Over the last 18 years of my practice, I’ve seen tremendous success in helping people improve their health when low-carbohydrate dietary changes are anchored as the foundation of treatment.  However, there is still a group of people that struggle with seeing success.  Even with the most effective ketogenic dietary control, there are those that see abnormal weight gain, inability to lose weight, poor libido, fatigue, foggy thinking, mood swings, persisting depression, headaches, bloating, breast tenderness, fibro-cystic breast changes, hair loss, and hot flashes.  They may not experience all these symptoms, however, many are often present.  If you have been following a ketogenic lifestyle and are still experiencing any of these symptoms, you are probably suffering from estrogen dominance.

Estrogen dominance is a condition that elusively effects thousands of women (and men) and your doctor probably doesn’t even know about it.  I didn’t know about it.  I, like all of my physician colleagues, were trained in school that the symptoms above are related to fluctuations of estrogen as a woman ages (or dropping of testosterone as a man ages).  We were, and still are, taught that they are fixed by giving more powerful doses of estrogen or testosterone.

Over the years of my clinical experience, giving more estrogen frequently didn’t work.  And, giving men more testosterone didn’t work either.  What I found very effective, for many, was changing the diet.  And, for about 85% of people, the symptoms list above resolved.  However, the cause of the symptoms above in that last 15% of patients I see was still elusive.  Examinations, blood tests, and even psychological evaluations never revealed the answer.  Giving synthetic estrogen, progestin or testosterone when the blood work showed abnormality partially alleviated some of the symptoms for a few months, but then the patients would end up back in my office with the symptoms having returned.

I’ve found a number of problems following the “standard” medical approach to using synthetic sex hormones.

The first problem is that estrogen, progesterone and testosterone are heavily bound to proteins in the blood. It is only the free component of the three forms of estrogen and progesterone in the body and the free testosterone that acts upon the delicate cells located throughout the body.  Blood testing does not account for the levels of free estrogen forms and progesterone effectively.  These can only be tested through salivary testing.

The second obstacle is that the synthetic forms of progesterone (progestin), cannot effectively enter the brain. When synthetic forms are used, a person only gets half the benefits of progesterone found in the human body.  This is why so many women have depression, anxiety and foggy brain feelings when using the synthetic versions.

The third challenge is that pharmaceutical companies cannot patent a drug that is identical to your human hormones.  The chemical structure of the synthetic estrogen, progestin or testosterone must be slightly different. Hormones effectively work on certain aspects of various cells throughout the body, however, progesterone and progestin (the synthetic version found in medroxyProgesterone) DO NOT have the same hormonal effect on each cell.  Natural progesterone is broken down by the stomach when ingested. That’s why progestin was invented, however, it doesn’t act the same in the body and only does half the job.

The fourth dilema is that much of our food in the standard American Diet stimulates increased estrogen production or inhibits clearance of estrogen excess through the gut and digestive tract.  This happens in men and women.  We can get excess estrogen from animals treated with hormones in meats, milk and dairy products.  Hydrogenated oils in processed foods change the way estrogen and progesterone are handled in the body.  These unstable fats increase the effects of estrogen on the body and amplify the risk for cancers.  Excessive omega-6 fatty acids in the diet magnify estrogen receptor response to estrogen.

Estrogen metabolism in the liver and removal in the gut are dependent on vitamins B & E, magnesium  and idol-3-carbinol (IC3).  Diets without adequate IC3 from glucobrassicin found in leafy green and crucirferous vegetables allow re-uptake of estrogen in the gut leading to high estrogen levels and estrogen dominance.  This is where gut health is even more important, and where I see failure in the “carnivore” approach to a ketogenic lifestyle.

The fifth problem is that the more estrogen I give a person, the more estrogen receptors are unregulated to the surfaces of the cells in the body.  When that happens, more estrogen is required.  Excess estrogen can actually cause many of the same symptoms present in progesterone deficiency including:

• Irregular or heavy bleeding
• Breast tenderness
• Depression
• Fatigue
• Poor concentration
• Fibrocystic breast changes
• Decreased libido
• Fibroid growth on the uterus
• Endometriosis
• Water retention and bloating
• Fat gain around hips and thighs
• Bone mineral loss (osteoporosis)
• Hair loss
• Skin thinning
• Disturbed sleep
• Breast and uterine cancer

More estrogen isn’t needed. Balancing natural progesterone with the current estrogen the body is already making is the solution in most cases.  This can only be effectively assessed through a salivary hormone test.

In my clinical experience, a ketogenic lifestyle is foundational to balancing these hormones consistently and naturally.  Carbohydrate restriction by itself corrects many of the diseases of civilization.  I addressed this in my book The Keto Cure.  For many, there are few more steps necessary to living a long, happy and healthy life.

The treatment to this issue isn’t difficult.  For that reason, much more is to come on this subject.  I will address each of the points above in future blogs. However, the first step is get your hormones checked by someone who understand this problem.  And, then knows how to interpret it and treat it.