioned before the body naturally wants to fix itself). It can’t with something preventing it. One of the things that usually is preventing is your body not making the ATP to fund that activity. Why isn’t it? The thyroid is tied into everything. If you’ve got liver dysfunction, which is huge, in women who have hormonal problems, thyroid is converted into the active form partly in the liver. You’re going to have thyroid problems. Everything has its hand in the thyroid, and thyroid has its hand in everything. So it’s just so fundamental to me, it’s like, you should get weighed, you should get your blood pressure, respiratory rate and you should get your thyroid checked.
Lindsey:
Okay. Let me also dig in a little further. You mentioned food sensitivity testing. In my experience, anybody with a leaky gut, which is pretty much anybody with a gut infection, just kind of has every single thing they eat come up positive on those food sensitivity tests. I’ve written them off as not terribly useful. Maybe I would think after we’ve done some work, and after we feel like we’ve sealed up the gut, and we healed gut infections that the food sensitivity testing might be useful at that point, but but beforehand, it just seems like everything. And that’s what happened with me, by the way. I did an IgG test and pretty much every food that I ate came up positive.
Kyrin Dunston, MD:
Right and if you have leaky gut, which most people with autoimmune do, everything you’ve been eating is going to come up. Let me say this. There is no perfect food sensitivity test or we have yet to find it. Because there’s so many different branches of the military immune system, you can react in so many different ways. Most people are creatures of habit and eat the same stuff over and over and over again. Their immune system is so over it. It’s screaming, “Oh my gosh, not again. You’re not eating and drinking milk again.” There is no perfect test. Now having said that, I find that a lot of people are in denial about what they’re actually eating with themselves and they also are very resistant to give up what they love.
They’re also addicted to the things that they eat all the time. It’s why they eat them all the time. In fact, if you are sensitive to a food, you are highly likely to be addicted to it. It’s going to make you feel really good when you eat it. Part of what happens when your immune system is deployed against the food you’re sensitive to, is your endorphin system being deployed and that makes you feel really good. Maybe people listening can relate to like that euphoria you get after you eat pizza made with cheese and gluten at some point in your life. That’s because the cheese produces something called casomorphin after you eat it. That is a morphine-like substance which makes you feel really good. Gluten produces gluteomorphin, which is a substance like morphine which makes you feel really good. This is why people love bread and cheese. It’s because they’re addicted to it. They’re getting a morphine hit every time they eat it. Now, lets get back to the food sensitivities. I find if you just tell someone to stop eating all the foods that they regularly eat and eat all these things they never eat (because you don’t like them) and do it on a four day rotational basis, most people are going to doubt me. They will just refuse to do it. I like a food sensitivity test sometimes just to be able to show them in black and white. Look at all the things you are sensitive to and they say “Oh my god, it’s all the things I eat all the time!” Exactly. Stop!
Lindsey:
Tell me about the four day rotation. How does that work?
Kyrin Dunston, MD:
Your body was made to eat rotationally on a seasonal basis like back in the stone age. That’s part of what keeps our microbiome healthy. Our microbiome doesn’t want to eat the same thing every day anymore than our immune system does. It’s our human nature. We don’t like change. We like security. We like sameness. We like safety. What do you eat for breakfast? I have two scrambled eggs and I have a piece of toast and one slice of bacon and I have coffee with two scoops of sugar and a drop of milk. We we are such creatures of habit, but the only reason we have that luxury is because we are (particularly in America) relatively wealthy. We can have whatever we want, whenever we want, how we want it over and over and over again. Back in the stone age, how nature made us is we could only eat seasonally and locally. Until we came up with canning methods, we could only eat blueberries in blueberry season. We could only get a deer, when we could kill a deer, which wasn’t every single day. Maybe a couple times a year, we could hunt a deer, then we would have deer. That kept our microbiome healthy, and it kept us healthy. Our immune system didn’t freak out because we weren’t eating the same thing all the time.
We already talked about how our gastrointestinal tract is our biggest interface with the external environment. It is the main central for our immune security system. Your immune system gives a bypass to food. It has to allow certain things. It has to back off when a woman becomes pregnant, otherwise, it would be attacking the baby, because the baby is not genetically the same as the mom. It knows and your body has systems set up to tell it “Okay, calm down. That’s not foreign,” and it has the same type of awareness when it comes to food. Your immune system rings your mouth, you have your adenoid glands and all kinds of lymphoid tissue that circle your throat. Why are they there? It’s not to make kids have to get a tonsillectomy and adenoidectomy, but because they are monitoring everything that comes in your mouth. Friend or foe, friend or foe, friend or foe. Your immune system gives food a bypass. If it only sees blueberries at blueberry season, it’s thinks, “Yeah, I know you’re good. You only come once a year blueberry season.” If you’re eating blueberries every day, it starts to freak out. The example I use is if you go out of your house and you see a stranger standing in the road by your house, you see them one day, you might just look around and go, “I don’t know them, what are they doing here?” You’re not going to worry about it. You come home the next day, they’re standing outside your house, you might wonder about their name and say, “Do you know who that is? I don’t know who that is? Why are they standing outside our house in the street.” If you come home every day, for a week or a month, and you see this stranger standing outside your house, you are going to call the police and say come, “Something’s wrong. They’re doing something wrong.” It’s the same with your immune system.
I know there’s some of you listening who eat certain things. Every single day your body sees something that’s wheat, or gluten, or something that comes out of a cow. Your immune system does not like that; it starts reacting. Not to mention that if you’re eating the same things that are highly inflammatory, gluten is inherently inflammatory, particularly the GMO strains in the US that have such a high gluten content, or cow’s milk dairy; we are not baby cows and are not made to digest cow’s milk. They’re inherently inflammatory, and you’re going to have inflammation from that which will affect the gut. It’s going to be destroying your microbiome. You’re going to start to get your tight junctions that are going to start separating in your gut and you’re going to start to get a leaky gut. After that it becomes a chain reaction where you don’t break down and digest your food properly, then you have these ginormous particles of broccoli coming through, because they still look like broccoli in the small intestine when they’re not supposed to. They’re just supposed to look like magnesium and some carbs and amino acids, but they don’t look like that. If they look like broccoli, well, then they can get through these tight junctions and your immune system really freaks out about that.
So you need to eat on a rotational basis. So in the stone age, we ate seasonally, locally. We don’t live in that way. Today we can have whatever we want whenever we want it. A way we can emulate the stone age is to do a four-day rotational diet. This means any food you eat on a Monday will not pass your lips until four days later. If I eat olive oil on a Monday, I won’t eat olive oil or anything containing olives until Friday because it’s the particular antigen of the food. So you can have olive oil, or maybe olive tamponade. So that all falls in the same category. If I have arugula on Monday, I’m not going to have it again till Friday, but I can have spring mix on Tuesday because that is a different antigen than arugula.
Lindsey:
Is this just with the things that come up positive on the test, or is this a way that you eat normally?
Kyrin Dunston, MD:
I recommend for people in a gut healing protocol period to eat all foods on a rotational basis. Once you get your gut healed, then I say everyone has to find their own edge of what your body can tolerate and what it can’t tolerate. Like gluten for me, I’m not celiac. I do have the DQ 2 and 8 genes heterozygous, so I have a genetic predisposition to a gluten sensitivity and that was a big part of my leaky gut went before I got healthy. Gluten came up sensitive on my first food sensitivity test and like I said, I love seeing in black and white, oh yeah, those are all the things I eat. So I got rid of it for six months. I always say, three strikes, you’re out. I tried to add it back. I tried one food at a time, no more than one every four days and I reacted to it. That was the second strike, so I took it out for another six months. Six months later, I tried again, and I reacted to it. That was the third strike. This was 12 years ago. I love Indian food, probably a lot of other people do too, and I particularly love naan bread. I have had a hard time finding gluten free naan bread, and I’ve tried to make it and alas, I can’t make it like they make it. I have found that I can have one piece of naan bread about once every three months and I am okay.
You have to find your own edge with this food situation. I really don’t recommend that people go back to eating the same things over and over every single day once they feel their gut because I think it’s just asking for a problem. It’s trying to go against our biology. It’s not how we’re wired and as much as we want to watch blue lights until 1 a.m., then immediately fall asleep because that’s just how we want to be. We want to be able to thrive on five hours of sleep. I know people who say, “I’ll sleep when I’m dead. It’s a waste of time.” No matter how much we want to do that, your body doesn’t care. The body will have the final say. If you’re not getting seven or eight hours of sleep, you will pay for it, you will die sooner, you will have more health problems and your sleep will be disrupted if you look at blue lights until right before bed. The eating patterns are just like that. Now, having said that, I do know some people who have healed their guts, but I will say they don’t go back to eating bread and cheese every single day.
Lindsey:
Yeah.
Kyrin Dunston, MD:
And I find that those who do really struggle. I think that people have to learn their own edge of what their body will and will not tolerate and they have to live that edge. Though it’s a living edge. It’s not a hard edge. It’s not like the wall in your bedroom. It can change if you are under a lot of stress at work. Your body is not going to be able to tolerate certain foods with a certain frequency that maybe it can at other times.
Lindsey:
And of course the irony is that’s exactly when people eat those bad foods.
Kyrin Dunston, MD:
Exactly. So everybody’s has to figure it out individually.
Lindsey:
Yeah, okay, but getting back to the hormones, although that was certainly tangentially related. One relatively common complaint I have for some of my female clients is PMS type symptoms like migraines, bloating, etc., prior to their period. Do you think this is gut related?
Kyrin Dunston, MD:
First off, let me say that PMS, bloating PMDD, premenstrual symptoms or menstrual symptoms like dysmenorrhea pain on your period, heavy periods, painful periods, passing clots, none of this is normal. Let me say this. I just want everyone to hear that. We have normalized menstrual dysfunction in our modern society, and it is not. So is it microbiome related? I definitely think that could be part of it, and usually is part of it. What all those things generally mean is that you’ve got too much estrogen or estrogen dominance and not enough progesterone. We also live in a culture that fosters our lifestyle, our diet, estrogen dominance, lack of estrogen and detoxification. We end up accumulating too much estrogen. We take in a lot of pseudo estrogens like phytoestrogens from plants or xenoestrogens from our environment, like in plastics. I heard it estimated that we eat a credit card of plastic on average, every month. I was appalled by that.
The plastics act like estrogens in the body. Parabens, phthalates and all these additives in our cosmetics or cleaning products act as estrogens and endocrine disrupters in the body. Most of us have too much estrogen and if you’ve got any of the symptoms you mentioned, you generally have too much estrogen and not enough progesterone. Why don’t we have enough progesterone? It’s because we’re all stressed out and we already talked about how Queen cortisol will be taken care of and served at all costs. There’s something called pregnenolone steal that happens in your body and the adrenal glands. A lot of these hormones are made from the grandmother hormone which is pregnenolone, and they all are made from cholesterol, which comes from animal protein that’s turned into pregnenolone. The grandmother can be made into estrogen, testosterone, progesterone, aldosterone (which regulates your kidney, water and electrolyte balance), cortisol, DHEA and a bunch of other minor hormones on the pathway.
We already said cortisol will be served at all costs at the expense of progesterone. This is why when you’re stressed out, you might miss a period. This is also why when you’re worried about missing a period, you might miss a period. It’s because you’re worried your stress. Cortisol goes up and your body stops making progesterone. Progesterone is the antidote to estrogen. Estrogen is the builder and progesterone is the developer.
Think of it this way: Estrogen would make a tree grow tall. Progesterone makes that tree grow wide with a lot of branches and a wide trunk. You need both for balance. You don’t want a 200-foot tall tree that’s a little toothpick. It’s going to fall over in the wind and is not sturdy. You also wouldn’t want a one inch stub of a tree with a million branches, so that it just looks like a hairy monster. You want a healthy height tree and you want good branching architecture so that it gets good sunlight exposure and it can have photosynthesis. It’s the same with estrogen in your body. Your breasts, uterus and all your tissues respond to estrogen and progesterone. You want good growth and development, so if you have too much estrogen and not enough progesterone, you’re going to have symptoms like PMS, PMDD, bloating and painful periods (PMDD is premenopausal dysphoric disorder; it’s more severe than PMS).
What does it have to do with the microbiome? Like we mentioned with estrogen earlier, estrogen metabolism is regulated not only by what your body makes, in terms of estrogen or takes in, but what it discards or doesn’t discard. A key step in estrogen detoxification occurs in the gut and there are certain bacteria that are dysbiotic that you can have that can cleave off the tag that your liver put on the estrogen to tag it to go in the trash, which is your poop, which goes in the toilet. This beta glucuronidation can cleave off the tags, so your liver tags the estrogen to go in the trash, and these bacteria cleave it off. Next you reabsorb it. Not only are we getting all these exogenous estrogens from the outside, but we’re not pooping our estrogen that we need to detox out.
Constipation is epidemic in our country. Nature made you to poop every time you eat. You have something called the gastrocolic reflex. Eat, poop. Eat, poop. Eat, poop. If you aren’t doing that, your doctor is not going to call it constipation because based on the Rome criteria doesn’t meet the criteria. It’s some insane thing like not pooping regularly more than once every four to seven days which is insane. Basically if you’re not pooping when you eat, I consider it abnormal. I don’t care what you call it, constipation or not. I can’t tell you. I’m sure you do too, when we talk to people who say, “Oh, I poop once every seven days.” If you’re not pooping, you’re not taking out the trash and you’re not getting your estrogen detox. Your body’s just sucking it back up along with everything else it’s taking and making. This is why we are a nation of estrogen dominant people.
Lindsey:
Yeah, I had that problem. Can you supplement it? Obviously, you want to fix the gut, and you’re going to fix the root cause issues, but can you supplement progesterone by itself or do you just try and detox the estrogen? What do you do to fix that?
Kyrin Dunston, MD:
I’m a proponent of root cause resolution. Fix the cause of the problem. Don’t mask it. Typically, in younger women, if you start taking exogenous progesterone from the outside, it can help you in the short term, but long term, you can wonky your cycle worse. You’ve got to detoxify the estrogen. Stop using cosmetics and cleaning products that have xenoestrogens. Stop drinking cow’s milk. Stop eating hormone-laden animal protein and get your liver tuned up. You can take supplements to help your liver detox, get your poop tuned up. You can do coffee enemas, to get your liver getting rid of that stuff and just get your gut, which is the sanitation department. You can do supplements, diet and activities to get the poop moving and get the estrogen moving out. That’s usually the best place for everyone to start.
There are also things you can do if you’re not making progesterone. The number one reason is because you’ve got a cortisol problem, so you have to work on your cortisol. We all have cortisol problems. I’ve only ever seen one person who didn’t and that was a woman who already took impeccable care of herself and brought her daughter to me, because her daughter was having problems. I’ve never seen another perfect one.
There are supplements you can take. I’m at a yoga retreat right now, Lindsey, and I’ve been here three weeks. Sometimes it is so painful for me to sit in the classes and see how slow they go, because they’re all about mindfulness and that deep belly breathing. I love it and helps your cortisol, but I even think that in my day to day life, I do way less than many people and I think that I’m doing it slow – then I come to a place like this and I find out just how not slow I am. We really have normalized a very unhealthy level of stress. Now, some of it we can’t get rid of, but a lot of it we can. The intention with which we approach the activities that we do undertake, and the rapidity with which, like I noticed how I speak really fast. I noticed how that’s stressful, but it’s just a habit and I can choose to do it differently.
Back to the progesterone, the number one thing we need to do to fix our progesterone is cut our stress. I think you should do those things first. Address the root causes. Sometimes if women are trying to get pregnant, they do need to supplement with progesterone. Sometimes at a certain age, women just do need progesterone, and that can start as young as 30-35. By the time you’re 40 or 45, it’s almost guaranteed to feel like your normal self. Most women are going to have a hard time, but I will say there are some supplements you can take to help the ovaries function better, if they have enough reserve, like chasteberry. That can help if you have enough reserve. Once you get over 40, your number of eggs in your ovaries is going down and your reserve is going down for most women. You might get some benefit with that but you have to see and then you might just need to go to progesterone and progesterone is pretty easy to get. It’s over the counter and you don’t need a prescription. It’s pretty easy to use and it’s pretty forgiving, so it’s certainly something people can do.
Lindsey:
Are we talking about creams or over the counter pills?
Kyrin Dunston, MD:
Oh yeah cream.
Lindsey:
Yeah, I have used those. Well unfortunately we are out of time and this has been such an interesting conversation. I really have enjoyed talking to you about this stuff.
Kyrin Dunston, MD:
Yes I’ve enjoyed it too. It was super fun. Thank you so much for having me
Where to find Dr. Dunston:
Kyrin Dunston’s Stop the Menopause Madness Facebook Group
The Hormone Prescription Podcast with Dr. Kyrin Dunston on Apple Podcasts
Lindsey’s episode of the Hormone Prescription Podcast with Dr. Kyrin Dunston
If you have follow up questions, a great place to ask them is in my Facebook group called Gut Healing. And if you’re struggling with gut and/or other health issues and need some help, I offer a free, 30-minute breakthrough session to talk about your issues and to see if health coaching might help you resolve them.
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