Episode 39: Are Your Hormones Causing Your Anxiety?
Kaycie Rosen Grigel, ND explores the relationship between hormones and anxiety on this week’s episode of Supplementing Health.
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[1:48] Cassy Price: Welcome back to Supplementing Health. I’m excited to be introducing Dr. Kaycie Rosen Grigel, ND. She has a practise in Golden, Colorado where she focuses on endocrine balance, digestive complaints, immune dysregulation and chronic inflammation. Today we will be discussing the relationship between hormones and anxiety. Welcome Casey, thanks for joining me.
[2:09] Dr. Kaycie Rosen Grigel: Thanks so much for having me.
[2:11] Cassy Price: So, when did you first become interested in hormones and the role they play in mental health?
[2:16] Dr. Kaycie Rosen Grigel: Well, I’ve always really been fascinated by how hormones work, how they govern the function of all our organ systems, how they all sort of work together to maintain homeostasis in the body, and specifically, when I went into naturopathic endocrinology. I love it because we have such effective tools to modify and improve the health of the endocrine organs, especially over time. And as a matter of course, when I see patients who have concerns with their hormones, often the first, or, and or the most disruptive symptom they experience is changes in mood or mental health so it kind of all goes together.
[2:49] Cassy Price: Are all forms of anxiety disorders or mood disorders affected by hormones?
[2:54] Dr. Kaycie Rosen Grigel: Well it depends on what you mean by hormones. Hormones are any signal that the body sends though the bloodstream that impacts many systems throughout the body. So cortisol fits there, thyroid, reproductive hormones. To differentiate, a neurotransmitter is a sort of a specialized type of hormone that only travels along neural pathways and just impacts the nervous system. So it’s sort of a special type of hormone. Most anxiety has some involvement with our stress hormones like cortisol or the neurotransmitter epinephrine, or sometimes we call it adrenaline. But other neurotransmitters and hormones can definitely also impact mood. So if you’re looking for a specific type of hormone, it’s not always necessarily one thing that’s always causing the issue.
[3:42] Cassy Price: Do our sex hormones play a role in it as well? Like our estrogen, progesterone, those sorts of hormones?
[3:48] Dr. Kaycie Rosen Grigel: Absolutely. You know, when I teach my course on women’s endocrine health, we talk about the hormones being sort of like a symphony. We have our brain which governs the production of primarily things like thyroid, reproductive hormones and adrenal hormones and they all work together to create balance in the body. So all of those can, if they get disrupted, contribute to anxiety.
[4:18] Cassy Price: And do you see more of a specific type of anxiety in your practice over others?
[4:23] Dr. Kaycie Rosen Grigel: So, in my practise, the anxiety disorders that I tend to see, tend to be more often associated with endocrinology issues and hormone balance because that’s what I specialize in.
[4:36] Cassy Price: Do you find they go hand in hand with other mental health issues as well?
[4:41] Dr. Kaycie Rosen Grigel: They can. Not always but you know, sometimes someone will feel like they’ve had a lifetime of feeling completely balanced and all of the sudden they get to a time of life and either there’s a ton of stress or there’s a big shift in their own hormones. You know maybe it’s post partum, maybe it’s pre menopause, maybe there’s a death in the family, and all of the sudden they, because of that shift, they’re experiencing anxiety. So that can happen too.
[5:09] Cassy Price: Okay. So we know that progesterone stimulate the part of the brain that’s responsible for our fight or flight response, but many people don’t realize that progesterone dominance can actually lead to similar symptoms and estrogen insufficiency. So could this imbalance lead to symptoms of anxiety as well then?
[5:29] Dr. Kaycie Rosen Grigel: It can potentially. I’ll tell you clinically, it’s not actually that simple. So clinically, I don’t see progesterone dominance anywhere near as frequently as I see estrogen dominance and that has a lot to do with just how our bodies produce estrogen and progesterone. Also, there’s another piece which I feel is really important to note, which is that it’s not just how much of a hormone that you have in your body. Progesterone dominance certainly could play out as looking at anxiety but it’s a really complex interplay between genetics, hormones stressors and then your own internal environment. So for instance, there’s some interesting research right now showing a metabolite of progesterone called allopragnanolone, and that works in the CNS, the central nervous system, to modify GABA receptors. And what we’re seeing is that, with that GABA receptor response, it’s actually dose dependent. So, it can either improve or decrease the mood. So, it does end up being more a little more fine tuned than just one or the other causing something.
[6:36] Cassy Price: Wow, that’s interesting. So then why is it that estrogen seems to be more prevalent, like the issues with estrogen?
[6:45] Dr. Kaycie Rosen Grigel: Well, so estrogen is known as being more relaxing to the mind and in terms of why estrogen dominance is more prominent, that has more to do with the way our ovaries produce estrogen and progesterone, especially as we head towards menopause. The production of progesterone is very dependant on the quality of the egg and the follicle that our ovary produces. And so a lot of times, we’ll be able to make estrogen in a really robust way while the quality of that follicle is falling so the progesterone does tend to fall first. Yeah, so again, estrogen has been know to be relaxing to the mind so that association between estrogen and anxiety can happen but just like progesterone, there are also more layers. One of the areas of research right now is looking at different types of estrogen receptors and their impact on mood. So, there’s alpha receptors, and beta receptors and some other types of receptors they’re actually finding as well. The beta receptors, they’re finding they are more associated with that sort of relaxation so when we’re using more of the beta receptor there’s more relaxation. And then another layer is the, looking at the different genetic subtypes of estrogen receptors, so different genetic subtypes will express and influence a person’s susceptibility to depression and anxiety. So again, it’s not just like high or low estrogen, it’s what your body is doing, it’s how your receptors are receiving the estrogen and your own genetic predisposition.
[8:41] Cassy Price: Does the methylation of the estrogen and the different types, whether it’s estrodial or estro like paranestrogen or any of the breakdowns play into that then?
[8:53] Dr. Kaycie Rosen Grigel: You know, that’s an interesting question, I know that some of those estrogenic breakdown products can be more stimulatory than the estrogen itself so I think there is a theory that if you aren’t clearing your estrogen breakdown products appropriately you may have different symptoms and manifest in different ways. We certainly see that with different types, other types of issues that I might treat. You know, things like you know heavy periods, or other types of menopausal issues that may come up. So, sometimes that clearance is actually a very crucial piece.
[9:34] Cassy Price: Okay, so now for men, estrogen doesn’t play the same role within their body systems as it does for women, so would low levels of testosterone or excess testosterone present in a similar that estrogen does for women?
[9:48] Dr. Kaycie Rosen Grigel: Well, so yes, we definitely see a much, much lower production of estrogen in men, although estrogen is produced in the peripheral tissues from testosterone in men. But what we’ve also seen in the literature is that testosterone is shown to have a protective effect against anxiety and depression and lower levels or serum testosterone and lower levels are associated with depressive type symptoms.
[10:16] Cassy Price: Do you fond that depending on what type of testing you’re using you’ll get a different picture like whether you’re doing say a blood testing and looking at serum levels or looking at say, a saliva hormone test?
[10:30] Dr. Kaycie Rosen Grigel: I do. I do tend to, especially when we’re looking at things like, there’s the best data out there is about cortisol. But I also do like looking at some of the saliva profiles for the other reproductive steroid hormones. And the reason for this is that usually when we look at serum samples, blood samples that is, we look at a total hormone level and generally with most of our hormone levels, about 99% of the production that we have in our body is going to be bound to some sort of other protein in the blood and so it circulates through the body but it’s bound and cannot be used. So usually somewhere under 1% of what we’re actually producing is unbound and free and so when we look at saliva samples, we actually get a better idea about what is free and available because we look at free hormone levels in the saliva sample. So, I do tend to like seeing those, although you know, whatever we can get. If we can get some data it’s always a good place to start.
[11:37] Cassy Price: Yeah, absolutely. Now, you were talking about testosterone and it can have a protective effect in mental health, is that correct?
[11:45] Dr. Kaycie Rosen Grigel: Um hmm.
[11:46] Cassy Price: What exactly is its role in creating that protective effect or how does that come about?
[11:54] Dr. Kaycie Rosen Grigel: Sure. So, one of the theories is that testosterone actually augments the production of serotonin and GABA in the brain. And those two are what we would call some of our primary inhibitory neurotransmitters. Those are the neurotransmitters that tell our brain to sort of shut down, relax and not be so vigilant and so if we can activate those more, we tend to feel calmer.
[12:24] Cassy Price: Okay yeah, that makes sense. And stress hormones like cortisol, we’ve talked about those a few times throughout our conversation, but they’re released in situations where we feel threatened, out of control, overwhelmed, just stress in general which seem to come up more often in this day and age than it did for our ancestors. People are getting excess excretions, and more consistent excretions of cortisol. So how can people work on lowering their cortisol levels, so they aren’t creating those anxious feelings on such a regular basis?
[12:59] Dr. Kaycie Rosen Grigel: Right, so that’s a great question. One of the things I like to explain to my patients is just to talk a lot about physiologically about what happens when we experience stress. And just like you said, the way we express or experience stress today is pretty different than how we experienced stress historically. Historically, it meant escape from danger, run from the bear so our stress hormones help us to prepare to escape danger. That means it helps us to think fast, run fast, pump blood quickly to your brain, to your muscles, and supply them with glucose or blood sugar to power your escape. So, cortisol is the part of that hormone cascade that mobilizes the blood sugar to you can run your brain, run your heart, run your muscles and escape danger. So today, we are not generally actually physically moving when we experience stress. Stress takes on a whole different thing, but physiologically the same thing is still happening. So, when we experience stress, we still make all this stuff and it still feels like anxiety, particularly when we’re not using all that extra blood sugar we just mobilized.
So, when we want to manage cortisol, we have a variety of options and of course, the first place to start is to do all the good lifestyle stuff that you know, right? Exercise, meditate, deep breathe, yoga, all those things that actively decrease your stress response. All those things that we know that we can do. And then another really critical piece for me is that cortisol has a second job, it doesn’t just kick in when we have stress. Cortisol kicks in when our blood sugar gets too low, for the very same reason. If our blood sugar gets too low, say it’s been eight hours since we ate, then our brain still needs to function so cortisol kicks in and gives us more sugar. So one thing I see really frequently in anxiety and with a lot of my patients, is that they wake up at three in the morning. So for instance, if you ate dinner at seven, by three it’s been eight hours and your blood sugar has gotten so low that your cortisol kicks in, particularly if you already have a trigger happy stress response. One thing I tell a lot of folks is a small protein snack before bed will often keep the blood sugar much more stable throughout the night and will help to sleep through the night. And generally, overall, balancing our blood sugar is really critical for managing stress and anxiety. And then there’s a whole range of other types of things I use to help manage stress and cortisol but those are my favourite sort of lifestyle tips.
[15:47] Cassy Price: And do you find that trendy diets or eating patterns such as intermittent fasting, Keto can also have an effect on people’s cortisol levels, or that reaction that they’re having where they are waking up at 3 am or are overstimulated?
[16:04] Dr. Kaycie Rosen Grigel: You know again, it really comes down to blood sugar. Some people tolerate intermittent fasting just fine, some people really don’t. It’s really individual. And so, yeah, if you’re eating dinner at five o’clock and you don’t want to eat again until 9 am the next day. Some people don’t do well with that. And so, by four in the morning, it’s been 11 hours and they’re up. Keto diets are a little bit different in that you’re engaging different parts of your metabolism. But again, it also can be somewhat challenging to keep that blood sugar regulated with any of those extreme type of choices.
[16:46] Cassy Price: Earlier in our conversation you mentioned that thyroid can play a role in anxiety and when it presents with physical symptoms, sometimes it can be things like heart rate, palpitations, shakiness, increased sweating, things that people associate with anxiety. So what about the thyroid function lead to this presentation.
[17:05] Dr. Kaycie Rosen Grigel: Yeah, so in a general way, the thyroid sort of sets the rate at which your body functions. Again it’s, how fast do you digest your food, how fast you metabolize, how fast you pump your blood, how fast you make new cells. So, I like to think of your thyroid, kind of like your thermostat. You know, if you’re pumping things up, they go faster, if you bring things down they go slower and that feeling of your body going faster that it needs to in all those levels can certainly feel like anxiety. I will mention though that low thyroid can also manifest as other types of mental disturbance. You can have the insomnia or the depression or the fatigue and so you know, it kind of can go either way in terms of the thyroid.
[17:52] Cassy Price: Okay, so what are some of the other signs of hormone imbalance that people should be looking out for if they’re thinking hey, some of this sounds like me and maybe I should consider hormone treatments.
[18:02] Dr. Kaycie Rosen Grigel: yeah, so some of the most common symptoms I see in hormone imbalances are shifts in weight, shifts in energy, hair loss, emotional changes, libido. Of course, obvious things like hot flashes and night sweats. Anything that seems to be impacting your whole system, that you’re not quite sure. Although I’ll sometimes just have people who come to me and their hair is falling out and they don’t know why. Or sometimes people will come to me and they just have one thing happening. It can manifest as just one thing but a lot of times if you feel like you’re having things happen in multiple systems that’s a good time to get your hormones checked.
[18:37] Cassy Price: And are there ways that people can kind of assess which hormones are triggering their symptoms so that they know kind of who to seek help from?
[18:44] Dr. Kaycie Rosen Grigel: The best way to know what is going on with your hormones is you need to test them and a lot of times the symptoms that you experience between one type of hormone imbalance and another may overlap. And so for me, when I see patients I like to make sure that their thyroid and their reproductive and their adrenal hormones are all working properly, because it’s not uncommon when one goes that the others will follow so sometimes we have to work with multiple systems.
[19:16] Cassy Price: yeah, that makes sense. The body is very intertwined so. Do you find that bio-identical replacement therapy helps in the treatment of anxiety or some of these other mood disturbances like sleep or insomnia, etc. that you have mentioned previously?
[19:32] Dr. Kaycie Rosen Grigel: Yeah, so I don’t think of bio-identical hormones as a first line treatment of anxiety, but it certainly can play a role when people’s reproductive hormones are out of balance. We have a lot of really good options for managing anxiety and managing hormone levels, both reproductive and otherwise but for people who it is appropriate we certainly can utilize bio-identicals and they can work well.
[20:02] Cassy Price: And are there specific nutrients that you find are important in the treatment protocols when dealing with anxiety?
[20:09] Dr. Kaycie Rosen Grigel: So for my patients, as I sort of already sort of harped upon, I always like to start with lab work so to see if you’re actually deficient in anything and then we can work from there. In terms of specifics, if you’re concerned about not making enough steroid hormones or thyroids, I’d start with the very basics. One, make sure you have enough cholesterol in your body to make steroid hormones and protein to make thyroid and adrenal hormones, especially when people are choosing animal free or very restrictive diets or they’re taking cholesterol lowering medication. You can deprive yourself of necessary, just basic macro nutrients to make those hormones, so that’s first. B vitamin complexes are helpful because they just provide co-factors to make healthy adrenal hormones. And you know, things like, depending on if we’re supporting something like the thyroid, we might look at iodine and tyrosine. Vitamin B12 tends to help reset the circadian rhythm in the body which is very helpful if insomnia is a piece. There’s some literature out there indicating that vitamin D can also help with optimal adrenal function. Also if we’re having an adrenal issue, I’ll look at electrolytes such as magnesium and calcium just to make sure we’re balancing the cort and the steroid piece.
[21:30] Cassy Price: Okay, and can we circle back to cholesterol for a second? Because I know it gets a bad rap. Most people, when you say cholesterol, they’re thinking heart attack or stroke. It gets such a negative connotation. But cholesterol actually plays a really important role in our overall health at proper levels and balanced with everything else that’s going on. So can you speak to a little bit, about the cholesterol roles and what people should be considering when the work cholesterol is said?
[22:01] Dr. Kaycie Rosen Grigel: Absolutely. Cholesterol is, as you say, so critical to our overall health and wellbeing. Cholesterol is indicated in cardiovascular health and we want it to be balanced, absolutely. But one of the keys I have people look for is if we did a total cholesterol count for instance, we want to make sure those HDL are nice and high. And if that, if the total cholesterol is getting down below 160, and you’re having symptoms of hormone issues, then we certainly look to that as a potential for needing to replenish cholesterol stores. And our body can synthesize cholesterol from starches, but we use it most optimally from animal products. So you know, it’s all about the balance, it’s all about your personal choices and what works for you.
[22:59] Cassy Price: Okay, so there’s therapy options and treatments available that aren’t directing assessing the hormone imbalance but can help with anxiety. So for example, one of those would be like animal therapy. It’s fairly well known that for lots of people cuddling their pets or playing with animals, it brings joy, puts a smile on their face. So is there a scientific explanation for this calming effect it provides and can it help to address the hormone imbalance that is at the base if they address it from a more topical level like that?
[23:30] Dr. Kaycie Rosen Grigel: Sure, so the way that I like to look at a lot of this, is we look at the autonomic nervous system. The autonomic nervous system the two part of what we would call our automatic nervous system, the part that helps us to rest and digest our food and to repair. Or the part that is more that fight or flight or that stress piece. Now when we’re in that fight or flight, in that sympathetic mode, it’s going to shut down all our rest and repair mechanisms. Fight or flight always wins. And when our brain perceives that we are in that sense of fight or flight, it’s not going to be as effective at appropriately making all our different hormones at the same time. All those hormones are made in our hypothalamus, in our brain, so they’re very effected by our thoughts and our moods. So, the more that we can engage our para-sympathetic side, you know, the more we can engage loving time, especially with snuggling a pet, you know there’s no better way to get the para-sympathetic working again.
[24:41] Cassy Price: So that would be sort of a similar effect that like therapies such as cognitive behavioural therapy would have, correct? Where you start addressing that negative self talk or negative thought loops that can occur, that would also be addressing that para-sympathetic system then?
[24:57] Dr. Kaycie Rosen Grigel: Yeah, I mean, ultimately our hormone production is governed by our hypothalamus, what we call the master gland in the brain, and so more we’re able to work though, rewire old thought patterns and introduce new healthy ones, the more we’re going to be able to theoretically balance the productions of our hormones.
[25:15] Cassy Price: Awesome. So if multiple hormones can contribute to the symptoms of anxiety, can this not sometimes result in a somewhat vicious cycle? So, just as an example, if your initial symptom was the result of low estrogen or testosterone and then cortisol takes over when you’re already feeling anxious, can that not kind of create you on a bit of a downward spiral?
[25:38] Dr. Kaycie Rosen Grigel: I mean yeah, as I mentioned earlier, all our hormones, they’re just one element in the big symphony and your brain is the conductor. So there has to be an overall balance for us to achieve optimal wellness. So that’s why I like to look at all the different hormone systems and when we’re talking about anxiety it can absolutely be self perpetuating and because it is definitely fed by these multiple systems. So, one example is when we experience chronic, unmitigated stress, our excitatory neurotransmitters like glutamate and epinephrine, they’re going all the time. And then that causes excess production of cortisol outside the boundaries of that normal circadian rhythm and then that disrupts sleep, and then that stresses the thyroid, and then when the thyroid production changes it disrupts the balance between estrogen and progesterone and yes, it all just kind of snowballs from there.
[26:27] Cassy Price: On that note, if someone wanted to work with you and they’re experiencing these symptoms, how would they go about getting in touch with you?
[26:39] Dr. Kaycie Rosen Grigel: So people are welcome to go to my website. I’m at goldenholisticmedicine.com and I’m always happy to book appointments with folks and I also run what’s called the, Women’s Hormone Health Master Class and that’s something where we meet once a month and each month we talk about new hormones and the way they impact our bodies. And we talk about all the ways we can really take charge and be empowered of our own health into menopause and beyond. So that’s also a really fun, fun group to be a part of.
[27:15] Cassy Price: Fantastic. Well thanks Kaycie, this has been an absolutely enlightening conversation and I really appreciate you taking the time to come and chat with me.
[27:23] Dr. Kaycie Rosen Grigel: Cassy, thank you so much for your time.
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