A client came in to see me a few months back. Let’s call her Maryanne. She was experiencing crippling pre-menstrual symptoms every cycle: incredibly volatile emotions and crying spells, fainting episodes, extreme bloating and cramping, and acne – all of which would start mid-cycle and escalate to being almost unbearable by the time her period finally arrived. She was miserable. And desperate.
For our first session together, we did a deep dive into her health history and food journal. She’d had horrible periods since she began menstruation in her early teens. Several doctors had prescribed the birth control pill, but it gave her headaches and she put on a lot of weight with it, so she’d never stayed on it for long. She also hated the idea of being constantly medicated.
Maryanne’s digestion, on the other hand, appeared to be rock solid. She had regular daily bowel movements, no heartburn, bloating, or any discomfort other than very occasional gas if she ate a lot of cruciferous vegetables or legumes. She ate well, avoiding gluten and refined sugar, and she always sought out organic options.
At the end of our session I recommended we start with gut healing and food sensitivity testing. She looked at me, confused. Her digestion was great – why start there?
Anne shared last week that we always start with digestion as the body’s top healing priority, and this client scenario is a great example of when it’s challenging to make the case for starting with the gut. Isn’t this obviously a case of hormonal imbalance? Or wouldn’t it be an endocrine-related issue like something to do with her adrenals, since we know these are intimately connected with hormones?
A hormonal issue may have its origins in the endocrine system, but without first assessing gut health and addressing anything we find there, the hormonal rebalancing work won’t last very long. Here’s the connection:
For one, all of our hormones need to be synthesized from nutrients accessed via the diet. If one’s digestive capacity isn’t strong enough, those nutrients aren’t readily available. When we’re talking about reproductive hormones, we’re thinking about fat digestion in particular because sex hormones are steroid hormones and built from fats.
Next, our body’s ability to process and clear spent hormones is directly connected to two key digestive organs: the liver and the intestines. The liver conjugates all our hormones whether they are endogenous (those our body creates) or exogenous (those we are exposed to from external sources. This is true for intentional hormone replacement therapy or unintentional exposure from xenobiotics hidden in our food and environment). If the liver isn’t functioning properly, the conjugation process will be compromised.
Once the hormones are conjugated, they leave the body, escorted out through the intestines via the bile (another key digestive player that contributes to peristalsis and emulsifying fats). When there are gallbladder issues or if the bile is thick and sludgy, it will negatively affect those hormones trying to leave the body. Likewise, the enzyme beta-glucuronidase that inhabits the large intestines can proliferate and de-conjugate the conjugated hormones, essentially breaking apart the “packaging” the liver had put them into and allowing those hormones to re-enter the bloodstream. Beta glucuronidase proliferates in a dysbiotic gut environment.
And so: if Maryanne has any digestive issues that are compromising biliary secretions, liver function, microbiome balance, nutrient absorption or digestion enzyme production, this is going to directly affect her hormone levels and contribute to imbalances. If we don’t start there, we are ignoring a vitally important piece of the puzzle.
Sure enough, when we tested Maryanne’s digestive capacity with the GI MAP stool test, we found many opportunistic bacteria overgrowing, low levels of the beneficial bacteria, significant amounts of inflammation in her colon, and elevated b-glucuronidase levels. Food sensitivity testing revealed that several foods she was eating on a regular basis were highly inflammatory in her body, exacerbating the hidden digestive issues she had.
We focused entirely on healing up her gut and removing inflammatory foods, and hadn’t done any hormone testing yet. Her first cycle after we began this protocol, she still had some symptoms, but they were far less pronounced. By the end of our 3 month protocol, her hormonal symptoms had subsided to the point that we decided to hold on any hormonal testing for the time being and to give it another two months to see if things completely improved. And guess what: they did!
Had we started with hormone testing would the results have been the same? We’d not have identified the gut imbalances that were exacerbating her hormonal issues and so we wouldn’t have addressed critical underlying factors. It’s hard to imagine that her results could possibly have been so profound or so lasting.
Now, it’s important to be clear that starting with the gut doesn’t always assure that you’re going to knock out every other symptom your client is experiencing. Some hormonal issues are more complex and do require direct intervention beyond digestive healing. But when you start with the gut you will often find that other seemingly unrelated issues resolve, and if additional healing layers are required it is easier, longer-lasting, and more effective.
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FAQ
The following frequently asked questions expand on the clinical concepts discussed in this article and provide additional context for practitioners applying a gut-first approach to hormone-related cases.
Why should practitioners consider evaluating gut health in clients with hormonal symptoms?
Practitioners should consider evaluating gut health because digestive function directly influences hormone production, processing, and elimination. Even when hormonal symptoms appear to be the primary concern, underlying digestive dysfunction may contribute to ongoing imbalance. Addressing gut health first may improve outcomes and create a stronger foundation for any future hormone-focused interventions.
Can clients have significant gut dysfunction without digestive symptoms?
Yes. A client can have significant gut dysfunction despite reporting normal digestion and regular bowel movements. As this case illustrates, hidden imbalances may still affect nutrient absorption, inflammation, microbiome balance, or hormone clearance even when gastrointestinal symptoms are minimal or absent.
Why does digestive function affect hormone balance?
Digestive function affects hormone balance because the digestive system supports hormone synthesis, nutrient availability, and hormone elimination. Problems involving digestion, the liver, bile, or the intestinal microbiome can all influence hormonal regulation and contribute to symptoms.
How does nutrient absorption influence hormone production?
Hormones depend on nutrients obtained through digestion and absorption. If digestive capacity is compromised, the body may have reduced access to the nutrients needed to synthesize hormones. For reproductive hormones specifically, effective fat digestion is particularly important because sex hormones are steroid hormones built from fats.
What role does the liver play in hormone metabolism?
The liver helps process hormones by conjugating both hormones produced within the body and those introduced from external sources. If liver function is compromised, this conjugation process may also be impaired, affecting the body’s ability to prepare hormones for elimination.
How do bile flow and the intestines contribute to hormone clearance?
After hormones are conjugated by the liver, they are eliminated through the intestines via bile. Healthy bile production and intestinal function support this process. Gallbladder dysfunction or thick, sluggish bile may interfere with efficient hormone clearance.
What is beta-glucuronidase, and why is it relevant to hormone health?
Beta-glucuronidase is an enzyme found in the large intestine that can de-conjugate hormones after the liver has prepared them for elimination. When beta-glucuronidase levels become elevated in a dysbiotic gut environment, hormones may be reabsorbed into the bloodstream instead of being excreted.
How can dysbiosis contribute to hormonal imbalance?
Dysbiosis may contribute to hormonal imbalance by increasing beta-glucuronidase activity and disrupting normal hormone elimination. It may also affect other digestive functions that support hormone regulation, including nutrient absorption and overall digestive health.
When should food sensitivity testing be considered in clients with hormonal complaints?
Food sensitivity testing may be considered when hidden digestive dysfunction is suspected despite an absence of gastrointestinal symptoms. In this case, testing identified inflammatory foods that appeared to worsen underlying digestive issues and supported the overall gut-healing strategy.
What clinical findings suggested the gut was contributing to this client’s hormonal symptoms?
GI-MAP stool testing identified several findings consistent with digestive dysfunction despite minimal digestive complaints.
These included:
- Opportunistic bacterial overgrowth
- Low levels of beneficial bacteria
- Significant colonic inflammation
- Elevated beta-glucuronidase
Food sensitivity testing also identified foods contributing to inflammation.
Can improving gut health reduce hormonal symptoms without direct hormone testing?
Yes, in some cases it can. In this case study, the practitioner focused exclusively on gut healing and removing inflammatory foods before performing hormone testing. The client’s hormonal symptoms improved substantially over the course of the protocol, leading to a decision to postpone hormone testing.
Does starting with gut healing eliminate the need for hormone-focused treatment?
No. Starting with gut healing does not guarantee that every hormonal condition will resolve without additional intervention. As the article explains, some hormonal issues are more complex and require direct hormone-focused care, but addressing digestive health first may make later interventions more effective and longer lasting.
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ABOUT THE AUTHOR
Margaret Floyd Barry, FNTP MRHP is owner and Executive Director of the Institute of Restorative Health. She’s a functional nutritionist, author, speaker, educator, and real food advocate. Through years of experience working with the most complex client cases, including reversing her own autoimmune condition, Margaret uses a powerful system for restoring health by addressing the root cause of illness.
Today, Margaret teaches fellow practitioners the same proven system she uses to get her clients life-changing results through the Institute of Restorative Health – a two-year comprehensive functional nutrition certification program for qualified health professionals. Margaret also runs Restorative Corporate Wellness, a team of Restorative Health Practitioners facilitating health transformations with corporate clients. She is the author of Eat Naked and its follow-up cookbook The Naked Foods Cookbook. She’s also the host of the Clinician’s Corner podcast, where she interviews some of the world’s top experts in the fields of functional health and nutrition.
