February 28, 2015
[01:32] Dr. Michael Smith
[04:29] The Kalish Method
[07:46] Common Hormone Imbalances Found In Healthy People
[10:15] Testing For Low Progesterone
[16:08] Hormone Replacement Creams
[17:58] Herbs for Progesterone
[18:57] The Next Common Hormonal Imbalance After Low Progesterone
[20:18] Who Usually Deal With Estrogen Excess
[21:53] Testing For Excess Estrogen
[25:59] Using Calcium D-Glucarate Versus Other Strategies
[27:59] Effects Of Too Much Estrogen/Low Estrogen
[32:06] How to Bring Up Estrogen
[32:43] Testing For Low Estrogen
[34:52] Low DHEA and What to Do About It
[39:27] High Testosterone
[41:30] How Women Get High Testosterone
[43:51] What Kind of Tests Michael Uses
[47:42] More on Dr. Smith's Practice In Australia
[50:51] End of Podcast
In this episode of The Ben Greenfield Fitness Podcast:
“While the blood hormones are what's flowing freely through the blood, whereas the saliva hormones is what's actually getting into the cell, it's what your body can use.” “I find that hormone replacement creams, they're more of a Band-Aid approach. They're not addressing the cause of why it's happening.” “If there's high levels of the beta glucuronidase in the bowel, that's going to lead to reabsorption of estrogen from the gut.” “And unless you're professional athlete, you're also probably looking after a family, working, so you don't get as much time to rest and sleep, so you've got to do everything that you can to get your body functioning well.” “High testosterone in women will lead to high levels of prostaglandin in the blood, which will then lead to insulin resistance. It comes like a vicious circle.”
Ben: Hey, folks. It's Ben Greenfield, and I got to tell you, if you want to know if you have a hormone imbalance, or you've always wanted to test your hormones, or figure out how to do that, or you want to know how to fix your hormones and you're just a complete hormonal mess, you definitely want to tune in to this episode. And I actually want to start here because this is why I got today's guest on is I get tons of questions from listeners who are, pardon my accent, down under and they want to know about how to get things like blood, and gut, and hormone testing done, and a lot of them are having trouble kind of finding out how to do that in the in the great land of Oz. So I did some research, and I talked to some of my trusted Australian friends and coaches, and was eventually referred to and discovered this guy named Dr. Michael Smith. And Michael runs the website in Oz called PlanetNaturopath at planetnaturopath.com.
And Michael is not only a naturopath, as you probably would have guessed from the name of his website, but he's also what's called a Kalish method functional medicine practitioner, and he specializes in hormone disorders, adrenal thyroid, and digestive function, also as we like to call it on this show, your poop. He does blood, he does saliva, he does poop, he works with clients from the chronically ill to athletes who want to improve performance, and most of the work that he does is in Australia. So if you do live in Australia and you're listening in, you'll definitely want to look this guy up. But he's also chock full of information that's going to help all of us out all over the world, no matter where we are, and specifically today, we're going to be talking a lot about hormones. So first of all, Michael, thanks for coming on the show.
Michael: No worries, Ben. How you doing?
Ben: I'm doing well. Did you like my Australian accent?
Michael: [chuckles] Yeah. A little bit to work on. My wife's actually Canadian, so yeah, she's also does an Australian accent after 12 years here.
Ben: Well if I don't know if you have children, but they're going to be extremely messed up, I'm sure, based on the Canadian-Australian accent combo. That can't be good. Anyways though, I jest. I'm sure they'll sound just fine. You're a naturopath, and before we start to talk about hormones and stuff here, like I mentioned and like you have written on your website, you're also this Kalish method practitioner. For people who aren't familiar with what the Kalish method is, 'cause a lot of folks know what a naturopath, is but the Kalish method is something that people might not be quite as familiar with. Can you explain what that is? What the Kalish method means?
Michael: So the Kalish method is looking at a lot more functional pathology testing. So getting to the cause of the problem with saliva testing for the hormones, looking at gut dysfunction through parasite testing, thyroid testing, just getting to the cause of the problem through extensive testing rather than just relying on signs and symptoms which can be a little bit misleading.
Ben: Okay. Gotcha. So why do you need an entire, I guess, like practitioner certification for something like that? Is it like a special series of tests that you learn when you become a Kalish method practitioner? I mean are these tests unique to that method, or what kind of tests are we talking here?
Michael: The tests, they're not unique to the Kalish method. They're saliva hormone testing for the adrenal function, for estrogen, progesterone, testosterone. Dr. Daniel Kalish has a unique method of interpreting these tests and getting right results. So he teaches a six month course on how to go through step-by-step, getting to the cause, working at a systematic treatment, and the bottom line is getting great results.
Ben: Can anybody become a Kalish method practitioner? Is that something that you need to have like a medical degree to get a certification in or is that something like, for example, myself as a lowly podcaster could go and look into?
Michael: I don't think you need a medical degree, but you definitely need some sort of qualification. You want to have a really good base of knowing what you're doing before you would step to it. I have to talk to Dr. Kalish about that.
Ben: Gotcha. That's Kalish, is it kalishinstitute.com is where you go to look into that?
Michael: That's it, yeah.
Ben: Okay. Alright, cool. It's something I've been meaning to look into a little bit more myself because I've heard a couple of interviews with Dr. Kalish and he sounds really intelligent when it comes to this process of kind of basing medical treatments and procedures on really adequate testing and the type of testing that I know you and I are going to talk about here in just a second. So, okay. Cool. Well that clears up the whole Kalish thing then. It's not some strange Australian, I don't know, farming certification or something like that. It's an actual medical deal from, and I think Dr. Kalish is in California right?
Michael: Yeah. San Francisco.
Ben: Yeah. Okay, cool. So like I mentioned, I wanted to talk to you Dr. Smith about hormones because I know that's something that you specialize in. And there are things like low testosterone, like that's a horse that gets kicked to death and that you hear a lot about. But are there things that you would say, like hormone imbalances in seemingly healthy people, we have a lot of people who listen into this show who are already working out, who are already out of couch potato mode, who are out doing triathlons, or competing in CrossFit or something like that, what kind of hormone imbalances do you tend to find in seemingly otherwise healthy people?
Michael: Hormone problems come in four different categories. Probably the most common one is a decrease in progesterone, which can lead to mood problems, pain, breast tenderness. And that can be quite common in athletes because of the high training, the high stress, sometimes not getting enough calories in their diet.
Ben: Now is that mostly women or?
Michael: Yeah, that would be women. Hormonal imbalances for the progesterone, estrogen would mainly come down to women. So for men, that would be more low testosterone they would experience, and that can be from overtraining, once again stress. Stress is the big driver behind hormonal problems. So the first thing you want to look at is what stresses they're under, whether it's from diet, digestion, overtraining, it could even be just lack of sleep can lead to this stress which will lead to excess estrogen in men and low testosterone through the adrenal stress.
Ben: But it's low progesterone, when we're talking about hormone issues in healthy people or in athletes, the first one that you come up with is low progesterone, and specifically that would be something that you'd see in like athletic women?
Michael: Yeah. It's always an imbalance between progesterone and estrogen. So they kind of work hand in hand. You need them in the right balance. And for some women, it's excess estrogen, and that can be probably not always, but probably more women who are possibly overweight or having liver digestion issues. Whereas the low progesterone, that can probably be from athletes, and once again it's the stress on the body is the main cause, and the stress, as you know, it can come from many different angles. It can be from the diet, to just having a low calorie diet, especially a lot of athletes are still on the low fat bandwagon, so they still get, they just don't get enough calories in their diet. Some of the symptoms might be you start skipping periods, or getting more moody, getting breast tenderness, things like that.
Ben: Okay. So how would you test for something like low progesterone?
Michael: So you can get a blood test for progesterone or a saliva test. I use the saliva test 'cause that measures the bioavailable hormones. So sometimes might have normal progesterone levels in the blood, but in the saliva sample they're low. Sometimes you can have low progesterone symptoms, but the progesterone levels are normal as well. And that's, yeah?
Ben: Can you explain that distinction between blood measures of hormones and salivary levels of hormones a little bit more thoroughly? Because I'm kind of curious about the real reason that you say maybe wouldn't want to rely on like just blood cortisol, or just a blood progesterone, or just a blood testosterone versus the salivary. What's the distinction there in a little bit more detail?
Michael: Well, the blood hormones are what's flowing freely through the blood and they're unbound hormones, whereas the saliva hormones is what's actually getting into cell, it's what your body can use. So you can also with the blood, bloods can be okay if you're checking also sex hormone binding globulin, and there's an equation you can work out to work out the unbound hormone that you have and free. But the saliva one is, it's more convenient also for clients 'cause they can do that at home, they don't have to go and get blood taken at the lab, they can just do a sample in the morning and send it off to the lab. So it's convenient, a little bit cheaper, and you get what's available to the body.
Ben: Now in the blood, couldn't you get, like I know with testosterone for example, you can get a total testosterone reading and a free testosterone reading, and I know that's not progesterone, which we were kind of talking about just a second to go, but in a situation like that where when you get a blood test, you can get both a total and a free, would that mean that it would necessarily be necessary to also do a salivary test? Like would the free levels in the blood be indicative of the same type of information you'd get from the levels in the saliva?
Michael: Yeah. If you had free testosterone in the blood, that would be a good measurement as well. So yeah, that's fine.
Ben: Gotcha. So returning to the progesterone issue in women who suspect that they may have low progesterone due to low amounts of energy, or moodiness, or low sex drive or something like that, they can get what's called a salivary progesterone. Is that what it would be termed?
Michael: That's right. And I always do that with an adrenal test as well. Because you can have normal progesterone, but if you've got high cortisol, that's actually blocking the action of the progesterone. So you might have normal progesterone levels in your test, but actually the progesterone is not being able to be used by the body.
Ben: Interesting. So you could have, for example, high progesterone or normal levels of progesterone if you were to measure just salivary progesterone. But if you don't measure your levels of cortisol, that doesn't necessarily mean that you're able to use that progesterone?
Michael: That's right. So you got to take in the signs and symptoms. Sometimes a client might go to a doctor and get their hormones tested and be told everything's fine, but they have high cortisol which is blocking the body being able to use the progesterone. The inflammation that causes will block the progesterone receptors.
Ben: Okay. See, I was always under the impression that if you weren't making enough progesterone that it was potentially because you were making a bunch of cortisol and that you couldn't necessarily have a state of both high cortisol and high progesterone. But it sounds to me like what you're saying is you could have high progesterone and also have high cortisol, and that cortisol would keep that progesterone from being bioactive. Is that what you're saying?
Michael: Yeah. You probably wouldn't have high progesterone, you'd have normal progesterone and high cortisol. And the longer that goes on, you're right there, if someone's been under stress for a long time, eventually you'll end up with maybe even normal cortisol, but low progesterone, and then eventually low cortisol, low progesterone, and the symptoms are a lot worse than, and often leading to low DHEA, that's another way to measure just how long the stress has been occurring for.
Ben: Okay. Gotcha. So one of these salivary stress tests would be measuring cortisol, DHEA, progesterone, anything else?
Michael: You always measure estrogen 'cause you want to see that in the right balance between progesterone and estrogen too. So sometimes you can have normal progesterone, but the estrogen's high. Or we can have normal estrogen, but the progesterone's high, low, sorry. So the symptoms are often the same, but knowing which one's high or low helps target treatment a little bit better.
Ben: Okay. Gotcha. So returning to the progesterone issue, let's say that you find out that you've got normal progesterone with, obviously normal progesterone with high cortisol, you'd want to go after the cortisol, I would imagine, from a stress standpoint or a training standpoint or a recovery standpoint. But if you find that you have a low progesterone, a lot of times you'll see recommendations for like these progesterone creams, or like topical progesterone lotions, stuff like that. Are you a fan of those, or what exactly do you recommend for women who wind up having low progesterone? ‘Cause I frankly run into this all the time. It seems athletic women who either have low progesterone, or low progesterone and low estrogen, and I'm curious what your thoughts are on some of these hormone replacement creams, or lotions, or topicals, or whatever.
Michael: I find the hormone replacement creams, they're more of a Band-Aid approach, they're not addressing the cause of why it's happening. So they can actually help in the short term, but long term, they lead to very high progesterone levels, and it just leads to more progesterone resistance. So it's too much hormones and the body will sort of downregulate the receptors. So that's just as effective as it could be and should be.
Ben: Got it. So what do you do?
Michael: Well in Australia, I use herbs. Dr. Daniel Kalish, he uses the progesterone drops, which in very low doses, it doesn't bypass that feedback loop that the creams do. So there's different herbs you can use. So progesterone, if you've got low progesterone, that's the precursor to allopregnanolone in the brain. So that leads to a lot of those problems that people get. So I'll be looking at using things that stimulate GABA, herbs like zizyphus and magnolia, even herbs like vitex can help to stimulate progesterone production by reducing prolactin levels. So there some herbal and nutritional methods you can use to get around it.
Ben: What would you say would be, for people listening in, if they wanted to look into like, there's all sorts of ways that you can get organic herbs out there. Like my wife and I shop at, over here in the US, we shop at Mountain Rose Herbs which is one place you can get totally organic herbs. But if someone were to be looking for one of your top recommendations for a good progesterone increasing herb, what would you say would be one of the better that you've found?
Michael: The better herbs of the better places to get them from?
Ben: The better herbs. Or herbs, or herbs, as you say.
Michael: Herbs. Vitex or chaste tree, as it's sometimes called, is probably the better one for that improving the progesterone in the brain.
Ben: Okay. Gotcha. And isn't that something that guys would want to be careful with. ‘Cause vitex or chaste tree actually lower testosterone or lower libido in men?
Michael: Yeah. That's true. But it can actually be an effective treatment for say, teenage boys or young men with a lot of acne. So chaste tree can be effective for lowering the inflammation that testosterone is causing.
Ben: So basically they won't have zits, but they won't like girls anymore either?
Michael: [laughs] You just got to get 'em in the right balance.
Ben: [laughs] Okay. Gotcha. Alright, so we've got low progesterone as one of the four common hormonal imbalances that you tend to see. What is the second?
Michael: The next one would be excess estrogen. So estrogen's a growth hormone. So when it's in excess, it leads to inflammation, which can lead to heavy periods, plotting, a lot of painful periods. It can lead to things like endometriosis, fibroids, and especially if the estrogen's not getting detoxified correctly, it can be a cause of breast cancer.
Ben: Now do you tend to see the excess estrogen in athletic females? It seems like a lot of times, like in a state of caloric cutting or deficits combined especially with like heavy training, a lot of times low progesterone and low estrogen seem to go hand in hand. Do you find that high estrogen is something that occurs in like hard-charging female athletes or exercisers? Do you find estrogen to be more of a problem in women who don't exercise enough, or who are fat? Or do you find higher estrogen to be an issue in men? What are the populations that you think tend to deal with this high estrogen issue? Or estrogen excess?
Michael: So estrogen excess, you're right, it's probably not as common in really tuned-in, high performing athletes. It can be though, due to genetic predisposition or they might have a lot of, they might be doing all the training and the exercise, and have their diet down pat, but if they're in contact with a lot of environmental estrogens, that can lead to estrogen excess. Especially if they have issues with liver detoxification, they might have genetical pre-disposition with the COMT enzyme, or the MTHFR enzyme. While it's common not to have estrogen excess for athletes, it definitely can happen.
Ben: So you don't have to be like the stereotypical, and I don't want to use this word to be offensive, but like the stereotypical fat woman to have like estrogen dominance or estrogen excess. You could, for example, be getting exposed to perfumes and fragrances at your gym, or you could have, which genetic defect did you say? The MTHFR?
Michael: MTHFR and COMT. COMT's an enzyme that metabolizes estrogen in the liver.
Ben: Are you saying COMT or POMT?
Michael: COMT. Catechol-o-methyltransferase.
Ben: Okay. So how would a woman test, let's say a woman has excess estrogen. How would she know if it's because of maybe like the fragrance or perfume that her coworker is wearing on a daily basis versus whether to due to some kind of a liver that needs detoxing? Is that simply a test that you run, or how do you differentiate?
Michael: Well, quizzing them about their lifestyle and what they're coming into contact with, how they're reheating their food and what containers they're drinking out of, what things or creams they're putting on their body. You could do an organic acids test which measures, you measure the environmental toxins in that and also measure the liver, how the liver's working, to see if they're detoxifying those toxins or not. Sometimes people, they're not getting a lot of toxins in the environment, but their liver's not detoxifying them. Or their liver's working fine, they're just overloading their body with all the xenoestrogen, estrogens in the environment.
Ben: Now what about men? And I ask this question actually because I recently, I haven't even released the blog post about this yet, although it probably will be released by the time this interview with you comes out, I recently tested and I noticed that my estrogens have gone up a little bit, my estradiol has gone up a little bit since the last time that I tested. Now my testosterone has also gone up, and of course that means that potentially some of this extra testosterone that I'm making is getting converted into estrogens. In men, what are some signs and symptoms of having excess estrogen and what do you do about it?
Michael: So excess estrogen in men, it's actually becoming more and more common. So the signs and symptoms would be possibly not losing weight as easily as they used to do, putting on a bit of breast tissue, fatigue, muscle soreness. A lot of the same symptoms of low testosterone come from the higher estrogen, so always finding out why they've got that high estrogen is the most important thing. Some men, they're supplementing with testosterone, once again it's a Band-Aid effect. So often men with testosterone supplementation, they'll end up converting a lot of that to estrogen. Yeah, so that can be from inflammation. So looking at their gut health, if, there's an enzyme called beta-glucuronidase which will convert the estrogen that your body is trying to detoxify into estradiol in the gut. So that can lead to high estrogen levels from just not detoxifying properly.
Ben: So elevated levels of this beta, how'd you pronounce it? The beta-glucuronidase?
Michael: Yeah, glucuronidase.
Ben: Excess levels of that would cause potentially for estrogens getting metabolized in your liver to get converted into estrodiol in men, and that's what would cause like a higher level of blood estradiol?
Michael: Yeah. So that's where the calcium D-glucarate supplement is quite good. ‘Cause that inhibits that enzyme from doing that and helps the estrogen detoxification through the gut.
Ben: Calcium D-glucarate, that would be something that, for example, men with excess estrogen could look into as a way to keep that from occurring?
Michael: Yeah. Men and women, actually. If you've got excess estrogen, it can work with women, especially if it's the gut function that's causing the problem. So looking at all the signs and symptoms of their digestion, what their eating, how they're eliminating, what their poo's like, all those sort of things give you signs of what steps you need to do to reduce down the estrogen, whether you focus on the gut or focus on other things like detoxification.
Ben: Now a lot of people that listen in use, for example, glutathione, and I've talked to a lot of people use N-acetylcysteine as liver detoxification supplements, in addition to eating sulfurous vegetables, like broccoli, and cauliflower, and garlic, and onions, and things of that nature. How did those type of strategies compare to something like calcium D-glucarate? Are they acting via a similar mechanism, or is calcium D-glucarate different?
Michael: So herbs and nutrients like the N-acetylcysteine, glutathione, they work on phase one, phase two liver detoxification. So once the estrogen's metabolized in the liver, it gets cleared out through the bowel. But if there's high levels of the beta- glucuronidase in the bowel, that's going to lead to the conversion, that's going lead to reabsorbtion of estrogen from the gut back into your system rather than getting eliminated. So it's a step down in the process.
Ben: Okay. So theoretically, you could have like a one-two combo of using glutathione and calcium D-glucarate?
Michael: That's right. You always want to get the liver working well and detoxifying.
Ben: For pill-phobic people, are there dietary sources of calcium D-glucarate? Kind of like whey protein is one good way to glutathione?
Michael: Yeah, not really. Well, not that I know of. I always just used the supplement 'cause it's really effective. That's why I use the, I'm not too sure if there's another way of getting…
Ben: Gotcha. Well I'm certainly, by the way for people listening in, I'm taking notes as we go and you can find them all over at bengreenfieldfitness.com/saliva, just in case you have too many things from MTHFR to calcium D-glucarate rolling around in your head right now. Don't worry, I'm taking notes. Interesting, okay. So you like that for estrogen excess in men. One other question, before we move onto the third hormone imbalance you wanted to talk about. When men or women have estrogen excess, can that affect mood? I've always wondered if, I don't really experience this but I'm wondering if my estradiol, for example, were to continue to go up, would I get moody, would I get teary, would I turn into my grandma? What happens when you get too much estrogen from a mood standpoint?
Michael: Yeah. So that can affect… the excess estrogen will affect the conversion, it's an inhibitor of progesterone getting converted to allopregnenalone in the brain. So allopregnanolone's the final precursor to produce GABA. So GABA's like your calming neurotransmitter. So if that steps getting blocked, that can lead to less pain tolerance and more mood anxiety. So that's how issues would affect mood basically in the brain.
Ben: Gotcha. So you could for example, if you had excess estrogen, it could lead to something like anxiety, lack of sleep, things along those lines. Like you wouldn't necessarily just have to get more teary-eyed while watching a chick flick?
Michael: That's it, yeah. So it could be the excess estrogen or the low progesterone. Both have that same symptom of mood and emotional, also anger as well. GABA's another solution. Always getting down to the cause of working out why that's happening, so that comes down to stress, cortisol levels. But then a short term solution would be to supplement with GABA to help get things in balance while you get the rest of the body back in order.
Ben: Right. GABA as an inhibitory neurotransmitter to help with anxiety. Yeah. I'm personally, I got to tell you, a huge passion of things like passion flower extract, or even Valerian root as alternatives to getting like straight up GABA. I've had a lot of people feel like the both of those herbs help them to be very, very relaxed, especially like liquid passion flower or liquid Valerian root. Have you messed around with either of those much as an alternative to something like gamma-Aminobutyric acid as a supplement?
Michael: Yeah. Passion flower and Valerian are excellent. I also use zizyphus, the Chinese herb zizyphus, and magnolia, as well as even l-theanine as a precursor to GABA as well. So a lot of the Chinese herbs, they're great for premenstruals.
Ben: The Thorne FX multivitamin that I recommend has an AM and a PM, they're actually rebranding now, they're going to be called Exos Multivitamin now. But they have magnolia and philodendron in their PM formula to help as an anti-anxiolytic for sleep. So those two components are definitely included in that one. Interesting. Okay, so let's jump into the third hormone imbalance, in addition to low progesterone and excess estrogen. What's the third one?
Michael: Well the third one would be low estrogen, which often affects women later in life, but especially in athletic women that can lead to overtraining, once again, high stress can lead to low estrogen and low progesterone. Once again, that can lead to a lot of mood problems, more the heat and hot flushes, dryness. With athletes, that would be a big problem.
Ben: So in terms of low estrogen, is that something that typically goes hand in hand with low progesterone, or could you have normal progesterone levels and then have low estrogen levels?
Michael: In athletes, it probably comes hand in hand with low progesterone because of it would be due to that stress.
Ben: Now in men, wouldn't low estrogen be a good thing?
Michael: Low estrogen is the natural state in men. Men do need estrogen but the lower is generally the better. So I haven't seen, well I haven't noticed men with low estrogen symptoms. It's more of an excess.
Ben: Okay. Gotcha. So in women with low estrogen, what do they do? Just start to sniff more paraben-filled perfume, and use nasty shampoos and conditioners to get their estrogen back up, or eat a bunch of soy, or what exactly do you do there?
Michael: Yeah. Soy can be an option, especially if it's, I wouldn't recommend going and guzzling liters of soy milk, but having some of the natural, fermented soy products can actually help with low estrogen symptoms.
Ben: What would be an example of a natural fermented soy product?
Michael: Things like tempe, miso, even some of the fermented soy bean Japanese dishes.
Ben: Okay. Gotcha. So if a woman were to do, and is this a salivary test? Low progesterone?
Michael: Low estrogen would come up in the…
Ben: Or low estrogen, rather.
Michael: Yeah. That would come up in the saliva test.
Ben: Okay. Gotcha. So a woman would get a saliva test, she finds out she has low estrogens, then in addition to, well of course, and this is kind of the elephant in the room, like overtraining, and extreme caloric deficits, and fasting too much, and being fat phobic, I think most of our listeners probably know by this time that all of those things could cause you have to low estrogen, low progesterone, low hormones in general. But if folks were kind of getting those pieces into place, one of the things that can help is to actually start to increase the amount of fermented soy products that you're consuming, huh?
Michael: Yeah, that would be a, once again that's addressing the symptoms. The first thing I would look at is what's the cause, the other thing in the test I look at is DHEA. So DHEA is the final precursor for your body to make estrogen. So looking at the stress, whatever it's coming from, whether it's inflammation, from injury, or from the possibly inflammatory diet, but looking at why that DHEA is low. So you support the nervous system again with things like magnesium, and once again magnolia, with withania, also looking at blood sugar support, and possibly even thyroid function would come into this too. So low thyroid function could be a contributing factor.
Ben: So with the DHEA, I have actually, 'cause I work with WellnessFX, and one of the performance panels that WellnessFX runs, and a lot of times for me on Thursdays, I do a lot of consults with folks who've had their WellnessFX bloodwork done here in the US, I'll a lot of times see athletes who have decent levels of testosterone, for example, but who have low DHEA. Is that something that you run into much, like people who have adequate levels of estrogen, or progesterone, and or testosterone, but who have low DHEA. And if that is something that you see, what do you tend to do about it?
Michael: So the low DHEA, you can still have normal estrogen and low DHEA, but often, especially later in life, that becomes more a problem. That's when you might get more hot flushes, it becomes more of a problem with menopausal women, the low DHEA. So to support DHEA, we can't supplement with DHEA in Australia, well I can't…
Ben: Well over here in the US, it's banned if you're going to compete in anything sanctioned by USADA or the WADA. So, yes. Similar situation over here in the US as far as just like buying DHEA from Walgreens or whatever. So what do you do?
Michael: Get to the cause of why it's happening, addressing the stress, whether it's from the overtraining, or blood sugar support, inflammation, I might look at herbs like turmeric, rosemary, and also the nervous system support again, phosphatidylserine is one of my favorites, and withania. So they can all…
Ben: That last one you're saying, withania, maybe it's just the way you're pronouncing it with your strange Down Under accent, but how do you spell this, withania?
Michael: That's W-I-T-H-A-N-I-A.
Michael: You guys call it ashwagandha. I forgot about that.
Ben: Oh, ashwagandha! Okay, yeah. I'm very familiar with ashwagandha. Gotcha. So you're a fan of things like turmeric, curcumin, ashwagandha, like natural anti-inflammatory and natural, what we call over here, or who knows what the heck you call them in Australia, adaptogenic herbs to assist with adrenal function, all of those things as legal and safe ways to increase DHEA.
Michael: That's it, yeah. I can take time to, you can be quick to sort of adjust the levels of progesterone and estrogen, but DHEA can take time to improve. You might be looking at like a 6 to 12 month sort of plan to get everything back in the ideal range.
Ben: Okay. Gotcha. So you're basically recommending kind of, it sounds like, and this is something I recommend a lot of the athletes that I work with to just like use adaptogen, or use something like curcumin on a daily basis as almost like a preventive, as a preventive tonic?
Michael: Yeah. That's a great idea. And also magnesium would be another one I'd keep in there as a standard thing for people training hard.
Ben: Curcumin, magnesium, adaptogenic herbs, all of those are things that I've found a lot of success with in hard-charging athletes and in myself. So I personally use turmeric on almost every salad and dish that I use, I use a ton of turmeric and black pepper and and sea salt. I smear transdermal, like topical magnesium on my limbs after a tough workout, and then I'll typically do some type of adaptogen, whether it's cordyceps, or ashwagandha, or rhodiola, or I have the stuff I use called TianChi, which has like 40 different adaptogenic herbs, and I'll typically throw something like that in almost every day.
And to people who are listening in who are thinking that this sounds like, we talk about the calcium D-glucarate, and progesterone drops, and adaptogenic herbs, and all this jazz, people who think that this might seem like a lot, I'm not sure what you tell folks, Michael, and I'd love to hear it, but when you're training for an Ironman for example, a lot of times you need a natural means to achieve an unnatural end if you want to maintain hormone balance. And then we also live in an environment that's incredibly toxic, and polluted, and we're surrounded by EMF, and stress, and heavy traffic, and all these things that make life kind of a scenario where we almost need better living through science if we want to operate at full capacity.
Michael: Yes. Especially if you're training for an Ironman. And unless you're professional athlete, you're also probably looking out for a family, working, so you don't get as much time to rest and sleep, so you've got to do everything that you can to get your body functioning well. So often I'll see the people after they've been doing all the training and they've ended up with hormonal dysfunction, or adrenal dysfunction, and so you're better off preventing than waiting for the problems to start.
Ben: Yeah. Interesting. Okay. So we've got low progesterone, high estrogen, low estrogen, and what is the fourth?
Michael: The fourth one is high testosterone, which is not such a big problem for men, but testosterone, women need, but high testosterone can lead to all sorts of problems like amenorrhea, or irregular periods, insulin resistance, weight gain, hair growth, acne, all those type of excess androgen symptoms.
Ben: Interesting. So you tend to see high testosterone as being an issue in women?
Michael: Yeah. Often women, especially if they're doing a lot of weight training, they might have natural levels of high testosterone, and it may not be causing problems, but testosterone, it will lead to high testosterone in women will lead to high levels of prostaglandin in the blood, which will then lead to insulin resistance. It becomes like a vicious circle. Insulin resistance will drive the body to make more androgens. So that's where, not every woman, but probably 80% of women with the PCOS type of picture, polycystic ovarian syndrome, and struggle with weight.
Michael: You can be doing all the training, but still struggle to lose those last three, four, five kilos.
Ben: Now a lot of times what you'll hear people say, I hear this cement mixer analogy quite a bit and that is that a woman would never bulk up or get huge muscles because women naturally just don't have enough cement mixer, a.k.a. testosterone, on board to make that amount of cement unless they're using some type of performance enhancing drug, or using like AndroGel or something like that which when I was a bodybuilder, I used to see a lot of women backstage using that type of thing. But in the average woman who's exercising, what you're saying is she could have high testosterone without necessarily using some type of performance enhancing drug. How? How would a woman get high testosterone? In the same way they would get high estrogens or?
Michael: They have an upregulation of the androgen synthesizing enzyme. But women with high testosterone, it's not going to be like men. They're not going to get big, and bulky, and muscley. That's going to lead insulin resistance. So they're actually going to get excess body fat.
Ben: Interesting. So what do you do about high testosterone?
Michael: Well, there's two things you can do. The first thing is address the insulin resistance. So for someone like that, more of a ketogenic diet could be really beneficial. Especially in the short term to get things back into a balance. So high fat, low carbohydrate diet. The other thing is herbs like peony and licorice, that's a classic Chinese combination for inhibiting that enzyme that leads to the increase in the androgens. And another nutrient that I use…
Ben: What'd you call it again?
Ben: How do you spell that?
Michael: P–E-O-N-Y. Could be my accent as well.
Ben: Okay. Peony. Got it. Okay, cool. I'm just taking lots of notes for folks over here. Okay, so peony is one thing for high testosterone. And what else were you saying?
Michael: Licorice. So that combination together works really well.
Ben: Okay. So it's peony, licorice, and what?
Ben: Oh, inositol. Got it.
Michael: Yeah. So that can help prevent the conversion of the androgens to testosterone, which then leads to, yeah, the high [0:43:04] ______ factor, interluekin-6, those inflammatory prostaglandins then lead to the insulin resistance. So it just becomes that vicious circle. And that can be, you don't know you have PCOS often in the teenage years. It's often undiagnosed and many women have it with without even realizing it until they try and start making a family or something like that. Especially athletes, they might just be getting irregular periods, but they might just put that down to overtaining.
Ben: Okay. Gotcha. So when you're testing each of these different functions, is there a name for the type of test that you do or are these just like one-off salivary measurements that you order a la carte when you're working with a client?
Michael: Depending on what we're trying to look for, but generally I'll get a test between Day 19 and 21 and just do with saliva hormone analysis. If someone's having a lot of menstrual cycle problems or infertility problems, I might write a whole month-long panel. But that's asking a little bit more expensive, but sometimes that's the best way to track the cycle every three days and see exactly what's happening with the hormones.
Ben: Now what about urinary testing. That's not something that's come up much, but I certainly do know some docs who will do like a 24-hour urine sex steroids test as an alternative to salivary hormone testing. What's your opinion on the efficacy of urinary testing versus the salivary index that you're talking about?
Michael: Well I've never used urinary testing, but that can be valuable and it shows you how much of the hormones are getting secreted over a 24-hour period. Yeah, it's not something I'm really familiar with using but it's not a total waste of a test 'cause it sort of give you an idea of what your body is doing in that day. Whereas blood testing and saliva testing's like a snapshot of what's happening at that moment.
Ben: Gotcha. So the name of the actual test that you run is this ASI, this adrenal stress index?
Michael: Yeah. The adrenal stress index checks the cortisol four different times of the day and DHEA. And then the extra one would be the sex hormone test, which does the estrogen, progesterone, it does the three different types of estrogen as well, estradiol, estriol, and estrone, plus testosterone.
Ben: And you're simply dripping saliva into a tube. Did you have to do special things beforehand, like do you refrain from eating certain foods, or do you refrain from drinking water, or caffeine, or anything like that?
Michael: Yeah. Especially during the adrenal test. You want to have a caffeine-free day. You want to do it before you eat breakfast, before you eat lunch in the afternoon and evening. So you want to do after you haven't been eating. Sometimes people struggle, like they can't believe they're going a day without caffeine's possible, but they're often the people that really need the adrenal test if they can get through a day without caffeine.
Ben: I've actually been going without caffeine for the past week because we ran out of coffee, and generally like that's my sign we run out of coffee, I'll switch to decaf or to tea for anywhere from a week, to about a week and a half, or 10 days or so, and that's kind of like the way I tricked myself into cleaning out my system and staying sensitive to coffee. So it can be done. I find that a big part of it is just the taste of coffee as much as the chemical effect. What about that? What about drinking decaf coffee on a day that you do a salivary hormone panel?
Michael: Well decaf is still going to contain some caffeine. I generally recommend trying to go no caffeine at all. If it's the deal breaker between someone doing the test or not, I'm might get them to do their morning sample, and then have their decaf coffee, and the amount is going to be out of their system by the lunch time sample.
Ben: Gotcha. It sounds like caffeine and coffee addiction is just as much of a problem Down Under as is here in North America. So, wow. This is a lot of really cool stuff. I've been jotting notes furiously, and again if people want to check out the notes, I've got 'em over at bengreenfieldfitness.com/saliva.
Michael, like I mentioned in the introduction, one of the reasons that I looked you up in the first place was I've been looking for someone who I can refer my Australian listeners to as a practitioner who they can work with and there in Oz. So can you tell me a little bit about your practice there for our Australian listeners, or for people who are interested in working with you?
Michael: Yeah. I live in Queensland, which is a little place called the town of [0:47:46] ______ which is in the middle of nowhere. So I do practicing clinic one day a week, but the rest of the time I practice with anyone throughout Australia via Skype or the phone. So it doesn't matter where anyone is in Australia. I can get test kits sent to them directly, and if it's a saliva test, they can do it at home. If it's blood test for things like thyroid hormones, they can 'em at their local pathology. All the results get sent back to me, and then we just do a consult over the phone or over Skype.
Ben: Okay. Gotcha. And I know that you had graciously offered for any of the listeners who hear this podcast, if you mentioned that you heard about Michael on the show, you're giving some kind of a discount?
Michael: Yeah. If you just say that Ben sent you, send me an e-mail at [email protected], say Ben sent you, and I'll give you $50 off the consultation. My dog's agreeing. Consultation for adrenal and estrogen test.
Ben: Your dog's on board.
Michael: So that test does the estrogen, adrenals, and a one hour consultation to go through the results and work out a treatment plan.
Ben: Okay. Gotcha. Cool. Well I'll put a link to Michael's website there are so that if you are in Australia or you happen to be swinging through Queensland, you can meet with him and get your own saliva test done and walk around with a tube that you can drip saliva into. I know it. And I'll give folks a clue, I've done this test before, and I found that the clue to getting saliva to come out of your mouth in adequate amounts for this test was to sniff peanut butter. That worked for me. So there you go. By the way down in Australia, what's the stuff that you smear on bread there? I'm blanking on the name of it now. It's like a super salty…
Michael: Yeah, Vegemite. Yeah.
Ben: Vegemite. That's right. Just sniff a can or a tube of Vegemite.
Michael: Yeah. It's not to my liking, but…
Ben: Alright. Well, cool. Well again, all the resources for this show are at bengreenfieldfitness.com/saliva. And Michael, thanks for coming on and sharing the stuff with us. Really fascinating stuff about the four different hormone imbalances and what we can do about them.
Michael: Now worries, Ben! Thanks for having me.
Ben: Alright, folks. So this is Ben Greenfield and Dr. Michael Smith signing out from bengreenfieldfitness.com. Have a healthy week.
If you want to know if you have a hormonal imbalance, test your hormones, or fix your hormones, you'll definitely want to tune into this episode!
Let's start here: I get tons of questions from listeners down under (that's Australia for those of you who flunked geography) about where to get things like blood, gut and hormone testing done. So after a bunch of searching and talking to a some of my trusted Australian friends, I discovered Dr. Michael Smith from PlanetNaturopath.com.
Dr. Smith is a Naturopath and Kalish Method Functional Medicine Practitioner who specializes in hormonal disorders, adrenal, thyroid and digestive function. He works with clients from the chronically ill to athletes wanting to improve performance and does consultations face-to-face in Australia, and also via Skype or phone.
During our discussion, you'll find out:
-What exactly a Kalish practitioner…
-The 4 different hormone imbalances in seemingly healthy people…
-Why having normal progesterone could not be enough if your cortisol is also high…
-Why you don't have to be the stereotypical “fat” woman to have estrogen excess…
-How low estrogen can be just as big a problem as high estrogen, and what type of soy products you should be eating for low estrogen…
-Why you can have normal hormone levels for most hormones, but low DHEA…
-When high testosterone can be an problem…
Resources Michael and I discuss in this episode:
-Michael's website PlanetNaturopath.com – mention this podcast episode and you get $50 off a “Hormone Package”, which includes a one hour consult, an adrenal test and saliva sex hormone test.
–Progesterone drops for increasing progesterone.
–Mountain Rose Herbs – (look for Vitex or Chastetree for increasing progesterone).