The Gut - Hormone Axis and How to Improve its Functioning

In functional medicine, there is an increasing focus on the connection between gut health and various aspects of overall well-being, including hormonal balance. The gut and its microbial inhabitants play a significant role in modulating the body's hormonal systems, including sex hormones like estrogen, progesterone, and testosterone. This connection is often referred to as the "gut-hormone axis."

It’s very important to understand the premise that all hormones, including sex, thyroid and stress affect one another; so if any one of them is imbalanced it’s highly possible that another one may be off as well. This supports the notion that our hormones exist in a soup with precise “ingredients” or amounts to help us optimally function. The amounts of these hormones are so precise that the tiniest shift will affect many functions.

Here are some ways in which gut dysfunction can potentially affect sex hormones in the context of functional medicine:

1. Estrogen Metabolism: The gut microbiota that influence the metabolism of estrogen are referred to as the estrobolome. Certain bacteria can help metabolize and detoxify estrogen, while others may contribute to reabsorption, leading to higher estrogen levels which can be toxic and disease promoting. Some bacteria produce an enzyme in the gut and can help break down estrogen into less active forms, promoting its elimination from the body. One specific enzyme that can impact the gut-hormone axis, particularly concerning estrogen metabolism, is beta-glucuronidase. Its primary function is to break down certain compounds in the gut, including estrogen metabolites but we also need small amounts to digest phytonutrients in plants. If too much of this enzyme is produced, it snips too much used estrogen from its transport molecules (which are necessary to escort it out of the body via a bowel movement). This estrogen gets reabsorbed and creates all sorts of imbalance. It’s all about the balance.

2. Hormone Recycling: The gut plays a role in supporting the liver's detoxification processes. Efficient detoxification is necessary for the elimination of excess estrogen and other hormonal metabolites. After the liver processes estrogen, it is excreted into the gut to be escorted out via the stool. Certain gut bacteria can break down conjugated estrogen, allowing it to be reabsorbed into circulation. Imbalances in gut bacteria can impact this recycling process, affecting estrogen levels. If estrogen imbalance is suspected such as estrogen dominance, there may be some liver - gallbladder congestion in the mix. The likelihood of this being a dynamic at play increases if other lifestyle factors exist such as eating a standard American hyper - processed diet as well. Many people have liver - gallbladder congestion and aren’t even aware.

3. Inflammation: Gut dysfunction, such as leaky gut syndrome or chronic inflammation in the gut, can lead to systemic inflammation. Inflammation can disrupt hormonal balance and contribute to conditions like estrogen dominance or disrupted menstrual cycles as it impairs the estrobolome. This impairs and burdens the immune system which elevates cortisol and disrupts the delicate balance of the hormone balance.

4. Nutrient Absorption: A healthy gut is crucial for absorbing nutrients, including those necessary for proper hormone production and balance. Nutrient deficiencies such as B vitamins or iron caused by gut dysfunction can indirectly impact sex hormone production. This happens due to deficiency of these key vitamins necessary to activate hormones such as thyroid, stress and sex hormones that require an optimally functioning gut.

5. Insulin Sensitivity: Gut health can affect insulin sensitivity which is required for blood sugar regulation. Insulin resistance and blood sugar imbalances may contribute to hormonal disturbances, particularly in conditions like polycystic ovary syndrome (PCOS) as decreased insulin sensitivity or insulin resistance cause higher testosterone leading to irregular periods and excess weight, hair etc. This dynamic will ultimately lower progesterone and cause an estrogen dominance with other associated signs and symptoms. There is data that specific bacteria such as optimal levels of akkermansia muciniphila help to promote metabolism. 

6. Neurotransmitter Production: The gut is involved in the production of neurotransmitters such as serotonin. Imbalances in these neurotransmitters can influence mood, stress levels, and subsequently impact sex hormone balance as estrogen levels. Conversely, balanced estrogen levels maintain optimal secretion of many neurotransmitters as these cross all systems and interconnect and impact each other.

Functional medicine practitioners recognize that many disease processes begin in the gut. To this end, we address gut dysfunction and its potential impact on sex hormones through personalized approaches, which could include:

• Dietary Changes: Recommending a gut-friendly, anti-inflammatory diet that supports a healthy gut microbiome. This includes whole foods which are nutrient dense and not processed. If it came from or roamed the earth, it’s a go, if it did not, it’s a no. Specifically, cruciferous vegetables such as broccoli, cauliflower, arugula, brussel sprouts etc. help support estrogen metabolism. Nutrition is as important as stress management or nervous system regulation. If one or both are not optimal, it can burden the body and mind significantly.

• Stress Management: Implementing stress-reduction techniques to support cortisol regulation, starting with cultivating self awareness, is integral to healing your estrobolome. We must first know how we respond to stress before we can use some great tools to help us regulate. Stop, sit and listen is a necessary and wise initial approach - even if it is difficult. In our culture, we are taught to avoid uncomfortable feelings at all costs. It’s time to rethink that and if true healing is what you seek, you must start there. Journaling is a great way to start this. Intentional breathing is a great way to feel while keeping the overwhelming feeling at bay. There are many other techniques including somatic ones, where you concentrate on your body’s discomforts in response to stressors or triggers and learn healthy coping techniques. 

• Nutritional/Nutrient Support: Addressing nutrient deficiencies through targeted supplementation. This is a big one! If the body is deficient in vitamins and minerals - like  magnesium for example, it cannot optimally function, including gut and hormone function. It’s all interconnected!

• Detoxification Support: Supporting the body's detoxification pathways to aid in estrogen metabolism. This is crucial, as is maintaining open drainage pathways - pooping, peeing and sweating. The toxins and estrogen have to safely exit our bodies to not pose a problem, otherwise they are recirculated and can potentially cause a lot of issues.

• Lifestyle Modifications: Encouraging lifestyle changes that promote overall gut health, such as adopting a whole foods, nutrient dense way of eating, optimizing sleep and stress management will go far as you begin to heal your gut - hormone axis. Eating as much organic food as you can afford is a great place to start. Check out the Environmental Working Group’s “Dirty Dozen” and “Clean Fifteen” to dial in. Avoiding endocrine disrupting chemicals which can mimic estrogen or cause further hormone imbalances and toxicities - think most commercial personal hygiene products - is another. Instead, use more natural based ones such as coconut oil for moisturizing your skin. Keep in mind that our skin is our biggest organ and we absorb so much through it. 

It's important to note that while there is a growing body of research on the gut-hormone axis, this field is still evolving, and individual responses can vary.

If you're interested in exploring the connection between gut health and sex hormones, it's advisable to work with a qualified functional medicine practitioner who can assess your specific situation and develop a personalized plan based on your needs and goals.