Our hormones can be the difference between feeling energetic and vital day to day, or sluggish and unbalanced. Even those of us who don’t have a diagnosed condition can often benefit from tweaking lifestyle factors to optimize our hormone levels. We asked Christina Burns, licensed doctor of Chinese medicine and founder of the Naturna Institute, to share some insights on common hormonal issues from her 12 years of clinical practice. The Naturna Institute is located on NYC’s Upper East Side and takes a holistic mind-body approach to general wellness and the motherhood journey, leveraging functional nutrition, lifestyle management, acupuncture, and herbal medicine.
Q: What are some of the common hormonal imbalances women face?
In my practice I see many patients with polycystic ovarian syndrome (PCOS) or endometriosis - these are metabolic and autoimmune conditions too, rather than simple hormone imbalances, although to a certain degree it is all related. Some of the more basic cases include bad PMS, fluid retention, breakouts, and thyroid conditions such as Hashimoto’s. The underlying causes of these issues range from imbalances in pancreatic hormones, thyroid hormones, or reproductive hormones like estrogen and progesterone. Insulin issues and insulin resistance have become very common – 20% of the population today is insulin resistant.
Q: If you haven’t been diagnosed with something like PCOS, diabetes, or Hashimoto’s, how can you tell if you have a hormone imbalance or are experiencing symptoms beyond what is normal for the occasional off day?
You can start to observe patterns - is your sleep interrupted? Do you feel puffy, or have a bit of weight gain around your stomach? Are you having trouble getting pregnant? Is your energy an issue, either all the time or perhaps you notice a dip in the afternoon between 3 and 4pm? A lot of people don’t think of these things as meaning anything, but that afternoon fatigue for example, is actually not normal if it’s occurring regularly, it’s usually an adrenal or blood sugar imbalance.
There are a myriad of questions that you can ask in relation to blood sugar – for instance, do you crave sweets after meals? This is one of the signs of insulin resistance, which is a pre-diabetic state where the cells don’t respond normally to insulin and don’t take in sugar as well. People that are insulin resistant tend to want to eat more, not necessarily sugar, but just food in general – they might have cravings for carbs, or for salt. Often, blood sugar is at the root of all of these issues, where if you can balance your blood sugar, those PMS symptoms or the fatigue will go away. Learning how to observe your own rhythms and tendencies and knowing which foods or habits are better or worse for you, so you aren’t dependent on others or some magic pill, is very important. One of our quotes at Naturna is ‘empowering through knowledge’ – everyone with the right lifestyle education has the ability to be their own doctor to a degree in the home, for themselves and their families. We help patients grow awareness by asking questions – how did you feel after you ate this, how did you feel when you ate at this time vs that time, did this type of exercise vs that other type? It’s a process of discovery and partnership where we work with women to learn what will be the best treatment for them and train them to understand what’s going on with their bodies.
Q: What are some steps to consider taking if you suspect you may have a hormone imbalance? Does the fact that so many different factors can be at play mean that treatment protocols are very different across individuals?
They are different, but also similar. A lot of my patients present with similar issues, blood sugar imbalance and insulin resistance, or chronic low-grade stress. This can be emotional stress from work or a relationship, just the stress of being in New York, or stress internally from foods they’re eating that aren’t good for them. Stress hormones and blood sugar really affect estrogen and progesterone, so generally where I start with patients, in addition to doing acupuncture, is with their diet. Typically, the dietary and lifestyle approach is huge – what are your stress management techniques, what kind of exercise are you doing, what is your diet, not just the content of your food but your portions and the time of day you’re eating it.
There are certain foods that support hormone levels or will aggravate hormone levels – coffee for example is hard on the adrenals and blocks up the liver, which will create issues with some people more than others. Similarly, the right amount and form of exercise for each person can really vary. If you have adrenal fatigue or a progesterone deficiency, which manifests in being a bit puffy, or tired, or having really bad PMS, then marathon running is not for you. Exercise is good, but in gentler forms and shorter bursts, maybe 30 minutes rather than a 90 minute workout. If you have endometriosis, you should really avoid inflammatory foods that aggravate the immune system, like pork, beef, soy, and corn. If you have PCOS you are dealing with some degree of insulin resistance, so you need to be strategic about eating fats and proteins over excess carbs or sugar.
A lot of conditions can be healed through lifestyle, but it can take awhile. There’s no denying that we live in an instant gratification culture, and that’s one reason that acupuncture is so great – combining diet and lifestyle modification with acupuncture makes everything easier and helps patients see results much faster, which gives them extra motivation to continue living more consciously and healthfully. It can give people the illusion of a quick fix, when actually I’m getting my patients bought into a long term process that acupuncture is just one part of.
Q: What are your thoughts on the use of herbal adaptogens to remedy adrenal fatigue?
One-size-fits-all adrenal remedies are generally a bad idea – these types of issues often arise from underlying individual factors that it makes more sense to consider more holistically. Women with PCOS for example shouldn’t necessarily be taking chasteberry, because that could make their imbalance worse. Some women with PCOS also shouldn’t take ashwagandha for the same reason. However, ashwagandha is a really great herb for people with thyroid issues. Generally, adaptogens by their bi-directional nature will be a little bit kinder, more neutral on the system and therefore easier for a broader cross section of people to take, but it’s difficult to generalize and prescribe things globally. You can actually determine your level of adrenal fatigue with a saliva test – results are segmented into stage 1, 2 and 3, and if you have early stage adrenal fatigue and your cortisol is still high you’ll take certain adaptogens, whereas others will be more effective for more advanced cases of cortisol deficiency.
Q: We often start to pay more attention to hormones and low-grade symptoms when we’re trying to conceive. How soon before you ideally want to get pregnant should you begin adapting your lifestyle?
I recommend starting 3-6 months out and doing what I would call an all systems approach to pre-conception planning. Part of this is cleaning out your body, relieving the body of toxins to make sure they don’t affect your baby and also to make you more fertile. I usually don’t recommend fasts as a form of detox – fasting dumps a lot of toxins into your system quite quickly which stressed bodies can’t handle very well, and since I believe all New Yorkers have some level of adrenal fatigue, in my opinion this isn’t the best route for most people. Typically, something more along the lines of an elimination diet, eating a little more plant based and cutting out the inflammatory foods, is a good idea. Balancing blood sugar and adrenal hormones, primarily insulin and cortisol, is also important, because that provides a strong foundation – if those are stable, then your other body systems will be more stable as well. Remember, the reproductive system is a non-essential system. If we’re in fight or flight response all the time, our body is thinking that our blood needs to be directed to the muscles or to pump the heart, which can easily shut down the ovaries. I see a lot of women who have lost their period after a stressful time, or after a ton of extreme exercise – same idea, it’s just stress on the body, either mental stress or physical stress.
So, cleansing and stabilizing the system, and in some cases optimizing the system through the use of antioxidants, vitamins or herbs, can make for a better pregnancy. Particularly with advanced maternal age, using antioxidants to reverse some of the aging pre-pregnancy can help. And going through some type of preparation process just gives you better mental and emotional balance in general to prepare for this next phase of life. Of course, you can also just go get knocked up and everything will be fine! But if you have done a preparation phase there’s a mindfulness and a balance that goes into it, and I do find that women that have done that tend to get pregnant more quickly.
Q: How can acupuncture and herbal medicine work to enhance fertility?
Acupuncture is very good for stabilizing blood sugar, bringing down blood glucose and resensitizing the cells to insulin, as well as bringing down stress hormones to help balance the nervous system. It’s also cleansing and stimulates circulation to the reproductive organs, which allows them to function better. For most people it works better in conjunction with something called moxibustion, which involves burning an herb called artemisia (mugwort) near the skin at specific acupuncture points to elicit a therapeutic effect. This helps revitalize the organs even better than just acupuncture will.
How it works is that the needles tap into meridiens, rivers of energy. These have been shown to a degree to be correlated with the pattern of the nervous system - there are over 400 acupuncture points on the body, and what we’ve seen is that stimulating certain points will stimulate different regions of the brain, which will then send a signal to the body as part of a feedback system. In China, it’s believed that Daoist monks long ago meditated and achieved a level of mind-body awareness where they could actually feel the channels of energy, and mapped them out. Acupuncture is an incredibly sophisticated science, but it predates western medical science so it’s not explained in those terms, but rather in Chinese Daoist medical terms like qi, yin, and yang. And not only does it predate what we have in western medicine, it’s from a different paradigm where things are looked at more holistically and more in harmony with the environment and different elements.
Among the safest and more common herbs for fertility from the western herbal tradition is raspberry leaf, which is good as a tea for the ovaries and for toning the uterus. Nettle is really full of minerals and can also be beneficial, as well as maca for hypofunctioning reproductive organs. But the use of herbs has to be case specific to be effective - the most important factor is your overall state of health. You are more likely to succeed if you are playing an active role in your own health by adapting your diet and lifestyle to what it should be.