Episode 1: Hormones keeping you up at night?

Aug. 1, 2023 |  27 mins  

Join our host Jennifer Botterill as she chats with Dr. Nadia Saleem, a naturopathic doctor from Maple, Ontario. In this episode you’ll learn about hormones in men and women, how they change throughout your life and what you can do about it.

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You are listening to the Beyond Age podcast series.

Jennifer:

Hi, and welcome to Beyond Age, a Manulife exclusive podcast. Manulife cares about the physical, mental, and financial wellbeing of Canadians. And during this podcast series, we chat with industry experts to uncover the truth about holistic health and aging, to keep you living healthier for longer, no matter your age. I'm your host, Jennifer Botterill, and today I'm joined by Dr. Nadia Saleem, a naturopathic doctor and clinic director at EBL Naturopathic Clinic in Maple, Ontario. We'll be discussing how your hormones change as you age, and what you can do about it. Welcome, Dr. Nadia.

Dr. Nadia Saleem:

Thank you for having me, Jennifer. I'm very excited to be here.

Jennifer:

Oh, well, it's so nice to have you join us, so thank you. To get started, may you please share a little bit more about yourself and how you first got into this field.

Dr. Nadia Saleem:

Yeah, absolutely. So my long story short is I was dealing with my own health concerns, and I stumbled across naturopathic medicine and functional medicine, and it actually helped me get my health on track. So naturally it felt like the right thing to do to follow this course and really shift gears from where my career was headed. And I took the leap, you know, over a decade ago, and I haven't looked back since. So it's a very personal story in that way.

Jennifer:

Yeah. Well, good for you. And can you maybe start for many of us with the basics? We think about what actually is a hormone, and where in our bodies are they produced and how?

Dr. Nadia Saleem:

Great question, because we hear right now, you know, hormones are the buzzword we'll say, right? Everybody wants to work on hormones, talk about hormones, but at a very basic level, hormones are just a messenger, right? So if we were to look at the definition of hormones, they're just a chemical messenger, meaning they are working in our body, traveling through our blood, getting to organs and tissues, and telling that area to do something. The hormones are actually being produced and secreted in response to other signals, right? So there's always other sort of signals that are coming in from higher centers of the brain that are regulating, that's constantly assessing our body, and it's going to then tell the organs to go ahead and produce these hormones because a certain effect is needed. So we have our sex hormones mainly being produced from our ovaries and our testes, and we have our cortisol, our stress hormone being produced from the adrenals, which are these little glands sitting on top of our kidneys. Our thyroid hormone comes from the thyroid gland, which is produced in our neck, and then we have insulin, which is a blood sugar regulation hormone being produced from the pancreas. So it's really just a chemical messenger, and it's the way our body will communicate to function appropriately.

Jennifer:

Okay. So then if you think about our bodies then, and how many different types of hormones exist, how do different types of hormones influence each other? Absolutely. Right. If we think about, can a change in hormones in one part of the body impact other parts of the body? And if so, are there some real life examples that you could potentially share?

Dr. Nadia Saleem:

Absolutely. And I'll start with, you know, when we think of hormones, I find this quite often with women as they're reaching out to me to work on hormones, I find that the word hormone has become synonymous with our periods, right? Or testosterone and estrogen and progesterone. Those are some of the key hormones we think about. But I love that question because its so important to clarify and to expand that our hormones go beyond those, right? So there are so many different types of hormones in the body, and they're going to be exerting effects. We're getting inputs of all of these hormones from all areas. So our digestive system, our liver, our gallbladder, our intestines. There are various other hormones being brought in from all of these areas that are going to work synchronously with one another. The best way to think of it is a hormone web, right?

Yes. So we have this beautiful hormone web in our body, and some of the ones I really like to focus on with people is cortisol. Cortisol is one that we hear quite a lot about, that's produced by our adrenal glands, and it's our main stress hormone. Then we have our thyroid hormone, and thyroid hormone is there to help regulate metabolism and energy production, and temperature regulation and brain function. One example is actually digestion. So we'll speak to insulin. That is another big hormone system that we hear a lot about. And insulin's job primarily is to help us utilize energy better, right? So it's going to help us take sugars and put them away where they need to be so that they can be utilized for energy. So as soon as we're eating, right, so we have food in our system, our blood sugars going up, that's going to signal to the pancreas to go ahead and secrete insulin, and then we get into estrogen, progesterone, testosterone, all of those things.

When we're looking at our sex hormones, we're going to get this variation of the estrogen and progesterone being produced at various times of the cycle, because we need our uterine lining to grow. We need those things to kick in at that time. So there's always higher centers that are signaling the release of these hormones in a very coordinated way. So in terms of how these hormones are working together, the best example I like to give people is when we are stressed, right? We are going to get a rise in cortisol, but that cortisol's job is to do something in the body. It's to help us spring into action, right? So we think of it as our stress hormone, but cortisol helps us spring into action. And one of its jobs is to increase blood sugar, because that's what gives us energy. So when that happens, then insulin comes in and insulin then has to put the sugar away, right? So that's how those two hormones are connected quite intimately. Then when we think of estrogen and progesterone and the there, well, when we think of a menstrual cycle, for example, estrogen comes in, in the first half of the cycle, it's going to make everything grow, let's say, and progesterone helps oppose estrogen, and it calms everything down, right? So a lot of these hormones are working with one another and certainly not in isolation.

Jennifer:

Fascinating to think about how our bodies work. And if you think about the number of different hormones that you described, if you could take us through the typical expected change of hormones throughout our lives, whether it's estrogen or test testosterone, or the many other hormones that you just mentioned.

Dr. Nadia Saleem:

Absolutely. As we're aging, some of the things that are happening with our sex hormones, so estrogen, progesterone, testosterone, is they are declining, right? And that is a very natural phenomenon. So from a reproductive standpoint, as we're passing through our reproductive years, those hormones are naturally declining, right? So let's start with a male. So as men age, we are going to see a decline in energy and brain function, muscle mass, libido, right? So those are all going to be very key things that are going to change as the testosterone starts to decrease. There's a lot of buzz around testosterone and understanding testosterone itself. Yes. And we know for men and women, because women also have testosterone, it actually naturally starts to decline after the age of 30, let's say 1% a year or so. And what we're now seeing is a more rapid decline, and we're seeing lower levels of testosterone across the board than we did historically.

Meaning, let's say if we take a 45 year old today, that 45 year old has significantly less testosterone than a 45 year old did in the eighties. For women, we are going to see a loss of brain function. We're going to see an increase in fat mass, we're going to see a decrease in muscle mass. So some things are definitely very similar. Where we start to change, let's say, is when we're looking at the menstrual cycle, we are going to see very drastic changes to the menstrual cycle. We're going to see in terms of where the woman is storing fat in her body, as the estrogen decreases, we are going to see an increase more in fat deposits around the midsection, around the hips, around the thighs, decrease in breast tissue, right? So a lot of women will see a decrease in breast tissue, whereas actually a man, depending on, while his testosterone is decreasing, he may start to actually see an increase in breast tissue increase in similar fat deposits, at least around the midsection.

Then when we look at outside of the reproductive years, unfortunately, due to environment, due to a lot of factors, we're seeing, I'd say an even more exponentially faster decline in a lot of these hormones. What we're seeing over and over again is cortisol is coming in to help us deal with stress, to us bring into action throughout our day. And what we're seeing over time as we're growing older, is we're losing that ability to regulate or appropriately secrete cortisol, and we start to lose the ability to adequately or appropriately mount that response and secrete it in a way that's more appropriate to proper functioning of the body. Right? So there's a lot going on with our environment, with our lifestyles, that's creating an even bigger decline in these hormones, and that's actually really causing a lot of us to feel unwell and age in a way that we don't want to be aging. Right? We all want to aim to age in a more vibrant way, essentially.

Jennifer:

Yes, of course. And you talked about our environment and our external factors. So I mean, how are these hormonal changes influenced by that? Or how does that work?

Dr. Nadia Saleem:

Great question. So the way I explain this to all of my patients, and everybody who sits across from me, because you know, when people are coming in, they're wanting sort of the latest and greatest in hormone therapies, and what can I do to bring my hormones back into balance? And some of the things we really start to focus in on outside of any other therapies that we're using is two words, stress and inflammation. And so I really like to distill it down into, okay, we need to focus on, if we're to look at how do we naturally start to improve these hormones, and how do we naturally start to take away the things that are impeding the function of these hormones? We have to look at stress and inflammation. And so when we're looking at stress, so I'll start there, and then they're, they're actually tied together.

So the things that are going to create stress in our body will create inflammation. The things that create inflammation will create stress in the body. And these things, the stress and inflammation pieces are really throwing a wrench into those messenger pathways. So into the hormone pathways. And to answer your question, the things that are really affecting these, the external factors would be, let's start with traumatic events, right? So stress is a big one, obviously, and we all think of stress in the context of big trauma, big events. Let's say the pandemic, the big stressful trigger for all of us, but outside of that, we have to evaluate environmental factors, right? Yes. So, for one, taking a look at, let's say we go down the rabbit hole of toxins. Toxins are, again, another important thing we need to start paying attention to. So there are a lot of toxins in our environment that we're constantly knowingly and unknowingly exposed to.

So, you know, a few examples that I like to take people through is, okay, well what are we doing in terms of cookware? What are we doing in terms of food and beverage containers? These are simple areas that we can start to focus on that's going to really make a dent in our hormone health in a positive way. So something as simple as non-stick coating, that is actually very toxic for us. Using plastics that have BPAs, BPCs, phthalates, things of that nature. There's a lot of exposure on a day-to-day basis. From an environmental perspective there, that creates an issue. And what can we do about that? That's pretty easy. We can start to use glass, we can start to use stainless steel. We can start to use ceramic or stainless steel pots and pans. And even if we are to use plastics, one suggestion I give people is maybe we don't heat food in plastics.

Maybe we wait till food cools off before we transfer to plastics. Right? So simple suggestions that we can start to use. Then I have people evaluate their body care products. You know, men and women, all of us, were putting so many body care products, so shampoos, conditioners, soaps, creams, makeup, all of it. And all of these things are pretty toxic. So that is, you know, to me, very low hanging fruit for us where we can start to look at our environment, look at these surroundings, right, and start to clean up body care things that we don't think about. Air fresheners. Yes. Right. Perfumes. So we really just have to be cognizant of those environmental factors around us, because these are all modifiable factors.

Jennifer:

Can I ask you on one detail on that front? Even when you talk with the body care products Yes. Are there certain things that people should look for or should make sure that they're avoiding in that department?

Dr. Nadia Saleem:

Absolutely. And now the companies are getting better and better at labeling these, but some of the words, some of the keywords to maybe look out for would be parabens. They're called hormone disruptors. Mm. And they're really going to mimic and muck up, let's say, the machinery for these hormone systems. So something like parabens, sulfates, again, BPAs, all of these things will make a big difference.

Jennifer:

Right. Thank you. Yes. We're going to take a quick break, and we'll be right back after this passage,

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Jennifer:

Welcome back to Beyond Age. Dr. Nadia, when you think about hormonal changes, what are some of the most common health conditions that you've come across in your practice that have been caused by some of these hormonal changes?

Dr. Nadia Saleem:

So the biggest thing that I'm seeing these days, let's say in the most important thing to me, is when men and women are articulating that they don't feel like themselves anymore. So to me, that's actually very important because that speaks to how they're functioning, how their relationships are, how they're dealing with work, how they're dealing with stress. So, you know, what that really encompasses is people are losing brain function. They're not able to think as clearly. They're feeling absolutely fatigued, both mentally and physically. And that can certainly happen as those sex hormones start to decline. Right. We start to gain weight around the midsection, and it's even harder to put on muscle mass. That's a pretty good sign that we're probably dealing with some hormonal issues there. Right. People, women who are menstruating, they may see changes with their menstrual cycles, right? So PMS is starting to change, and that for a lot of women, can become very debilitating, because we're looking at now quality of life, and then mood and sleep changes, right?

So that's actually creating a lot of dysfunction, especially the sleep. Sleep is one of those areas for me, that is a hot topic because it's such a foundational part of our health. Yes. Poor sleep creates a lot of stress for us. Poor sleep creates a lot of inflammation for us. Poor sleep will then cause a lot of weight gain. And then with that comes part and parcel, we're looking at heart disease risk, we're looking at arthritis risk, we're looking at these all cause mortalities. We're looking at, you know, heart disease, all of these things that are going to be coming with the increased weight.

Jennifer:

Right. And so you just shared many signs, right? That some health conditions might be present. So is there anything else that you want to expand upon that people should be looking for, or when someone should potentially seek medical advice?

Dr. Nadia Saleem:

Yeah, absolutely. When somebody is dealing with a lot of fatigue, pain changes with menstrual cycle, inability to deal with stress, not able to focus on relationships, not able to do the things that they once loved to do, not having the energy to even go for a walk, for example. Right. Those are all pretty big red flags for us that we should not be ignoring.

Jennifer:

Right. Absolutely. I think that for all of us, right? We want to think about being at our best on a consistent basis, right? Absolutely. Not just once in a while. So when you think about that medical advice, I came across a type of treatment called bioidentical hormone therapy, or BHRT. May you please tell us a bit about BHRT and the facts about how it works.

Dr. Nadia Saleem:

Absolutely. So, BHRT, again, it's becoming more and more popular. And so BHRT, essentially what this is, is hormone replacement therapy. And BHRT specifically is bioidentical hormone replacement therapy. And I'm going to speak a little bit more to estrogen and progesterone. That's primarily my practice. That's what I have access to, that's what I'm utilizing with women. BHRT is the replacement of hormones, right? So it is giving our body, exogenous estrogen and progesterone to make up the decline for our own natural production of hormones. In essence, that's what BHRT is. And where that bioidentical term comes in is we are using hormones that are essentially identical in structure in the molecule as our own hormones. And where that treatment shines is for women going through perimenopause and menopause, where we start to see the decline of those hormones, and we start to see a lot of diseases come part and parcel, or health conditions come part and parcel with that. So we're looking at long-term effects of the decline of those hormones. We're looking at increased risk for dementia. We're looking at increased risk for osteoporosis, decreased libido, decreased quality of life, increased risk of stroke, increased risk of cancers. There's so many things that go part and parcel with that. So that's where bioidentical hormone therapy can shine. And that's the predominant use of it.

Jennifer:

Yes. And so what are some of the signs that we can look for to determine how well hormone therapy is truly helping someone? And what are some of the changes that a patient might expect to feel if their hormones become healthier?

Dr. Nadia Saleem:

So some of the things, again, that women come to me for is their brain function is suffering. They're not able to keep up with simple tasks in the day. So these are more of like the overt symptoms we're going to notice day over day. Right. So they're not feeling good, they're not feeling motivated. They have a lot of brain fog. So as soon as we start a woman on appropriate therapy, which includes bioidentical hormones in addition to other things, we are going to see quite a significant turnaround in those areas. So brain function, how they're feeling, their vitality, their libido. Outside of that, the big area that we use hormone therapy for is the vasal motor symptoms that come part and parcel with perimenopause. So we're looking at hot flashes, we're looking at anxiety, we're looking at sleep disturbances, because these are really big changes that are going to come as part of that perimenopausal picture, which really affects a woman's quality of life. So we're going to see a quick turnaround with that. And you know, in research we've seen over and over again, nothing is going to touch those symptoms as quickly as hormone replacement therapy will.

Jennifer:

I think when we're thinking about aging and things that we can control, I know for me, I do a lot of keynote events, and one of the things I talk about on the emotional and mental side of things, trying to focus on what we can control. So when we think about aging, how much of our hormonal changes can we control? Is there anything that we can do in our daily lives to help prevent hormonal ill health as we age? Or are there things that we can do to optimize. Our hormones, even if we don't have a health concern at this point?

Dr. Nadia Saleem:

Absolutely. So the biggest areas we want to look at is going back to what I mentioned about the stress and inflammation, right? So what are some of the areas that are creating more stress and inflammation for us? And when we start to unpack those, we're going to then put ourselves on a great path for better hormone health as we age. So those areas are going to be, so again, modifiable things we can do is focus on sleep, right? Make sleep a priority, focus on nutrition. From a nutrition perspective, you know, there's a lot of diets going around and flying around, but simple strategies that we can think about is, Hey, you know, are we eating enough throughout the day? Are we eating enough protein? Are we eating enough nutrient dense foods? Right. So enough fruits and vegetables getting movement in. Yes. Right. That is such a simple, simple strategy, but has such a great profound impact on our hormone health.

So something I recommend to people is, you know, what about just a 15 minute walk? Three times a day, maybe breakfast, lunch, dinner. Right? Let's get out and let's get some movement in. Right. And we're actually seeing, there's studies that show that men who walk, I think it's about 8,000 steps or more a day, have significantly higher testosterone levels than men who walk 4,000 steps a day. Right. So we are starting to see that in the research as well. And then, you know, taking care of our outside stressors, taking care of our relationships, taking care of, again, those environmental toxins that are coming in. Right. What are our lifestyle habits? Cutting back alcohol is the big point of contention for a lot of people. But the reality is, and the fact is, and now the research is there to show it, alcohol creates a lot of inflammation for us, and it's just, it's such a normal part of our society to drink, right. In North America at least. But there is a lot of negative health implications. So that's actually something simple we can do, where we can start to reduce that inflammatory input into our body. Right. And then as again, looking at the environmental stuff that we talked about, all those things will help.

Jennifer:

I think as I reflect even on my life and other people, it's incorporating these changes and it sometimes it just takes small steps Absolutely. In each of these different fields. I know, even for when I travel, it's just putting a pair of sneakers in my bag and maybe I don't have a half an hour, 45 minutes. Exactly. Just making sure that you can get some movement in, even if it's 10, 15, 20 minutes at a time, and then that adds up throughout your day. Exactly. If we think about different myths or misconceptions that might exist about hormones, are there any of those myths about both hormones and aging that need to be debunked from your point of view? Yeah. I mean, examples, you know, might be that you've heard, oh, menopause is reversible, or all hormone therapies are alike, or some hormone therapies cause adverse health effects and so on. So could you share your thoughts on that, please?

Dr. Nadia Saleem:

Absolutely. Yeah. So just to answer the first part of your question, one myth I would really like to dispel is we don't have to resign to this notion that once we've hit menopause, it's all downhill, and we should feel achy and brain foggy and in pain, and not enjoy life anymore. I think that is a very big myth. To the second part of your question, hormone therapies, not all hormone therapies are made the same. Right? And we can actually enter our older years feeling great, feeling vibrant, feeling vital. And I just want to go and speak to, I guess, where the fear around the hormone therapy initiated in the first place. So just to give a little bit of background in terms of the hormone therapy side. So in the early two thousands, we had the women's health initiative study that studied thousands of women.

And that study came to a pretty big halt. These women were administered synthetic estrogen and progesterone. So there was conjugated, equine, estrogen, and some progestins. And there were some pretty quick conclusions regarding risk, regarding cancer, risks regarding heart disease risk. So what happened at that time was that all women were stopped with the hormones, and for many, many, many years, for two decades now, women have not been offered hormone therapy. And what that's done is that's actually caused a big disservice for a lot of women. Right. So women have been left with no solutions or no adequate solutions for those hot flashes, those night sweats, those years of poor sleep, the brain fog, all of those things. And now we're starting to see that now as scientists have gone back and looked at the data, they've actually uncovered that, you know, hormone therapy was administered in a group that was actually older to begin with, and possibly had more risk factors, more heart disease, right at the onset of that therapy.

And when we looked at how the hormones were delivered, that may have caused an increase with, so the types of hormones, the combinations of the hormones, and again, the most important thing was the age of the women, right? So now we know that the safest time and the most effective time to start the hormones is actually within the first 10 years of menopause or perimenopause. And we know that these hormones are actually safe, and they are going to help reduce the risk of osteoporosis, of cancers, of heart disease, of clots, of all of these things, of a declining brain function as well. So we know these hormones are significantly safer. They're being administered in a different way. So that's where even the bioidentical hormones come in, the bioidentical hormones, essentially, were using estradiol and micronized progesterone, which is far safer than the way it was administered before.

Jennifer:

Right, right. Now I think you've shared so many valuable insights, but if you could summarize, are there one or two things or takeaways that you'd like people to leave with?

Dr. Nadia Saleem:

Absolutely. And I, both of those are going to connect to my philosophy, which is health is simple, and health really is in our hands. So for one, really the key takeaway is focus on the foundations, right? So we talked about the nutrition, the movement, uh, getting enough sunshine and prioritizing sleep, right? Those are simple, simple, simple things we can start to do. And second, and I keep going back to this, is let's start assessing the stress and the inflammation piece, right? Maybe do an inventory, go back and do an inventory on some of the things we've mentioned that create stress and inflammation for us, and start to see where can you start to improve that or knock some of those things out.

Jennifer:

Amazing. Well, this has been so educational, and we're so thankful for your time today and for sharing all of your insights. So, Dr. Nadia, thank you very much for joining us today. Thank you.

Dr. Nadia Saleem:

Thank you, Jennifer.

Jennifer:

So that's it. Thanks for tuning in to Beyond Age, an exclusive podcast from Manulife. Tune in to the next episode where we talk to Dr. Susan Biali Haas from Vancouver, British Columbia about the burnout crisis. Don't forget to visit our website, manulife.ca/LiveHealthier for more tips, videos, and content from Manulife that can help you live healthier for longer, no matter your age.

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