Paleo Diet and Paleolithic Diet Questions & Answers

Question

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Note: This is an update to Please hack my doctor appointment FAIL

I just got some interesting news. I ordered a saliva hormone panel (that my doctor refused to do) and got my results yesterday. According to the lab chart, a normal, pre-menopausal woman (I'm 33) should have progesterone levels of 127-446 pg/ml. A post-menopausal woman tends to have levels between 18-126. I'm clocking in at 20.44. Rock bottom, even for a person who is no longer menstruating. I do have a (somewhat) regular monthly cycle, but according to the lab, the test results mean that my cycles are anovulatory, meaning that I never ovulate. So interesting, given my husband's and my life choices, that in my current condition, I couldn't have a baby if I wanted to! Apparently, my ratio of progesterone levels to estradiol suggest estrogen dominance. If you look up "low progesterone symptoms" or "estrogen dominance" on the internet, it's everything that I've been complaining about. No energy, foggy thinking, NO libido, insomnia, cold hands and feet, thyroid disfunction mimicking hypothyroidism, inability to lose weight, weight gain... check, check, check... the list goes on.

Still waiting on my TSH blood test results. I think my old doc is taking his sweet time on purpose because of our less-than-jovial last appointment - the lab that drew the blood says that their results are returned to the doc 24 hours after the sample is taken - it's been over two weeks! In the meantime, I think I've found a new doctor that I want to try. The online reviews say that he's "open minded" and open to using compounding pharmacies, which I think is very encouraging.

I gotta say, I've never been so happy to learn something was wrong with me. It's nice to have proof that I'm not crazy after all, and there's something I can do about it. I should send the test results to my old doctor with a rude remark or two. Grrr.

I've read a lot about bio-idential hormone replacement and many people (and Suzanne Sommers) will tell you that bio-identical is the only way to go. Supposedly, the synthetic stuff like Provera has a long list of dangerous side effects (not really surprising to me) and may be linked with breast cancer, etc. Trouble is, it sounds like it's pretty difficult to find a doctor willing to use bio-identical hormones and insurance companies don't often cover them. Naturopaths will do it, of course, but you have to pay out of pocket for everything. Does anyone have any knowledge/opinions/recommendations about hormone replacement?

Futhermore, does anyone have any thoughts on WHY this severe hormone imbalance may have occurred in the first place? A quick internet search brings up the following possible reasons:

High Estrogen Levels - According to the lab tests, my estrogen levels were normal. I'm considered "estrogen dominant" because of the super-low progesterone
Chronic Stress - I just don't have a lot of stress. I get 8 hours of sleep a night, I don't have kids, my husband and I have a great relationship, I love my job, no serious hardships to speak of - life is good. :)
Lack of Proper Exercise - Yes, I stopped exercising for a good 6 months, but my symptoms appeared before I did (in fact, the fatigue was the reason I stopped).
Resistance to Insulin - I don't think I'm insulin resistant. I've eaten low carb for about 3 years. Isn't low carb supposed to make you insulin sensitive? I don't have issues with hypoglycemia - I can eat a sweet potato without incident.
Lack of Proper Nutrition - I eat pretty strictly primal/paleo, but on the lowish carb side (<20g for nearly 3 years; <75g the past three months)
Medication Interaction - Not on any medications
Poly Cystic Ovarian Syndrome - As far as I know, I do not have PCOS.

Any help is sincerely appreciated. I really want to get to the bottom of this!

flag	asked Nov 11 2011 at 1:15 Kimmie 4,620●1●9●28

	proof of why testing matters and paleo 2.0 is an epic failure for some. – The Quilt Nov 11 2011 at 2:24
	The reason why is simple......inflammation. And the cause is multivariant. You need more testing to get to root cause but at least you now know you have some serious issues to solve. Keep us informed at how you proceed. – The Quilt Nov 11 2011 at 2:26
	You mentioned insurance and bioidentical hormones. My hormone doc is out of network, so copay is much higher. However the estrogen patch is covered by BC/BS. Progesterone pills from compounding pharmacy are not, but cost is on $26/month. – AdrianaG Nov 11 2011 at 7:42
	Did you do the salivary hormone test on day 21 of your cycle? – Sue Nov 11 2011 at 11:09
	Sue: By my count, the samples were taken on day 10 of my cycle. – Kimmie Nov 11 2011 at 14:50

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Katherine · Accepted Answer · 2011-11-11 15:21:30Z UTC

Decided to put all my "comments" in one spot so it'd be easier to find info. Sorry for the redundancy.

Chronic Infection

The more I think of it, the more I'd be looking at some kind of chronic infection affecting thyroid function, hypothalamus function or pituitary function.

Since your issues have gotten worse in spite of your excellent diet and since your low progesterone level is the result (rather than the cause) of the anovulatory cycles, it's important to address what's going on with the hormones that should be driving egg maturation (estradiol?) and egg release/ovulation (lutenizing hormone/LH) and the organs that should be driving those hormones.

I'd be looking hard at chronic infection affecting thyroid function, hypothalamus function and definitely pituitary function. A problem with pituitary function could mean insufficient LH to trigger egg release. Without a corpus luteum to produce prog, you would be deficient (though you're really deficient).

It's good that you're working on getting a more complete thyroid panel. Honestly, it may be worth it to work with Chris Kresser on this if you can swing it.

In the meantime though, it seems reasonable to support hormone levels pharmaceutically using prometrium/progesterone obtained in the US via rx or perhaps using an offshore pharmacy if you're unable to otherwise obtain it.

Compounded Progesterone or Prometrium - What's the Difference?

Prometrium (not to be confused with premarin) is bioidentical. Avoid using the word "bioidentical" as it triggers a knee-jerk reaction in most docs to stop listening to anything you say after that word.Physicians get most of their information regarding hormonal drug treatments from pharmaceutical reps who sell synthetic hormones. The end result is that they erroneously believe that there is no difference.

Make no mistake, synthetic estrogens and synthetic progestagens, while having some benefits, also carry a good deal of risk for multiple body systems.

Someone asked about the difference between compounded prog and prometrium. Prometrium and compounded oral prog are both micronized in oil otherwise it wouldn't be effective. The difference between compounded prog and prometrium is, to me, just ease of use.

1)docs will generally willingly prescribe it - so no special searching for a sympathetic doc.

2)insurance covers it. so no unusual cost.

3)it's available at the stores where we're already shopping. so no extra trips.

I'm just saying that there is no benefit to using compounded oral prog over prometrium, not that prometrium is better in any way than compounded oral prog. (fwiw, I wouldn't use topicals - unless nothing else worked)

Supplements

Zinc intake of 120 mg is very, very concerning if that is indeed your intake and not a typo. At those doses, zinc is immunosupressive and could be exacerbating any (potential) chronic infection and is very likely causing a relative copper deficiency. Stop (maybe taper?) the zinc for a few weeks, then restart at a total dose (food and supps combined) of 30-50 mg zinc...more likely the lower end will be appropriate.

Copper need not be supplemented if you are eating beef liver once a week. Otherwise it should be taken at levels that will maintain a 10-15 to 1 zinc to copper level from food and supplements combined.

Selenium (you're using brazil nuts and 200 mcg selenium supplement)

Iodine (you're using Lugol's iodine). I don't know much about iodine supplementation but the possibility of taking too much does concern me. Maybe that concern is unfounded though.

D-3 - how much are you taking? What was your recent test result? Quest, LabCorp or other?

CLO/BO - how much CLO are you taking and how much A and D is it yeilding? What is BO?

I'd skip the brazil nuts but that's just my own bias about hardcore reduction of nut/seed n6 due to my own health issues. There are definitely two camps when it comes to A supplementation (ie CLO), I'm in the lower A to D ratio camp. Maybe 3-4 to 1 A to D. Maybe even less. As with most things, a sufficiency of A is important but above and beyond that, it seems that benefit would be unlikely.

There are also two camps when it comes to supplementing fish oil. I'm in the less PUFA is better camp. In a reversal of my thinking for many years, I can agree that it does seem n3:n6 ratios is best improved by eliminating n6 rather than adding n3. However, I don't know that changing those things will change your current situation...

ETA:

Vitamin D testing You can get your D tested easily via grassrootshealth.net. It's $65 for one test or if you join the study for five years, $60 twice a year. It's a simple, accurate, precise, gold-standard normed finger-stick test that you do at home.

Saliva and Blood Tests for Hormone Levels (incl thyroid, adrenal, sex hormones etc)

http://www.zrtlab.com/combination-profiles/view-all-products.html

Iodine Test http://www.zrtlab.com/iodine-tests/view-all-products.html

Dragonfly · Answer 2 · 2011-11-11 04:40:49Z UTC

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Just to share my experience;

I'm 48 & was I was experiencing the "perimenopausal: symptoms of belly fat gain, insomnia, fatigue and occasional vaginal dryness--all signs of estrogen dominance.

I used a double dose of Pro-gest cream for 6 months and my symptoms decreased, but did not go away completely.

After one year of being lacto-Paleo & supplementing D to sufficiency, Magnesium Citrate 200-400 mg, Zinc Picolinate 50 mg and Krill Oil 1000 mg, ALL my symptoms are gone. I will be 49 in January & have never felt better!

The Zinc was the key to the dryness. It has also eliminated pre-menstrual bloating & fatigue.

So while I definitely support the use of bio-identical hormones, I also think that dialing in your nutrition can make a big difference.

For example: Make sure that your supplements are getting absorbed. What form of zinc & how much, etc...

answered Nov 11 2011 at 4:40

Dragonfly
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Thanks Dragonfly! Honestly, I thought I had dialed in my supplements. I periodically track my nutrition on Cronometer, and I take the following supplements... Morning: iron-free multivitamin (Alive brand) vitamin C powder (camu camu) - 120 mg vitamin d3 - 5,000 IU alpha lipoic acid - 600 mg acrtyl l-carnitine - 1,000 mg 1/2 tsp butter oil/fermented cod liver oil blend – Kimmie Nov 11 2011 at 13:37

Evening: magnesium ultra (oxide/amino acid chelate/malate/taurinate) - 300 mg vitamin C powder (camu camu) - 120 mg zinc gluconate/picolinate - 50 mg ubiquinol CoQH - 50 mg alaria supreme (seaweed) - 500 mg selenium (as l-selenomethionine) - 200 mcg – Kimmie Nov 11 2011 at 13:40

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Dargonfly makes a good point - one that is applicable to many folks, but you have dialed in your nutrition quite well. Your zinc dose, if you wrote that correctly at 120 mg, is WAY too high and needs to be stopped immediately. At those doses, zinc is immunosupressive and could be exacerbating any (potential) chronic infection and is very likely causing a relative copper deficiency. Stop (maybe taper?) the zinc for a few weeks, then restart at a total dose (food and supps combined) of 30-50 mg zinc...more likely the lower end will be appropriate. – Katherine Nov 11 2011 at 14:10

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Copper need not be supplemented if you are eating beef liver once a week. Otherwise it should be taken at levels that will maintain a 10-15 to 1 zinc to copper level from food and supplements combined. – Katherine Nov 11 2011 at 14:13

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How is your ferritin level? – Katherine Nov 11 2011 at 14:13

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Kamal · Answer 3 · 2011-11-11 01:49:07Z UTC

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Paging paleohacks user Katherine. She researches progesterone at her job, I believe.

answered Nov 11 2011 at 1:49

Kamal♦
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Hey Kamal, I do. @Kimbo, while I don't have the expertise to cover the how/why you are in this situation (aside from moderately informed speculation), I can with a good degree of certainty that most docs, given your situation, would be very comfortable rx'ing prometrium. Prometrium (not to be confused with premarin) IS bioidentical. Just don't ever use that word. Because docs have pharmaceutical reps who sell synthetic hormones educating them, they truly believe there is no difference (cont...) – Katherine Nov 11 2011 at 2:07

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between synthetic and structurally identical hormones. Make no mistake, synthetic estrogen and progesterone carry a good deal of risk in multiple body systems. Avoid the word "bioidentical" and just say you'd like to use prometrium. – Katherine Nov 11 2011 at 2:12

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I read your other post as well. How is your selenium and iodine intake? It's clear that there is something going on. Aside from addressing selenium and iodine intake, I'd be looking hard at chronic infection, autoimmune thyroid disease. Chris Kresser's info on gut-brain axis may help as may Paul Jaminet's information on Chronic infections. You really do need a more complete thyroid panel. Were you able to get it? I'll talk to some folks to try to find out more about why you have such low prog levels at this stage. – Katherine Nov 11 2011 at 2:18

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And fwiw, every insurance co will cover prometrium. It's cheap. Just the compounded stuff is expensive (and often unnecessary). – Katherine Nov 11 2011 at 2:19

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Hi Katherine - thanks so much for your help!! As far as supplements go, most days I supplement with D-3, fermented CLO/BO, vitamin C, zinc, biotin, CoQ10, ALA/Acetyl L-Carnitine, magnesium and Lugol's iodine. I try to eat a couple of brazil nuts most days for selenium. Based on advice I was given a couple of weeks ago, I've added 200 mcg of selenium. – Kimmie Nov 11 2011 at 3:01

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Travis Culp · Answer 4 · 2011-11-11 01:43:15Z UTC

Low carb (with presumably enough meat) should rule out a zinc deficiency at least. I suppose low carb and the subsequent elevation of cortisol could result in pregnenolone steal, which would soak up the substrate for progesterone synthesis. Seems like that would affect estrogen as well however.

GinT · Answer 5 · 2011-11-11 02:12:04Z UTC

I use BHRT and my insurance covers it. I think it is becoming a little more widely accepted now. If all you need is progesterone, then Katherine is correct and Prometrium would be a good option for you. I have to have prog, test, and estrogen, so I am using a compounded cream. You may have to take it at night. It can be a tiny bit sedating, but you will sleep very well. :-)

Alexandra · Answer 6 · 2011-11-11 16:53:34Z UTC

Hi Kimbo,

Your symptoms plus family history scream hypothyroid condition. This would exacorbate weight gain but also, I noticed that the gain coincided with upping carbs to around 75 per day. This may be too much for you. Cut back to 50 for a few weeks to see how you do. It is imperative that you get free t3 and free t4 and antibodies tested. Get Mark Starr MD's book as well as Broda Barnes MD's book. Starr's book is outstanding and gives step by step instructions on how to titrate thyroid hormone. He is also hypothyroid himself and details his own years of misdiagnoses and needless suffering.

As for the other hormones -- I would urge you to not do any of that at this point until you know about your thyroid. I bet this will be unpopular on this board -- but I do not believe a single sex hormone panel showing low progesterone is indicative of anything other than the fact you didn't ovulate in that month. That's assuming the test is accurate and many labs simply are not. I had an endo send two sets of my blood to two different labs and they came back with markedly different results. Also, you just know a snapshot in time -- I think multiple tests throughout the month would be more meanigful but not necessary right now. So before you start smearing progesterone cream all over or trying to get all complicated with supplementing several different hormones -- I suggest keeping it simple and start with your thyroid. I'm not agains natural progesterone and have read Dr. Lee's work but remain unconvinced. I've known too many failures with it and the magical promises that it will shrink fibroids, increase bone mass etc etc have simply not panned out. Also, if you do go that route or any other topical hormone route -- take precautions so that your husband doesn't find his progesterone level suitable for a pregnancy. That happened to Dr. Eades -- he blogged about it -- after his wife began using topical progesterone cream.

As to the Lugol's -- Dr. Brownstein, Dr. Derry, Dr. Abraham etc etc all have interesting info on iodine insufficiency but even Brownstein says in his book that optimal doses may vary between people. All I know is that there are plenty on the iodine yahoo group who claim they are still "detoxing" from bromide after years -- that's right years! -- of taking double digit miligram doses of iodine in the form of Lugol's or Iodoral etc -- doesn't occur to them that they may simply be poisoning their thyroids. I'm not doubting the success stories but there are huge numbers of failures. Suddently taking even a miligram of iodine (multis usually contain 150 micrograms) can cause hypo OR hyper symptoms in some people. This is not a do it yourself thing and I would stop the Lugol's at least temporarily to see if you feel better. It's very concentrated and even one drop is several miligrams -- far higher than you may be used to given that multis are generally 150 micrograms. The iodine is a confounding factor so I would stop it for now and then reintroduce gradually under a doc's care. Many hypothyroids (read thyroid activist Mary Shomon's website) do not do well with supplemental iodine. Shomon herself tried on several occassions and it made her Hashimoto's worse. Iodine is a YMMV kind of thing and I don't care that Asians who have been consuming it for thousands of years in high doses fare well with it. Unless you are Asian, that's irrelevant.

It is not uncommon or a "diseased" state for a woman in her thirties to occassionally not ovulate and if you don't want kids, I don't think you should stress over it. Your symptoms scream low thyroid and it's so simple to correct.

One other thought on the eyebrows -- if you have allergies or blepharitis or dandruff that spreads to your brows -- these conditions can all cause both temporary eyebrow and eyelash fallout. Also, make sure you are removing your eyemake-up well. I always thought I was until my own bout with allergic blepharitis and my eye doc showed me with a magnifying mirror that I was leaving plenty of eyeliner and mascara at the root area. Always use a magnifying mirror when removing eye makeup to get off all traces.

Renae · Answer 7 · 2012-07-16 05:50:56Z UTC

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How did your Dr. visit go? I am going through the same thing, and have done the saliva test. My results were 15, and everything is out of whack. I feel emotional all the time, and I feel like my body isnt functioning properly, despite vigerous exercise and proper diet. I am paying out of pocket for a new dr. and looking forward to treatment. I was on natural cream, but did not see any results even after 1 month. I have not had my period in 6 months, and cant fit into my clothes as I have gained in the middle. I am so frustrated!!! Any words of advice???

answered Jul 16 at 5:50

Renae
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	Hi Renae, It turns out I have hashimoto's autoimmune disease, stage 2 adrenal fatigue and "leaky gut." Apparently, thyroid hormone is needed to produce progesterone, so Katherine's (and others') suspicions that something was going on further upstream was spot on. I am now seeing a Functional Medicine doctor, trained by Dr. Kharrazian, who is currently working with me to heal my leaky gut in an effort to control the autoimmune response. I am also seeing naturopathic endocrinologist who is managing my prescription for Armour, which helps me to feel "normal" for the first time in years... – Kimmie Jul 16 at 14:24
	... I hope your doctor will run a full battery of tests for you, as low progesterone does seem to be a symptom of something bigger - not the problem itself. All I can say is don't give up and don't take no for an answer. Trust your instincts and be prepared to move on to the next doctor when your gut tells you it's time. Good luck! – Kimmie Jul 16 at 14:32

Vivalapaleo · Answer 8 · 2011-11-11 08:54:58Z UTC

Just doing a normal estrogen test that the doc does will not really tell you much - you need to do a e2 and e16 ( estrogen ) test to find out the ratio - when that is out so is your progesterone and that's normally low. Then you know you have estrogen dominance. A naturopath will be able to ask for this test - might be worth paying for a few visits to sort this out. There are some tablets ( DIM Diindolylmethane that are phytoestrogens made from cruciferous vegetables this drops the E16 level - or you can just up your intake of those veg.

In my reading natural progesterones are useful but they are only masking the problem and not correcting the Estrogen imbalance - food for thought. Do some research on e2 :e16

tiphanie · Answer 9 · 2013-01-03 08:32:22Z UTC

Well, I beat you at low progesterone at 5.3 pg/ml on a saliva test. I'm confused as well. But two things to look into are Adrenal Fatigue and the awesome website for CeMCOR, the Ctr for Menstruation and Ovulation research. They are amazing. The Dr. in charge even has a nobel peace prize for a 1980's initiative of Drs. for nuclear disarmament. But what she and they know about estrogen and progesterone, meno- and peri-menopause is ground-breaking.

I have low results from ALL of my salivary panel: testosterone, dhea, dht, estrool, progesterone to estrogen, cortisol, all of it. My GP described it as a "dearth" of hormones in a letter to my insurance company.

You should at the very least get an endocrinologist; they deal with hormonal stuff and related systems and disorders including but not limited to diabetes. Anything hormonal and you need an endocrinologist.

Good luck!

Sandy · Answer 10 · 2013-05-21 00:43:09Z UTC

My progesterone level is .3 which is very low. I have also low testerone level. Dr is calling in compounded prg cream along with pills for testosterone. Krill oil as a supplement. Im taking Centrum silver chewables which has iodine zinc....etc. I cant loose weight. Hoping I start sleeping and can loose weight. Hoping for increased libido and sleep. Anyone out there experienced weight loss after taking these things?

Crazy-low progesterone levels, bio-identical hormones & the meaning of life

10 Answers