The Estrobolome: The Gut-Hormone Connection You Can’t Ignore
The gut microbiome plays a much larger role in hormone regulation than most people realize. While its influence on digestion and immunity is well known, certain gut bacteria also directly impact how the body processes and eliminates estrogen.
Comprehensive patient care for anyone dealing with symptoms related to hormonal dysregulation (such as PMS/PMDD, headaches, PCOS, endometriosis) or taking an oral contraceptive or hormone replacement therapy (HRT) must not overlook this critical connection.
The Microbiome & Estrogen: A Critical Relationship
Estrogen is produced in the ovaries, fat tissue, and adrenal glands, but it doesn’t simply disappear after use. Once the body has used it, estrogen must be metabolized, detoxified, and excreted through the liver and gut. If this system is not functioning efficiently, estrogen can be reabsorbed, leading to hormone imbalances, worsened PMS, bloating, and inflammation.
One of the most important players in this process is a specific subset of gut bacteria known as the estrobolome.
What is the Estrobolome?
The estrobolome is a collection of gut bacteria that regulate estrogen metabolism and clearance. These microbes produce the enzyme beta-glucuronidase, which plays a critical role in determining whether estrogen is eliminated or recirculated in the body.
When the estrobolome is balanced, it helps remove excess estrogen efficiently, preventing hormonal imbalances.
When it’s dysregulated, estrogen that was supposed to be excreted can be reactivated and reabsorbed, increasing the risk of estrogen dominance, PMS, and hormone-related symptoms like bloating, headaches, and heavy periods.
Factors That Disrupt the Estrobolome
A well-functioning estrobolome is essential for maintaining hormone balance, but several factors can throw this system off track.
- Gut Dysbiosis – Overgrowth of certain bacteria can lead to excess beta-glucuronidase activity, which causes estrogen to be reabsorbed instead of eliminated.
- Chronic Constipation – The longer stool sits in the colon, the higher the chance that estrogen will be reabsorbed rather than excreted.
- Low-Fiber Diets – Fiber binds to estrogen in the gut, helping to escort it out of the body. Without enough fiber, this process is less efficient.
- Inflammation & Leaky Gut – A damaged intestinal lining makes it easier for inflammatory compounds to disrupt estrogen metabolism.
- Antibiotic Use – Broad-spectrum antibiotics can wipe out beneficial bacteria involved in estrogen clearance, creating long-term imbalances.
Oral contraceptives (OCs) can also influence the estrobolome. Research indicates that OC use may lead to alterations in the gut microbiome, including changes in bacterial diversity and function. These alterations can disrupt the estrobolome's ability to regulate estrogen metabolism effectively.
Additionally, OCs have been associated with nutrient depletions—such as vitamins B, C, and E, as well as minerals like zinc and magnesium—that are vital for maintaining gut health and supporting the enzymes involved in estrogen detoxification. As a result, OC use may contribute to hormonal imbalances and symptoms of to impaired estrogen metabolism.
Read more about drug-induced nutrient depletions (DIND) associated with OCPs here.
The Liver’s Role in Estrogen Detoxification
The liver plays a central role in estrogen metabolism, ensuring that once estrogen has done its job, it is safely processed and eliminated. This occurs in two distinct but interconnected detoxification phases.
Phase 1: Estrogen Metabolism via Cytochrome P450 Enzymes
In this initial step, the liver uses cytochrome P450 enzymes to convert estrogen into hydroxylated metabolites—primarily 2-hydroxyestrone (2-OH), 4-hydroxyestrone (4-OH), and 16-hydroxyestrone (16-OH). These metabolites vary in their biological activity:
- 2-OH is the most protective form and is more easily cleared.
- 4-OH and 16-OH are more reactive and have been associated with increased estrogenic activity and DNA damage if not properly detoxified.
This phase requires key nutrients like B vitamins (B2, B6, B12, folate), magnesium, and glutathione to function efficiently.
Phase 2: Estrogen Conjugation & Clearance
Once estrogen has been metabolized, Phase 2 detoxification prepares it for elimination by conjugating (binding) it to molecules like glucuronide and sulfate, making it water-soluble and ready for excretion. This step occurs through the following pathways:
- Glucuronidation – Uses calcium-D-glucarate to bind estrogen for excretion through bile and stool.
- Sulfation – Attaches sulfate molecules, aided by sulfur-rich foods like garlic, onions, and cruciferous vegetables.
- Methylation – A critical step regulated by SAMe, magnesium, and methyl donors (B12, folate), converting estrogen metabolites into a form the body can efficiently remove.
What Happens When Liver Detoxification is Impaired?
If either phase is compromised due to nutrient deficiencies, poor bile flow, high toxin exposure, or sluggish digestion, estrogen metabolism slows down. This can lead to:
- Recirculation of estrogen rather than proper elimination, contributing to estrogen dominance.
- An accumulation of reactive estrogen metabolites may increase inflammation and oxidative stress.
- Symptoms like bloating, PMS, heavy periods, and hormone-related headaches.
Because the liver and gut work together, any dysfunction in one impacts the other. Supporting both liver detoxification and gut health is critical for maintaining hormonal balance and optimizing estrogen metabolism.
Key Gut Markers for Assessing Estrobolome Function
Functional stool testing can provide insights into how well the estrobolome is functioning and whether estrogen metabolism is being disrupted.
- Beta-Glucuronidase Levels – Elevated levels indicate that estrogen is being reabsorbed, which may contribute to estrogen dominance.
- SCFA (Short-Chain Fatty Acids) Production – SCFAs like butyrate support gut barrier integrity and help regulate inflammation, which influences estrogen metabolism.
- Microbiome Diversity – A lack of diversity in gut bacteria is linked to hormonal imbalances and poor estrogen clearance.
- Inflammation Markers (Calprotectin, Zonulin) – Increased gut permeability may contribute to poor estrogen metabolism and histamine overload.
HRT, Oral Contraceptives & the Estrobolome
Hormone replacement therapy (HRT) and oral contraceptives (OCPs) introduce exogenous estrogen into the body. Because the estrobolome helps metabolize and regulate estrogen, gut health can directly impact how the body processes these hormones.
Disruptions in gut bacteria may cause variability in how individuals respond to HRT or birth control, leading to bloating, nausea, mood swings, or breakthrough bleeding. Maintaining a healthy microbiome can enhance hormone therapy outcomes and minimize unwanted side effects.
Dietary Strategies to Support the Estrobolome
What you eat directly impacts how efficiently estrogen is metabolized and eliminated. Key dietary strategies include:
- Cruciferous Vegetables (Broccoli, Kale, Cauliflower) – Provide sulforaphane, which supports estrogen detoxification pathways.
- Flaxseeds & Chia Seeds – Contain fiber and phytoestrogens that help bind and regulate estrogen levels.
- Healthy Fats (Olive Oil, Avocado, Nuts) – Support gut barrier function and bile production.
- Polyphenol-Rich Foods (Berries, Pomegranate, Green Tea) – Help feed beneficial gut bacteria involved in estrogen metabolism.
- Adequate Hydration & Electrolytes – Essential for proper bile flow and toxin elimination.
While these dietary strategies provide a strong foundation for supporting the estrobolome, they should be personalized based on individual hormone patterns and estrogen-related conditions:
- Estrogen Dominance (High Estrogen, Low Progesterone) – Focus on fiber-rich foods, cruciferous vegetables, and calcium-D-glucarate to enhance estrogen clearance and reduce reabsorption.
- PCOS & Androgen-Dominant Patterns – Balance insulin levels with steady blood sugar support (protein, healthy fats, fiber) while optimizing liver function to promote healthy estrogen-androgen ratios.
- Perimenopause (Fluctuating Estrogen, Lower Progesterone) – Support hormone metabolism with phytoestrogen-rich foods like flaxseeds, along with liver and gut-friendly nutrients to help stabilize shifting hormone levels.
Each stage of hormone health presents unique challenges, and fine-tuning diet and lifestyle strategies to match individual needs can make a significant impact.
Nutraceuticals for Supporting the Estrobolome
In addition to dietary strategies, specific nutraceuticals can support estrogen metabolism and gut health by influencing detoxification pathways, microbiome balance, and hormone regulation. The following are some evidence-based examples; this is by no means is this an exhaustive list:
- Calcium-D-Glucarate – Helps eliminate excess estrogen by inhibiting beta-glucuronidase, an enzyme that can otherwise lead to estrogen reabsorption.
- Diindolylmethane (DIM) & Indole-3-Carbinol (I3C) – Both derived from cruciferous vegetables, these compounds support healthy estrogen metabolism. DIM is often preferred due to its stability and bioavailability.
- Maca Root – An adaptogen known for supporting hormone balance, particularly in perimenopause and menstrual cycle regulation.
- Vitex (Chaste Tree Berry) – Helps regulate menstrual cycles and progesterone levels, making it useful for PMS and cycle-related symptoms.
- Probiotics (Bifidobacterium Longum, Lactobacillus Rhamnosus GG) – Support gut health and estrogen metabolism while reducing inflammation and histamine-related symptoms.
- Prebiotics (Inulin, FOS) – Feed beneficial gut bacteria, promoting a balanced microbiome to support hormone regulation.
- Sulforaphane (Broccoli Sprout Extract) – Enhances liver detoxification, improving the clearance of estrogen metabolites.
- Resveratrol & Curcumin – Help regulate gut inflammation and support microbiome diversity, which impacts estrogen balance.
- Magnesium (Glycinate, Citrate) – Supports hormone metabolism, gut motility, and bile flow. Magnesium glycinate is best for overall hormone support, while magnesium citrate may help with constipation and estrogen clearance.
A Personalized Approach is Key
The best supplement strategy depends on individual hormone imbalances.
- Estrogen Dominance – DIM, calcium-D-glucarate, and fiber to promote estrogen clearance.
- PCOS & Androgen-Dominance – Insulin-supportive nutrients, probiotics, and liver detox support.
- Perimenopause & Estrogen Fluctuations – Maca, Vitex, and adaptogenic herbs for hormone modulation.
Since gut health, liver function, and hormone balance are highly individualized, it’s essential to work with a clinician who can personalize and guide supplement choices based on your unique needs.
Final Thoughts
Understanding the estrobolome is a crucial piece of the hormone health puzzle. Addressing gut imbalances, optimizing liver detoxification, and implementing targeted diet and supplement strategies can support estrogen metabolism, reduce symptoms of estrogen dominance, and promote overall well-being.
References
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- Salliss M, Farland L, Mahnert N, Herbst-Kralovetz M. The role of gut and genital microbiota and the estrobolome in endometriosis, infertility, and chronic pelvic pain. Hum Reprod Update. 2021. doi:10.1093/humupd/dmab035.
- Prabakar S, K M, M K, et al. Automated liver detox therapy. 2024 2nd International Conference on Artificial Intelligence and Machine Learning Applications Theme: Healthcare and Internet of Things (AIMLA). 2024;1-7. doi:10.1109/AIMLA59606.2024.10531483.
- Hu S, Ding Q, Zhang W, et al. Gut microbial beta-glucuronidase: a vital regulator in female estrogen metabolism. Gut Microbes. 2023;15. doi:10.1080/19490976.2023.2236749.
- Honda S, Tominaga Y, Espadaler-Mazo J, et al. Supplementation with a probiotic formula having β-glucuronidase activity modulates serum estrogen levels in healthy peri- and postmenopausal women. J Med Food. 2024. doi:10.1089/jmf.2023.k.0320.
- Della Torre S. Non-alcoholic fatty liver disease as a canonical example of metabolic inflammatory-based liver disease showing a sex-specific prevalence: relevance of estrogen signaling. Front Endocrinol (Lausanne). 2020;11. doi:10.3389/fendo.2020.572490.
- Ayyadurai V, Vajro P, Colecchia A. Mechanistic understanding of D-glucaric acid for liver detoxification. Mol Nutr Food Res. 2023. doi:10.1002/mnfr.202300123.
- Williams DE. Indoles and cancer chemoprevention. Mol Nutr Food Res. 2021;65(1):e2000149. doi:10.1002/mnfr.202000149.
- Odimegwu DC, Oyinkansola OA. Qualitative analysis of cruciferous vegetable extracts for DIM. Food Chem. 2023;370:131055. doi:10.1016/j.foodchem.2021.131055.
- Makris G, Trifonidi E, et al. Effect of supplementation with prebiotics on levels of gut microbiota and vitamin absorption. Nutrients. 2024;16(2):349. doi:10.3390/nu16020349.
- Wong RHX, Zaw T, et al. Regular supplementation with resveratrol improves bone mineral density and hormonal balance. Nutrients. 2020;12(3):761. doi:10.3390/nu12030761.
- Drăgoi CM. Potent NRF2-activating dietary supplements: potential in hormonal and gut health. J Funct Foods. 2020;65:103738. doi:10.1016/j.jff.2019.103738.
- Capozzi A, Scambia G, et al. Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health: a review. J Endocrinol Metab. 2020;10(1):27-33. doi:10.14740/jem625.
- Hong T, Zou J, Jiang X, et al. Curcumin supplementation ameliorates bile cholesterol supersaturation in hamsters by modulating gut microbiota and cholesterol absorption. Nutrients. 2022;14(9):1828. doi:10.3390/nu14091828.
- Feng D, Jiang X, Hong T, et al. Hepatoprotective effect of curcumin against bisphenol A-induced hepatic steatosis via modulating gut microbiota dysbiosis and related gut-liver axis activation in CD-1 mice. J Nutr Biochem. 2022;109:109103. doi:10.1016/j.jnutbio.2022.109103.
- Del Carpio N, Alvarado-Corella D, Quiñones-Laveriano D, et al. Exploring the chemical and pharmacological variability of Lepidium meyenii: a comprehensive review of the effects of maca. Front Pharmacol. 2024;15:1360422. doi:10.3389/fphar.2024.1360422.
- Bizinelli D, Navarro F, Faldoni F. Maca root (Lepidium meyenii) extract increases the expression of MMP-1 and stimulates migration of triple-negative breast cancer cells. Nutr Cancer. 2021;74(2):346-356. doi:10.1080/01635581.2021.1882511.
Simple Constipation Fixes for Better Digestion, Hormones, and Energy
Poop isn’t exactly dinner-table conversation. But your bathroom habits—how often you go, how easily it happens, and even how it looks—can reveal a lot about your health.
Take constipation, for example. Many assume it’s just part of life, something to tolerate or ignore. But what if your daily (or not-so-daily) trips to the bathroom are silently shaping other aspects of your well-being? Your energy levels, PMS symptoms, and even your mood could all be linked to how well your digestion is functioning.
Let’s dive into a real-world example that shows how working on the basics of digestion can unlock a ripple effect of improvements you didn’t even know were connected.
Meet Amy: A Case Study in Hormonal Balance and Gut Health
Amy, a 38-year-old self-employed designer, came to me feeling utterly drained. Her biggest complaints? Debilitating PMS symptoms, year-round allergies, and the kind of fatigue and brain fog that made it tough to stay focused on her work.
During our first session, Amy also mentioned she’d always had digestive issues—bloating after meals, occasional heartburn, and irregular bowel movements every 2–3 days that were often difficult to pass. “But that’s just how it’s always been,” she shrugged.
Amy didn’t realize how much her digestion might be impacting her hormones and energy levels. But as we reviewed her health history and symptoms in more detail, it became clear that her gut health was playing a much bigger role than she thought.
The Plan: Laying the Groundwork for Better Gut Health
Amy came to me frustrated and overwhelmed, feeling like her body was working against her. She knew something wasn’t right but couldn’t put her finger on the root cause – she felt like she was playing whack a mole with her symptoms.
Her heavy PMS symptoms, allergies, and relentless fatigue seemed like separate issues. Just when she thought she figured out a trigger, something would change!
It wasn’t until we started peeling back the layers of her health history that a hidden pattern emerged—her gut health was a key piece of the puzzle.
Instead of jumping to advanced testing, we began with some basics that aren’t usually fun enough to be a Tiktok trend. These are foundational strategies that don’t just support digestion but also set the stage for hormonal and overall health. Here’s what we uncovered and the steps we took:
1. Experimenting with Safer Fiber Options
When Amy tried increasing fiber in the past, it made her bloating and discomfort worse, which didn’t make any sense and left her discouraged.
Together, we explored a different approach: low-FODMAP fibers. By focusing on gentler options—like cooked zucchini, carrots, spinach, and firm bananas—we found foods that nourished her microbiome without triggering her symptoms.
This small tweak made a big difference. As her bloating eased, Amy realized that finding the right balance of fiber wasn’t about eating more but eating smarter. This gave us a big clue about what was going on “under the hood” even though we didn’t test for it.
2. Prioritizing Hydration with Electrolytes
Water alone wasn’t cutting it for Amy. Her busy mornings were usually coffee fueled and her long days meant she often forgot to hydrate until late afternoon, which only compounded her sluggish digestion.
So we emphasized starting the day with water. And we added a pinch of sea salt and a squeeze of lemon to her water in the morning, a simple electrolyte hack to help her body retain fluids and support optimal motility.
There’s “drink more water” and then there’s hydration <insert jazz hands here>. There’s a whole lot I can say about this topic beyond just about guzzling water— but the take-away is it’s about giving your body what it needs to use that water effectively.
3. Magnesium Citrate and Triphala
Amy’s stool patterns suggested that her system needed a little extra help. Enter magnesium citrate, a gentle stool softener, and triphala, an Ayurvedic herbal blend known for supporting regularity.
These additions weren’t harsh or disruptive, but they worked quietly in the background to help restore rhythm to her digestion.
When we looked closer at Amy’s bowel habits, it was clear her system needed some additional support to get things moving.
My first stop is usually magnesium citrate —a form of magnesium known for its ability to draw water into the intestines, softening stool and promoting motility without being overly harsh.
Not only does magnesium play a vital role in muscle relaxation (including the smooth muscles of the GI tract), but it also supports hundreds of enzymatic processes – so it's a win-win situation.
Alongside this, we introduced triphala, an ancient Ayurvedic blend of three fruits (amalaki, bibhitaki, and haritaki) that gently supports digestion and elimination. Unlike traditional laxatives, triphala works holistically, helping to tone the digestive tract over time while also offering antioxidant and anti-inflammatory benefits without developing tolerance like senna.
4. Stress, the Vagus Nerve, and the MMC
As we dug deeper into Amy’s daily habits, it became clear that her hectic lifestyle was working against her digestion.
She often ate while multitasking—answering emails, scrolling on her phone, or rushing through meals in between work calls. Barely chewing her food before swallowing. So many of my clients (myself included!) are guilty of these mindless eating habits. .
We began with mindful eating practices: slowing down, chewing thoroughly, and pausing between bites. But there was another critical piece of the puzzle—the vagus nerve.
The vagus nerve acts like a two-way superhighway between the brain and gut, regulating digestion, mood, and inflammation. When activated, it triggers the rest-and-digest state (AKA the parasympathetic system), helping the digestive system do its job.
Chronic stress, however, suppresses this system, keeping the body in a constant state of “fight or flight” (AKA the sympathetic system). When activated, this stress state prevents our nervous system from fully relaxing and allows us to digest our food leading to various gut issues and food reactivities.
To stimulate her vagus nerve, I introduced simple but powerful evidence-based techniques:
- Deep Breathing: Slow, diaphragmatic breathing helps activate the vagus nerve and signal the body to shift into a relaxed state, preparing the digestive system for its work.
- Humming and Gargling: Both techniques stimulate the vagus nerve via vibration, helping to tone and strengthen its function over time. These simple practices can easily be incorporated into a daily routine.
- Neck Stretches: The vagus nerve runs along the neck, and certain stretches can release tension and improve its activation. One effective movement involves tilting the head to one side, holding the stretch for 15–20 seconds, then switching to the other side. Another involves looking over one shoulder and holding for a count, then repeating on the opposite side. These stretches not only support vagus nerve function but also relieve physical tension that accumulates with stress.
Another critical piece of the digestive puzzle is the migrating motor complex (MMC)—a natural cleansing wave that moves undigested food and debris through the gut between meals – like a digestive custodial crew.
Amy’s tendency to graze throughout the day then eat a large, late dinner was disrupting this critical process. By spacing meals 3–4 hours apart, the MMC can activate properly, reducing bloating and promoting smoother digestion.
Together, these strategies address the often-overlooked connection between the nervous system and the gut. Practices like mindful eating, vagus nerve stimulation, and meal timing have been shown to enhance digestive function, reduce bloating, and promote regular bowel movements.
5. Movement, Massage, and Posture
Movement is a well-documented way to improve digestion. Research shows that even light physical activity, such as a 15-minute walk after meals, can stimulate the MMC.
In addition to walking, abdominal massage techniques were introduced to support motility and ease discomfort. These techniques involve applying gentle, clockwise pressure along the path of the colon, starting from the lower right abdomen, moving upward toward the ribs, across to the left side, and then down toward the pelvis. Studies suggest that regular abdominal massage can improve stool consistency and ease symptoms of constipation.
Finally, we addressed posture during bowel movements. A standard seated position on a toilet often creates an angle that can make elimination more difficult. Incorporating a Squatty Potty—a footstool designed to elevate the legs and mimic a squatting position—helped align the rectum for easier, more complete bowel movements. This simple change in positioning can reduce straining and improve overall bowel health.
Important Tip: Avoid sitting on the toilet for too long! If you can’t go, don’t sit there and just doom scroll away on your phone (common, we all do it, but seriously it’s a bad habit). This can lead to unnecessary strain, increasing the risk of hemorrhoids, weaken the pelvic muscles, or cause a rectal prolapse.
The Detective Work That Made the Difference
For Amy, constipation wasn’t at the top of her list of concerns. She had lived with it for so long that it simply felt normal.
I see this all the time, and for what it’s worth, there’s zero judgment here. Many of us don’t immediately recognize the connections between our symptoms—until someone helps us piece them together.
And that’s exactly why it stood out during our assessment. Chronic constipation is more than an inconvenience; it’s often a red flag that both influences and is influenced by a long list of other symptoms. In Amy’s case, her sluggish digestion was quietly contributing to hormone dysregulation, low energy, and even her severe PMS symptoms.
By doing a little digging into her symptoms, habits, and history, we uncovered how her gut health was a missing link in her overall wellness. Addressing her constipation wasn’t just about improving bowel habits; it became the foundation for better hormone balance, clearer thinking, and more sustainable energy.
Sometimes, the seemingly “normal” things we brush off hold the biggest clues to unlocking major transformations.
The Results: A Ripple Effect of Health Improvements
Within weeks, Amy’s digestion started to improve. Her bowel movements became regular, easier to pass, and less of an ordeal. But the changes didn’t stop there—what truly surprised her was how better digestion had a ripple effect on the rest of her health.
Her PMS symptoms were the first to shift. The headaches that had sidelined her for days were less frequent, and while she still felt tired before her period, it was manageable—no longer the all-consuming fatigue she’d come to dread. These small wins were proof that her body was starting to respond.
While her hormones, allergies, and histamine issues required more focused interventions (more on that in a future post), Amy made an impactful connection: tackling her gut health was about creating a foundation for habits that supported her entire body.
Ending Constipation: A Digestive Health Toolkit
Addressing constipation and improving gut health requires a thoughtful balance of diet, supplements, and lifestyle. Here’s how to lay a strong foundation:
Foods That Support Motility: Incorporate these gut-friendly options:
- Prunes: Containing natural sorbitol, prunes gently stimulate the bowels. Eat 2–3 daily or add to smoothies.
- Chia Seeds: Soak 1–2 tablespoons in water or almond milk for a gel-like pudding that promotes stool formation.
- Flaxseeds: Ground flaxseeds provide soluble fiber and omega-3s. Add a tablespoon to oatmeal, yogurt, or salads daily.
- Kiwi: Studies show 1–2 kiwis per day improve motility and ease constipation.
Choose Fiber Wisely: If fiber or probiotics seem to worsen symptoms like bloating or discomfort, this might indicate underlying issues such as SIBO (small intestinal bacterial overgrowth) or dysbiosis. While elimination diets like low-FODMAP can temporarily help reduce symptoms, they’re not a long-term solution. If this resonates with your experience, consider consulting a professional to explore root causes and personalized interventions.
Hydration is Key: Staying hydrated is essential for motility, but it’s more than just drinking water. Aim for steady hydration throughout the day, and include hydrating foods like cucumber, citrus fruits, and soups. Proper hydration helps soften stool and supports the gut’s ability to move waste effectively.
Feed the Microbiome Thoughtfully: Focus on “safe” microbiome-friendly foods that won’t exacerbate bloating. These include a variety of cooked, colorful vegetables (like carrots, pumpkin, and Swiss chard), low-FODMAP fruits (such as kiwi, berries, and papaya), and anti-inflammatory options like turmeric and ginger. Polyphenol-rich foods like pomegranate seeds, dark chocolate, green tea, and extra virgin olive oil support microbial diversity and overall gut health.
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Supplements: Gentle and Targeted Support
Magnesium Citrate: Take 200–400 mg in the evening with water to support regularity. Start with a lower dose and increase gradually, as needed, to avoid loose stools.
Triphala: Take 1–2 capsules or 1 teaspoon of powder mixed with warm water before bed to gently support digestion and regular bowel movements.
Digestive Bitters: Use 1–2 droppers of bitters (or follow the product’s dosage); can be taken 10–15 minutes before meals or taken between meals to promote better digestion motility. Hold the bitters on your tongue briefly to stimulate digestive secretions, then swallow.
Prokinetic Agents: For sluggish digestion, try natural options like ginger tea after meals or supplements containing ginger, artichoke, or motility-support herbs.
Electrolytes: Mix a clean electrolyte formula, like LMNT or Redmonds ReLyte, into a glass of water once or twice daily. Alternatively, add a pinch of sea salt and a squeeze of lemon to your water for a homemade option.
View my comprehensive constipation protocol HERE***
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Lifestyle Practices: Set the Stage for Digestion
Abdominal Massage: Gently massage your abdomen in a clockwise direction, following the path of the colon. Start at the lower right, move up toward your ribs, across to the left side, and then down toward your pelvis. This helps stimulate motility and ease constipation.
Vagal Nerve Activation: Engage your parasympathetic nervous system to support digestion:
Practice diaphragmatic breathing—slow, deep breaths into your belly.
Try neck stretches, tilting your head side to side and holding each stretch for 15–20 seconds to relieve tension along the vagus nerve.
Incorporate humming or gargling for 30–60 seconds daily to stimulate vagus nerve function.
Mindful Eating: Chew your food thoroughly, breathe deeply before meals, and avoid eating on the go to promote the “rest-and-digest” state.
Leverage the MMC: A 3–4 hour gap between meals and before bedtime is ideal for supporting this natural process.
Move After Meals: A simple 15-minute walk after eating can stimulate digestion and reduce bloating.
Use a Squatty Potty: Elevate your feet during bowel movements to align your rectum and allow for easier, strain-free elimination.
The Takeaway
Constipation is so common it’s become one of those things many of us brush off or normalize. But as I hope Amy’s story shows, addressing something as basic as digestion can lead to a ripple effect.
Amy noted improvements in her energy and hormones, Improved digestion also means she’s getting more from her diet – she’s actually absorbing nutrients and nourishing her body. But there’s also a subtle impact, the habits she’s building are essential for any other steps she’s going to adopt for the deeper dives into her hormones and allergy symptoms.
If you relate to Amy’s story, and you’re ready to stop the rollercoaster of symptoms and start making real progress, begin with the strategies outlined here.
And remember, you don’t have to figure it all out on your own.
I specialize in helping clients connect the dots, uncover the root causes of their symptoms, and build personalized, realistic plans that actually work. Together, we can uncover the root causes of your symptoms and build a plan tailored to your needs.
👉 Learn about programs and consultation options
Top 12 Supplements for Blood Sugar Control: Backed by Research
The foundation of blood sugar regulation starts with diet and lifestyle. Managing macronutrient balance, prioritizing diet quality, and incorporating regular movement are essential first steps. These strategies lay the groundwork for steady blood sugar levels and improved metabolic health.
However, blood sugar regulation is a complex process influenced by deeper factors like inflammation, insulin sensitivity, and gut health. (For a deep dive into these connections, check out our comprehensive blog on the relationship between blood sugar, inflammation, and the microbiome.)
In many cases, nutrient depletions, increased metabolic demands, and/or specific health conditions can leave the body needing additional support. This is where nutraceuticals (herbs, nutrients, and other targeted supplements) can play a pivotal role. By addressing root causes and filling in the gaps, they work alongside diet and lifestyle changes to enhance results, improve insulin sensitivity, and reduce fasting glucose.
In this blog, we’ll explore the 12 most effective supplements for balancing blood sugar, with evidence-based mechanisms, dosing tips, and clinical applications to help you make informed choices.
1. Berberine
Why It Works:
Berberine is often called “nature’s metformin,” and for good reason. It activates AMPK, a key enzyme in energy metabolism, which helps reduce liver glucose production and improve insulin sensitivity. Research has shown that berberine can lower HbA1c levels by ~1%, a result comparable to metformin.
Dose and Clinical Tips:
- Dose: 500 mg, 2–3x/day with meals (target 1000 - 2000mg/day).
- Tip: Take with food to minimize gastrointestinal discomfort
2. Magnesium
Why It Works:
Magnesium is crucial for insulin function and glucose metabolism, yet magnesium deficiency is common in individuals with insulin resistance. Studies show supplementation improves fasting glucose and insulin sensitivity, particularly in magnesium-deficient individuals. Magnesium also improves levels of circulating vitamin D, another important nutrient in blood sugar control.
Dose and Clinical Tips:
- Dose: 200–400 mg/day.
- Forms: Magnesium glycinate or malate are preferred for better absorption, specific metabolic benefits, and reduced GI side effects. Avoid magnesium oxide, which is poorly absorbed.
3. Omega-3 Fatty Acids
Why It Works:
Omega-3s reduce systemic inflammation, a key driver of insulin resistance and metabolic dysfunction. They also improve lipid profiles and reduce triglyceride levels, which are often elevated in those with poor blood sugar control.
Dose and Clinical Tips:
- Dose: 2–4 g/day of combined EPA/DHA.
- Quality Tip: When choosing an omega-3 supplement, prioritize molecularly distilled fish oil or algae-based alternatives to ensure purity. Triglyceride (TG) forms are considered better absorbed over ethyl ester forms. High-quality fish oil should also be third party tested for rancidity—oxidized oils can lose effectiveness and may even promote inflammation – and screened for heavy metals like mercury. Remember, a high-quality fish oil supplement won’t cause the dreaded “fish burps,” a sign of lower quality or poor formulation.
4. Vitamin D
Why It Works:
Vitamin D plays a vital role in regulating insulin secretion and improving sensitivity. Low vitamin D levels are linked to increased insulin resistance and poor glucose metabolism, as well as increased risk of cardiovascular complications. Optimizing vitamin D levels can improve all of these outcomes. Regular blood testing to monitor levels and adjust dose accordingly is the ideal method for achieving a personalized target dose.
Dose and Clinical Tips:
- Dose: generally 2,000–5,000 IU/day.
- Forms: D3 paired with K2 enhances absorption and supports calcium metabolism. Aim for serum levels of 50+ ng/mL. Magnesium deficiency will interfere with vitamin D optimization.
5. Alpha-Lipoic Acid (ALA)
Why It Works:
ALA is a powerful antioxidant that improves insulin sensitivity, supports mitochondrial function, and reduces oxidative stress. It’s particularly beneficial for individuals with fatty liver—a condition closely tied to insulin resistance. Fatty liver impairs glucose regulation by increasing hepatic glucose output and worsening inflammation..
Dose and Clinical Tips:
- Dose: 300–600 mg/day.
- Tip: Take with food or at the same time as fish oil and vitamin D to improve absorption.
6. Probiotics
Broad Spectrum Probiotics
Why They Work:
The gut microbiome plays a critical role in blood sugar regulation. Probiotics improve gut barrier integrity, reduce inflammation, and modulate glucose metabolism. Multi-strain probiotics containing Lactobacillus and Bifidobacterium species are particularly effective according to studies.
Dose and Clinical Tips:
- Dose: Varies; generally starts at 10–20 billion CFUs/day.
- Tip: Choose high-quality probiotics that guarantee live cultures through expiration.
Akkermansia muciniphila (Strain-Specific Probiotic)
Akkermansia muciniphila is a keystone species in the gut microbiome, playing a critical role in maintaining gut barrier integrity and regulating metabolic health. Studies have shown that robust levels of Akkermansia are associated with improved insulin sensitivity, lower fasting insulin levels, and reduced systemic inflammation. These effects make it a promising target for managing blood sugar and metabolic disorders like type 2 diabetes and metabolic syndrome.
This bacterium works by enhancing the production of mucin, which supports the gut lining, reducing gut permeability (commonly referred to as “leaky gut”). A healthy gut barrier helps to mitigate systemic inflammation and improve metabolic outcomes, as inflammation is a major driver of insulin resistance. It’s worth noting that excess Akkermansia has been associated with inflammation and leaky gut, so balance is key.
Dose and Clinical Tips:
- Support with: Targeted Akkermansia probiotics or a specific polyphenol blend (derived from berries, pomegranates, green tea) which encourages the growth of Akkermansia in the gut.
- Clinical Tip: Consider stool testing to assess baseline Akkermansia levels and monitor progress. For patients who are low, dietary strategies combined with supplementation can optimize outcomes without promoting excess mucosal irritation.
7. Fiber (Dietary and Supplemental)
Dietary fiber is essential for gut health and blood sugar regulation. Soluble fibers, in particular, slow glucose absorption, stabilize blood sugar levels, and serve as a fuel source for beneficial gut bacteria. These bacteria ferment fiber to produce short-chain fatty acids (SCFAs) like butyrate, acetate, and propionate, which play a critical role in metabolic health by improving gut barrier integrity, reducing inflammation, and enhancing insulin sensitivity.
Key Fibers to Include:
- Hydrolyzed Guar Gum (PHGG): A soluble fiber derived from guar beans, PHGG is gentle on the gut and well-tolerated even in those with digestive sensitivities. It promotes SCFA production and improves glycemic control by slowing glucose absorption.
- Pectin: Found in apples, citrus fruits, and berries, pectin is a soluble fiber that feeds beneficial gut bacteria and helps regulate postprandial blood sugar levels.
- Arabinogalactan: A prebiotic fiber derived from larch trees, arabinogalactan promotes the growth of Lactobacillus and Bifidobacterium species, enhances immune function, and supports the gut microbiome’s role in blood sugar regulation.
- Inulin and Fructooligosaccharides (FOS): Found in chicory root, garlic, onions, and bananas, these fibers specifically encourage the growth of beneficial bacteria like Bifidobacterium and increase SCFA production.
- Resistant Starch: Found in cooled, cooked potatoes, green bananas, and legumes, resistant starch improves insulin sensitivity and enhances gut health by feeding butyrate-producing bacteria.
Why Avoid Synthetic Fibers?
While synthetic fibers like those found in many commercial laxatives (e.g., psyllium husk in Metamucil) can provide some benefit, they often lack the diverse prebiotic activity of natural fibers. Synthetic formulations are typically isolated, not well-fermented by the microbiome, and may not support SCFA production as effectively as whole or naturally derived fibers.
Clinical Tips:
- Start Slowly: Gradually increase fiber intake to 25–35 g/day to minimize bloating or discomfort.
- Stay Hydrated: Drink plenty of water to support digestion and prevent GI distress.
- Prioritize Variety: Incorporating a range of fiber types supports a more diverse gut microbiome and maximizes metabolic benefits.
8. Chromium
Why It Works:
Chromium is a trace mineral with a big impact on blood sugar control. It enhances insulin receptor activity, making cells more responsive to insulin, which improves glucose uptake and reduces fasting blood sugar levels. This makes chromium particularly effective for individuals struggling with poorly controlled blood sugar or insulin resistance.
Studies have shown that chromium supplementation can significantly lower HbA1c and fasting glucose, especially in those with type 2 diabetes or metabolic syndrome. By optimizing how the body uses insulin, chromium helps break the cycle of elevated glucose and insulin resistance, supporting more stable energy levels and improved metabolic health.
Dose and Clinical Tips:
- Dose: 200–1,000 µg/day (picolinate form).
- Tip: Take with meals to maximize effectiveness.
9. Cinnamon Extract
Why It Works:
Cinnamon is a traditional herb known for its impact on blood sugar control. It enhances insulin sensitivity and boosts glucose uptake by activating insulin receptors, helping cells use glucose more efficiently.
Beyond its glucose-lowering effects, cinnamon also has antioxidant properties that combat oxidative stress, further supporting metabolic health.
Dose and Clinical Tips:
- Dose: 1–6 g/day of cinnamon extract.
- Tip: Choose Ceylon cinnamon to reduce the risk of liver toxicity from coumarin found in cassia varieties.
10. Curcumin
Why It Works:
Curcumin is the vibrant active compound in turmeric. It also reduces inflammation and oxidative stress—two major drivers of insulin resistance—while directly improving insulin sensitivity.
What sets curcumin apart is its ability to support pancreatic beta-cell function, which is critical for producing and regulating insulin. By protecting these cells from inflammatory damage, curcumin not only helps stabilize blood sugar but also supports long-term metabolic health.
Dose and Clinical Tips:
- Dose: 500–2,000 mg/day.
- Tip: Combine with piperine (black pepper extract) to enhance absorption by up to 2,000%.
11. Green Tea Extract (EGCG)
Why It Works:
EGCG is the powerful antioxidant and polyphenol found in green tea. It’s one of the most well studied compounds for metabolic health. It has been shown to improve glucose metabolism by enhancing insulin sensitivity and reducing inflammatory markers—both critical factors in blood sugar regulation.
Beyond its effects on glucose control, EGCG also boosts fat oxidation, making it a valuable tool for supporting weight management and reducing visceral fat, a key driver of insulin resistance. Furthermore, EGCG is known to enhance the favorable microbiome environment associated with improved metabolism. Its anti-inflammatory and antioxidant properties make EGCG a multifaceted nutraceutical for improving overall metabolic health.
Dose and Clinical Tips:
- Dose: 400–800 mg/day.
- Tip: Tannins in tea, including EGCG, can bind with non-heme iron, forming insoluble complexes that reduce its bioavailability. Avoid taking it with iron-rich meals to prevent reduced bioavailability.
12. Resveratrol
Why It Works:
Resveratrol, a potent polyphenol found in red grapes, berries, and other red and orange foods, is a metabolic game-changer. It activates AMPK, a key enzyme involved in energy regulation, to enhance insulin sensitivity and lower fasting glucose levels.
What makes resveratrol particularly powerful is its dual action: alongside improving glucose metabolism, it delivers potent anti-inflammatory effects, helping to combat the chronic inflammation that drives insulin resistance and metabolic dysfunction. This unique combination makes resveratrol a valuable ally in improving blood sugar and supporting long-term metabolic health.
Dose and Clinical Tips:
- Dose: 500–1,000 mg/day.
- Tip: Combine with a diet rich in polyphenols for synergistic benefits.
Conclusion: A note on synergy for better blood sugar control
The foundation of blood sugar regulation always begins with diet and lifestyle. A nutrient-dense, balanced diet combined with regular movement is essential for improving metabolic health, managing inflammation, and stabilizing blood sugar levels. These are the cornerstones of any effective approach which supplements cannot replace.
Herbs and nutritional compounds provide a unique advantage by working synergistically with the body’s natural systems. Unlike pharmaceuticals, which often target a single pathway, nutraceuticals offer a more balanced approach, addressing multiple underlying factors such as inflammation, oxidative stress, microbiome balance, and insulin sensitivity simultaneously.
It’s important to note that this list isn’t exhaustive, nor are we suggesting that everyone needs to take all of these supplements. The right approach emphasizes personalization. The right combination of supplements should be carefully curated based on individual needs, metabolic markers, confounding factors, and health goals.
Diet, lifestyle, and targeted nutraceuticals create a holistic framework for long-term health—not just by managing symptoms but by addressing the root causes of dysregulation.
Curious how your diet supports your metabolic health? Download the free Rainbow Evaluation to assess your plant diversity and start optimizing your blood sugar control today!
References
- Dama A, Shpati K, Daliu P, Dumur S, Gorica E, Santini A. Targeting Metabolic Diseases: The Role of Nutraceuticals in Modulating Oxidative Stress and Inflammation. Nutrients. 2024;16(4):507. Published 2024 Feb 10. doi:10.3390/nu16040507. https://pmc.ncbi.nlm.nih.gov/articles/PMC10891887/
- Wang, C., Yen, H., Lu, W., Ho, H., Lin, W., Kuo, Y., Huang, Y., Tsai, S., & Lin, H. (2022). Adjuvant Probiotics of Lactobacillus salivarius subsp. salicinius AP-32, L. johnsonii MH-68, and Bifidobacterium animalis subsp. lactis CP-9 Attenuate Glycemic Levels and Inflammatory Cytokines in Patients With Type 1 Diabetes Mellitus. Frontiers in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.754401.
- Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes. Metabolism. 2008;57(5):712-717. https://pubmed.ncbi.nlm.nih.gov/23118793
- Barbagallo M, Dominguez LJ. Magnesium and type 2 diabetes. Magnesium Research. 2007;20(4):245-252. https://pubmed.ncbi.nlm.nih.gov/12663588
- Bhat S, Sowmya S, Baskaran V, et al. Omega-3 fatty acids and metabolic health. Advances in Nutrition. 2016;7(5):804-818. https://pubmed.ncbi.nlm.nih.gov/27329332
- Mitri J, Pittas AG. Vitamin D and diabetes. Endocrinology and Metabolism Clinics of North America. 2014;43(1):205-232. https://pubmed.ncbi.nlm.nih.gov/27528514
- Henriksen EJ, Diamond-Stanic MK. Modulation of insulin resistance and glucose tolerance by alpha-lipoic acid. Current Pharmaceutical Design. 2011;17(33):3948-3958. https://pubmed.ncbi.nlm.nih.gov/15263922
- Depommier C, Everard A, Druart C, et al. Supplementation with Akkermansia muciniphila in overweight and obese human volunteers: A proof-of-concept exploratory study. Nat Med. 2019;25(7):1096-1103. https://doi.org/10.1038/s41591-019-0495-2
- Canfora E, Jocken J, Blaak E. Short-chain fatty acids in control of body weight and insulin sensitivity. Nat Rev Endocrinol. 2015;11:577-591. https://doi.org/10.1038/nrendo.2015.128
- Asbaghi O, Choghakhori R, Sadeghian M, et al. Effects of chromium supplementation on glycemic control in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Journal of Trace Elements in Medicine and Biology. 2020;62:126603. https://pubmed.ncbi.nlm.nih.gov/32687991
- Khan A, Safdar M, Khan MMA, et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Am J Clin Nutr. 2003;78(4):725-732. https://pubmed.ncbi.nlm.nih.gov/14633804/
- Na L, Li X. Curcuminoids exert glucose-lowering effect in type 2 diabetes through multiple mechanisms. Pharmacol Res. 2013;76:8-12. https://doi.org/10.1016/j.phrs.2017.09.010
- Hsu CH, Liao YL. Does supplementation with green tea extract improve glucose regulation and insulin sensitivity in obese individuals with type 2 diabetes? Obes Res Clin Pract. 2011;5(4):e267-e348. https://pubmed.ncbi.nlm.nih.gov/27329332
- Movahed A, Nabipour I, Louis XL, et al. Antihyperglycemic effects of short-term resveratrol supplementation in type 2 diabetic patients: A randomized placebo-controlled study. PLoS One. 2013;8(7):e70360. https://doi.org/10.1155/2013/851267
- Weisberg, S., Leibel, R., & Tortoriello, D. (2016). Proteasome inhibitors, including curcumin, improve pancreatic β-cell function and insulin sensitivity in diabetic mice. Nutrition & Diabetes, 6. https://doi.org/10.1038/nutd.2016.13
- Delimont, N., Haub, M., & Lindshield, B. (2017). The Impact of Tannin Consumption on Iron Bioavailability and Status: A Narrative Review. Current Developments in Nutrition, 1, 1 - 12. https://doi.org/10.3945/cdn.116.000042
Blood Sugar and Inflammation: What Your Gut Is Trying to Tell You
Note: This is a case study from a real-life example in my practice. This is meant to be educational only; not medical advice. All names have been changed to protect the client’s privacy.
When Jen first came to see me, she was fed-up.
Diagnosed with prediabetes and Hashimoto’s thyroiditis, Jen had followed every conventional recommendation without much guidance. She adjusted her diet, added exercise, and even tried Ozempic (a GLP-1 agonist).
Yet, her A1C remained stubbornly elevated, weight wouldn’t budge, and all her symptoms persisted, despite all her best efforts.
Her symptoms painted a broader picture: persistent fatigue, joint stiffness, restless sleep, and exercise intolerance (She lacked stamina and showed little progress in building muscle strength).
In addition to an elevated fasting blood sugar (>95 mg/dL) and hemoglobin A1C ( >6.1%), her lab work also revealed elevated hs-CRP, a marker of systemic inflammation.
We started with foundational dietary changes and targeted nutrients and herbs to support her thyroid and reduce her most disruptive symptoms.
Jen experienced small (but impactful) wins: slightly better sleep, reduced joint pain, and more energy. But her weight still barely budged, and her A1C hadn’t improved by more than a point or two.
What was missing? A deeper look into the interconnected systems driving her symptoms: blood sugar regulation, inflammation, and gut health.
Blood Sugar—More Than Just Willpower
When we think about balancing blood sugar, the conversation often revolves around diet – as it should. Macronutrient balance—pairing carbohydrates with protein and anti-inflammatory fat—is a great starting point. Studies show that patterns like the Mediterranean diet exert a benefit because they balance macronutrients and emphasize anti-inflammatory polyunsaturated and monounsaturated fats. But that’s just the tip of the iceberg.
Blood sugar spikes and dips are not just dietary challenges; they’re systemic issues. Every time your blood sugar spikes, your body releases insulin to bring it back down. Over time, frequent spikes can create insulin resistance, a condition where your cells become less responsive to insulin.
Insulin resistance: The Lock and Key
Think of insulin as the key and the receptors on cells as the locks. Normally, when food is consumed, the body releases insulin, which acts as the key to unlock the receptors and allow glucose to enter cells for energy.
However, frequent blood sugar spikes flood the system with insulin, causing the locks (cell receptors) to become worn out or jammed. The keys (insulin) no longer fit as effectively, making it harder for glucose to enter the cells.
The result? Glucose stays in the bloodstream, causing elevated blood sugar levels and symptoms such as fatigue and cravings, despite plenty of energy being available but inaccessible.
What does this mean for Jen? These spikes were likely fueling her inflammation, poor sleep, and fatigue. Functional medicine looks beyond diet to address the deeper drivers of blood sugar dysregulation, like inflammation and gut health.
The Blood Sugar x Inflammation Connection
Blood sugar imbalances and inflammation are deeply intertwined. When blood sugar spikes, it triggers inflammatory pathways, releasing cytokines that increase oxidative stress. This chronic inflammation further worsens insulin resistance, creating a vicious cycle.
For Jen, her elevated hs-CRP—a marker of inflammation—was a key clue. Chronic inflammation doesn’t just cause symptoms like joint pain, fatigue, and exercise intolerance; it also perpetuates insulin resistance, creating a cycle that’s hard to break. In Jen’s case, this cycle was particularly damaging because insulin resistance was fueling her autoimmune condition, keeping Hashimoto's symptoms flared.
When cells are resistant to insulin, glucose builds up in the bloodstream, triggering more inflammation and oxidative stress. This inflammatory environment can exacerbate autoimmunity by overstimulating the immune system and promoting tissue damage.
For Jen, this meant her thyroid function couldn’t stabilize, leaving her stuck in a pattern of persistent fatigue, poor sleep, and joint stiffness. Addressing blood sugar without targeting inflammation—and vice versa—would only offer temporary relief.
Research shows that nutraceuticals like omega-3s, curcumin, and berberine can help reduce inflammation while improving insulin sensitivity. But there’s another piece of the puzzle: gut health.
The Role of the Microbiome in Metabolic Health
Your gut isn’t just key to digestion—it’s also home to trillions of bacteria that make up your microbiome. These bacteria play a crucial role in regulating blood sugar levels.
On busy days, Jen’s diet often lacked the variety of plants needed to support a healthy microbiome. Research shows that eating a diverse range of fibers and colorful foods enriches the microbiome and boosts the production of short-chain fatty acids (SCFAs), such as butyrate. These compounds play a vital role in maintaining gut barrier integrity and promoting better metabolic outcomes.
The more phytonutrients and polyphenols we consume—compounds found in colorful foods like vegetables, fruits, nuts, seeds, legumes, coffee, green tea, and herbs like turmeric—the greater the positive shift in the microbiome toward improved metabolic health.
For example, Akkermansia muciniphila, a beneficial gut bacterium, has been linked to better insulin sensitivity and reduced inflammation. Studies indicate that low levels of Akkermansia can negatively impact insulin sensitivity and body composition. By targeting this species through dietary strategies, we can enhance the microbiome’s ability to regulate blood sugar and reduce inflammation.
The Blood Sugar x Cortisol Connection
Blood sugar regulation doesn’t just impact inflammation and insulin sensitivity—it also plays a significant role in hormonal balance and sleep quality. One key player in this dynamic is cortisol, the body’s stress hormone, which has a profound impact on blood sugar levels.
Under normal conditions, cortisol levels follow a predictable daily rhythm, peaking in the morning to help the body wake up and tapering off throughout the day. However, blood sugar imbalances can disrupt this rhythm, creating a cascade of issues, including disrupted sleep and fatigue.
The Dawn Phenomenon
For individuals with insulin resistance or blood sugar dysregulation, the “dawn phenomenon” is a common occurrence. Overnight, the liver releases glucose into the bloodstream to provide energy for the waking hours—a natural process that helps maintain steady blood sugar levels. Cortisol plays a role in this process by signaling the liver to release glucose.
In a healthy individual, insulin regulates this rise in blood sugar. But in cases of insulin resistance, the body struggles to respond effectively. This causes blood sugar levels to spike in the early morning and may lead to waking up during the night, particularly between 2–4 a.m., as cortisol levels begin to increase.
Sleep Disruption and Fatigue
Blood sugar swings can trigger cortisol production at inappropriate times. When blood sugar drops too low overnight, the body perceives it as a stressor, prompting cortisol to spike to restore glucose levels. This cortisol surge can wake the body from sleep, leaving individuals feeling restless or fatigued in the morning.
For Jen, this cycle of dysregulated blood sugar and cortisol spikes helps explain her restless sleep and persistent fatigue. Despite her efforts, her body was stuck in a loop of poor sleep and metabolic stress, further exacerbating her symptoms.
Tools in the Functional Medicine Toolkit for Blood Sugar Balance
For Jen, balancing her blood sugar required a multi-faceted approach. Here’s some of what we focused on when we tailored her personalized plan:
Dietary Changes
- Add more fiber and colorful, phytonutrient-rich foods to enrich the microbiome.
- Pair carbohydrates with protein and healthy fats to stabilize blood sugar.
- Focus on PUFA/MUFA fats, including sources like fish, olive oil, avocados, nuts, and seeds.
Nutraceutical Support
Berberine: Lowers A1C by ~1%, comparable to metformin, by improving insulin sensitivity and reducing glucose production.
Omega-3s: Provides anti-inflammatory effects that support insulin function.
Curcumin: Reduces inflammation and improves glucose regulation.
Magnesium: Essential for insulin sensitivity and overall metabolic health.
Vitamin D: Supports glucose metabolism and insulin sensitivity.
Alpha-Lipoic Acid (ALA): Improves glucose regulation and reduces oxidative stress.
Movement
- Focus on low-impact exercises like walking to reduce stiffness and enhance mitochondrial function.
- Research highlights evening walks, HIIT, and resistance training as the most effective activities for improving blood sugar sensitivity.
Gut Health
- Support GI mucosa and digestion to promote a healthy microbiome.
- Incorporate polyphenols and prebiotic-rich foods to target beneficial bacteria like Bacteroides and Akkermansia muciniphila and enhance gut health.
What Happened Next?
After incorporating these changes, Jen started to see progression in her blood sugar. We started using a continuous glucose monitor (CGM) to keep tabs on her progress. At her 6 month follow-up, we had re-assessed her A1C and hs-CRP which had begun to drop.
Most exciting was that her energy stabilized, her joint pain improved significantly, and her brain fog lifted for the first time in years! She also reported that her body composition started to improve (we started to monitor her weight mass instead of just body weight).
By addressing the root causes of her symptoms—blood sugar dysregulation, inflammation, and gut health—Jen finally felt like her efforts were paying off.
Conclusion: What Jen can teach us about balancing blood sugar
Jen’s journey is a powerful reminder that blood sugar management is about more than oversimplified recommendations about low-carb or over restrictive diets. Understanding how the body’s systems — blood sugar, inflammation/immune system, and gut — work together is the key to optimizing metabolic health.
Functional medicine offers a toolkit that addresses the root causes of imbalances and builds on the foundations of diet and lifestyle to achieve lasting health.
Are you curious about how plant diversity impacts your microbiome, inflammation, and metabolic health? Download the free Rainbow Evaluation to see where you stand—and start your journey to vibrant health today!
References
- Depommier C, Everard A, Druart C, et al. Supplementation with Akkermansia muciniphila in overweight and obese human volunteers: A proof-of-concept exploratory study. Nat Med. 2019;25(7):1096-1103. https://doi.org/10.1038/s41591-019-0495-2
- Scoditti E, Capurso C, Capurso A, Massaro M. Vascular effects of the Mediterranean diet-part II: role of omega-3 fatty acids and olive oil polyphenols. Vasc Pharmacol. 2014;63(3):127-134. https://doi.org/10.1016/j.vph.2014.07.001
- Zand H, Morshedzadeh N, Naghashian F. Signaling pathways linking inflammation to insulin resistance. Diabetes Metab Syndr. 2017;11(Suppl 1):S307-S309. https://doi.org/10.1016/j.dsx.2017.03.006
- Dama A, Shpati K, Daliu P, Dumur S, Gorica E, Santini A. Targeting Metabolic Diseases: The Role of Nutraceuticals in Modulating Oxidative Stress and Inflammation. Nutrients. 2024;16(4):507. Published 2024 Feb 10. doi:10.3390/nu16040507. https://pmc.ncbi.nlm.nih.gov/articles/PMC10891887/
- De Freitas P, Barros M, Fróes R, França L, Paes A. Prebiotic effects of plant-derived (poly)phenols on host metabolism: Is there a role for short-chain fatty acids? Crit Rev Food Sci Nutr. 2022;63:12285-12293. https://doi.org/10.1080/10408398.2022.2100315
- Dao M, Everard A, Aron-Wisnewsky J, et al. Akkermansia muciniphila and improved metabolic health during a dietary intervention in obesity: Relationship with gut microbiome richness and ecology. Gut. 2015;65(3):426-436. https://doi.org/10.1136/gutjnl-2014-308778
- Blaak E, Canfora E, Theis S, et al. Short chain fatty acids in human gut and metabolic health. Benef Microbes. 2020;1-46. https://doi.org/10.3920/BM2020.0057
- Canfora E, Jocken J, Blaak E. Short-chain fatty acids in control of body weight and insulin sensitivity. Nat Rev Endocrinol. 2015;11:577-591. https://doi.org/10.1038/nrendo.2015.128
- Dimitriadis G, Maratou E, Kountouri A, Board M, Lambadiari V. Regulation of postabsorptive and postprandial glucose metabolism by insulin-dependent and insulin-independent mechanisms: An integrative approach. Nutrients. 2021;13(1):159. https://doi.org/10.3390/nu13010159
- Wu W, Huang Y, Qiu J, Tao X, Sun J. Association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes. BMJ. 2019;18(8):746-750. https://doi.org/10.3760/CMA.J.ISSN.1671-7368.2019.08.008
- Hsu CH, Liao YL. Does supplementation with green tea extract improve glucose regulation and insulin sensitivity in obese individuals with type 2 diabetes? Obes Res Clin Pract. 2011;5(4):e267-e348. https://pubmed.ncbi.nlm.nih.gov/27329332
- Liu K, Zhou R, Wang B, et al. Effect of green tea on glucose control and insulin sensitivity: A meta-analysis of 17 randomized controlled trials. Am J Clin Nutr. 2013;98(2):340-348. https://doi.org/10.3945/ajcn.112.052746
- Na L, Li X. Curcuminoids exert glucose-lowering effect in type 2 diabetes through multiple mechanisms. Pharmacol Res. 2013;76:8-12. https://doi.org/10.1016/j.phrs.2017.09.010
- Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes. Metabolism. 2008;57(5):712-717. https://pubmed.ncbi.nlm.nih.gov/23118793
How Medications Can Deplete Essential Nutrients: Understanding Drug-Nutrient Depletions
By Lara Zakaria, PharmD MS CNS CDN IFMCP & Sara Gibbons MS CNS LDN
Supplements Are on the Rise
In recent years, there's been a noticeable increase in public interest in—and use of—dietary supplements. As more individuals take charge of their health, they turn to natural products and nutraceuticals to help prevent illness and promote overall wellness.
This trend is partly driven by the growing body of research supporting the health benefits of certain herbs, vitamins, and minerals, and the growing public interest in ways to support health and immunity post-COVID-19 pandemic. However, while supplements offer numerous health benefits, they can also pose risks, particularly when interacting with prescription medications.
This blog explores the various types of drug-nutrient interactions (DNI), drug-induced nutrient depletions (DIND), and drug-herb interactions (DHI). By understanding these interactions, individuals and healthcare professionals can learn about common examples of these interactions, their implications for health, and strategies for managing them effectively.
Benefits and Risks of Dietary Supplements
Many people are unaware that certain supplements can interact with medications, leading to adverse effects or reduced effectiveness of the drugs. These interactions fall into three buckets:
- Drug-Herb Interactions (DHI)
- Drug-Nutrient Interactions (DNI)
- Drug-Induced Nutrient Depletions (DIND)
With more people using supplements, there are more opportunities to educate them on how to use these products safely. Supplement-savvy healthcare professionals can play a key role in guiding and advising individuals about safe and effective nutraceutical use, therefore improving overall health outcomes.
How Medications Can Deplete Nutrients
Drug-Induced Nutrient Depletions (DIND) occur when certain medications cause the body to lose or use up essential nutrients. Unfortunately, these depletions often go unnoticed when medications are prescribed. Here are a few common examples highlighted in the table below. These examples call attention to the need to monitor nutritional status and for clinicians to suggest appropriate supplements when necessary.
Table 1: Examples of DINDs of commonly prescribed medications
Examples of common Drug–Induced Nutrient Depletions of commonly prescribed medications
Key Drug-Nutrient Interactions (DNI)
Drug-Nutrient Interactions (DNI) happen when a drug and a nutrient affect each other in the body. Despite their potential impact, DNIs are often not a part of the conversation around prescription drugs. However, studies have shown that as many as 48% of patients taking prescription drugs have been found to be at risk for a DNI. These interactions can alter how the drug or nutrient is absorbed, distributed, metabolized, or excreted. Some examples include:
- Fatty foods can increase the absorption of some lipid-soluble drugs, such as certain antipsychotics and antiepileptics, potentially leading to higher than expected drug levels and increased side effects.
- Antibiotics can alter the gut microbiome and lead to vitamin K deficiency, which is crucial for blood clotting. This interaction is particularly significant for individuals on anticoagulant therapy, as it can lead to an increased risk of bleeding.
- Grapefruit inhibits the CYP3A4 enzyme - a detoxification enzyme needed to metabolize certain statins, calcium channel blockers, and immunosuppressants. Recognizing these food-drug interactions allows clinicians to counsel patients effectively, preventing potentially dangerous drug toxicity in individuals taking medications that rely on this enzyme for metabolism.
- Certain nutrients (like iron or calcium) can form insoluble complexes with medications, such as tetracycline and fluoroquinolones antibiotics or bisphosphonates (i.e. alendronate), reducing their bioavailability and effectiveness. Individuals are often advised to take these medications at different times from their supplements to avoid this issue.
Understanding these interactions allows clinicians to tailor interventions that minimize risks and enhance the therapeutic efficacy of both medication and supplement.
Managing Drug-Herb Interactions (DHI)
Drug-Herb Interactions occur when prescription medications and herbal supplements are used together. These can change the effectiveness or safety of the drug. For instance, St. John's Wort can interact with many medications, such as antihypertensives, oral contraceptives, and certain antidepressants, potentially leading to reduced drug effectiveness or increased side effects.
- John's Wort induces the activity of the CYP3A4 enzyme, which can lead to decreased levels of medications metabolized by this pathway, reducing their efficacy. This includes drugs like cyclosporine, used in organ transplant patients, and certain antiretrovirals used in HIV treatment.
- Ginkgo Biloba, often used for cognitive enhancement, can increase the risk of bleeding when taken with anticoagulants like warfarin or antiplatelet drugs like aspirin.
- Echinacea, commonly used to prevent colds, can interact with immunosuppressants, potentially reducing their effectiveness and compromising the management of autoimmune diseases or organ transplant patients.
Healthcare professionals need to be aware of and careful when dealing with drug-herb interactions (DHIs). They should know how herbal products work in the body and how they might interact with prescription medicines.
At the same time, we want to be careful not to be overly cautious and prevent safe and potentially beneficial use of herbs alongside medications. By giving good advice on safe herb-drug combinations, clinicians can gain the trust of patients and can help prevent harmful side effects while simultaneously improving treatment results.
The Importance of Research and Personalized Care in Drug-Nutrient Interactions
One of the challenges in the field of nutrient-depletions is the lack of robust research data. Most evidence comes from lab studies or animal models, with limited human clinical trials. However, understanding these interactions is crucial for providing informed and personalized healthcare. By integrating knowledge of DNIs, DINDs, and DHIs, healthcare professionals can offer personalized lifestyle advice and improve drug prescribing practices.
The personalized care approach includes:
- Regular Monitoring: Routine checks of nutrient levels in patients on long-term medications that are known to cause nutrient depletions.
- Patient Education: Informing patients about potential interactions and how to manage them, including dietary adjustments and timing of supplement intake.
- Collaborative Care: Working in a team of healthcare providers, including pharmacists, doctors, and nutritionists, to ensure a holistic approach to patient care.
Conclusion and final thoughts
As interest in a holistic approach to health grows among consumers and patients, understanding the interactions between drugs, nutrients, and herbs becomes more important for clinicians. Health professionals—including physicians, pharmacists, nutritionists, and other allied health professionals—can work together to provide comprehensive and personalized care.
Fellow clinicians, by staying informed and seeking unbiased education about these interactions, we can help individuals use nutraceuticals safely and effectively. This collaborative approach not only enhances patient safety, but also fosters a more holistic approach to healthcare.
References
- Lordan R. Dietary supplements and nutraceuticals market growth during the coronavirus pandemic - Implications for consumers and regulatory oversight. PharmaNutrition. 2021;18:100282. doi:10.1016/j.phanu.2021.100282.
- Djaoudene O, Romano A, Bradai YD, et al. A Global Overview of Dietary Supplements: Regulation, Market Trends, Usage during the COVID-19 Pandemic, and Health Effects. Nutrients. 2023;15(15):3320. Published 2023 Jul 26. doi:10.3390/nu15153320
- Prescott JD, Drake VJ, Stevens JF. Medications and Micronutrients: Identifying Clinically Relevant Interactions and Addressing Nutritional Needs. J Pharm Technol. 2018;34(5):216-230. doi:1
- Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf. 2018;10:2042098618809927. Published 2018 Nov 19. doi:10.1177/20420986188099270.1177/8755122518780742
- Amadi CN, Mgbahurike AA. Selected Food/Herb-Drug Interactions: Mechanisms and Clinical Relevance. Am J Ther. 2018;25(4)
. doi:10.1097/MJT.0000000000000705. - Cleveland Clinic. Bisphosphonates. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/24753-bisphosphonates. Published December 6, 2022. Accessed July 9, 2024.
- Hogle BC, Guan X, Folan MM, Xie W. PXR as a mediator of herb-drug interaction. J Food Drug Anal. 2018;26(2S)
. doi:10.1016/j.jfda.2017.11.007. - Fasinu PS, Bouic PJ, Rosenkranz B. An overview of the evidence and mechanisms of herb-drug interactions. Front Pharmacol. 2012;3:69. Published 2012 Apr 30. doi:10.3389/fphar.2012.00069.
- Pan HY, Wu LW, Wang PC, Chiu PH, Wang MT. Real-world Evidence of the Herb-drug Interactions. J Food Drug Anal. 2022;30(3):316-330. Published 2022 Sep 15. doi:10.38212/2224-6614.3428.
- Karadima V, Kraniotou C, Bellos G, Tsangaris GT. Drug-micronutrient interactions: food for thought and thought for action. EPMA J. 2016;7(1):10. Published 2016 May 12. doi:10.1186/s13167-016-0059-1.
Understanding the Impacts of Oral Contraceptives on Nutrient Depletion and Gut Microbiome
There are many reasons that someone might opt to use oral contraceptives (OC) - including essential benefits like family planning, and relief from menstrual-related symptoms. OCs might also extend protective benefits for certain types of cancers and provide specific symptom relief for conditions like endometriosis and polycystic ovarian syndrome (PCOS).
However, they can also come with adverse side effects, including an increased risk of cardiovascular events, cerebral hemorrhage, gallbladder disease, and hepatic complications. Some more common side effects associated with OC use include depression, migraines, edema, allergic skin reactions, abdominal cramps, bloating, and carbohydrate intolerance, to name a few.
Contributing (at least in some part) to these risks are the potential depletions of essential nutrients and alterations to the gut microbiome that occur with OC use. In this article, we'll examine the latest evidence on drug-induced nutrient depletions (DIND) related to OCs, the effects of OC use on the gut microbiome and microbiota metabolites, and conclude with general diet, lifestyle, and nutraceutical options to consider for birth control users. The goal is to find a balanced approach that respects an individual's autonomy over their body, maximizes available medical choices, and minimizes any associated risk.
A Background on Oral Contraceptives
In the US, OC can be categorized into three types:
- Combined estrogen-progesterone
- Progesterone-only
- Continuous or extended use
Examples of common OC Brands (not an exhaustive list; US brands)
OC Type | Brand Name | Ingredients |
Combined estrogen-progesterone
● Includes mono- bi- ti- and quadrophasic formulations ● Differences include doses of both components and progesterone type ● Some formulations include nutrients like folate and iron for improved nutrient repletion |
Brevicon, Modicon, Wera, Balziva, Briellyn, Gildagia, Philith, Zenchent
Aranelle, Tri-Norinyl, Leena, Alyacen 7/7/7, Necon 7/7/7, Nortrel 7/7/7, Dasetta 7/7/7, Cyclafem 7/7/7 Loestrin, Microgestin, Tilia Fe |
Ethinyl Estradiol, Norethindrone |
Estarylla, Previfem, Sprintec | Ethinyl estradiol and norgestimate | |
Apri, Desogen, Juleber, Reclipsen, Kariva, Cyclessa, Solia, Mircette, | Desogestrel, Ethinyl Estradiol | |
Safyral, Beyaz | Drospirenone, ethinylestradiol, and levomefolate | |
Ocella, Yasmin, Zarah, Yaz | Drospirenone and ethinylestradiol | |
Levora, Altavera, Lessina, Lybrel, Amethia | Ethinyl Estradiol, Levonorgestrel | |
Continuous or extended use | Amethia Lo, Camrese Lo, Daysee, Introvale, LoSeasonique, Jolessa | Ethinyl Estradiol, Levonorgestrel |
Progestin-only | Aygestin, Camila, Errin, Jolivette, Lyza, Nora-Be, Nor-QD, Ortho Micronor | Norethindrone |
How do Oral Contraceptives Work?
Oral contraceptives (OCs) contain synthetic hormones that mimic the natural hormones in the body. The two main types of hormones in these pills are estrogens and progestins.
Estrogens:
- Regulate the menstrual cycle: Estrogens help maintain stable hormone levels and regulate the menstrual cycle.
- Prevent ovulation: They prevent the ovaries from releasing an egg, a process known as ovulation.
- Stabilize the uterine lining: Estrogens also stabilize the lining of the uterus, reducing the chances of irregular bleeding.
Progestins:
- Prevent ovulation: Progestins play a crucial role in preventing ovulation.
- Thicken cervical mucus: They thicken the mucus around the cervix, making it harder for sperm to enter the uterus and reach an egg.
- Thin the uterine lining: Progestins thin the lining of the uterus, making it less likely for a fertilized egg to attach and grow.
While there are progestin-only formulations, combined estrogen-progestin pills are often more effective in preventing pregnancy by stopping ovulation, thickening cervical mucus, and thinning the uterine lining. However, progestin-only pills might be recommended in certain situations.
When Progestin-Only Pills Are Recommended:
- Breastfeeding: Progestin-only pills are often recommended for individuals who are breastfeeding, as estrogens can reduce milk production.
- Estrogen Sensitivity: For those who cannot tolerate estrogen due to side effects or health risks, progestin-only pills are a good alternative.
- Medical Conditions: People with certain medical conditions, such as a history of blood clots, high blood pressure, or cardiovascular disease, may be advised to avoid estrogen-containing pills.
- Migraines with Aura: Those who suffer from migraines with aura are generally advised to avoid estrogen-containing contraceptives due to an increased risk of stroke.
- Older Age and Smoking: Individuals over 35 who smoke are at an increased risk of cardiovascular problems when using estrogen-containing contraceptives. Progestin-only pills are often a safer alternative.
- Perimenopause: People going through perimenopause may use progestin-only pills to manage symptoms like irregular periods and to provide contraception during this transitional phase.
Progestin-only pills are highly effective when taken consistently at the same time every day, but they require strict adherence to the dosing schedule to maintain their effectiveness.
Therapeutic Uses of Oral Contraceptives
An estimated 25% of people (15 to 44 years-old) currently using contraception use OC as their method of choice. The most frequently prescribed OC is combined contraceptive; progesterone is the hormonal component that prevents pregnancy while the estrogen component controls menstrual bleeding.
Although most people take OCs to prevent pregnancy, approximately 14% are using them for non-contraceptive reasons. People with periods use OCs for menstrual-related disorders such as well as conditions like PCOS, acne, and osteopenia, and vasomotor symptoms associated with menopause.
Personalizing the OCs based on Components
In the combination pills, the estrogen component (i.e. usually Ethinyl Estradiol) is combined with various generations of progestin components (i.e. Norethindrone, Levonorgestrel, Drospirenone, Desogestrel, Norgestimate, or Norethindrone) with varying degrees of androgenic and progestogenic potential. In the US the most frequently prescribed formulations have drospirenone or norethindrone components.
These components have slightly different activity which might be favorable to different treatment goals, for example:
- Some components of oral contraceptives (OC) can help manage symptoms such as heavy bleeding, pain, and androgenic symptoms like hirsutism and acne. These benefits are especially relevant for conditions like polycystic ovary syndrome (PCOS) and endometriosis. Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, causing pain and potentially leading to fertility issues.
- Drospirenone suppresses ovulation and also has anti-mineralocorticoid activity which reduces fluid retention, edema and has some antiandrogenic activity making it useful in androgen-dominant conditions like PCOS.
- Norethindrone primarily acts by thickening cervical mucus which reduces risk of pregnancy through multiple mechanisms as well as alters the endometrium. This can help in reducing pain and heavy periods, as well as other symptoms associated with endometriosis.
Contraceptive pills can be delivered as monophasic (same dose of both components in the active pills) or multiphasic (biphasic, triphasic, or quadrophasic). The latter contains varying weekly doses of either one or both components. This helps in personalization because it can better complement the natural cycle changes to reduce side effects and improve efficacy.
The formulation can also be personalized based on length and frequency of desired withdrawal bleeding, cyclic monthly bleeding (for example 7 days or 3 days), extended cyclic (every three months), or continuous (no bleeding).
Estrogen & Progestin Components commonly used in OC in the US
Estrogen component | Estradiol, Ethinylestradiol, or Estetrol |
First-generation progestin | Norethindrone acetate, Ethynodiol diacetate, Lynestrenol, Norethynodrel |
Second generation progestin | Levonorgestrel,dl-Norgestrel |
Third generation progestin | Norgestimate, Gestodene, Desogestrel |
Unclassified progestin | Drospirenone, Cyproterone acetate |
The Benefits of Oral Contraceptives
The United Nations (UN) and the World Health Organization (WHO) consider contraceptive access to be a human right and a public health priority. That’s partly because historically, access to contraception has afforded individuals better health, education, and financial outcomes.
Beyond contraception, oral contraceptives are also used to manage menstrual-related symptoms. These conditions can often leave those afflicted with pain, migraines, fatigue, dizziness, and other life-disrupting symptoms. Without these medications, it’s not an exaggeration to say that these individuals would be significantly disabled or unable to perform to their full potential in school or work.
In people experiencing menopausal symptoms (before the age of 60), OC can help reduce vasomotor symptoms as well as preserve bone density and prevent osteopenia and osteoporosis.
OCs are also known to reduce the risk of conditions like endometriosis and endometrial cancers. Epidemiologic evidence reports a 50% risk reduction of endometrial cancer among people who use combined OCs compared with those who have not, with the protective effect lasting up to 20 years. Furthermore, combined OC reduces risk of ovarian cancer by 27% and of colon cancer by 18%.
The Downside: Nutrient Depletion and Microbiome Disruptions
Despite the benefits, oral contraceptive use has also been associated with drug-induced nutrient depletions (DIND) of several micronutrients and disruptions in the gut microbiome. We’ll focus on the evidence available on these aspects and the subsequent impact on a woman's health as a result of oral contraceptive use.
Nutrient Depletion: A Closer Look
Vitamins and minerals play crucial roles in our bodies. They are involved in numerous biological processes, including energy production, immune function, blood clotting, and maintaining the health of our skin, hair, and nails. Without these tiny powerhouses, our bodies wouldn’t be able to function at their best.
Oral contraceptives have been linked to lower levels of several vitamins and minerals, including vitamins B, C, and E, zinc, magnesium, and selenium. Mechanisms of these depletions vary, but largely involve altered absorption and metabolism.
Oral Contraceptives and Vitamin B Depletion
Oral contraceptives can reduce levels of several B vitamins, including B6, B5, B9 (folate), and B12. These vitamins are important for energy production, DNA synthesis, and brain health. However, the current literature isn't clear about the need for supplementing these B vitamins, except for folate.
Folate is crucial for early embryo development, so it's especially important for individuals of childbearing age to continue folate supplementation while using oral contraceptives. Although reductions in B12 levels and increases in homocysteine and methylmalonic acid (MMA) are sometimes seen with oral contraceptive use, they are not usually significant or consistent enough to need special supplements. However, regular monitoring for signs of B12 deficiency can be helpful.
Oral Contraceptives and Mineral Depletion
Oral contraceptives can lead to a decrease in several essential minerals, including calcium, copper, iron, zinc, magnesium, and selenium. These minerals are vital for many body functions, such as immune function, skin and gut health, bone density, neurotransmitter production, glutathione production, hormone balance, and insulin and thyroid activity.
It's particularly important to monitor iron levels, especially in people of childbearing age who are prone to iron deficiency anemia (IDA). This is particularly relevant for those who experience heavy menstrual bleeding, as they are at a higher risk for developing IDA. Regular monitoring and appropriate supplementation can help maintain healthy iron levels and overall well-being.
The Gut Microbiome and Oral Contraceptives
The gut microbiome is a complex community of microorganisms living in our intestines that plays a crucial role in our health. It helps digest food, regulates the immune system, protects against disease-causing pathogens, and produces small amounts of vitamins like B12 and K.
The gut also influences hormone regulation, particularly through the estrobolome, which is the group of gut bacteria involved in estrogen metabolism. Certain gut microbes produce beta-glucuronidase, an enzyme crucial for estrogen detoxification. An imbalance in the gut microbiome, known as dysbiosis, can disrupt this process and affect estrogen levels, potentially leading to health issues like obesity, metabolic syndrome, cancer, and cardiovascular disease. Some of these conditions overlap with the side effects of oral contraceptives (OCs).
External sources of estrogen, known as xenoestrogens (found in plastics, pesticides, etc.), can alter the gut microbiome. There's a question about whether the estrogen in OCs contributes to this alteration. While hormone replacement therapy (HRT) is known to disrupt the gut microbiome, research has not clearly established that OCs cause dysbiosis. Studies show that OCs do not significantly affect gut microbiome diversity but may influence certain bacterial functions.
OCs are associated with higher levels of estradiol and sex hormone-binding globulin (SHBG), a protein that binds to sex hormones and regulates their activity. This may affect specific bacteria, such as Eubacterium ramulus.
Supporting Reproductive Health: A Balanced Approach
While the side effects, DIND, and GI-implications of OCs need to be considered, it's essential that we balance them against the potential benefits. By supporting individuals in their decision to use OCs, we can improve their health and economic outcomes, build trust, and ensure they can maintain their bodily autonomy.
To comprehensively support patients taking oral contraceptives, we can apply a comprehensive functional medicine (FxMed) and personalized nutrition approach. Clinicians focusing on this whole-person approach can recommend:
- A foundational antiinflammatory diet that includes macro- and micronutrient balance and diversity of antioxidants, fibers, and polyphenols to support gut health and integrity.
- Basic supplementation strategy that covers the foundations of key minerals depleted, especially noting folate, zinc, selenium, and magnesium due to their implications in related conditions and health risks including skin health, gut support, and cardiometabolic risks.
- Targeted GI and microbiome support is likely a useful strategy especially in people who are experiencing digestive and gut-related symptoms. Supporting healthy digestion, regular bowel movements, and addressing any gut-related problems should be part of the holistic strategy.
- Consider regular monitoring of nutritional status and metabolic markers to personalize the strategy and catch any problems in advance. This is especially true for folate, B12, iron, magnesium, selenium, and zinc.
Other lifestyle strategies that support hormonal balance, neurotransmitter function, gut motility and hepatic function including stress management, movement, and sleep, and circadian rhythm syncing, are proving to have wide benefits and are a wise part of a truly holistic strategy. And, as always, it's essential for patients to discuss any concerns or side effects with their healthcare provider.
Nutraceutical Protocol with Fullscript
I collaborated with Fullscript to develop a nutritional protocol to personalize the approach in supporting individuals on OC. These supplements address nutrient depletions caused by oral contraceptives and offer additional support for hormone metabolism, gut health, and overall well-being:
- Multivitamin/multimineral: Includes folate, zinc, selenium, vitamin C, vitamin A, vitamin E, and B complex. Recommended doses: minimum of 400 mcg folate, 100 mcg selenium, 15 mg zinc, and 500 mg vitamin C.
- Magnesium bisglycinate: Recommended dosage of 200–400 mg daily.
- Prebiotics fiber blend: 4–8 g daily to support gut health and hormone balance.
- Iron bisglycinate: Recommended dosage of 25–30 mg every other day to prevent iron deficiency anemia.
- Ashwagandha (Withania somnifera): Recommended dosage of 500 mg daily for stress management, hormonal balance, and mood improvement.
The Fullscript protocol details are available here.
Assessment Plan
We should begin to rethink our annual assessment to include a more comprehensive evaluation of the nutrition status, gut health, and microbiome status of patients taking OC. This starts with a comprehensive dietary assessment to identify and address potential deficiencies in essential nutrients affected by contraceptive use discussed above, as well as laboratory testing for nutrients such as folate, vitamin B12, B6, iron and magnesium.
Additionally, assess gut health by noting symptoms of gastrointestinal distress and confirming consistent and daily bowel movements. Clinicians can also conduct more comprehensive evaluation of gut health by using tools like stool analysis to evaluate the diversity and composition of the gut microbiome. Monitoring these factors can identify imbalances and help guide dietary and nutraceutical recommendations.
Conclusion
Oral contraceptives are a useful tool for reproductive health, but like any medication can also cause risks and contribute to nutrient depletions and gut-related complications. More research is needed to fully establish mechanisms and determine clinical guidance. But by understanding these impacts, clinicians can better support people who choose to use these medications.
Oral contraceptives are just one piece of the puzzle when it comes to health. By considering all aspects of health – including diet, lifestyle, and medication use – we can help people who menstruate live healthier, happier lives.
References
- Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017;103:45-53. doi:10.1016/j.maturitas.2017.06.025. Link
- Balle C, Konstantinus IN, Jaumdally SZ, et al. Hormonal contraception alters vaginal microbiota and cytokines in South African adolescents in a randomized trial. Nat Commun. 2020;11(1):5578. Published 2020 Nov 4. doi:10.1038/s41467-020-19382-9. Link
- Basici S, Porcaro G. Counteracting side effects of combined oral contraceptives through the administration of specific micronutrients. Eur Rev Med Pharmacol Sci. 2022;26(13):4846-4862. doi:10.26355/eurrev_202207_29210. Link
- Berenson AB, Rahman M. Effect of hormonal contraceptives on vitamin B12 level and the association of the latter with bone mineral density. Contraception. 2012;86(5):481-487. doi:10.1016/j.contraception.2012.02.015. Link
- Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;5(5):CD001019. Published 2018 May 22. doi:10.1002/14651858.CD001019.pub3
- Cooper DB, Patel P, Mahdy H. Oral Contraceptive Pills. [Updated 2022 Nov 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430882/
- Eyupoglu ND, Caliskan Guzelce E, Acikgoz A, et al. Circulating gut microbiota metabolite trimethylamine N-oxide and oral contraceptive use in polycystic ovary syndrome. Clin Endocrinol (Oxf). 2019;91(6):810-815. doi:10.1111/cen.14101. Link
- Eyupoglu ND, Ergunay K, Acikgoz A, Akyon Y, Yilmaz E, Yildiz BO. Gut Microbiota and Oral Contraceptive Use in Overweight and Obese Patients with Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2020;105(12):dgaa600. doi:10.1210/clinem/dgaa600. Link
- Hoeger KM, Dokras A, Piltonen T. Update on PCOS: Consequences, Challenges, and Guiding Treatment. J Clin Endocrinol Metab. 2021;106(3):e1071-e1083. doi:10.1210/clinem/dgaa839
- Hua X, Cao Y, Morgan DM, et al. Longitudinal analysis of the impact of oral contraceptive use on the gut microbiome. J Med Microbiol. 2022;71(4):10.1099/jmm.0.001512. doi:10.1099/jmm.0.001512. Link
- Judkins TC, Oula ML, Sims SM, Langkamp-Henken B. The effect of a probiotic on gastrointestinal symptoms due to menstruation in healthy adult women on oral contraceptives: randomized, double-blind, placebo-controlled trial protocol. Trials. 2022;23(1):481. Published 2022 Jun 10. doi:10.1186/s13063-022-06410-w. Link
- Krog MC, Hugerth LW, Fransson E, et al. The healthy female microbiome across body sites: effect of hormonal contraceptives and the menstrual cycle. Hum Reprod. 2022;37(7):1525-1543. doi:10.1093/humrep/deac094. Link
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Estrogens and Oral Contraceptives. [Updated 2020 May 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548539/
- Mahfouz MS, Elmahdy M, Ryani MA, et al. Contraceptive Use and the Associated Factors among Women of Reproductive Age in Jazan City, Saudi Arabia: A Cross-Sectional Survey. Int J Environ Res Public Health. 2023;20(1):843. Published 2023 Jan 2. doi:10.3390/ijerph20010843. Link
- McArthur JO, Tang H, Petocz P, Samman S. Biological variability and impact of oral contraceptives on vitamins B(6), B(12) and folate status in women of reproductive age. Nutrients. 2013;5(9):3634-3645. Published 2013 Sep 16. doi:10.3390/nu5093634. Link
- Prescott JD, Drake VJ, Stevens JF. Medications and Micronutrients: Identifying Clinically Relevant Interactions and Addressing Nutritional Needs. J Pharm Technol. 2018;34(5):216-230. doi:10.1177/8755122518780742. Link
- Shere M, Bapat P, Nickel C, Kapur B, Koren G. Association Between Use of Oral Contraceptives and Folate Status: A Systematic Review and Meta-Analysis. J Obstet Gynaecol Can. 2015;37(5):430-438. doi:10.1016/S1701-2163(15)30258-9. Link
- Smrekar K, Lodise NM. Combined Oral Contraceptive Use and Breast Cancer Risk: Select Considerations for Clinicians. Nurs Womens Health. 2022;26(3):242-249. doi:10.1016/j.nwh.2022.01.003. Link
- Teal S, Edelman A. Contraception Selection, Effectiveness, and Adverse Effects: A Review. JAMA. 2021;326(24):2507–2518. doi:10.1001
- Yong EL, Logan S. Menopausal osteoporosis: screening, prevention and treatment. Singapore Med J. 2021;62(4):159-166. doi:10.11622/smedj.2021036
An Introduction to Eating the Rainbow: Your 4-Week Guide to Better Health
What’s the deal with eating the rainbow?
A phrase you’ve no doubt heard thrown around - it’s cute and catchy, but it’s also being adopted by the likes of Harvard Medical School, Tufts Friedman School of Nutrition Science and Policy, and even the American Heart Association (AHA) to name a few notable institutions.
The phrase refers to consuming a variety of produce - including fruits, vegetables, culinary herbs, legumes, grains, nuts and seeds - in a way to maximize the variety of colors consumed. This is because the phytonutrients responsible for the color pigmentation have been associated with a long list of health benefits.
In fact, a 2022 review on consuming “the rainbow” demonstrated significant improvements in health benefits related to:
- Body weight
- Lipid profile (cholesterol)
- Inflammation
- Cardiovascular disease
- Type 2 diabetes
- And even cancer and all cause mortality.
The authors concluded that benefits were associated with multiple color pigments - for example blue and purple foods containing compounds called proanthocyanidins have particularly powerful neurological protection. However, they go on to show that color variety may confer additional synergistic benefits.
In other words it’s great to get certain colors in for certain health benefits, but we should spend our energy on getting as many shades and hues into our routine on a weekly basis as possible to maximize on the synergistic health benefits.
Examples of pigments and polyphenols associated with various health benefits. Image adapted from Blumfield M et al. Molecules. 2022 Jul; 27(13): 4061. PMID: 35807307
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Health Benefits Associated with “Eating the Rainbow”
Part of the “magic” of the benefits of the concept of eating a diverse range of colorful fruits and vegetables (F/V) comes down to synergy. Focusing on diversity has been shown to be crucial for promoting optimal gut health, supporting a thriving microbiome, and maintaining overall metabolic well-being.
Why Eat the Rainbow?
The concept of "Eating the Rainbow" offers a visual representation to communicate the goal and therefore is a simple yet effective way to ensure you're getting a wide range of benefits.
Let’s take a moment to introduce Phytochemicals or Phytonutrients - interchangeable terms referring to natural chemical compounds produced by plants. There are thought to be tens of thousands of them (the graphic shows some of the classifications, but we don’t quite know many of them yet!).
Phytonutrients are generally produced by plants to help them resist plant infections and disease and to act as repellent to insects and other animals. These phytonutrients include various categories of compounds that in turn have health benefits on us.
In part, consuming different colorful foods can be beneficial because it ensures we’re consuming different combinations and types of antioxidants, vitamins, and minerals, fibers - but the mega-power is it also maximizes on the synergistic potential of thousands of beneficial phytonutrients. Therefore, by consuming a variety of colors and aiming for the rainbow, you're nourishing your body with diverse nutrients it needs to thrive.
Classification of the main phytonutrient families adapted from Monjotin N. et al. Nutrients. 2022;14(9):1712. PMID: 35565680
From the image, you can see how these compounds can get a little confusing to keep track of! Knowing that they contribute to plant colors, we can confidently say that by eating a variety of colors and focusing on “eating the rainbow” we can maximize these compounds in our weekly routine.
Let’s explore this in a little more detail
1. Microbiome Diversity
Eating a variety of colorful foods provides an array of nutrients that nourish different beneficial bacteria in the gut. Part of the benefit is increasing the quantity of fiber that naturally occurs when we focus more on confusing F/Vs along with the variety in the types of fibers.
These fibers feed the “gut bugs” and promote their resilience and diversity and the production of beneficial by-products like short chain fatty acids (SCFA). Polyphenols are also associated with similar benefits on an even more significant scale (consider that there are potentially tens of thousands of polyphenols to work their magic). This diversity in the microbiome is linked to improved digestion, nutrient absorption, and a strengthened immune system.
2. Antioxidants and Anti-Inflammatory Compounds
Fruits and veggies are also full of antioxidants. These compounds neutralize harmful free radicals in the body, preventing oxidative stress - a process that is associated with chronic disease.
Oxidative stress occurs when there’s more free radicals and not enough antioxidants to neutralize them. This imbalance potentially leads to cellular damage and contributes to various health issues. Think of these antioxidant systems as the fire extinguisher putting out a grease fire caused by free radicals gone wild.
Many compounds act as antioxidants, for example vitamin C is a powerful and versatile antioxidant compound. Selenium is a mineral with both direct antioxidant activity, as well as indirect activity by helping make more antioxidant compounds - including glutathione the “master antioxidant.”
Phytonutrients such as flavonoids and carotenoids among others have direct “fire fighting” activity and are able to combat oxidative stress, reducing inflammation in the body, through various well-established mechanisms.
3. Mitochondrial Function
Mitochondria are the powerhouse of cells - think of them as “energy factories” - and their proper function is vital for energy production, immune regulation, cardiovascular, and neurological function, and our body’s natural detoxification pathways.
As a normal part of their “factory process,” mitochondrial function results in byproducts that bump up oxidative stress. Luckily, as we learned above, antioxidants from colorful foods play a role in maintaining mitochondrial health by protecting against oxidative damage. As long as enough antioxidants and phytonutrients are present, the mitochondria can continue to pump out energy molecules with minimal damage.
Maintaining healthy mitochondrial function ensures healthy immune response to infection as well as potential remission in autoimmune and allergic disease. It can also support hormone health, cardiovascular and brain health, protecting against degenerative disease.
4. Metabolic Health
Phytonutrients found in colorful foods have been associated with improvements in various contributors to metabolic health. They may influence factors such as insulin sensitivity and blood sugar regulation, lipid metabolism and cholesterol, contributing to overall metabolic well-being.
Consumption of diets with a variety of polyphenols such as resveratrol, beta-carotene, flavonols, lutein - to name a few - have been found to have direct impact on risk reduction of cardiometabolic disease risk factors. This includes hypertension, diabetes, heart health, and the number one driver of cardiovascular disease - inflammation.
Embracing the “Rainbow Challenge”
Hopefully you can see the benefits of eating the rainbow and you’re excited as we are to make this a sustainable lifestyle habit. Lasting changes don’t happen overnight, but I suggest that you gradually expand your intake of colorful foods over the next several weeks. To do that you can focus on:
- Embrace the Rainbow at every opportunity - breakfast, snacks, lunch and dinner. Very often we get into routines or habits that prevent us from maximizing our plant intake (sacrificing colorful variety along with it).
- Introduce at least one new colorful food weekly. Remember this can be fruits and veggies, as well as legumes, grains, nuts, seeds, and culinary and aromatic herbs and spices. For example trade out apples for pears, switch from baby spinach to arugula, or add cinnamon and almonds to your oatmeal.
- Diversify your plate, include at least two colors in each meal. Remember it’s not just about quantity or serving size, it’s about diversity! So instead of a cup of blueberries in your greek yogurt (which is already a great step), mix in ½ cup of blueberries and ½ cup of raspberries - add some walnuts for a bonus (yes beige/brown counts as a color!).
- Squeeze it in, get creative with new recipes that feature multiple colorful foods. For example smoothies and soups can help you sneak in more diverse ingredients. Or try making your own dips and dressings, tossing in a handful of greens or other veggies into your puree.
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References
- McDonald D, Hyde E, Debelius JW, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018;3(3):e00031-18. Published 2018 May 15. doi:10.1128/mSystems.00031-18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954204/
- Monjotin N, Amiot MJ, Fleurentin J, Morel JM, Raynal S. Clinical Evidence of the Benefits of Phytonutrients in Human Healthcare. Nutrients. 2022;14(9):1712. Published 2022 Apr 20. doi:10.3390/nu14091712. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102588/
- Minich DM. A Review of the Science of Colorful, Plant-Based Food and Practical Strategies for "Eating the Rainbow" [published correction appears in J Nutr Metab. 2020 Nov 28;2020:5631762]. J Nutr Metab. 2019;2019:2125070. Published 2019 Jun 2. doi:10.1155/2019/2125070. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770496/
- McDonald D, Hyde E, Debelius JW, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018;3(3):e00031-18. Published 2018 May 15. doi:10.1128/mSystems.00031-18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954204/
- Nicolson GL. Mitochondrial Dysfunction and Chronic Disease: Treatment With Natural Supplements. Integr Med (Encinitas). 2014;13(4):35-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566449/
Understanding Adaptogens: Building Stress Resilience
Stress is well understood as a significant contributor to chronic disease, including cardiovascular and autoimmune disease, cancer, mental health, and neurodegenerative illness like dementia. In a world where stress is a constant companion, finding effective and natural solutions to combat its impact is crucial.
In an ideal world, we would sidestep stress entirely. However, since a life of uninterrupted relaxation isn't the reality for most of us, stress is often inevitable making effective stress management strategies essential. These strategies include a variety of practices like meditation, yoga, breathing exercises, therapy, and both somatic and mind-body approaches, among others.
Allow me to introduce you to another solution that lies in the power of a class of herbs referred to as adaptogens. But what are they exactly and how can we maximize their potential to help us achieve stress resilience?
What Are Adaptogens?
Adaptogens are a unique class of herbs or plants that are known to enhance the body's ability to resist stress. They work by interacting with the hypothalamic-pituitary-adrenal (HPA) axis and the immune-neuro-endocrine system, which are the body's primary stress response systems.
According to the FDA, the term adaptogen is considered a functional term used to describe a kind of metabolic regulator that can help our system adapt to environmental changes - these adaptations allow us to “go with the flow” and prevent burn out or illness that often comes with chronic stress.
The primary criteria for a plant to be considered an adaptogen are:
- It must be plant-derived, non-toxic at normal doses, and must not cause side effects such as insomnia, muscle wasting, or other metabolic irregularities
- Natural bioregulators that increase the ability to adapt environmental factors and thereby reducing the harm caused by prolonged stressed states - including fatigue, infection, and depression
- It should help the body return to a state of homeostasis (balance) regardless of how the body has changed in response to stress.
For centuries, adaptogens have been a cornerstone in traditional medicine practices, including Traditional Chinese Medicine (TCM), indigenous herbal practices, and Ayurveda. Their popularity is on the rise in the realm of integrative medicine, bolstered by an expanding body of research that underscores their health benefits.
Stress Resilience and Adaptogens
Adaptogens play a pivotal role in fostering stress resilience. They help in harmonizing the body's physiological systems to help the body cope with external stressors more effectively.
At a cellular level, adaptogens enhance the body's ability to efficiently use resources like oxygen, glucose, fats, and proteins to supply enough energy to ensure the body maintains optimal function, especially under stress when resources are limited.
The extensive benefits of adaptogens are evident as they have been proven to support health both directly and indirectly to improve:
- Immune health and reduce inflammation and pain
- Hormone balance, especially cortisol, estrogen, and testosterone
- Healthy metabolism and blood sugar control
- Cholesterol and blood lipids
- Mental health, anxiety, sleep, and adrenal health
Some examples of adaptogenic herbs include Asian ginseng (Panax ginseng) - not to be confused with Siberian ginseng (Eleutherococcus senticosus), Rhodiola (Rhodiola rosea), Magnolia berry (Schisandra chinensis), and the fan-favorite Ashwagandha (Withania somnifera).
The Magic of Ashwagandha
Among the wide array of adaptogens, Ashwagandha is particularly noteworthy. The roots of this modest shrub, also known as winter cherry, have been revered in Ayurvedic medicine for their broad-spectrum properties for many generations. Ashwagandha is a powerful adaptogen known to:
- Lower cortisol levels
- Reduce anxiety
- Support sleep quality
- Improve metabolic health and blood sugar
- Reduce inflammation
Studies have shown that Ashwagandha can significantly reduce cortisol serum levels in chronically stressed adults. This effect has been shown to have a cascade of benefits on hormone and metabolic health. Furthermore, it has been found to improve mental health - both depression and anxiety - as well as improve sleep quality. In one study, subjects reported over 70% improvement in sleep quality after taking Ashwagandha for six weeks.
Example of the versatility of adaptogens like ashwagandha on various health conditions adapted from Am J Mens Health. 2019;13(2).
The Power of Adaptogenic Mushrooms
One particularly interesting group of adaptogens is adaptogenic mushrooms. These fungi are known to support various bodily functions, including the immunity, the nervous system, hormonal balance, and cognitive function. Moreover, they have been recognized for their potential to improve mood, fight fatigue, and even exhibit anti-tumor properties.
Some well-known adaptogenic mushrooms are Reishi, Cordyceps, and Lion's Mane. These can be consumed in various forms, whether individually or in blends, and are available as capsules, teas, or even incorporated into soups.
5 Adaptogens for Burnout & Stress Resilience (my top picks!)
- Ashwagandha: Jack of all trades - this adaptogen is well-known for reducing cortisol levels, anxiety, and inflammation, and supporting sleep. Whether you’re “wired” or “tired,” ashwagandha is a truly versatile choice for almost anyone looking for an adaptogen.
- Holy Basil (or Tulsi): Another multi-talented herb, is probably best known for improving stress response to both physiological, psychological, and environmental stressors while also improving brain function. Similar to ashwagandha, Holy basil can also improve blood sugar and cholesterol balance, reduce inflammation and pain, and possess antimicrobial properties. All together, these properties make it another great choice for
- Asian Ginseng: Used for centuries to combat fatigue and reduce the response to stress, Asian ginseng (not to be confused with Siberian ginseng) is a good choice for those experiencing fatigue or exhaustion.
- Rhodiola: Known for reducing fatigue, depression, and brain fog. It can also help improve exercise endurance and insulin resistance often associated with burnout.
- Cordyceps: Traditionally used to boost energy, support low libido, enhance kidney and lung function, and enhance the immune system - it’s also been shown to be beneficial for anxiety.
Find my Nutraceutical Picks Here
A quick note for those with an autoimmune disease: Although generally considered safe, those with autoimmune conditions should use adaptogens with caution. In some cases, adaptogens have been shown to stimulate or over-activate the immune system leading to symptoms emerging.
Key Takeaways
Adaptogens, long appreciated by traditional medicine for their unique mechanisms, are increasingly recognized in the literature for their role in stress management and for contributing to vitality. Although they should not replace a foundational healthy lifestyle or a stress management routine, adaptogens can be a powerful strategy in our longevity toolkit.
Achieving stress resilience is a gradual process, and adaptogens can serve as a valuable ally on this path. As with any supplement, it's important to seek guidance from a healthcare provider before starting a new routine. If you’re in search of support and personalized guidance, consider a Medicine Cabinet Overhaul consultation.
Book a Medicine Cabinet Overhaul here
References
- Salleh MR. Life event, stress and illness. Malays J Med Sci. 2008;15(4):9-18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341916/
- Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240259/
- Chugh RM, Mittal P, Mp N, et al. Fungal Mushrooms: A Natural Compound With Therapeutic Applications. Front Pharmacol. 2022;13:925387. Published 2022 Jul 13. doi:10.3389/fphar.2022.925387. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9328747/
- Salve J, Pate S, Debnath K, Langade D. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus. 2019;11(12):e6466. Published 2019 Dec 25. doi:10.7759/cureus.6466. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979308/
- Mikulska P, Malinowska M, Ignacyk M, et al. Ashwagandha (Withania somnifera)-Current Research on the Health-Promoting Activities: A Narrative Review. Pharmaceutics. 2023;15(4):1057. Published 2023 Mar 24. doi:10.3390/pharmaceutics15041057. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10147008/
- Todorova V, Ivanov K, Delattre C, Nalbantova V, Karcheva-Bahchevanska D, Ivanova S. Plant Adaptogens-History and Future Perspectives. Nutrients. 2021;13(8):2861. Published 2021 Aug 20. doi:10.3390/nu13082861. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398443/
- Lopresti AL, Drummond PD, Smith SJ. A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males. Am J Mens Health. 2019;13(2):1557988319835985. doi:10.1177/1557988319835985. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438434/
Fire Cider: A Traditional Herbal Elixir for Enhanced Immune Health
Winter is coming. The first chill breezes let you know it's time to prepare. This year, instead of reaching for over-the-counter remedies (that don’t really work), you’re going to turn to nature's own medicine cabinet to get your immune system ready.
Instead you’ll be ready with your homemade fire cider, an age-old concoction well-known for its immune-boosting properties. This potent brew is a unique blend of select herbs and spices that fortify your body against the colder months. But, what exactly makes this elixir so magical? Let's explore.
A Brief History of Fire Cider
Fire cider is a traditional herbal remedy with its roots in folk medicine, popularized by the renowned herbalist Rosemary Gladstar in the late 1970s. The beauty of fire cider lies in its simplicity. There’s a base recipe that has been adapted to suit various needs and states over the years, but each of the ingredients has well-established benefits for immune health.
Decoding the Potency of Fire Cider
What gives fire cider its potent immune-boosting punch? It's the unique blend of zesty, spicy, and sweet ingredients, each pack a powerful punch.
Let's break down some of the key components:
- Ginger root: A cornerstone of Chinese medicine for thousands of years, ginger has well-studied immune balancing benefits - including anti-inflammatory, anti-microbial, and digestive benefits.
- Horseradish root: Packed with a compound called sinigrin, another beneficial immune modulator and anti-microbial. The unique benefit of including horseradish is because it helps break up congestion and calm inflammation.
- Turmeric root: The main compound in turmeric, curcumin, has been proven to demonstrate antioxidant, anti-inflammatory, antiviral and antibacterial properties.
- Garlic and Onion: These common kitchen staples are loaded with beneficial compounds and antioxidants that support digestive health - which is central to immune health - as well as support various mechanisms involved in preventing cold and flu. Both have also been shown to have antiviral and antibacterial propertie
- Hot peppers: Rich in capsaicin, hot peppers assist the body in managing inflammation through various mechanisms. The spicy flavor can also help open up the sinuses and stimulate mucus flow.
- Lemon: In addition to being a rich source of vitamin C and bioflavonoids, which are very well-known for supporting immune function - the peel/rind is particularly rich in a compound called Limonene. It exhibits anti-inflammatory and antioxidant properties, contributing to immune system modulation
Crafting Your Own Fire Cider: Ingredients and Method
Crafting your own fire cider is fast and easy! Here's a basic recipe to get you started, but remember, the beauty of fire cider is in its adaptability. Feel free to experiment with different herbs, roots, and spices to create a blend that suits your palate and health needs.
Ingredients:
- 1/2 cup fresh ginger* root (peeled and diced)
- 1/2 cup fresh horseradish root (peeled and diced)
- 1/2 cup fresh turmeric* root (peeled and diced)
- 1 medium white onion (chopped)
- 1/4 cup garlic cloves (minced)
- 2 small jalapeno peppers (sliced)
- 2 organic lemons (slice with rind)
- Raw apple cider vinegar
- Raw honey (to taste)
*if you can’t find whole, fresh roots you can substitute dried herb powder; swap for ½ the recommended amount.
Optional additional ingredients:
- 1/4 tsp organic cayenne powder
- 2 Tbsp Rosemary leaves
- 2 Tbsp Thyme
- ½ tsp whole black Peppercorn
- 2 Tbsp Astragalus root
- 2 Tbsp Echinacea root
Method:
- After prepping, add all the ingredients including the ginger, horseradish, onion, garlic, jalapeno, and lemon slices to a clean jar. Make sure your jar has an airtight lid.
- Pour apple cider vinegar over the roots and vegetables until they're well covered.
- Cover the jar with a lid and store it in a cool, dark place for 2-4 weeks. Remember to shake daily.
- When ready, use a cheesecloth to strain out the pulp, squeezing out as much of the liquid as possible.
- Time for the last ingredient - stir in raw honey to sweeten to taste.
Harnessing the Power of Fire Cider
Fire cider is a versatile tonic that can be used in various ways:
- Drink 1-2 tablespoons (15-30 oz) once daily as a preventative measure.
- Some people take a tablespoon at the first sign of a cold, repeating every 3-4 hours until symptoms subside.
- Others incorporate it into their cooking, using it as a marinade for meat or chicken, drizzled on veggies, or as a salad dressing.
- You can add it to hot water and honey to create a warming tea or mix it into fresh juices for a healthful kick.
Cheers to to a healthier, warmer winter!
Disclaimer: The benefits of fire cider and its ingredients have been widely recognized in folk medicine, but scientific research is still ongoing. Always consult with a healthcare professional before starting any new health regimen.
The information provided in this article is intended for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Fire cider is a traditional remedy and not a substitute for medical advice from a healthcare professional.
References
- Mashhadi NS, Ghiasvand R, Askari G, Hariri M, Darvishi L, Mofid MR. Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: review of current evidence. Int J Prev Med. 2013;4(Suppl 1):S36-S42.
- Mazumder A, Dwivedi A, du Plessis J. Sinigrin and Its Therapeutic Benefits. Molecules. 2016;21(4):416. Published 2016 Mar 29. doi:10.3390/molecules21040416
- Kuwabara Y, Hirose A, Lee H, Kakinuma T, Baba A, Takara T. Effects of Highly Bioavailable Curcumin Supplementation on Common Cold Symptoms and Immune and Inflammatory Functions in Healthy Japanese Subjects: A Randomized Controlled Study. J Diet Suppl. 2024;21(1):71-98. doi:10.1080/19390211.2023.2185723
- Jennings MR, Parks RJ. Curcumin as an Antiviral Agent. Viruses. 2020;12(11):1242. Published 2020 Oct 31. doi:10.3390/v12111242
- Rouf R, Uddin SJ, Sarker DK, et al. Antiviral potential of garlic (Allium sativum) and its organosulfur compounds: A systematic update of pre-clinical and clinical data. Trends Food Sci Technol. 2020;104:219-234. doi:10.1016/j.tifs.2020.08.006.
- Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. Cochrane Database Syst Rev. 2014;2014(11):CD006206. Published 2014 Nov 11. doi:10.1002/14651858.CD006206.pub4.
- Miles EA, Calder PC. Effects of Citrus Fruit Juices and Their Bioactive Components on Inflammation and Immunity: A Narrative Review. Front Immunol. 2021;12:712608. Published 2021 Jun 24. doi:10.3389/fimmu.2021.712608
Emphasizing the Importance of Optimal Vitamin D Dosing
Few nutrients have emerged as significant to our overall health as vitamin D - often referred to as the "sunshine vitamin" because we can make it with adequate sunlight exposure. However with our modern lifestyles and concerns surrounding sun damage, we’ve observed a trend of deficiency.
Most of us appreciate the role of the “sunshine vitamin” as aiding calcium in building bone density, but Vitamin D has a diverse set of function beyond bone health, including:
- Immune System Support: Reducing inflammation and improving antimicrobial defense, including reduced risk of complications from influenza and COVID-19
- Autoimmune disease: Reduced risk of autoimmune disease development and relapse including Hoshimotos, Inflammatory Bowel Disease (IBD), rheumatoid arthritis, multiple sclerosis, and psoriasis among others.
- Cardioprotective: Improved risk factors for cardiovascular disease (CVD) including blood pressure regulation, vascular health and flexibility, cholesterol, reduced oxidative stress
- Blood sugar balance: Vitamin D supports insulin production in response to glucose and insulin sensitivity for better glycemic control
- Neuroprotective: Reduces risk of neurodegeneration reduces neurotoxicity due to oxidative damage
- Cancer risk: Reduced cell proliferation, tumor growth, and metastasis
- Musculoskeletal health: support bone mineralization to reduce risk of bone loss and even improves muscle mass and reduces fall risk in those over 65 years-old.
Illustration from https://pubmed.ncbi.nlm.nih.gov/32679784/
Vitamin D actually has hormonal properties that have been associated with sleep-wake cycle - also referred to as circadian rhythm. The”sunshine vitamin” might be related to balancing circadian rhythm by playing a counter role to melatonin - like the ying to its yang.
Significant deficiencies of vitamin D are also associated with Rickets, osteomalacia, and muscle and bone weakness.
I rounded up my favorite vitamin D supplements in a Fullscript protocol. You can find my favorite Vit D forms and dosage options here.
The road to optimizing vitamin D
Deficiencies of vitamin D are common - in fact, it has been referred to as the vitamin D epidemic. To better understand why it’s been so challenging to pin down the recommendations, let’s review all the factors that result in bioindividual variations.
First a little biochemistry background
Biochemistry not your thing? All good - skip down to sources of vitamin D below.
Cholecalciferol and ergocalciferol, the biologically inactive precursors of vitamin D, are activated by UVB exposure to form calcitriol. The precursors pass through the liver then the kidneys for activation before entering systemic circulation. Vitamin D activation and activity has been associated with a variety of tissues throughout the body, including skin, parathyroid gland, breast, colon, prostate, as well as cells of the immune system and bone cells.
25-Hydroxyvitamin D (25-OH vit D or calcifediol) constitutes the major circulating form of vitamin D (a combination of the total of 25-OH D2 and 25-OH D3 form) and is used to determine the serum concentrations to determine vitamin D nutritional status. Most of the physiological effects of vitamin D in the body are related to the activity of 1α,25-dihydroxyvitamin D (calcitriol).
Vitamin D acts through modulation of a transcription factor known as the vitamin D receptor (VDR). Think of this as a lock with a code, when vitamin D is present it unlocks the activity of VDR which turns on a sequence of genes that is responsible for its activity. This messenger system is why we often refer to vitamin D as a hormone. This transcription factor also requires vitamin A, which is the first example of nutrient synergy required for optimal vitamin D levels.
Sources of vitamin D
Reprinted with permission from Linus Pauling Institute
Sun exposure is the “gold standard” approach for maximizing vitamin D levels. Recommendations are 15-30 min of daily sun exposure to skin on the arms, torso, and/or legs. It’s been suggested that 15 minutes/day of sun exposure may be the equivalent of 1,000IU of vitamin D supplementation in light skinned individuals (more about this under risk factors below).
Alongside sun exposure, there are some foods that naturally contain vitamin D. These include fatty fish (mackerel, salmon, sardines), fish liver oils, eggs, and animal liver - all great sources of vitamin D3. There’s one significant vegetarian source - mushrooms that have been exposed to sunlight or UV light which produce vitamin D2.
There are also vitamin D fortified foods, meaning they don’t naturally contain significant sources of vitamin D but it’s been added to help fill a public health need. Milk is a great example - where vitamin D isn’t typically found in milk, it’s been fortified to help support calcium absorption.
All that said, it’s challenging to get an accurate estimate of average dietary intakes of vitamin D due to high variability of vitamin D content. You can look up details of the nutrient content of specific foods on USDA's FoodData Central database.
Defining vitamin D deficiency, insufficiency, and sufficiency
You may have noticed that the reference ranges for vitamin D lab levels vary depending on the lab and that clinicians often have different opinions on targets. That’s because more research is needed to establish definitive parameters for defining the cut-offs for vitamin D deficiency and sufficiency 1,5.
Here’s a summary of what we do know:
- Most would agree that deficiency is defined at a level below < 25 ng/mL
- Levels of 40-60 ng/mL seems to be a reasonable target for immune and metabolic outcomes
- Levels between 30-40 ng/mL are generally considered sufficient for preventing bone loss
- Levels above 100 ng/mL are not recommended and regarded as toxic
Many functional medicine clinicians will target levels between 60-80 ng/mL in an effort to maximize vitamin D. This is often a clinical judgment based on weighing the pros and cons of maximizing vitamin D levels.
Vitamin D levels above 70 ng/mL can be associated with parathyroid hormone suppression, hypercalcemia, and hypercalciuria, but they are rare and there’s no consensus on that level and it might vary individually.
Although, there’s currently not a lot of literature to support this as a public health therapeutic target above 60 ng/mL, this might be a reasonable individualized targeted approach under sufficient medical guidance.
Remember that Vit D is the foundation for immune health. Get my top "9 Nutrients & Foods for Boosting Immune Health" download.
Risk factors for vitamin D deficiency
There are multiple environmental, social, and biological factors that might increase someone's risk of vitamin D deficiency or insufficiency. These includes:
- Geographical location: People living in locations with less light exposure, colder climates, or atmospheric conditions (e.g., air pollution, presence of clouds) which reduce UVB rays and therefore, vitamin D production in skin.
- Sun safety measures: These include limiting sun exposure, wearing protective clothing and hats, and applying sunscreens, hinder skin exposure to sunlight.
- Skin pigmentation: People with a darker complexion synthesize less vitamin D with sunlight exposure relative to light-skin individuals.
- Genetic variations: Certain people have VDR variations (called genetic a polymorphism) that alter vitamin D synthesis and activation.
- Clothing style: People who wear more conservative or warmer clothing; for example practicing Muslim women who cover with long sleeves, ankle-length clothes, and a headscarf (hijab or niqab) were at significantly increased risk of vitamin D deficiency (96% had serum 25-OH D concentrations less than 20 ng/mL, and 60% had vitamin D concentrations below 12 ng/mL according to one study).
- Exclusively breast-fed infants: Exclusively breast-fed and do not receive vitamin D supplementation are at high risk for vitamin D deficiency. The American Academy of Pediatrics recommends that all infants be given an oral vitamin D supplement of 400 IU/day
- Older age: Changes in skin composition, metabolism, liver and kidney function reduces capacity to synthesize vitamin D. This risk is elevated in institutionalized adults who are not supplemented with vitamin D.
- Chronic kidney disease (CKD): Reduced kidney activation of vitamin D due to impaired renal function in CKD as well as increased loss of 25-hydroxyvitamin D in urine.
- Increased body mass/altered body composition: Body mass index (BMI) ≥30 kg/m2 increases the risk of vitamin D deficiency because of increased sequestration in body fat stores (reduced bioavailable vitamin D).
- Fat malabsorption: Vitamin D is a fat soluble vitamin, so any condition - including IBD or small bowel resection - that impairs fat absorption will impair vitamin D absorption.
- Magnesium deficiency: Low magnesium is associated with risk of vitamin D deficiency. This is another really significant nutrient synergy for maximizing target levels.
Supplementing Vitamin D
In recent years, the recommendations were changed from an adequate intake (AI) recommendation to a recommended dietary intake (RDA) which is an improvement in recommendations. However, the RDA recommendation is 600-800 IU/day for adults, which most clinicians agree is insufficient to optimize vitamin D levels and continues to contribute to the deficiency epidemic.
There is some research that points to general blood level targets for certain disease states, however, there aren’t currently established dosing recommendations for immune health (or metabolic health, for that matter). However, recent studies suggest between 2000-5000 IU/day are a reasonable target range for most adults to optimize their circulating vitamin D levels.
Supplementing should ideally be the D3 (cholecalciferol) form, most supplements contain this form of the fat soluble vitamin. However, it’s important to note that if you’re taking the prescription version of 50,000 IU vitamin D - often prescribed to be taken once weekly for 12 weeks at initial diagnosis of vitamin D deficiency to quickly raise the levels in circulation - is the D2 (ergocalciferol) precursor.
Here are my thoughts based on my research and clinical experience**:
- Optimal blood levels probably vary individually, 40-60 ng/mL seems to be a reasonable target
- Many of my colleagues - myself included - often aim for 60-80 ng/mL in patients with increased complications of metabolic, autoimmune, and allergic disease. This is still considered reasonably safe below the upper limit of 100 ng/mL. Even though there isn’t any established research to justify this goal this time, it may still be a clinical judgment to personalize targets.
- For most people it’s hard to get enough vitamin D from food and sunshine, especially with the factors discussed above. Therefore, supplementing is usually necessary especially in the winter or if you have darker skin tone.
- Ideally, dosing should be adjusted based on regular monitoring of blood levels and working with a nutritionist or nutrition-savvy clinician. Ideally, I aim for getting a level twice a year if possible - at the lowest level in the early spring, and at the most likely peak in the early Fall.
- I usually start at 2,000-3,000 IU/day (take with food or fish oil to optimize absorption) but frequently will adjust up to 5,000 IU/day to achieve sufficient vitamin D blood levels. I often opt for vitamin D liquid forms (suspended in MCT oil) for best absorption.
- Nutrients often work best in synergy, and vitamin D is no exception. Optimizing the balance of vitamin K2, vitamin A, and magnesium are also important especially if you’re struggling to get to the target blood level. I always work on these before I maximize the vitamin D dose alone.
If you’re looking for resources to help you optimize your vitamin D level, I’ve created a free download you can use as an educational tool that you can bring to your doctor to help you work together to find your optimal vitamin D dose.
Conclusion: And a note to clinicians
Recognizing vitamin D’s therapeutic potential within preventing and managing chronic disease and related symptoms that contribute to quality of life is a critical component of lifestyle medicine. Because it has such wide-reaching benefits, it can be an easy first step to nutrition personalization.
Clinicians: Join me on Fullscript
Fullscript is a digital health platform that helps practitioners build better patient relationships through quality supplementation and intuitive tools for treatment adherence — all at no cost. Beyond supplement planning, Fullscript delivers evidence-based resources, ready-made protocols, personalized refill reminders, and more to help sustain optimal health over time.
Practitioners write online supplement plans or dispense supplements in-office, giving patients easy access to high-quality products and education for optimal health. Physicians and other healthcare practitioners can join Fullscript HERE for free.
**Educational purposes only; talk to your doctor or healthcare provider to determine your optimal dose
References
- Rebelos E, Tentolouris N, Jude E. The Role of Vitamin D in Health and Disease: A Narrative Review on the Mechanisms Linking Vitamin D with Disease and the Effects of Supplementation. Drugs. 2023;83(8):665-685. doi:10.1007/s40265-023-01875-8. https://pubmed.ncbi.nlm.nih.gov/37148471/
- Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12(7):2097. Published 2020 Jul 15. doi:10.3390/nu12072097. https://pubmed.ncbi.nlm.nih.gov/32679784/
- Wei FL, Li T, Gao QY, et al. Association Between Vitamin D Supplementation and Fall Prevention. Front Endocrinol (Lausanne). 2022;13:919839. Published 2022 Aug 10. doi:10.3389/fendo.2022.919839. https://pubmed.ncbi.nlm.nih.gov/36034418/
- Pludowski P, Holick MF, Grant WB, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018;175:125-135. doi:10.1016/j.jsbmb.2017.01.021. https://pubmed.ncbi.nlm.nih.gov/28216084/
- Romano F, Muscogiuri G, Di Benedetto E, et al. Vitamin D and Sleep Regulation: Is there a Role for Vitamin D?. Curr Pharm Des. 2020;26(21):2492-2496. doi:10.2174/1381612826666200310145935. https://pubmed.ncbi.nlm.nih.gov/32156230/
- https://lpi.oregonstate.edu/mic/vitamins/vitamin-D
- Nichols EK, Khatib IM, Aburto NJ, et al. Vitamin D status and determinants of deficiency among non-pregnant Jordanian women of reproductive age. Eur J Clin Nutr. 2012;66(6):751-756. doi:10.1038/ejcn.2012.25. https://pubmed.ncbi.nlm.nih.gov/22415337/