Rachel (not her real name) came to see me feeling desperate for help with her hormones and unwanted weight gain. She had gained weight around her waistline, and her bra size had increased from a 12 to a 14. Since menopause she had gained nearly 10 kilos in the past year, from a slim 58kg to heavy 68kg.
She was concerned about this because her diet was generally a healthy one and she exercised regularly. She had not changed her lifestyle or diet but now she was having to buy a new bra size and was tipping the scales 10 kilos higher. Despite cutting down her carbs and trying various diets, her weight barely shifted and kept coming back on.
“It must be menopause!” she wailed in utter despair. She wanted hormone tests. After some very thorough questioning and looking at her past symptoms and medical history, it was revealed that she had always had some digestive problems, such as bloating and a sluggish bowel, usually bordering on constipation. She was reliant on dried fruit or laxatives to keep her bowels moving. She had never had any investigations or treatments for these symptoms, as they were mild, and considered normal symptoms. After all, she thought, "didn’t most people have those problems"? She said she was surprised at all the questioning I was doing and wondered why I was interested in her bowel function!
I said, "yes, it was very common to have these issues with digestion and bloating and sluggish bowel, but this didn't mean it was healthy". In fact, the “normal” or average gut is actually quite unhealthy, and this is why people suffer with various health issues as they get older. In fact, it is widely known in functional medicine that most diseases can be linked to poor gut function.
“Death begins in the colon” (Hippocrates)
Most people view menopause as a situation where oestrogen levels drop due to the decline of ovarian function. This is why there has been a profitable marketing of HRT hormone medication to women during and after menopause. There are common cases however, where women have too much of a “bad” type of oestrogen! Too much of this type of oestrogen causes fluid retention, increased waistline, breast enlargement, and a feeling of being bloated all round. This toxic type of oestrogen can also put extra work on the liver as the liver tries to clear it from the body. The over-worked liver then has trouble clearing any other toxins that it usually has to deal with. As a result, the patient then finds they can’t cope with other toxins, such as alcohol, the way they used to. Rachel said she really feels the effects of her nightly wine, but she is actually wanting more wine than usual because her energy is low, and her mood has become quite depressed and tired.
Looking at copies of her previous blood tests, what I found was that her hormone levels were definitely in menopause but that they were normal for her age. Her liver function was normal but showed a tendency to high cholesterol and bilirubin. There are no available blood tests to check for gut function, so I convinced her to have test called a Stool Analysis for gut microbiome testig. This involves sending a stool sample off to the lab for testing.
The stool test results were really interesting. The two most important findings were that she had very high levels of the enzyme β-glucuronidase and high levels of Escherichia Coli bacteria. Now let me just elaborate on this. These findings would not show up on a standard Medicare stool test which is done when a gut infection might be suspected. This test for gut function is what is called a “Functional Test”. Functional tests look at how the gut is working. They are done to look at the causes of problems from a deeper level rather than just for diagnosing a disease. It’s a bit like looking under the bonnet of a car to find out why there’s a warning light flashing on the dashboard, rather than simply replacing the bulb of the warning light.
In Rachel’s case, I discovered that because she had high levels of the enzyme β-glucuronidase in her gut, her body was not able to get rid of the unwanted levels of toxic oestrogen metabolites that would normally be excreted by the bowel. Instead, the oestrogen metabolites were being reabsorbed back into her body’s blood circulation and returning to the liver. These recycled oestrogens were not the healthy type of oestrogens. They were toxic waste products that her liver had filtered by a detoxification process called 'conjugation'. These toxic oestrogens are usually then excreted into the bowel to be eliminated completely from the body.
However, in Rachel’s case, her bowel was not eliminating this toxic waste oestrogen. The problem with this is that it reduces the body’s health status, and puts the body at a higher risk of fibroids, breast and ovarian cancers.
Therefore the primary aim of Rachel’s treatment was to enable the excretion of the toxic oestrogens. The excess enzyme β-glucuronidase in her gut was the cause of cause of her body’s inability to clear them out.
It all happens in the gut!
However now you might ask, what is this the enzyme β-glucuronidase and how on earth did it get there in first place? Basically, it’s an enzyme produced by a bacteria. Bacteria are normal commensals in the gut, and without them we would die. Certain bacteria in excess, such as E Coli, are known to synthesize the enzyme β-glucuronidase. Now, looking at Rachel’s stool test, I found that her gut was loaded with too much E Coli bacteria. The plot thickens as they say, but to me it all made sense.
E. coli can cause an increase in the enzyme β-glucuronidase, which then causes a buildup of toxic oestrogens, which then upsets gut function and general wellbeing, and also increases risk of cancer. People who have high levels of β-glucuronidase in their stool may be at increased risk for gall stones, hormone imbalances, and also breast and colon cancer. Naturopathic work is sometimes like being a detective, always seeking the underlying causes of the presenting symptoms.
Rachel’s treatment program will involve the following steps:
1. Reduce the E Coli to a healthier level without eliminating it entirely. Her body needs a healthy level of E Coli, but definitely not removal of it altogether. This is why herbal medicine sometime works better than antibiotics, because antibiotics would remove all of it and then other problems would arise which are too complex to describe in this article.
2. Increase her levels of lactobacillus and Bifido bacilli in the gut so they keep the E. Coli at its healthy level. This is done with appropriate probiotics.
3. Look at her diet, and choose foods which suit her body type and gut function.
4. Supplement with a nutrient product called Calcium D-glucarate, which inhibits β-glucuronidase and increases net phase II glucuronidation (detox). The bonus outcome is that it also decreases oestrogen, is anti-carcinogenic, improves lipid and bile metabolism, is anti-inflammatory and also antioxidant (anti-aging)
In simple terms this kind of treatment is included for conditions such as endometriosis, fibroids, breast cancer, prostate cancer, gallstones, and dyslipidaemia aka high cholesterol. Although Rachel came in initially for help with hormones and weight gain, she embarked on a holistic health care plan that embraced her whole health and wellbeing. In the next article I shall talk about how easy it was for her to eventually lose weight and keep it off. Something she couldn’t have achieved if she hadn’t first attended to the gut issues and the hormone imbalances.