Episode 38: Hormones and Autoimmune Disease with Dr. Justin Marchegiani

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The Complex Interplay of Hormones and Our Immune System

I think every woman with autoimmune disease knows how strongly our hormones can impact autoimmune symptoms. Some women flare around their menstrual cycle. Some go into remission during pregnancy and then flare after delivery (or vice versa). Others find their symptoms start to increase during the hormone fluctuations of perimenopause. And others actually develop autoimmune disease after menopause. So clearly hormone balance is a topic near and dear to us all, and I have an expert guest to help us achieve this. Justin Marchegiani is a functional medicine practitioner who specializes in this area. He’ll teach us what’s at the root of hormone problems at all stages of a woman’s life, and how to correct them. For my male listeners, today’s podcast focuses mostly on women, but at the end of the podcast, Justin talks about hormone balance for men as well.

Listen to the Show

Show Notes

  • Intro (0:00)
  • Thank You to our Podcast Sponsor – Paleo on the Go (2:02)
    • A frozen meal delivery service, they have a large menu of items for the paleo autoimmune protocol (AIP).
    • Use the code PHOENIX for 10% off your first order.
  • Meet Dr. Justin Marchegiani (2:45)
    • Dr. Marchegiani is a chiropractor and functional medicine practitioner in Austin, TX, but he works with people around the world via telehealth.
    • He has received advanced training with leaders in the functional medicine field, including doctors Datis Kharrazian, Dan Kalish and Janet Lang.
    • He has Hashimoto’s himself, so understands autoimmune disease both personally and professionally.
    • One of his specialties is female hormone balance.
  • The Science Behind Hormone Balance (5:30)
    • The female hormones are estrogen and progesterone and they fluctuate throughout the menstrual cycle. During the first half of the cycle, estrogen naturally increases. In the second half, progresterone rises and falls. These hormones are meant to fluctuate like a symphony, in harmony. When they get out of balance they can affect our health bodywide.
    • There are many things that can increase the estrogen in our bodies, causing our hormones to go out of balance and become estrogen-dominant. These are called xenoestrogens (which have estrogen-like effects on both males and females) and include BPA (found in plastics), pesticide residue, soy proteins, chemicals, and birth control pills.
    • Stress also has a dramatic impact on sex hormone balance, because progesterone is a building block for cortisol, the stress hormone. This means that stress depletes progesterone levels, again causing estrogen dominance.  When looking at female hormone imbalance, you have to address the adrenals as well.
    • Cholesterol is a building block for all hormones, so people who follow a low-fat, low-cholesterol diet are especially vulnerable to hormone imbalance.
    • Thyroid hormones help break down cholesterol, so if your thyroid hormones are out of balance, hormones bodywide will be out of balance. Also, low thyroid hormones often lead to high cholesterol in the body.
    • HPA axis – The hypothalamus and the pituitary glands in your brain act like your body’s “hormone thermostat.” When we’re under stress, the HPA sends signals to release the hormones that help buffer and manage stress. If your adrenals are depleted, they can’t release the hormones that are needed, and that leads to HPA axis dysfunction.
    • Vitamin D is actually a hormone also. This video explains how we make this hormone, why it is important, and the difference between D3 and D2. When taking Vitamin D as a supplement, start slow with 1,000 iu and watch how your body responds before increasing. Eileen threw her sex hormones out of balance for 3 months after trying some high-dose Vitamin D supplementation. Sunshine is a natural way to increase Vitamin D levels, but it is season-dependent.
  • The Interaction Between Hormones and Autoimmune Symptoms (7:59)
    • Because stress affects hormone levels and autoimmune disease puts a lot of stress on the body, people with autoimmune disease are especially susceptible to hormone imbalance.
    • In addition, hormone imbalance can throw our immune system out of balance. Ideally, there is a 1:1 ratio with CD8+ (our natural killer cells) and CD4+ cells (our helper cells). Hormone imbalances can cause CD8+ deficiency, exacerbating autoimmune symptoms and even pre-disposing healthy people to autoimmune disease.
    • The paleo autoimmune diet and lifestyle is the foundation step to achieve hormone balance, because it addresses a lot of the stressors: food intolerances, inflammation, the importance of sleep, stress management, etc. However, some people need help beyond that.
  • Testing and Diagnosis (22:30)
    • Hormones function and dysfunction together, so when you test, you need to test all systems: adrenals, thyroid and sex hormones.
    • Since women’s hormones fluctuate throughout the month, they need to be tested over many days. For a woman with a regular cycle, sex hormones are measured from days 18-24. For irregular cycles, they’re measured every other day for 30 days. For menopausal women, you still do a 6-day test, but the timing doesn’t matter. Here are the tests Dr. Justin uses in his practice.
  • Treating PMS (29:35)
    • If a woman is experiencing extreme PMS symptoms (typically between day 21-28 of their cycle) it is often caused by premature drops in progesterone. Vitex/Chaste Tree can often help with the symptoms, but you want to address the root cause as well.
  • Healthy Autoimmune Pregnancy (31:41)
    • If you’re not yet pregnant and are planning to have children, the best thing to do is to balance your immune system’s Th1/Th2 levels ahead of time. Glutathione helps balance the immune system, but it’s also detoxifying, so you want to do this well before getting pregnant so it doesn’t negatively impact your eggs. Supplements that boost glutathione include NAC, Methionine, and Glycine. Low Dose Naltrexone is a mild medication that can also help balance the immune system.
    • Once you’re pregnant, there is a shift from Th1 to Th2 dominance during the second half of pregnancy, which is why some Th1 dominant autoimmune conditions go into remission during the switch and then flare after delivery, and why some Th2 dominant conditions flare during pregnancy. You can’t control this shift, but the more stable your health prior to pregnancy, the better your experience during pregnancy and after delivery.
    • To balance hormones while pregnant: stabilize your blood sugar, have optimal levels of vitamin D, and take some quality probiotics. Listen to Episode 17: An Autoimmune Paleo Pregnancy for tips.
  • Perimenopause (39:21)
    • Perimenopause is the 1-3 year phase before menopause when menstrual cycles become less regular. This sometimes comes with wildly fluctuating hormone levels which cause autoimmune flares. When the ovaries slow down hormone production, the adrenals need to pick up the slack and produce the sex hormones that the body needs. If your adrenals are depleted, they can’t keep up with the new demand, leading to hormone imbalance bodywide. Testing and supporting the adrenals is key to correct this imbalance.
    • Listen to Episode 15 for more information on Adrenal Fatigue.
  • Menopause (42:30)
    • The same thing that happens in perimenopause happens dramatically during menopause. Estrogen and progesterone levels drop which puts more stress on the adrenals. Supporting the adrenals is the most important step. And estrogen modulating herbs can help symptomatically (such as Dong Quai, Black Cohosh, Vitex/Chaste Tree, Wild Yam, and Genistein). Lastly,  plant based bio-identical hormones can be prescribed specifically based on one’s lab results.
  • How Long Does It Take To Balance Hormones? (46:52)
    • Usually 6-9 months. The earlier you can get a handle on hormone balance, the better. But it is never too late to stabilize your hormones!
  • Hormone Balance in Men (51:05)
    • Adrenals are a big factor for men as well, because as men age, the adrenals need to produce much of the testosterone the body needs. Once the adrenals are dialed in, focusing on nutrients, gut issues, and detoxification can help men reach optimal health.
  • Dr. Justin’s Treatment Steps (53:30)
    • Detailed history: what the patient has tried in the past – what worked and what didn’t – that itself can be diagnositic. Looking at labs from the past year can be helpful. And any prior history of illness, infection or trauma can influence what’s happening today.
    • Teach about healthy nutrition and lifestyle choices.
    • Order the labs to look under the surface. He prioritizes hormones first, gut second and detoxification third.
    • Follow-ups to track progress and troubleshoot as needed.
  • Related Podcast Episodes (56:42)
  • Outro (57:14)

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