She started her day with coffee just to get moving. Didn’t have much time for breakfast, maybe grabbed a piece of toast or a banana on her way out the door (or took a few bites of her kid’s leftover oatmeal.)
After the school drop off and commute to the office, she’s tired already. (Of course, it doesn’t help that she was up again at 3am with worries wandering through her mind.)
Running from patient to patient (or meeting to meeting), she’s trying her best, but she’s struggling to focus, feeling brain foggy and sluggish. Hasn’t slept well since the youngest was born, and now the baby is 6, and she’s past 40.
Is this how postpartum depression feels, or perimenopause?
She can’t remember the last time she had sex. She loves her husband, but she’s just so tired… and sex is starting to hurt. Her PMS is getting worse. Hitting an after work bootcamp class and dropping dessert is no longer enough to get rid of the weight around her middle.
It looks like she has a happy life, and she does (mostly)… weekend soccer, getting promoted, Friday night pizza and movie night together. But, she feels like it’s all about to crash. She’s been burning the candle at both ends for so long. She can’t remember the last time she actually saw her friends, rather than just texting them about the carpool.
Is this your client?
Where do you begin to address her myriad of hormone imbalance symptoms – PMS, insomnia, weight loss resistance, loss of libido, painful sex, brain fog, forgetfulness, fatigue, and more?
Where to start?
First, take a deep breath and create for her the gift of a safe space to tell her story. To exhale. To feel any emotions that may bubble to the top from trying to hold it together for so long.
Then, spend 10 solid minutes mindfully listening. You will learn which of her struggles is most bothersome. Her story will give you the insight you need to know where to begin.
Physiologically, there is a rhythm to what the female body needs to keep its hormones in balance. This is where you come in holding her hand through the baby steps to recover her health.
Step 1: Test for Nutrient Deficiencies
Thyroid hormones, for example, need optimal amounts of iron, zinc, selenium, iodine, and retinol to function (1,2). Adequate magnesium is essential for the optimal functioning of estrogen to reduce the risk of cardiovascular disease (3). And, adequate B-vitamin levels improve the cortisol awakening response (4).
To address common nutrient deficiencies in your clients with hormonal imbalance symptoms, first measure the nutrient deficiencies with either organic acids testing or cellular micronutrient testing, such as SpectraCell.
Once you know what your client’s nutrient deficiencies are, you have a few options, you can restore her optimal nutrient levels with food or supplements. However, neither of those options will work very well, unless her digestive function is optimal (unless you’re using IV nutrient delivery.)
Step 2: Optimize Digestive Function
Eating in a relaxed environment and chewing adequately (at least 20-40 chews per bite) is the first step towards optimal nutrient absorption.
Is your client under constant stress? Are her hormone levels more off balance at more stressful times of the day? Are mealtimes stressful? Is she eating in the car? Is she regularly eating with others with whom she has a toxic relationship? Does she have a stressful relationship with food, or body dissatisfaction as a side dish to her meals (that would be common since up to 84% of American women report body dissatisfaction) (5).
It’s essential not to overlook the stress hormone impact of eating in a stressful environment. It’s not just what she’s eating, but how she’s eating, where she’s eating, and who she’s eating with.
Then, it’s essential to be sure that she has adequate stomach acid. Hypochlorhydria (low stomach acid) is very common. Up to 50% of the population over 60 struggles with hypochlorhydria. Hypochlorhydria contributes to poor protein, vitamin B12, and iron absorption, even if she’s eating foods high in these nutrients (6).
Next, check for imbalances in the bacteria in her intestines (challenges such as SIBO or colon dysbiosis are very common), using organic acids and/or stool testing.
Finally, is she moving her bowels regularly? She should have 1-2 daily Bristol 4 bowel movements. If not… In addition to adequate nutrients, she might need more fiber, visceral mobilization from a skilled physical therapist to get her bowels moving better, more exercise, or simply more water each day.
Step 3: Restore Her Hormones Through Nourishment
Once you know which nutrients are lacking, and you correct any challenges with her digestive function, it’s time to restore the nutrients using nutrient dense diets and targeted nutrient supplements.
This is where the real challenge can come in for many women with hormone imbalance symptoms…
Knowing what to eat and what supplements to take is the easy part.
The hard part is doing it… for life.
The grocery shopping, food prep, cooking, serving food that her family “hates,” eating at parties, traveling, overcoming emotional eating, feeling deserving of this degree of self-nourishment.
These are the real challenges.
Use your clinical nutrition skills to use testing and other assessment tools to fine tune her recommendations, then you need to use your health coaching skills to support her to fully implement the nutrition changes that she will need to restore her hormonal balance, and optimize her hormone levels.
1. Ravaglia G, Forti P, Maioli F, Nesi B, Pratelli L, Savarino L, Cucinotta D, & Cavalli G. (2000) Blood micronutrient and thyroid hormone concentrations in the oldest-old. J Clin Endocrinol Metab. 85(6), 2260-5.
2. Triggiani V1, Tafaro E, Giagulli VA, Sabbà C, Resta F, Licchelli B, Guastamacchia E. (2009) Role of iodine, selenium and other micronutrients in thyroid function and disorders. Endocr Metab Immune Disord Drug Targets. 2009, 9(3), 277-94. Epub 2009 Sep 1.
3. Seelig MS. (1993) Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. J Am Coll Nutr.,12(4),442-58.
4. Camfield, D. A., Wetherell, M. A., Scholey, A. B., Cox, K. H. M., Fogg, E., White, D. J., … Pipingas, A. (2013). The Effects of Multivitamin Supplementation on Diurnal Cortisol Secretion and Perceived Stress. Nutrients, 5(11), 4429–4450. http://doi.org/10.3390/nu5114429
5. Runfola, C. D., Von Holle, A., Trace, S. E., Brownley, K. A., Hofmeier, S. M., Gagne, D. A., & Bulik, C. M. (2013). Body Dissatisfaction in Women Across the Lifespan: Results of the UNC-SELF and Gender and Body Image (GABI) Studies. European Eating Disorders Review : The Journal of the Eating Disorders Association, 21(1), 52–59. http://doi.org/10.1002/erv.2201
6. Mandal, U., Ali, K. M., Chatterjee, K., De, D., Biswas, A., & Ghosh, D. (2014). Management of experimental hypochlorhydria with iron deficiency by the composite extract of Fumaria vaillantii L. and Benincasa hispida T. in rat. Journal of Natural Science, Biology, and Medicine, 5(2), 397–403. http://doi.org/10.4103/0976-9668.136202