Functional Medicine and Women’s Health: Interview with Joel Evans, MD
Part 1: Thyroid, Adrenals & Excess Estrogen
We sat down with Joel Evans, MD to talk about Functional Medicine options for common women’s health issues.
Q: Let’s talk about thyroid dysfunction. What are underlying causes that can be addressed through nutrition? What are the risks if left unaddressed?
A: Thyroid dysfunction is incredibly prevalent, and the signs may be a little bit insidious. That’s why we have to evaluate our patients for thyroid health with every annual visit. It’s also very important to understand that there are symptoms that come up with adrenals, like fatigue, that totally overlap with thyroid. Assuming we’ve evaluated our adrenals, it’s important that we do adequate thyroid testing, which would include TSH, total T3 and T4, free T3, free T4, the anti-thyroglobulin antibody, the thyroid peroxisome antibody, and reverse T3. Abnormalities can be found that may not be noted if they’re not tested. This is an example of a difference between conventional medicine and Functional Medicine.
Conventional medicine says if your thyroid function is normal and you have elevated antibodies, who cares? They just wait until symptoms get worse or thyroid function becomes abnormal. However, from the Functional Medicine perspective, we do everything we can to achieve immune health and get rid of that autoimmune disease where we are attacking the thyroid gland.
When testing shows positive antibodies, we do a whole autoimmune Functional Medicine protocol. If we look at the things nutritionally that are important for thyroid, it’s iron, it’s iodine, an amino acid called tyrosine, zinc, selenium is important, vitamin E, B vitamins, primarily B2, B3, B6, vitamin C, and vitamin D.
Then we have to improve sensitivity to the circulating thyroid hormones: Add in vitamin A, add in physical exercise, and that makes the body more sensitive to existing thyroid hormones. Selenium and zinc are important for the conversion of T4 to T3. Remember, the thyroid gland makes T4, but the body doesn’t use it; the cells only use T3, so T4 has to be turned into T3. You need selenium and zinc for that.
It’s also important to remove what inhibits that conversion: stress, eating too few calories, inflammation in the body, toxins in the body, and certain medications, and increase the things that are good, like iron and iodine and zinc and selenium and physical exercise, reducing stress, and reducing inflammation.
Q: Can you give a patient example of addressing thyroid issues with Functional Medicine?
A: A 46-year-old woman came in with fatigue and stress. She had low adrenal function; both DHEAS as well as cortisol were low. I helped her adrenals with adaptogenic herbs and DHEA, and I also noticed that her thyroid tests had low TSH. Stress can inhibit TSH.
I then had to do stress reduction techniques, gave her thyroid supplementation with nutrients like selenium and iodine, and she ended up feeling so much better and was slightly more energized.
I then did a heavy metals test and mercury, and that’s why her T3 was low. We worked on getting rid of mercury, and her thyroid bumped up into normal range, and she finally felt well again.
Q: Obesity is sadly becoming more and more rampant. How does obesity cause an excess in estrogen? Why do women who carry too much weight have issues with fibroids, endometriosis, or breast cancer?
A: Estrogen in the body is made by an enzyme called aromatase. That enzyme takes androgens, like testosterone or androstenedione, and converts them into estrogens. Two conditions that lead to increased estrogen production would be if there is too much aromatase activity or too much aromatase in the body.
If there is too much inflammation or too much insulin, patients make too much estrogen. Also, the enzyme is found in visceral adipose tissue. When you’re obese, you have more visceral adipose tissue, so you have more molecules of aromatase in the body, so therefore, more estrogen is produced.
A second whammy is when you have increased visceral adipose tissue, you’re more likely to have dysglycemia and more likely to be walking around with increased insulin levels. Visceral adipose tissue is pro-inflammatory, so you can have more pro-inflammatory cytokines and more insulin just by being obese, and that further stimulates the aromatase enzymes in your body.
Joel Evans, MD
Joel Evans is the Director of The Center for Functional Medicine in Stamford, CT, a member of the core faculty of both The Center for Mind/Body Medicine and The Institute for Functional Medicine, and formerly an assistant clinical professor of Obstetrics, Gynecology, and Women’s Health at the Albert Einstein College of Medicine. He is a nationally recognized wellness expert, educator, author, and physician specializing in nutrition, functional medicine, mind/body medicine, and spirituality. Having pursued studies in spirituality, metaphysics, and personal transformation for many years, Dr. Evans has recently created a core curriculum designed to share ancient spiritual wisdom with others in order to help bring health and happiness into their lives.