Fatigue and Estrogen Dominance Dr. Lee believes that many people are suffering from estrogen dominance. Estrogen dominance is the imbalance of a person’s hormones which results in a disproportionate amount of too much estrogen and too little progesterone, although there may not be any actual deficiencies of either. He believes this imbalance is caused by xenoestrogens from chemical pollutants in our environment, as well as from poor diets and stressful lifestyles. Estrogen and progesterone usually work together to maintain hormone levels, but when there is an excess of one or too little of the other, our hormone levels can become very unbalanced and illness can result. The following information on fatigue and estrogen dominance was taken from Dr. Lee’s book,”What Your Doctor May Not Tell You About Premenopause”. I think when you read it you will see, as I did, that estrogen dominance may very much be involved in Chronic Fatigue Syndrome. The Mitochondria Estrogen dominance, an imbalance in hormones resulting in too much estrogen, can affect the mitochondria which produce the energy used by our bodies. p. 189 Adenosine triphosphate(ATP), a substance used to produce energy in an organism, is created in the mitochondria. Anything that hinders your mitochondria from producing ATP can cause fatigue and any damage to the mitochondria could therefore result in chronic fatigue. In some cases damage to the mitochondria is inherited by faulty DNA. The mitochondria produce pregnenolone from cholesterol. Pregnenolone is used to produce progesterone and DHEA, these are two hormones necessary for proper adrenal function. Improper function of the adrenals from too low levels of these hormones can cause fatigue. Estrogen can block the mitochondria from functioning properly. When the mitochondria do not function well there is less pregnenolone synthesis (as well as less progesterone and DHEA) and also less energy production(ATP) both of which results in causing a person to be fatigued. Other substances that inhibit the function of the mitochondria are radiation, some unsaturated fatty acids and iron. Full spectrum light, T3 -triodothyronine ( a thyroid hormone), vitamins B2, A, E and the trace element copper, aid the mitochondria. NADH (nicotinamide adenine dinucleotide) plays a pivotal role in the production of ATP. Dr. Lee says that if you’re suffering from chronic fatigue that is due even in part to mitochondrial damage NADH can help give you the pep you need. It has been shown to improve Parkinson’s disease and chronic fatigue syndrome. NADH is best taken on an empty stomach in the morning. I wonder if some of the things suggested to cause CFS could have a damaging effect on the mitochondria? I’m not sure there is any evidence of that. Dr. Lee believes that xenoestrogens cause damage to the developing reproductive systems of fetuses and embryos so that progesterone production is lost in early adult life and the person becomes estrogen dominant. p.88 The Adrenals p.149 Adrenal exhaustion can cause fatigue. Adrenal exhaustion is the failure of the adrenals to produce adequate levels of steroids to meet our needs. Often the adrenals are so stressed that they no longer are able to produce adequate amounts of their hormones. Our society is very stressful. Epinephrine, adrenaline, androgens and cortisols are all stress hormones produced by the adrenals that give us an “up” feeling. People often live off stress looking to find that “adrenaline rush” which will speed them through their daily activities. Unfortunately these stress hormones are not meant to be used all the time, but rather for times of emergency where short bursts of intense energy are needed. If we are always calling on these hormones to drive us through our day our adrenals can become exhausted from over production. The adrenals may swell from overwork and the inflammation can cause adrenal cells to die off (which is something we don’t need). All of the adrenal hormones are produced from pregnenolone. Any disruption in the production of pregnenolone can effect the adrenal output of its hormones. Many adrenal hormones are produced from progesterone. The adrenals can produce progesterone from pregnenolone, but if the adrenals are exhausted they may not be able to produce as much progesterone as is needed. Add that to the loss of progesterone manufactured as a person ages and progesterone may end up not being produced anywhere in the body. The following are symptoms of adrenal exhaustion listed by Dr. Lee. p. 153 Constant fatigue, especially in the morning when trying to get out of bed and after exercise, muscle weakness, low blood pressure, low metabolism coupled with decreased thyroid function, excess pigmentation which may look like tanning or dark freckles on the skin, allergies and/or asthma, low reserves for coping with stress so that if anything doesn’t happen on schedule, you’re unable to meet demands and have to take time to recuperate, irregular menstrual cycles, fibrocystic breasts, anovulatory periods, infertility, susceptibility to infectious illness like flu and upper respiratory infection, depression caused by the constant fatigue, weakness and irritability to cope with stress. (Do these symptoms sound familiar?)p. 154 The thyroid gland and the adrenals work very closely together. If a person’s adrenals are weak their thyroid might slow down to compensate, and vice versa. This often causes low blood pressure. To find out if you have low blood pressure as a result of adrenal dysfunction take a reading of your blood pressure when you are lying down and then after standing up. If your blood pressure from lying down to standing up is normal there will be an initial drop and then a quick rise in blood pressure. If your blood pressure is low the response after the initial drop will be much slower. You may also experience dizziness, unsteadiness or blurry vision when you stand. Salt is not always good for our health but, using a moderate amount of salt for raising blood pressure is very good for people with tired adrenals. Natural progesterone and even natural cortisone in very small doses can help to overcome hormone imbalances and improve energy from tired adrenals. Licorice is an adrenal-supportive herb, but should be used carefully as it can raise estrogen levels. Cortisol p.151Glucocorticoids are secreted by the adrenal cortex. An important class of glucocorticoids are the cortisols. Cortisol regulates blood sugar and the movement of carbohydrates, protein and fats in and out of the cells; it also regulates inflammation and muscle function. Cortisol is produced from progesterone. A drop in progesterone can cause a concurrent drop in cortisol production. Stress causes cortisol to be produced. Chronic stress leads to chronically elevated levels of cortisol. Some symptoms of too much cortisol are weight gain, (especially around the midsection) and blood sugar imbalances- a good clue to whether you have sugar imbalances is if you are a sugar junkie and/or get shaky when you don’t eat regularly. Other symptoms of too much cortisol are thinning and papery skin , muscle wasting and memory loss. It is possible to have symptoms of both too much cortisol (caused by stress which keeps our adrenals functioning at a heightened response level) and too little cortisol (caused by the inability to maintain adequate production of this hormone in response to this heightened demand). This takes it’s toll on progesterone levels setting the stage for estrogen dominance. It is possible that estrogen may also interfere with the impulses produced by the hypothalamus which signals the adrenals to produce more cortisol, but further study is needed. A diet high in sugar promotes estrogen dominance. Most of this sugar is turned into fat. Fat cells produce estrogen, especially after menopause when they take over most of the duties of estrogen production from the ovaries. Cortisol sends glucose (blood sugar) flooding into the cells which may make you feel great after the initial rush of glucose into the cells, but twenty or so minutes later your blood sugar level falls and then your body will want more glucose to get your blood sugar and energy back up. A consistently high sugar diet can set up a pattern of struggling to keep your energy up and your weight down. High levels of sugar in the blood stimulates the release of adrenaline which stimulates the release of cortisol which in turn causes a craving for quick calories which increase the blood sugar, which stimulates the release of adrenaline which stimulates the release of cortisol.....and on and on it can go. In hypoglycemia sugar causes our blood sugar to rise, but then fall back to even lower levels than before resulting in fatigue. The drop in blood sugar may be so low the person may black out. Some researchers believe that hypoglycemia results because we have stressed our body’s insulin response so much with our high sugar diet that it starts to overcompensate and produce too much insulin causing the blood sugar level to drop much lower than normal. Eating unrefined carbohydrates that take much longer to enter the blood stream and eating small meals steadily throughout the day which don’t cause the blood sugar levels to fluctuate way up and down will help to keep the blood sugar levels steady and prevent hypoglycemia. Magnesium p. 152 Magnesium is an important activator of enzymes that help to produce energy. It would seem therefore that too little magnesium can negatively effect energy levels. Estrogen can deplete magnesium levels. Mineralcorticoids, especially aldosterone regulate the balance of minerals in the cell, mainly sodium and potassium, but magnesium is also affected. Mineralcorticoids are produced by the adrenal cortex. Stress triggers the release of aldosterone which raises blood pressure by causing the body’s cells to hold onto sodium and lose potassium and magnesium. Long term release of mineralcorticoids due to chronic stress can cause a potassium deficiency and a magnesium imbalance as well as chronic water retention and high blood pressure. The Thyroid Low thyroid levels can result in a condition called hypothyroidism. Fatigue is a symptom of hypothyroidism. Low progesterone levels create symptoms similar to hypothyroidism and it is important to determine which is causing the symptoms. This is what Dr. Lee has to say. p.187 “During the first few years that Dr. Lee recommended progesterone cream to his menopausal patients, he noticed that those who were also taking thyroid medication often needed a reduced dose of it after a few months on the cream. Quite a number of these patients eventually were able to discontinue thyroid supplementation completely. When he went back and reviewed their cases he found that many of them had been started on thyroid supplements for symptoms of fatigue, weight gain, low basal body temperature, and other signs and symptoms often associated with low thyroid (hypothyroidism) in spite of normal thyroid tests. After nearly twenty years of observing this phenomenon Dr. Lee has come to believe that estrogen dominance interferes with or inhibits thyroid hormone activity. Estrogen and thyroid do have some opposing actions. Estrogen instructs the body to store calorie intake as fat tissue, whereas thyroid increases the body’s ability to metabolize fat for energy. Progesterone, on the other hand, has an anabolic action similar to that of thyroid: They both promote energy production and raise body temperature. Progesterone deficiency would lead to lower basal temperature, simulating symptoms of hypothyroidism. The most common symptoms of low thyroid (hypothyroidism) can include: fatigue and weakness, low basal temperature (measured under the armpit first thing in the morning), dry or coarse skin and hair, cold hands and feet, slurred or slow speech, poor memory, weight gain. There is no doubt that many premenopausal women are truly suffering from hypothyroidism. However, women who have symptoms of hypothyroidism but come out “normal” on a thyroid test may be progesterone deficient and can often be adequately treated by restoring normal progesterone levels using transdermal progesterone creams.(This thyroid-balancing effect does not occur with the synthetic progestins such as Provera or the oral progesterone pills.) Dr. Hanley saw so many women in her practice with low thyroid function that she began to dig deeper to find the causes, and discovered that even small amounts of radiation can permanently destroy the thyroid gland. She found government statistics showing that in the 1950s the amount of radioactive fallout from nuclear weapons testing was enough to cause thyroid problems in an average person. Growing children exposed to the radiation were even more susceptible. Also the ranges of normal used to determine thyroid function were calculated in the 1940s on twenty-two-year-old medical students, so she believes that they don’t apply to premenopausal women. The consequence, Dr. Hanley believes, is an undiagnosed epidemic of low-level hypothyroidism. If you have low thyroid symptoms, you can try using some progesterone cream for a few months. If you still have the symptoms you can either use Armour Thyroid which is a combination of cow (bovine) and pig (porcine) thyroid extract, or one of the synthesized thyroid hormones such as levothyroxine (Synthroid). There is much debate about which one of these forms of thyroid supplementation works best...the jury is still out on this question.” Stress Because of the demand that chronic stress places upon the adrenals hormonal imbalance may result creating the condition of estrogen dominance. p.50 Stress causes estrogen dominance which causes insomnia and anxiety the stress of which then causes more estrogen dominance. Dr. Lee says, “A woman who has been caught in this type of cycle for a few years will find herself in a constant state of ‘wired but tired’ (‘or tired but wired’), which will eventually result in dysfunctional adrenal glands, blood sugar imbalances, and debilitating fatigue that may be diagnosed as chronic fatigue syndrome.” Excess stress can be reduced by slowing down, by reducing work and activity and by relaxing. Rest is the best remedy for restoring tired adrenals. Pushing your adrenals to function more with the help of supplemental hormones and herbs can only work for so long and can result in further damage. Sleep is very important. Insomnia is a sign of estrogen dominance. Allow yourself to sleep as long as necessary. You may need to allow yourself to sleep all day if necessary until your adrenals start to heal. Dr. Lee uses natural progesterone cream to treat and balance hormone levels. Natural progesterone cream when taken in proper amounts has few side effects. One side effect is that it makes you sleepy. This is not such a bad thing for CFS patients with trouble sleeping. Because it makes you sleepy it is best to take progesterone just before bedtime. p. 138 Stress can raise levels of prolactin, a hormone that stimulates the breasts to make milk. High levels of prolactin reduces progesterone production. Low levels of progesterone in turn stimulate an increase in prolactin levels. It is a vicious cycle. Prolactin levels are also influenced by hypothyroidism, herpes zoster, estrogens, oral contraceptives, and a number of prescription drugs. Elevated prolactin levels are becoming increasingly common. You can take progesterone supplements to make up for any deficiencies but if you have high cortisol and prolactin levels from excess stress you need to manage and reduce your stress so that you’re not just using up the supplemental progesterone before your progesterone levels can rise back to normal. Dr. Lee’s book,”What Your Doctor May Not Tell You About Premenopause” is a must read for all people with chronic fatigue syndrome. The title does the book a great disservice, THIS BOOK IS ALL ABOUT CHRONIC FATIGUE SYNDROME. I believe that you will see yourself in the description of symptoms and case histories. It is all about balancing hormone levels for health. I do not have a medical background so I hope that I was able to paraphrase what he had to say with some accuracy. I urge you to read the book and consult a doctor before following this information. I cannot encourage people with CFS enough to read this book. What I have excerpted here about fatigue is only a small sampling of helpful information about the miseries that plague us.