Dr. Natasha Iyer 0:02
Introduction to Show and Topic: How Alcohol Alters Estrogen Levels.
Welcome, everyone, to today’s episode of the Better Hormone Balance show. I’m Dr. Natasha Iyer. So this show is dedicated to all things hormone-related. I love hormone balancing. Hormones or the chemistry of life and balancing hormones keep you useful and feeling young, long term. Last month on November 25, 2019, an article was published in Medscape, looking at two factors that alter estradiol levels. (One is alcohol, the other is smoking). And I thought that today would be a good day to talk about how alcohol, in particular, alters estrogen levels in your blood.
Introducing the Director of Medical Education. Both NI and SDK love red wine!
To explore that further, I have the pleasure of introducing our Director of Medical Education Dr. Shabnam Das Kar to you all, she’s a Functional Medicine consultant at Better and her role in the clinic is research and protocols. It’s through this daily reading of everything interesting that comes out in our field of Functional Medicine and hormone balancing that Dr. Kar pointed me to this article that came out. And I thought, wow, it’s the holiday season, party time, Christmas is just a week away. Why don’t we talk about this so that all of you know how to stay healthier and happier with your hormone balance through the holidays. So, Dr. Kar, what did you think of this little review?
Dr.Shabnam Das Kar 1:34 Okay, so thank you, Natasha, that was such a wonderful introduction, and welcome to our show. So, before Dr. Iyer and I move ahead with what we’re going to discuss today, full disclosure, both of us love red wine. So, it’s not like, you know, two sanctimonious doctors telling you what not to do.
NI 1:54 And I will say that clearly when patients come to me and I and I say to them, please don’t think I’m going to judge you, I have a love affair with red wine.
Estrogens, smoking and alcohol.
SDK 2:05 So what we are talking about now estradiol is one of the estrogens that our body makes and there are three different types of estrogens and just for clarity, I think we, you and I will just say estrogens because it makes it easier. Estradiol is the most powerful estrogen in the body. So, this paper which was presented at the recent North American Menopause Society conference, it looks at whether smoking and alcohol impact estrogen levels in the body. So, they looked at women who were on hormone therapy. There are two different studies and I will post all the details on the show notes. So, don’t worry if you’re wondering what paper what notes I was talking about. So, what did they look at?
Smoking Reduces Estrogens.
Now these women were, the interesting thing is the type of estrogen that they were on and we have talked about that on the videos. I’m not going to go into details here. But smoking, we know that smoking reduces your levels of estrogens in the body. So obviously smoking, you all know that smoking is not good. But what about alcohol use? And how much is healthy and how much is not healthy for women? Those are difficult to answer, but then there are some guidelines, I will post that as well. So, what they found on this is alcohol use increased levels of estrogen in the body and higher estrogen, again, there’s a difference between high estrogen and optimal levels of estrogen. So, Dr. Iyer would you like to say something about the estrogen and what impact higher levels would have on your metabolism and weight gain and all of that?
High Versus Optimal. Other hormones
NI 3:51 Yes, thank you. So, I’m just making notes as you’re speaking about topics, I want to circle back to so that’s great. Thank you for that. When it comes to balancing hormones, I absolutely believe in optimal. And one thing I want to point out though is that what’s optimal for you Shabnam is not the same as what levels are going to be optimal for me. When you practice precision medicine, we want to balance all hormones in relation to each other, and for that particular individual, and I don’t want to actually call it a set point.
But what I’ve seen in all these years of balancing hormones with people is that I’m trying to get to the 50th percentile for one person. Someone else might feel great on the 48th percentile or the 30th percentile for that particular hormone level. So, it’s all about how that person feels and how it is in balance with progesterone and all the other hormones that we treat like just estrogen and cortisol, thyroid, insulin, all these things impact each other. So, I don’t know if that’s what you are wanting me to mention but then the other thing about high versus optimal.
High dose versus low dose of estrogen.
I’m just seeing a flurry of patients coming in from some source where their doctor is no longer available and yesterday I saw a lady on 8 milligrams of estrogen! In my entire 14 years of having this particular practice, I have never once prescribed 8 milligrams.
And I have one patient on three, sorry, on five milligrams everybody else in my practice has a lower prescription. Now, does it mean that someone on eight milligrams has necessarily overdosed? What if she is a smoker? What if she is on other things that lower her levels based on how her liver processes that? Right, so that’s one thing to consider. But the more important thing is that eight milligrams, I think is absolutely an enormous dose for her and you can see it because her liver function tests are abnormal. She’s not balanced well. She’s got hot flashes on eight milligrams.
Unbalanced estrogen and hot flashes. More is not necessarily better.
And so, the natural thing to do is to try and increase the dose because everyone thinks that hot flashes have to do with estrogen. So, I think that’s the point. When your levels of estrogen are too high in relationship to others, you can have hot flashes, increasing it will not make you feel better long term, you might get a result for a short period of time like two or three weeks. And then after that, you’ll start to feel as you did before because the problem is not estrogen. So, when estrogen is too high or too low, you’ll get very similar symptoms actually too high, you’ll get the weight gain, you’ll get the cellulite, you’ll get the hip and the side effects and all of those things happening as well. So, is that sort of where you wanted to go with the too high?
Oral estrogens, alcohol and the importance of your liver.
SDK 6:57 Yeah, definitely. And just a few more things. I wanted to mention you brought up the liver. And thank you for reminding me. Because for Dr. Iyer and me, the liver is like, of course, for all of you. The liver is a very important organ. And sometimes we kind of don’t think about it as much as we think of the heart and the brain and bones. So, the type of estrogen that you are on, whether it is an oral estrogen or is it a cream, is very important. So, when you’re reading about any articles, and this particular one, they had used oral estrogen, so the oral estrogen goes to the liver.
So definitely that would have an impact on liver health and all of that. And the other thing is alcohol goes to the liver as well. So, both these things, alcohol goes through the liver, oral estrogens go through the liver. Both of these will definitely impact you know, how you do and your liver health. And along with that if you have metabolic dysfunction, fatty liver, prediabetes, all those things will also impact the liver as well.
So just wanted to, you know, bring that up. And yes, what you talked about; about high doses of and not just estrogen, any hormones. So, one way of looking at it is as I mentioned, someone who has hot flashes at a very high dose of hormones. What would you know a lot of people do, they would just increase the hormones, right?
Hormone Therapy before. Add higher doses and then add antidepressant medications.
NI 8:24: So sorry, Dr.Kar I’m going to interrupt you. You are an Obstetrician-Gynecologist by trade. That’s what you did in your life before Functional Medicine. And I was a resident in Obstetrics and Gynecology and then I did rural Obstetrics and Gynecology for eight years. So, it’s not like we were unfamiliar with the medical approach to hormones, but I can tell you.
I worked in the menopause clinic. We used to prescribe Premarin at 0.3 milligrams and if that didn’t give the lady relief, then when she came back for follow up, we go up to 0.625 and then that’s a follow up again we’d go to 0.9 and sometimes would increase higher. But other than that would say, sorry, it’s not working, we’ll just, you know, here’s your antidepressant because we know that Effexor, for example, helps you to not have hot flashes, or here’s your prescription, because there’s nothing else we can do for you. And at no point did we ever test levels or look at liver function or anything? Did you do anything different to that when you were practicing?
How to measure accurate hormone levels. Blood, saliva or dried urine? Hormone therapy is not commonly used in India.
SDK 9:29 So, Natasha, I’m sorry, I missed the last few sentences. I’m having problems with my internet connection. So, going back to my background is an OBGY. So, I was an OBGY in India. And I have told you many times before. In India, we never recommended menopausal hormone therapy and I don’t think the practice has changed even today.
So, we left women deprived of hormones and I now know with my knowledge in this field, I feel that is so unfair. Yeah, that was the standard of care. Because we still read the same textbooks that if a low dose is not making someone feel better, not making the hot flashes go away, then you just keep increasing the dosage.
Because back then, and even now, people don’t always look at the hormone levels for estrogen, progesterone and testosterone, though we don’t do that for thyroid. So here is the point where, you know, Dr. Iyer, our approach to hormone therapy is we look at not just your blood levels, we look at saliva levels, and that is for a different episode where you know, what is the controversy about the testing? Why should it be saliva or dried urine or serum?
Hormones applied on skin don’t show up on a blood test.
So, one important point and many of you are familiar with this. If you are using hormones, on the skin as a cream or a gel, blood levels are not the most accurate way to measure. Sometimes you have questions about a particular symptom if it is related to your hormones. I can’t say anything about this if you don’t do a saliva test, and sometimes you wonder, you know, you hear saliva tests are not valid. All those things. We talked about all of that on the other video. So yes, just increasing more and more hormone levels, just because your symptoms are not, you know, not taken care of is not what we recommend.
NI 11:25 Sorry, Shabnam, and I’m just going to pause you there. So, for all of my patients listening, this is all my future patients. Please know this. Never, ever self-adjust your hormones.
SDK 11:40 Oh, yeah.
Topical Hormone Therapy and Oral Estrogen
NI 11:42You know, this is the point we’re trying to make when you’re on topical hormone therapy, which we know even with the North American Menopause Society and before they released that consensus guidelines Shabnam, we’ve been using topical hormone therapy for years and years, because we know it’s safer.
And I want to circle back to that oral estrogen part, we know that when you take estrogen by mouth, so as a pill, it is more inflammatory. And that’s related to more side effects like blood clots and other things. So, in our practice, we never use oral estrogen, which is an important point for this study, but I still think that the findings are comparable.
Because of my own personal experience with my love affair with red wine and going into you know, I can feel in my body when I’m estrogen dominant, and when I’m not and it’s directly related to my consumption of red wine, I can say that for certain, but back to patients listening, do not adjust your own hormone levels. Do know that what we found from reading this study or what was found was that your net levels internally of estrogen will rise with increasing your alcohol consumption. That being said, no two people are the same. And this is why, we love to look at genetics in our practice, right? It’s because how you metabolize something is very different to how I would Shabnam, isn’t that right?
SDK 13:16 Oh, absolutely.
How alcohol changes your estrogen balance:
NI 13:18 And then, of course, with the biochemistry and everything else going on in all of our other exposures, how would we know what level you’re going to get and what level I’m going to get after two glasses of wine? We don’t know. What we’re saying to you, though, is be aware that alcohol consumption changes your estrogen balance. So that translates into real life as well when we’re working with patients in that. And now it’s you know, I always ask questions, what’s your alcohol consumption? And people always just scribble something, but I don’t think they realize why I asked that at every single visit.
It’s because when we’re struggling to get you balanced, and we’ve just adjusted all your dosing and then it works and then it stops working. Have we considered all of the factors? Now alcohol is just one factor. And we’re talking about alcohol because it’s the season.
I mean, goodness, people are going to be consuming alcohol from first thing in the morning, when they’re having their eggnog with rum, or the, you know, at lunchtime, they’re going to have their Christmas punch and all their lovely drinks. And so, alcohol is easy to consume in excess over the holidays, because it’s so usual to do that. And there’s nothing wrong with it if it’s for a few days, but if you feel hormonally unbalanced, talk to us first before you run out and adjust your levels that you’re using.
Navigating the holidays better: Manage your social calendar.
SDK 14:44 Yeah, sure. That’s a very important message. And another thing is, again, you know, looking at how can you manage these holidays better. So, all of you know what you have on your social calendar. So, this is just a suggestion and no, I have not always been able to implement it. So, if you know that, you know, you’re going to like for example, if I know I’m going to meet Dr.Iyer, then I’m going to make sure that I can drink some wonderful wine. Because that’s something we would love doing. You know, I’m going somewhere else where I don’t know whether the wine is going to be of good quality or you know, then I’ll say, okay, I will choose when I’m going to drink wine.
And of course, with whom I’m going to drink wine. So, these are just you look, take a look at your social calendar and decide ahead of time, okay? These are the places where I would probably drink this is a place where probably I wouldn’t drink.
And of course, the usual things about driving and all those things, of course, are important, but from a standpoint of hormonal balance, and how you can navigate the holiday season a little better, because so many times we’ve met people who said, oh, I’ve been bad during the holidays, and I feel so bad to hear that because it’s nothing like bad or good. All of us are humans. Right?
So just to have a few strategies in place. And maybe ahead of time if you can plan number one is don’t drink on an empty stomach of course that you know that.
Tips on how to manage your social drinking :
NI 16:09 Rule number one. Yes. And I think everybody knows it hits you harder and faster. Yeah, I say to patients, make sure you enjoy it. So, don’t drink just for the sake of drinking or to be social. Try to not worry about what other people think.
And I’ve seen this you know, you go to someone’s house or you’re having a party, and they’re like, half has more wine and in restaurants. I think you’ve seen me do this. I put my hand over the glass. I do not allow them to top up without me finishing what I had first. Yeah. So, I make sure to know in my head, how many servings I’m going to have and I don’t always stick to it. I have to be honest like I’ve taken an Uber home more than once, just because I’ve had that second glass when I didn’t plan to. Oh, yeah, me. And so yes, even though definitely plans can go awry.
However. It’s, you know, let’s plan it. Let’s maybe fast for the morning and skip breakfast. Let’s eat lunch with protein and fat.
Plan how many drinks you are going to allow yourself and try to stick to that. What I’ve started doing is having a glass of soda water with lime, it looks like a drink. And I noticed nobody asks me if I want more alcohol at a party and they’re coming around serving more, and they see that glass in my hand they don’t stop and ask me if I want some which is great.
Estrogen dominance and wine. Alcohol and oxidative priority.
And you know Shabnam, I have noticed not only do I get estrogen dominant when I have wine, like two-three days in a row. But my belly fat like it just shows up as belly fat and there are not enough calories.
I’ve heard patients say that you know wine is not so high in carbs, it doesn’t have so many calories and you know, this is another how you often talk I’m not even going to try and get into it like that explanation that Michal gives as an oxidative priority. It makes sense to me and I see it physically.
Belly fat and more tips.
So, you know, other than for managing your estrogen. Just think belly fat when you’re trying to manage how many drinks so the little tricks I do, I have nuts in my purse, I eat nuts before I go anywhere.
I try to eat a small meal before I go anywhere. So, I’m not forced to eat badly when I’m there. I know I’m going to enjoy alcohol, or I know I’m not going to enjoy alcohol that day. And that’s a choice I make prior to getting to where I’m going. And I think everybody knows I’m really social. Sometimes in a week, I’m on four or five times a week. And I don’t necessarily have alcohol at every single event. So, I’m not being pious here at all. I’m not trying to be better than I just don’t want to have the other complexities to deal with in including when estrogen is high.
Liver, gut, progesterone. Balance between estrogen and progesterone.
I have very poor liver metabolism of everything. So, I want to circle back to the gut and the liver for hormone balancing. You know, we know we’re saying that alcohol raises estrogen levels, especially for our menopausal patients who are on estrogen.
That makes sense. Our perimenopausal and premenopausal patients should be aware that when they’re starting to not feel great when they start feeling like their progesterone levels are low, it might be because we’ve raised the estrogen levels. And what I’m talking about here is that balance between estrogen and progesterone. So, I’m taking this slightly away from the article Shabnam if that’s okay. Just because I think every woman has estrogen or will have estrogen levels to some degree.
Hormones and the heart:
And the reason I’m doing that is I want you to comment on estrogen and heart disease, please.
SDK 23:50 Okay, thank you. So, Dr.Iyer gets a lot of people who are known, they come to her asking for hormones. And then the cardiologist said all hormones are probably going to be harmful for you. So, what is the truth?
NI 24:04 Sorry, sorry, sorry, but cardiologists have said to my patients, you should not be on hormones because it’s going to increase your risk for heart disease, you already have high risk, and so you need to stop your hormones. So please comment on cardiologists saying that to patients, okay.
SDK 24:23 So, yes, they are right, in a way because it depends on what type of hormone therapy, you’re on. As Dr. Iyer has mentioned before, if you are taking oral estrogens; now progesterone is a different story and we talked about it already.
NI 24:39 For a different day.
SDK 24:40 Yeah, for a different day. So, if you are taking oral estrogens, even if it is bioidentical, and we’ve talked about bioidentical before. So, even if it is bioidentical, it would go through the liver and all estrogens increase clotting. So, the cardiologist is right in the sense that If it is already estrogens he or she is talking about yes, that is not what we would recommend.
But estrogens applied to the skin, they are not going to increase your risk for clotting, they are not going to make you know have a heart attack. Of course, there are a lot of other factors as well. So yes, it is right and not right in the sense it depends on what form of hormone therapy you’re on.
So, progesterone again, we talked about it on the other video and I’ll post the link to that as well. So, it is the devil is in the details actually.
Low hormones and higher risk for disease.
So, but at the same time, women who have lower hormones are at a much higher risk for heart disease, dementia and you know, metabolic dysfunction and everything. So, it has to be tailored to you. And it has to be tailored not just to your physical body and your genetics and all that it also has to be tailored to your lifestyle to your individuality and that is what Dr. Iyer and I are so excited about.
NI 26:01 Okay, so I just want you to see it in one sentence. Is estrogen important for heart disease risk reduction?
SDK 26:14 Yes, but all the caveats of what are you using it and how much. As Dr. Iyer mentioned high doses will not be the best thing, but having low estrogens, postmenopausal, how long after menopause all those factors are extremely important. So low estrogen is not a great idea for if you want to prevent heart disease and stroke.
NI 26:36 Thank you because there’s enough data now and science available to support that statement. And I’m sorry, I’m making you say it over and over again because I just want our listeners to know for certain that managing your estrogen levels is not detrimental to your health, provided yes, that we look after the metabolism we optimize the levels and we stick to transdermal rather than oral.
Yeah. Okay. All right. So, I think we, I thought we were going to just spend five minutes saying, hey, ladies, everybody listening? Yes, estrogen. Yes, alcohol raises your levels and how to make it to the holidays, lowering your alcohol consumption are all the things that you can do.
Gut Health and Hormones. Supporting liver health.
I think I’d give you one last bit of advice other than also, you know, like managing your bowel movements and looking after your liver health. I think and then personally, I do this every day, I take something to support how my liver processes out all sorts of things and I don’t have time to talk about, you know, the cytochrome enzymes and the genetics of detoxification and all of that. However, I recommend liver support, especially through periods like this, what do you think of that?
SDK 27:54 Oh, yeah. And what Dr. Iyer means is, you know, supporting your liver by the use of nutrients and it would be a combination of food and supplements. So liver is a major organ of detoxification and a lot of nutrients are required in the detoxification process. So yes, if you know that you’re going to make your liver work harder.
NI 28:20 I will make mine work harder this week. I’m meeting you tonight remember? And, then I’m leaving. Leaving to see family after that. Go work really hard. So just quickly, what are some of the important nutrients, Dr. Kar?
Important nutrients to support liver detoxification.
SDK 28:35 All the important ones would be the B vitamins then the curcumin then broccoli extract, then NAC (N-acetyl cysteine) and we have a lot of stuff which you know, the common combination of all of these together.
NI 28:50 So, I’m taking Cell Deep Clean right now because it has a little bit of everything in it. And then I take my B vitamins separately, but the brassica vegetables you said food
And, we know that all of the brassicas like brussels sprouts, broccoli, cabbage, kale, broccoli sprouts, all these things. What do they have? And why does it help support the liver and estrogen balance if we’re looking to add food to help us have better estrogen levels while we’re drinking alcohol over the holidays? Because we’re gonna do it anyway.
SDK 29:25 Yeah, so food and you know, the sort of plant chemicals that most of these contain are things called glucosinolates or sulforaphane. And I’m not going into big words.
Cannot get enough from food only:
But just one point I want to highlight is they did a few years ago they did a study on, so they looked at the levels of these beneficial plant chemicals in broccoli. And from the outside, all the broccoli looked alike, but when they actually measured the levels of these they found that they varied and of course we know that it would vary depending on the soil and depending on how long ago you plucked it.
The point I am making is, yes you do need food but if you are going to rely on food only to balance your hormones that is not going to work because you don’t know how much you know of this beneficial stuff you’re getting from the broccoli that you eat and you know here versus you know, relying on food as well as supplementation. And again, some of you may need more if you’re going to make your liver work. I don’t think you’re going to get that from you know, eating only broccoli.
NI 30:29 Well, I can tell you something for certain I do eat lots of broccoli and Brussels sprouts. I’m in fact eating so much. I think I’m going to look like a broccoli and Brussels sprouts soon. However. I do not ever count on my food. I just wanted to address that. They have valuable compounds that help you with healthy estrogen metabolism and balance because you can just add these little things to help you even further so I would recommend if you’re going to have a blast this holiday and say I don’t care what I do and how I do it, I’m not interested in managing how many drinks I have, I’m just going to do it. Fine. Take a Cell Deep Clean, take a little bit of extra liver support. And make sure to eat more of these things that are helpful for you and then increase your good fat intake so that you don’t end up overly consuming because I find fat is very satiating, and I like that because then I just don’t want to consume more things than I should.
SDK 31:38 Okay, yes, that makes absolute sense.
NI 31:38So, hopefully, this was helpful to all of you. Feel free to post your comments and let us know what topics you want us to cover. Dr. Kar will be really good about sharing the links as she mentioned and adding the extra information below and we look forward to providing you with regular education, updates and advice on how to just live a more balanced life. And at the same time how to achieve better hormone balance because you don’t balance hormones by simply taking hormones.
SDK 32:14Thank you and bye now. Happy Holidays to everybody!
NI 32:19 Thanks, Dr. Kar. Bye-bye.
(You may need to create a free account om Medscape to read this)
Trials mentioned in that article: