Our hormones are vital to good mental and physical health, and keeping them balanced can be challenging, especially for people with SIBO. In this episode Rebecca talks to Dr. Robyn Kutka, who is a naturopathic physician specialising in hormone imbalances, about the various ways that a hormone imbalance can affect patients, from fatigue to thyroid disfunction. She is a leading light in the field of hormone balancing and bioidentical hormone therapy. Dr Kutka believes that patients require an individualised approach to treatment, she chats with Rebecca about the various treatment options available for hormonal imbalances.
In Episode 23 of The Healthy Gut Podcast, we discuss:
✓ The role hormones play in our daily lives
✓ How to tell if your hormones are imbalanced and the kind of symptoms you may experience, such as fatigue and brain fog
✓ Why hormonal imbalance can occur for people with SIBO and, what comes first hormonal imbalance or SIBO?
✓ How to balance hormones naturally and/or via pharmaceuticals, and who you need to see about this
✓ What are the most common types of hormonal imbalances for men and women with SIBO? And what are the differences between the two genders?
✓ Female cycles: the impact hormones have on SIBO symptoms. Do symptoms worsen or improve during your cycle?
✓ The role the contraceptive pill plays on our hormones and gut health, and can its usage lead to SIBO or make SIBO worse?
✓ Can SIBO cause amenorrhea, and what to do about it.
✓ Whether the transition into perimenopause, pre-menopause and then menopause affects the progression and recovery of SIBO.
✓ Should people with SIBO avoid, or be wary of, certain hormone replacement therapies?
✓ How much of our weight gain/weight loss can be attributed to hormonal imbalances?
Dr. Robyn Kutka received her medical education from the National College of Natural Medicine where she trained as a general practitioner. Subsequently she tailored her education to receive more focused training in the field of women’s health, completing a 3 year women’s health clinical internship. She continues to advance her knowledge in the field, studying with the International Society for the Study of Women’s Sexual Health and the American Academy of Anti-Aging Medicine. Hormone balancing is a cornerstone of her private practice and she serves as an educational resource for providers across the world on the topic of hormone balancing and bioidentical hormones. She shared her knowledge by speaking for a variety of organizations including The Integrative Healthcare Symposium. When not exploring new gluten free recipes, Dr. Robyn spends her spare time enjoying the outdoors with her children, partner and dogs.
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Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.
REBECCA: Welcome to the show Dr. Robyn Kutka. It’s really lovely to have you here today.
ROBYN KUTKA: Thank you. I am so excited to be here.
REBECCA: I have you on the show, and I am personally extremely interested and excited about today’s topic because it is all about hormones and it’s something that I feel that I have had to live with the highs and the lows of altered hormones and disrupted hormones most of life. So I am really excited about today. So I would love for you to share with the listeners how you came to be a doctor and how you came to be specializing particularly around hormones.
ROBYN KUTKA: Sure. Absolutely. As far as becoming a physician I had always thought that I would become a conventional physician and when I was in my mid-twenties, that’s what I would think was a reasonably healthy young woman and I went to my physician for stomach complaints and they gave me another pill. And so I was 26 years old and on 9 medications. As an individual that if I walked into my own office right now, I would consider reasonably healthy. So when that happened I threw away my dream of becoming a doctor because that’s all I knew and that’s what I wanted to do for people. I knew that there must be more out there. And I ended up just taking odd jobs here and there. And in the back of a magazine article, I saw advertising for naturopathic physicians. And when I read the tenets of care for that, doctors teach the healing body or healing power of nature and the body’s ability to heal itself. That resonated.
And I realized that I could pursue my dream in medicine. And so I did and attended med school with two young kids. It was tough but it has brought me to where I am today were I do see people as a primary care physician in my state. And I never thought that I would be doing hormones. That was not on my list. I got done with school and thought that I was gonna be focusing in autism and pediatrics. And I found myself working at a laboratory. The lab actually did a lot of hormone testing. That was their main focus. I still work there today and we did celebrate hormone testing and I was immersed in this world of knowledge that I had no idea. And I learned so much and I have been able to do so much research.
I realized that hormone imbalances are so prevalent both in men and women in all ages. And when we work with balancing hormones people get better profoundly or at least allows them to start to focus on the other areas of life that they can do and we’d steal their energy and everything that comes along with hormone imbalance. So I currently work with physicians around the world helping them learn how to interpret hormones panels and use bio identical hormones to treat their patients and get success with that. As far as myself and hormones, it goes just a little bit deeper and as a physician I found myself with thyroid cancer. And I don’t share that with a lot of people but I’ll share it with your listeners because I think it’s important because they have also probably experienced the same things I did. When I was being treated for thyroid cancer, it was a conventional approach and I experienced extreme hormone imbalance just by nature of the treatment. And with that I experienced the lack of individuality and the conventional approach to hormone balancing and I didn’t feel good, I didn’t feel better and it wasn’t until turning back to our own medicine and individualized therapies that I did feel better. So I bring that level of both expertise and empathy to my patients when we are coming up with our own plans and looking at what’s really going on for them and coming up with an individualized approach.
[04:22] REBECCA: I am really sorry to hear that you experienced thyroid cancer but I guess it has been official as well in your practice to know exactly firsthand what your patient’s experience as well with hormone imbalances. And that must have been really tough. So it’s so great to have you here still with us today and have that great journey.
What does it feel like when you do have hormones that are out of balance? Are there some common signals or symptoms that we can categorically say, “Oh that’s your hormones.” Or is it a little bit more subdued and could often be thought of as something else going wrong in the body.
[5:10] ROBYN KUTKA: Great question. Oftentimes I think it’s pretty vague and the things that we live with are explained away just to the aging process. Things like fatigue or brain fog. Those are two big ones. But mood disturbances are just not feeling like your stuff. You know oftentimes if people go in to their health care provider and they complain about these symptoms that’s chopped up to aging or having too much on their plate and levels might play a role. Very often, there’s much more to it and some type of underlying hormone imbalance.
[5:48] REBECCA: That’s really interesting. I am just thinking of conversations I have heard with so many people that – “Listen I’m just really tired. I’m working a lot. The kids are keeping me busy and I am not sleeping well at night,” but it’s because I am so busy rather than well is there something else happening that’s causing these feelings?
[6:04] ROBYN KUTKA: Yeah absolutely. Maybe everything I am doing is contributing to that hormone balance or it can be hormone imbalance that’s being symptomatic. I kind of call that super mom syndrome were we try to do everything. We are caregivers, mothers and working jobs and trying to take care of ourselves. But there’s a lot that we can do with that without having to give up what we are doing in our daily lives that addressing the hormone imbalances can profoundly affect our abilities to continue doing that while we feel better.
[6:43] REBECCA: And taking a step back, can you tell me a bit about what a hormone actually is, like what is its purpose in our body and what are they there for?
[6:54] ROBYN KUTKA: yeah absolutely. So hormones are main messengers. They are there to communicate with their cells and your tissues and tell your body to do something. It’s kind of a bit of communication molecules. They regulate systems and from anything from the menstrual cycle to quick changes in blood pressure, our blood sugar regulation, our metabolism. And they work with other chemicals known as neurotransmitters. Together they help control our mood, our desire, our drive, libido, our sleep cycles. You mentioned sleep, that’s a big one. Our energy levels and our how we handle stress.
[7:39] REBECCA: I think for many people hormones equals some form of reproductive or sex hormone. I think there is a bit very well aware and strong awareness out there in the community around hormones have something to do with those functions of the body. I think where perhaps there is less awareness is that hormones are also responsible for other things like you say sleep or regulating blood pressure or blood sugar. It’s really interesting that people might think that it has nothing to do with their hormones when in fact these little communication messengers or the things that are responsible for passing on messages to other sections of the body.
[8:23] ROBYN KUTKA: yeah absolutely. I think when we hear hormones, most people automatically think menopause and hot flashes. But it’s whole much more than that. And there are so much that we can do to help balance it that often gets overlooked. But even little things like skin changes, dry skin, hair loss, things that we wouldn’t necessarily attribute to hormones can be affected to hormone balance. Along the line, the hormones we often think in women. Does the hormones that affect women at menopause? But men have hormonal imbalance.
Yes, hormone imbalance is exacerbated or increases with aging when we think about lower testosterone. But it’s more than that and it affects their prostate health and stress levels. So it really truly does affect both men and women.
[9:20] REBECCA: Definitely. And what about the health of one’s digestive system on hormones? Does the health of our gut and given that many people listening to this episode have SIBO or another GI condition, how much does that impact our hormones?
[09:39] ROBYN KUTKA: Quite a bit actually. As you all our gut is full of bacteria and there is something known as the gut brain access that’s influenced by our hormone levels. But the bacteria also influence our hormone levels. For example, our bacteria will help … in the small intestine the bacteria will affect estrogen levels. And instead of excreting estrogen through the stool like we are supposed to our bacteria, through a process, make it so that we are recycling our estrogen and reabsorbing it.
So if we think about that example for somebody with SIBO were we have this intestinal overgrowth and excessive bacteria, they are actually influencing our systemic estrogen levels which can further exacerbate our imbalances and be symptomatic. Somebody with too much estrogen in women might be moody, irritable, weepy, depressed. They might actually see more hair loss with that. So in that regard the bacteria can influence our hormone levels but then the hormone levels influence our gut motility. And I think oftentimes things like IBS are likely misdiagnosed hormone imbalances. And if we use estrogen as an example again, estrogen works very closely with the neurotransmitter serotonin. 90% of serotonin is found in our gut and it’s a motility neurotransmitter. It affects how quickly or not so quickly our gut moves. And estrogen’s role is to increase its availability, to increase its receptor activity and to increase its receptors themselves. So too little or too much estrogen will affect serotonin levels and thus gut motility.
And we see those changes in multiple populations whether its women starting to go through menopause or women using birth control. I know we’ll go there in more detail but it’s a two way street. Hormones affect bacteria and bacteria certainly affects…. Excuse me… hormones affect the gut and the gut affects our hormone levels.
[12:14] REBECCA: that’s fascinating. Gosh. I am just thinking of my own journey. I was thinking, Wow! NO wonder I ended up with SIBO. I kind of had the perfect storm.
I am interested to know, “Is it a bit chicken and the egg. What comes first, is it something like SIBO commencing first or is it hormones that can lead to SIBO or is it a combination?
[12:38] ROBYN KUTKA: I think that is a great question. And honestly I think it is person dependent. We have some people who say, “Oh I know SIBO started after X.” they had that surgery or something happened and the gut has never been the same since. And for those people I think that X happened and then the hormonal imbalances became a part of it or came with it a little bit later. And maybe that exacerbated by the nutrient deficiencies that come with SIBO especially B12 and iron. It came with the bacterial influences like we just talked about. Or maybe the stress from that situation increased their cortisol levels which would then affect the inflammation in the gut and the permeability. And lead us to even more gut concerns.
Yet for other taking a medication that affected the hormone balance or going to the menopausal transition that affects hormone balances. Or maybe it’s a woman who has an ovulatory cycle so she is menstruating but she is not ovulating. Those are all times when our hormone levels are going be lower than they are meant to be and then affect gut motility which would predispose us to SIBO.
[14:02] REBECCA: fascinating. I am so interested in this. And I said in the beginning I have been looking forward to this discussion with you so much because I just am so fascinated around hormones. Are there particularly common types of hormonal imbalances for women and men and whether they are different for those people that do have conditions like SIBO? Can you say generally speaking where you can categorize you as having these imbalances versus say the general public?
[14:33] ROBYN KUTKA: I see. You know honestly I think the vast majority of people have similar imbalances. And it’s how they present in the person. So I don’t think that people with SIBO necessarily have different imbalances. They may have the same but they are there for a different reason. And let me give you an example. So cortisol levels. Cortisol is our stress hormone. It is secreted by the adrenal glands during times of stress and it’s our brain that tells the adrenal glands to do that. In times of chronic stress, that whole system becomes what we call down regulated and after cortisol has been secreted in excess for while that stressor becomes the new norm. And why would we secret excess cortisol if stress is our new norm? We have to reserve that reactivity for us on more stressful time.
So the down regulation results in lower cortisol levels. The lower cortisol makes someone feel exhausted. Maybe they are having sleep problems, they are irritable, they have new allergies. But for someone with SIBO, SIBO is the chronic stress. And until we treat that, we can’t fix that brain adrenal HPA access dis-regulation. Whereas maybe somebody else has cortisol dis-regulation but it’s because they burn the candle at both end, are SO the imbalances may be the same but they are there for different reasons and if they treat the underlying reason in this case SIBO we can start to reset that HPA access and those cortisol levels back to a more optimal level.
[16:19] REBECCA: And I think for many people listening that they can see a visible stress with a condition like SIBO in terms of particularly chronic pain where they are suffering or they are really suffering every day. They are really feeling miserable. So there is almost like that surface level if you like or above the ice berg, stress. And then there is the below the iceberg stress where the body is just… it’s not performing the way it should and that can be as I can imagine, that must be a stress for the body at just a biological level as well.
[16:50] ROBYN KUTKA: absolutely. And with stress and hormone imbalances, it’s a little bit of a catch 22 because as the cortisol level become dis-regulated our response to stress is not as strong and it becomes harder to deal with the stressors. And there could potentially be more pain associated with that and just harder time dealing with the stress overall. So there’s just a lot of things we can do for that. There are supplements that help. There are daily activities that help depending on where somebody is in that process or how severe that dysfunction is. And that can help hold the symptom at the mean time while they are working on addressing SIBO.
[17:30] REBECCA: and so what are some of those things that people could do if someone is listening and they are thinking, that is me. My gosh, I’ve had this chronically for ages. I am really stressed out by it because I feel so sick and in pain. What can I do today to help my system?
[17:49] REBECCA: Absolutely. Great question. That’s one thing I mentioned and I am sure many of you listening are being treated for this or have read about it. What I am referring to is what is commonly called adrenal fatigue. It’s not the adrenals are not working. Per se it’s dis-regulation and the stress response. And our bodies have two states. We can be in that go, go, go, stressed out, running from a saber tooth tiger or we can be in the rest and digest state. Our calm state. And for people with adrenal dysfunction, we tend to be living in that stress state. So one of the easiest things for people to do are deep breathing techniques. If your breath out is longer than our breath in it takes us out of go, go, go and puts us into rest automatically. And these are deep belly breaths. It doesn’t have to be anything fancy. It can be a 4 count in and a 7 count out. But what that does is it helps tonify the system, puts us into the rest state that most people are living in and starts to tonify the vagal nerve which is the nerve that innervates our gut. And it’s that there is potentially some dis-regulation with that in our SIBO patients.
So this is an activity where I ask people to do throughout the day. Think of something that you look at regularly, the clock, your watch, your phone. Every time you look at that, that’s your cue to do some deep breathing. It’s cheap, it’s free, nobody has to know we are doing it and it actually works.
[19:21] REBECCA: that’s great. I love cheap and free. Nobody knows because we feel like we have got spotlights on us at the best of times especially if we’re bloated. We are feeling a little gassy, we are in pain, we are miserable. We feel like there is a big arrow pointing at us. If we can do some exercises were no one knows what we are doing, we can just quietly do it. I think that that’s just wonderful. And are there a number of repetitions that you need to do in order to have the benefits? Do you need to do 3 or 5 or 10? Or is it literally 1 breath that is longer out than a breath in is going to have an impact?
[19:58] ROBYN KUTKA: that is a great question. I would say listen to your body. You know what it feels like to be in that go, go, go state versus to be in the rest state. So for some people it’s gonna be just a couple of breaths and for others they are gonna need to do it for a couple of minutes. It likely depends in where we are in the severity of the dysfunction but also how tightly wound we are. I would recommend at least a few breaths there.
[20:25] REBECCA: and you mentioned as well that there are some supplements that you can use with some of your patients. Obviously this show is not medically diagnosing anybody or giving any medical advice. But just general if you are able to share general advice on supplements that can be beneficial, that would be great.
[20:42] ROBYN KUTKA: Yeah. General things that would be beneficial for the HPA access are things like B vitamins particularly B5 and B6. Vitamin C, vitamin E. there are things called adaptogenic herbs, herbs that helps u adapt to stress. That’s why they are called adaptogenic. They will help people. There cortisol levels are high or their cortisol levels are low. But for others, they are able to find a provider to work with then really see how far in they are to that picture. We might actually consider things like low dose hydrocortisone or adrenoglandulars but I would reserve that for somebody were I know where they were in that picture of adrenal dysfunction or HPA access dysfunction and knowing that they need a little bit more robust support than just adaptogenic herbs and vitamins.
You don’t want to give too much support either. We’re just kind of shutting off that system if we don’t need to so to speak.
[21:49] REBECCA: What’s the best way to test your hormones? Is it a blood test or a saliva test? How do you go about it?
[21:57] ROBYN KUTKA: yeah, it depends on what you want to see? And clinically for me, I want to see tissue levels. That’s what’s important. So in our blood, hormones have to be chaperoned or carried to the tissues on a bus and that bus is a protein. So if they are on the bus they love being on the bus and it’s not reflective of what’s available for your tissues. That’s your total levels and there’s no way by drawing blood work that I can see what is reflective in somebody’s tissues and that’s where saliva comes in because it is reflective of tissues levels, your hormones also, they have peaks and troughs throughout the day. And if we are doing blood spot we don’t know if we are getting a peak or a trough whereas when we are doing saliva we can average someone’s hormones throughout the day. So we don’t have to worry about that. So the saliva testing will tell you if what your tissue levels are.
It is the gold standard for cortisol testing and has been for actually more than three decades now. And it tells you your average of the day so you don’t have to worry about a peak or a valley. It’s not a metabolite. It’s truly reflective of what is available for the tissues to use. And it’s more clinically relevant. It really fix’s the picture for people.
[23:15] REBECCA: I am thinking back to my own journey and seen a traditional medical practitioner, a GP as we call them here in Australia. The number of times that I was sent off for blood tests for my hormones and it would come back and, “You’re find, you’re fine.” And it was only when I found my naturopath and she said, “I think we’ve got some hormonal issues at play and I did the saliva test. And this was right at the beginning before we even had the SIBO diagnosis. And my cortisol was completely out of whack. It was the wrong way around and it was…. She gave me some supplements that literally within the first time I took them I felt like a different person because it was really helping support my body where it needed. And I finally had that answer that yes there were some hormone dis-regulation and now I understand why the blood tests just didn’t show it and I love that explanation that they are on the bus. And I love being on the bus.
It works well. It paints the picture. Now the other thing that we think about with serum testing is what are we looking at and when we look at the record thing you are being standardized to an average of who walks into that laboratory. And we know that most people going in through a laboratory are sick. So we are catching a sick population and we are checking to see if they fall within this wide range of what is considered normal. and you will see that if you were to look closely at the reference range for serum testing whether a woman depending on where she is in her cycle, any level is gonna fall into “normal.” But people don’t want to be normal. We want to be optimal because normal doesn’t always feel good.
And when you are looking at depending on how the laboratories are set for a salivary lab, often they are set to optimal versus the average of the population and that can be really helpful.
[25:14] REBECCA: That’s so true. Yeah, gosh I am loving this episode. And just that comment about our laboratory results are often people who are unwell. And so we don’t want to be falling into that norm. I think that is just excellent. So for people to think of in the future when they perhaps might be getting results that are coming back and saying… and I myself has experienced this many times where my results were normal as they said but I felt rubbish and a bit like that you are in a normal range but like you say, normal wasn’t optimal.
And I wonder I wasn’t feeling great.
[25:55] ROBYN KUTKA: Yeah. It happens often.
REBECCA: yeah. Definitely. I feel from other people and I myself have this whereby we have SIBO and then we have other conditions like endometriosis or polycystic ovaries or thyroid dysfunction and I am just wondering it seem anecdotally to me just from the number of people I speak to everyday that these conditions seem to be more prevalent in people that have SIBO. And I am wondering if that is actually the case or it’s just anecdotal evidence that I am seeing that and if so what’s the link between a condition like SIBO and other dis-regulation like endometriosis and PCOS and thyroid dysfunction?
[26:41] ROBYN KUTKA: I love this question. I love. But unfortunately there is no research out there to show us that yes it exists. As we know this is a newer field. But I think we can speak to it and we really can tie it all in together. Thyroid is an easy one. You know your thyroid hormones, they set your rate for pretty much everything, metabolism, how warm or how cold we are, how often we are going to the bathroom. Or, people with too little thyroid hormone will tend towards constipation. Or, people with too much thyroid hormone will tend towards loose stools. So it’s your metabolism setting a hormone and that will also affect how quickly your gut is moving. So if you think about any underlying issues with SIBO, I think thyroid hormone is a hands down one that we should all be looking at.
Again unfortunately in the conventional model, most people are only screened in thyroid for something called TSH, at least here in the states. I don’t know what it is Australia but…
[27:53] REBECCA: it’s the same
ROBYN KUTKA: Ok. So TSH, it’s not a thyroid hormone. It’s a hormone that comes from the brain. And the person who invented this test actually said, “I hope this doesn’t keep doctors from thinking.” And I think sometimes it does. It’s what we do. The standard is for our physician to run a TSH and if TSH falls within and we are gonna use that norm term again, we know it’s not optimal but if it falls within norm, then it’s thought that the thyroid is functioning optimally without actually looking at thyroid hormones.
So, what I do differently in my patient population is I look at the thyroid hormones as well because we do see that TSH might look ok but the thyroid hormones themselves don’t. And further yet, we can reflex … so TSH tells us the thyroid to make something called T4. And we measure for your T4 to see if those levels look good. From free T4 becomes free T3. And that is your most biologically active and most potent in the tissues. And that’s what’s gonna influence a lot of your gut motility but most people aren’t having that screened. It’s not standard of care. Or we just assume that if T4 looks good T3 must as well. But it doesn’t. That is not always the case. That conversion requires adequate iron which a lot of folks with SIBO don’t have. It requires cortisol not too much and not too little. And T4 can go into opposite direction. Instead of going forward to free T3 and if it goes that opposite direction, it doesn’t have any biological action.
So I think for anybody with SIBO, and again I am not giving medical advice, but if thyroid haven’t been screened, it’s really important that does at our metabolic rate and how quickly things are moving and if there are imbalances there balancing it could help quite a bit with symptoms and with a resolution.
[29:53] REBECCA: and what about with thyroid and excessive iron for conditions like hemochromatosis which I myself have although now that my SIBO has gone, my levels with my iron are actually back into that normal range but they have differently dropped. But if your iron is, obviously if it’s too low, then that’s not ideal. But what if it’s too high? And on your thyroid?
[30:17] ROBYN KUTKA: to my knowledge, too high does not affect thyroid but I could be wrong there. I have a very few patients with hemochromatosis from my practice and I haven’t seen a clinical correlation. It doesn’t mean it doesn’t exist but of course too much iron could potentially be damaging to any tissue in the body. So we would want to fix that too.
[30:43] REBECCA: Exactly. And what has been fascinating for me was my general practitioners who still doesn’t really believe in SIBO although I really hope that with all the work that i am doing, I might be able to help change that. when I got through my SIBO treatment and I got my all clear diagnosis, I redid my blood work for my hemochromatosis which I got the genetic mutation of that. And within the 6 months from the first test to the last test, my numbers had dropped dramatically to the point where she couldn’t quite believe that that had happened because she had never seen another patient have those kind of results. And when I said to her she said, “What on earth have you been doing?” and I said, “I told you I am healing my gut. I am treating my SIBO and I tried to heal the leaky gut and changing my diet and changing my stress, putting everything back into a healthier state.” And she was like, “yeah, yeah but what are you really doing?” which is crazy. Crazy for me anyway. But what was really interesting to me was that the conditions was A) I didn’t know I had until the beginning of my SIBO treatment and B) that I had been told had no known cure or no known treatment other than regular bloodletting… had dramatically improved because I have treated another condition which just shows our body is completely interlinked and we nothing works in isolation.
[32:08] ROBYN KUTKA: Absolutely. That’s so the truth and with that I am sure your absorption processes have changed. As you heal the gut whether you are absorbing too little or too much of something, in this case too much with iron. As you heal that, you’re proof that it changes. That’s amazing.
[32:32] REBECCA: yeah, it’s been great. I love being a science experiment of one.
What about other conditions like polycystic ovaries and endometriosis and SIBO because I hear about these too in correlation a lot? And I also have endometriosis. I have a full kit bag of conditions.
[32:52] ROBYN KUTKA: Well I could absolutely see the connections there. I don’t think it’s written on any literature at least. .i couldn’t find it. But that being said, both endometriosis and polycystic ovarian syndrome have similar hormone imbalances with them. And they are both what we call estrogen dominant or progesterone insufficient conditions meaning in those conditions, the ratio of progesterone and estrogen are the relationship between the two is imbalanced. There’s more estrogen in relation to the progesterone that she has. And endometriosis, the estrogen of course helps the endometrial tissue grow and progesterone’s job is to keep estrogen in check. So women with endometriosis might be more sensitive to estrogen or truly has higher levels or just the tissues themselves are more sensitive to that for whatever reason.
For a woman with PCOS, she is ovulating less frequently than a woman who does not have that or maybe not ovulating at all. And it’s when we ovulate in the second half of our menstrual cycle that we produce robust amounts of both estrogen and progesterone. So in either these conditions, there’s potential for lower progesterone levels. That’s what they have in common. And we think, if you are on the go quickly and search for progesterone and gut, you’ll see a lot of writing on it that progesterone increases constipation and slows gut motility.
But clinically, honestly I don’t see it. Very often when I write that imbalance for a woman that’s when her gut symptoms heal. That’s when she feels less bloated, starts having regular bowel movements. I have worked with one woman who have been treating her SIBO for some time and we got this… just gave her progesterone and symptoms got 60% better in a couple of weeks. And by all intents and purposes in literature that shouldn’t happen. But it does. And in conventional approached to hormone balancing we really don’t give women progesterone and there is a long explanation for that. I’ll try to keep it short but I think it’s the missing link for a lot of people, for a lot of symptoms.
In the women’s health initiative when which was a big study on hormones in women, we found that women with utilizing hormones were at an increased risk of estrogen dependent cancers and stroke. Cardiovascular risks. So that study was probably halted but they were being given conjugated equine estrogens which is a little bit of estrogen which we don’t give women. Excuse me, 50% estrogen which we don’t give women. A little bit of estradiol which is our main estrogen and our pre-menopausal years and 13 other estrogens that aren’t known to the female body. And they were given that in conjunction with a progestin. And progestin is what is found in birth control and what I have been talking about is progesterone. That’s the hormone that maintains the pregnancy.
So our conventional approach to hormones is based often this approach using conjugated quinine estrogens and progesterone with no known risks of breast cancers or increased risk of breast cancers and stroke. But progesterone actually has properties that actually decrease risks of estrogen dependent cancers – dementia, osteoporosis in cardiovascular disease. So in our medical literature, in our providers offices, there’s a lot of confusion between the two and they are not differentiated and women aren’t getting progesterone. And that is unfortunate because it has such great benefits. It’s not only to those disease risk factors but also with things like moodiness, irritability, prolonged menses, not feeling like yourself and I see it helping so much in this particular conditions with IBS and SIBO.
[37:13] REBECCA: that’s fascinating. My gosh I am learning so much today. It’s wonderful.
[3:19] ROBYN KUTKA: I could talk about it forever but…
REBECCA: I could listen to it forever. So this is great. I know we have talked a lot about female conditions and female hormones, but I would really like to touch on our male counterparts because I do have male listeners and I don’t want them to feel left out at all. Are there hormone imbalance conditions, a bit like what women have with say endometriosis or PCOS. Are there things that men can experience that anecdotally or that you see in practice were if they have SBO they are more likely or they present more often in clinic with these types of conditions.
[38:02] ROBYN KUTKA: Not so much on condition driven. Like we see in women with PCOS or endometriosis. But signs of hormone imbalance in men could be prostate concerns. So difficulty with urination, increase urge for urination. Those types of things there. Of course fatigue, the cortisol stress fatigue picture is going to be the same for men. And what a lot of people don’t realize is that men can have hot flashes too. And they are not necessarily forthcoming with that information unless we ask. Yes, men experience hot flashes as a sign of hormone imbalance or night sweats is a sign of hormone imbalance as well. And I think one of the main things that gets men into the office often times for hormone imbalance is low libido or erectile dysfunction. That is a sign that hormones or other ratings are imbalanced going on and needs to be addressed.
With men… you know we think about women and there’s this estrogen and progesterone imbalance or cortisol imbalance. In men we could tend to see lower testosterone. In the literature that is a little bit… you can find that either way. But there are a couple of things that we see with men and gut symptoms and one can be a decrease in the hormone that tells the testes to make testosterone. And so that itself would result in lower testosterone levels. But we also see an increase in a protein called sex hormone binding globulin and that is the bus for testosterone. So for testosterone’s on the bus, it’s not gonna be in the tissues and available. The present then is low, free or bioavailable testosterone with all the symptoms that come with that which can be again fatigue, apathy, depression, hot flashes and night sweats.
So that’s one thing to consider. Also, when being checked for testosterone, quite often men area checked in serum and a lot of times that is reasonable. With a couple of readings you can get a… that’s the one hormone you could check in serum and get a reasonable average. But we have to look at more than just total. In most practitioners we are doing, testosterone therapies for men look at that or look beyond total but not all. And so it’s a total testosterone without sex hormone binding globulin is not reflective of what is available for use for men. So that is something to keep in mind when advocating for yourself and trying to get an assessment of your hormone levels.
[40:53] REBECCA: I am thinking some guys that I know who I can see that just through their symptoms that there is probably issues with their GI tract and when I try to talk to them about how do you feel? How’s your libido? The really common thing that they say to me is, “you don’t have a libido when you’ve got dodgy guts.”
If you got someone feeling great then you don’t have to be getting romantic with your partner and I am wonderfing if… obviously no one feels particularly romantic if they just had a nasty taste of diarrhea. But I am wondering if often that can be a signal that perhaps there is a hormone issue as well. It’s not just the fact that you are not feeling great with your guts that there could be more at play.
[41:45] ROBYN KUTKA: Oh yeah absolutely. I would agree with you there. And as you mentioned earlier, it’s not just one thing. All the systems interact and when you think about proper gut health or optimal gut health, hormones certainly are a huge part of it whether that is motility or maintaining integrity of the tissues or helping to maintain adequate and appropriate levels of bacteria and neurotransmitters. So they probably…. Probably both are going on. In your friends, there’s some hormone imbalance and some actual digestive concerns going on too and medically, honestly both need to be treated.
[42:26] REBECCA: Definitely. And that’s gonna be an interesting conversation. Have you thought about getting your hormones tested I think particularly for young guys who wouldn’t consider themselves at an age where hormone dis-regularity should be an issue for them. I think it can be quite confronting whereas if I were to have that conversation with a girlfriend and I think we could talk very openly about how our hormones are making us feel or not feel and whether that is an issue. Do you see that in practice were men are more or less willing to discuss hormonal issues?
[43:09] ROBYN KUTKA: no I don’t. In my practice most of it is women and when men are coming to me it’s because their wives or their friends either really strongly suggested it or they made the appointment for them. And but usually we can talk about things. In men, you are right we think about hormones being changed with age but testosterone levels start declining in men at age 30. So here we are 30 year old male just learning what we want to do with life. The brain only just stopped developing a couple of years ago and hormone levels are already declining. And when we couple that with environmental factors affecting hormones that we encounter in a day to day basis, it’s a double whammy.
So I think we could open up the conversation more. I hope that that happens for men but in my practice they don’t get to see it very often.
[44:08] REBECCA: And I see that there’s plenty out there for female hormones. It’s so much written and talked about but there just isn’t that much for our guys and I think that is a shame because I am thinking of all the 30 year olds that I know and there is no way that they would be thinking that their hormones would be starting to decline. I think that most of them would think that they are strong, energetic. Manly man that will have testosterone that they had at 18 until the day they die.
[44:44] ROBYN KUTKA: The neat thing about it is that when I do end up getting to work with a man who get hormones balances and he feels good, he will tell his friends and then we get to start working with a lot more of the male population. There are a couple of guys out there who have done that and it would be great to share that with your guy friends and they don’t keep it a secret.
[45:10] REBECCA: yeah exactly. That’s great advice. Don’t keep it a secret to your other mates. I would like to talk about the contraceptive pill and the role that that plays on our hormones and also gut health. And I know that when looking at some of the underlying risk factors for SIBO, the contraceptive pill is often listed as something that can exacerbate or worsen symptoms. And I myself came off the pill around the time I got diagnosed with SIBO because I decided I wanted to try and keep my body as natural as I could to help in the healing process. So I would love to hear about the role that that plays on our hormones and our gut health and any issues with the pill and SIBO.
[45:58] ROBYN KUTKA: Yeah and not to talk about this because I think it demystifies some misconceptions that we have around birth control and birth control, the pill for women it’s a catch 22 because a lot of people are using it for their contraceptive needs and might not have access to other means. But it does put people in a hormone imbalance just by the nature of what it does. So we have this misconception that the birth control pill regulate our hormones or regulate our hormone’s cycle.
It does keep hormone level steady but we have to think about what it is doing. Its job is to stop ovulation. And it does that very, very well. But if we don’t ovulate then we are not producing the best amounts of estrogen and progesterone, estradiol and progesterone that we normally would be that helps to sensitive our neurotransmitters and keep things moving and desensitize us to pain and things like that.
So we whip the birth control pill. We end up with low level estrogen and very low level progesterone. It puts us in an estrogen dominant or progesterone insufficient state just by the nature of what it does. That’s its job but with that most women experience or can experience increased symptoms and I would attribute that to the change in gut motility that would be associated with that where we talked about how estrogen can help make serotonin and help keep it more available for tissues to use and things of that nature. We don’t have ample levels and then we couple that with the birth control pill. It’s effect ton testosterone. It will decrease testosterone production in women because of the decreased ovarian activity. But the pill also will increase sex hormone binding globulin levels. And just like in men testosterone loves to be on that sex hormone globulin best and in women as well. So the double whammy there with decreased production from the ovaries but also increased binding.
And so with that I think we are seeing slowed motility for some but we are also seeing a decrease in androgen levels that can lead to an increase in pain. And so we might even be able to be more hyper aware of our symptoms with that. So there is a twofold mechanism that I would see with that.
[48:45] REBECCA: Hmm, it’s really interesting. And obviously the one thing I don’t want to do is say, “We must never take birth control pill because it has been wonderful for women were it gives us so much freedom and the ability to live a life without constantly worrying about falling pregnant. “but I think it is really important that we know what it is doing to our bodies and I myself blindly took the birth control pill for it must have been close to twenty years because my endometriosis was so terrible that…. Having staying on the pill was the easiest way to control sever symptoms and I had great fear about coming off it because I didn’t want to be bedridden with the endo symptoms. But really luckily that kind of all disappeared once I started treating SIBO which has been great.
For women who aren’t on any kind of birth control and who are having let’s call it a natural cycle that it isn’t impacted by hormone treatment. What I also hear anecdotally from people is that their symptoms get worst at points in there cycle. So I have some ladies say to me, “Oh my bloating and my pain is terrible when I am ovulating.” or I have other ladies say to me the week prior to my period commenting, “I’m terrible. My gut is really bad. I have either got really bad diarrhea or really bad constipation. I am bloated.” One lady said to me, “I only have 1 week were I feel good at the end of the cycle.”
Why does that happen and what can I do about it?
[50:27] ROBYN KUTKA: that’s a great question and I see that time and time again in my office. And that is a huge sign that there is a hormone imbalance there. Quite often depending on where someone is in their transition towards menopause, the vast majority of the time that is too little progesterone in relation to estrogen and that occurs either because, well for most reasons, it can occur because a woman didn’t ovulate. If you don’t ovulate you have ovulatory cycle but your body is still making estrogen. It makes it in the peripheral tissues in our adipose cells. So those are fat cells. So we can make estrogen. But if you don’t ovulate then you are not making robust amounts of progesterone. You are making a teeny tiny bit of it in the adrenal glands but not a lot from ovulation like you normally would. So there is a large imbalance there. And people will feel moody, irritable, quicker to trigger, bloated, bowel habit changes. But besides not all are ovulating. Some women will have what we call a luteal phase failure were they do ovulate but the corpus luteum, the tissue from which the eggs come from and express these hormones doesn’t hang around and do its job as well and as optimally as it could.
And with that you’ll see hormone imbalances and fluctuations as well. So maybe that’s someone who just week before menses starts to see similar symptoms. It doesn’t feel like yourself. You feel bloated, irritable, more quick to trigger or anger, more fatigued. Things along those lines. Those are probably the two biggest reasons and then as we… another thing to consider and this goes kind of something we haven’t talked about is just our dietary choices, our clean healthy living. But in our world, we are exposed to what we call xenoestrogens on a regular basis for most people. And that’s chemicals that act like estrogen in our body at the receptors but we can’t measure them as estrogen. So you are not gonna measure that at a test and see oh my xenoestrogens are this high. But they have estrogen-like effects. So depending on what our estrogen burden is that can also impact how we are feeling and our need for maybe more progesterone’s than our neighbor who doesn’t have as large of an estrogen burden. So those changes in the hormones are the fluctuations in hormones is what causes those symptoms. And everyone is different. So it used to be, years ago we had menopausal symptoms or we are trending towards menopause and had symptoms, we were just given estrogen. But it’s not that simple. If we were to keep that approach, most women probably wouldn’t feel better. And so it’s an individualized approach that we take and I wanna make sure it doesn’t sound like I am saying that those changes only occur in menopause because it can take us… the average age of menopause is about 52 but that transition can last 13 years plus or minus 5 on either end. So our hormone levels really are starting to fluctuate starting in our mid-thirties. And I know that’s kind of the age group of your listeners but often times those women are told, “You are too young for hormonal changes to be happening. It must be something else here doing anti-depressant?” I am not knocking anti-depressants but oftentimes hormones are overlooked as the cause for some of these symptoms when truly it can be we are considered “too young” for that to be occurring.
[54:25] REBECCA: I hear that quite often and I think that is a really important point for anyone listening. But if you’ve been told you are too young to be going into that menopausal cycle perhaps go find somebody else that knows more about hormones that can work with you around what is actually happening for you personally.
You talked about xenoestrogens and that we can be exposed to them. How are we exposed to them? Are there certain things that people will regularly… how people will regularly come into exposure with them that they could be aware of?
[54:57] REBECCA: Absolutely. Thanks for bringing me back full circle there. Xenoestrogens are found in things like plastics. These are plastic water bottles or plastic containers that we are cooking in. they are found in our cosmetics, things that we are applying to our face, our nail polish. They are found in pesticide, herbicides, potentially some of our meats and scarily actually even in our water supply. So they can be hard to get away from in today’s world but if you are making… it’s like a case of “do the best you can with the information you have at that time” and trying to limit exposure to those things by maybe eating organic when you can. Or drinking out of glass. Not using plastic if it’s been heated. Things along those lines – using oils, coconut oil or something as a moisturizer instead of something that has had perfumes added to it. It’s just these things along those lines which I realized is, your listeners in particular are already having to pay so much close attention to what they are eating and what they are doing with their gut that might be a little bit much to ask. So again we do what is feasible for each individual and that might be different from person to person based on what you are currently dealing with that what you’re already spending your priorities on.
[56:37] REBECCA: and I think it’s also a process. I know that initially for me it was all about dealing with SIBO but then I became aware of just what…. My system is really compromised. What else am I compromising it with and I started to… it was like I just opened my eyes for the first time and really looked at what I was using every day like my hand wash, my body lotions, my shampoo and condition, my skin care, make-up deodorant. All of that stuff. And just very slowly over a probably 12 month period I just started swapping things out. I would throw anything out but as soon as I finished it I would then replace it with something that was either organic or that was free from all the nasties. And that has been my way of slowly transitioning away from things that could be giving me greater toxic exposure.
I know it’s only just now that I have realized. I looked around and I thought, “Wow I have pretty much done most things. I have changed everything out. But because I did it one at a time, it didn’t feel a) expensive and b) it didn’t feel overwhelming because I just picked one thing.
[57:47] ROBYN KUTKA: Awesome. I love that advice. I will give that often when we are doing dietary work or something in the clinic. And I think one thing to consider is it took us, 30, 40, 50 years to learn how to live this way. It’s not going to change overnight and so those little baby steps and just working towards clearing those things overtime like you mentioned and did yourself. It was a fabulous approach.
[58:14] REBECCA: yeah. One of my women asked me around what happens if a period stops completely around the time that SIBO has developed and is that caused because of SIBO? And I don’t know whether you’ve got any literature around that or just clinical experience around that?
[58:37] ROBYN KUTKA: that’s a great question. I am going to assume that it is a rare happening and I could be wrong so please reach out to me if I am. I don’t think it’s a direct cause of SIBO per se but there is something called hypothalamic secondary amenorrhea which is a very long word for stressed induced stopping of the period. And so whether for some people it is stress like, “oh my gosh I have this diagnosis, what do I do with it?” or I worked with one woman whose partner left her when she was living in a country far away from her hometown and her menses stopped. It could literally be stresses of that nature but it can also be particularly in SIBO, I think I think it could be stresses associated with actually what is coming in.
So if we start to get so focused on what we are eating and every time we eat we don’t feel good and we are limiting calories, that could be one stressor – caloric limitations. We have to be eating adequate calories nor we can have our menses. It could be potentially nutrient deficiencies or of we have lost weight with SIBO and we don’t have adequate fat stores to have menses. That could be another reason for it as well. So I definitely see where the associations could be but I think they are secondary to the SIBO diagnosis versus SIBO causing that per se. I think it’s the things that come along with SIBO that would cause menses to stop.
[1:00:10] REBECCA: Sure. We have talked a little bit about menopause and just from my listeners, I just like to get a little bit of an explanation around what is perimenopause, pre-menopause and then full menopause and what happens in that cycle. You gave a really great explanation of the length of time that a woman can expect that that may occur. And also the impact that that has at each of those specific phases on the gut, obviously with reference to things like SIBO.
[1:00:43] ROBYN KUTKA: sure. So when women are experiencing these symptoms for the first time, a lot of times it parallels their hormone imbalances that they are experiencing. And when we are premenopausal that can happen from stress. It can happen from weight gain. It can happen from new dietary changes. All sorts of reasons there.
In the peri-menopausal years, hormone imbalances typically happen because of fluctuating hormone levels as we trend towards menopause. So maybe a woman skips a period or she has an in-ovulatory cycle or she skips three periods or she bleeds longer than normal. So these fluctuating levels can be problematic as far as being symptomatic in their effects on the gut specifically I think about gut motility with that. But also inflammation and inflammation in itself creates a happy home and a lot of our organisms will move in specifically candida because we created that happy home. So we have to treat the underlying cause which hormone imbalance may be playing a role there. So we treat that and remove that, that happy hormone and kick out the invaders basically.
But then when we trend towards menopause, once a woman haven’t had a menstrual cycle for 12 consecutive months, she is officially menopausal and at that point hormone levels become pretty steady that aren’t the same robust fluctuations that we were experiencing as we trend towards that age and towards that transition. And with that usually there is a decrease in symptoms severity. It’s not that the symptoms aren’t there but they might not be as robust as they were when hormone levels were fluctuating. That transition looks different for everybody as far as hormone levels. And again they are significantly impacted by our lifestyle, our diet, weight gain, weight loss, stress, things of those nature. And so the actual hormone picture might be different. But usually we see a decrease in symptomology with the menopausal transition.
[1:03:05] REBECCA: And in terms of hormone therapies and using things like bio identical hormones, how does that work and how does somebody find a practitioner that they can work with to do that and why would you use hormone therapy.
[1:03:25] ROBYN KUTKA: I think that’s gonna be an individual choice based on the patient, his or her medical history and their goals. In young women who are still a couple of decades out from that menopausal transition they may still have the ability to ovulate and to really maintain adequate hormone levels through ovulation. And for them maybe we are talking women in their twenties, late teens, things of that nature. They might opt not to use hormone therapies and to use things like diet and herbs to help maintain ovulatory cycles and thereby maintaining their sex hormone levels but also working with the practitioner for cortisol levels.
In the populations, in kind of mid-thirties and beyond for women or same kind of age group for men as we start to see hormonal shifts as part of our current lifestyles. Hormone therapies may be a consideration but we have to be both the patient and provider. We should be comfortable with that ad understanding what they are using. One of my typical approaches is to use the lowest amount possible for the least amount of time. And that’s gonna be hormone dependent.
When we are talking about things like progesterone, that really doesn’t have any negative side effects. Maybe that’s a long term consideration for most people. Especially because as women, once we go through menopause, we are not making much of it and we don’t have the ability to make it in at least in a robust amount. Whereas estrogen we do have the ability to make that. And so that might not be a consideration for all people. Same with our testosterone, our DHEA levels, cortisol levels. We can come up with individualized plans based on where a woman’s hormone levels are. And that’s something that we revisit on a yearly basis at minimum to make sure that we are approaching this as safely as we can and that hormone levels remain well balanced despite any lifestyle changes.
Working with a practitioner who utilizes individualized bio identical hormone therapies is really what we are looking for with the idea that we are depleting levels using what is called physio lactosis. So a dose that the body would normally make on its own versus something known as pharmacologic. And that would be a dose that is well above and beyond what the body would make on its own. And when we do that, we tend to see better outcomes and potentially even better safer risk profiles. You know we are still talking about hormones here but really having a clear understanding about what they do and making sure they are balance.
I know I gave parked on progesterone a little bit but the one thing I want to mention on this is in conventional standard of care, women are not given progesterone regularly. If they are given progesterone, if they are given estrogen and they have a uterus because progesterone will protect against the growth effects of estrogen at the uterine lining or the endometrium. But we have to remember that as we as women also have breast tissue and brains and bones and a cardiovascular system that need protection too.
And that only giving it endometrial protection is a large disservice for women and that comes from that old women’s health initiative that we talked about where our progestin’s potentially increase our risk of certain conditions.
[1:07:35] REBECCA: that’s fascinating. My final question for you is around weight gain. Because I myself am included in this category of women who would say, “Ah it’s my hormones that’s why I am putting on so much weight. And particularly with SIBO there really are two camps. There’s the ones those of us who cannot stop the weight gain or if we’ve put it on we find it really hard to take off. And then there is the others who are losing weight rapidly. How much of weight loss or weight gain is to do with our hormones or is it to do with something else? We should stop blaming our poor little hormones for it?
[1:08:18] ROBYN KUTKA: hormones definitely play a role especially based on what hormone we are talking about and where we are in our menopausal transition as women. I usually teach that hormones lay the foundation. So typically if we get hormones balanced it’s not a magic pill for weight loss but it lays that strong foundation so that what you are doing, your lifestyle changes, your dietary approach, your exercise approach actually take effect because otherwise we don’t have that strong foundation. We are really spinning our wheels there.
The average weight gain in menopause is about 12 pounds and that has to do with fluctuating hormones and women will notice that that weight actually moves where they used to have it in their hips now all of a sudden are belly fat for the very first time. And that has to do with changing estrogen levels. But then with that a lot of women will have imbalanced blood sugars which led towards elevated testosterone or DHEA which can further affect weight gain and of course cortisol. We all expect our cortisol levels to be high because we are gaining weight. But usually when cortisol levels are higher we aren’t feeling bad yet. So once we test them when they are feeling bad, they are well beyond the part were cortisol was laying down excess belly fat, and we are now at a stage were the cortisol levels can be lower as well.
The same for men. As men age their testosterone levels decline naturally. As testosterone levels decline estrogen levels go up and men are predisposed to insulin resistance or metabolic syndrome. And they will also start to put weight on around the middle. So while SIBO likely plays a role because of nutrient deficiencies and our change in diet habits that come with it, hormones play a huge role there. But we also know bacterial shifts, the metabolism of our gut plays another large role and that’s a topic that I can’t speak to as well as somebody who is so well immersed in that field and that’s a newer filed that’s becoming more and more prevalent. And I think we are gonna learn more a lot about whole gut- brain access influence on weight and everything in the coming years.
It will become much more prevalent to us.
[1:10:59] REBECCA: it will and I am so excited by that. I look forward to seeing all of the research that comes out around that field because I think it’s just fascinating.
ROBYN KUTKA: it is. It truly is.
REBECCA: Doctor Robyn Kutka, it’s been wonderful having you on the show today. If somebody would like to reach out and connect with you, how can they do that?
ROBYN KUTKA: they can go to my current website which is PDXMD.com and that website will be live for a while. We are rebranding our clinic because I have brought in several other physicians at this point and I am excited to be launching program around hormone balancing for people where they can actually test their hormones and get a consult with someone. So that will be coming in the next couple of months too and as that does the info will be up there on the PDXMD website.
[1:11:53] REBECCA: that’s wonderful. So thank you so much for coming on the show. I myself have learned an enormous amount and as I said at the beginning. I was just looking forward to this episode with you so much. I really appreciate your time and I know my listeners have enjoyed it as well because you have answered a lot of the questions that they asked me to ask you. So thank you once again for coming on the healthy gut podcast today.
ROBYN KUTKA: You are so welcome. I hope everybody was able to get something out of it and I really appreciate being able to share this information and get it out there for people.