Part 2 of The Importance of Gut Health & Stool Tests During Hormone Therapy

How To Improve Gut Health To Improve Hormones 

For my patients with hormone imbalance and those taking hormone replacement therapy, stool testing is an important way to gather data to optimize hormone levels. 

In Part 1 of this series, I talked about why gut microbiome health and the estrobolome are vital to hormone balance. In today’s article, let’s keep the conversation going with details about stool testing and how to improve the gut microbiome. 

In today’s article, learn more about:

• Functional stool testing
• How to improve gut health 
• Gut healthy foods 
• Gut health supplements 
• Prebiotic vs probiotic

Stool Tests on Hormone Therapy Patients

Stool testing is an important consideration for women taking hormone therapy. If I am prescribing estrogen patches, creams, or oral doses, I want to be sure that my patient can detoxify and eliminate estrogen, so it doesn’t build up in the body.

Stool testing is an important consideration for women taking hormone therapy. If I am prescribing estrogen patches, creams, or oral doses, I want to be sure that my patient can detoxify and eliminate estrogen, so it doesn’t build up in the body.

Stool testing gives us clues about estrogen detoxification. There are many types of stool tests, but I typically choose one of the functional stool testing options that evaluate:

• Digestive health in terms of fat absorption and digestive enzyme production
• Types and amounts of beneficial bacteria as determined by DNA
• Pathogenic infections including bacteria, yeast, viruses, and parasites
• Markers of gut immunity 
• Gut inflammation 
• Blood in stool
• Beta glucuronidase to assess estrogen reabsorption and estrobolome health (see Part 1) (Add link)

Suppose there is a microbiome imbalance or gut health is compromised. In that case, we put together specific gut healing protocol for each patient, considering other lab work, symptoms, health history, and goals. The functional medicine approach is genuinely personalized and comprehensive! 

How To Improve Gut Health 

Here are some lifestyle tools I discuss with patients to improve microbiome and estrobolome health. Of course, there is a lot of room to personalize with supplements and other interventions too. 

Gut Healthy Foods 

Food feeds the microbiome and estrobolome. By adjusting what we eat, we can encourage the proliferation of more beneficial organisms, which help to crowd out less-desirable ones. 

Beneficial bacteria thrive on a plant-rich diet. Plants are rich in fiber and prebiotics that promote and maintain microbiome balance. 

Gut health foods are high fiber foods and include: 

• Berries – strawberries, blackberries, raspberries, currants, elderberries, and others
• Onions, garlic, and leeks
• Asparagus
• Artichokes
• Sunchokes
• Bananas
• Rice and potatoes that have been cooked and cooled
• Beans and lentils

Fermented foods are also an excellent choice to consume regularly. Through fermentation, sugars in the food metabolize into beneficial compounds, including B vitamins, and the food contains an abundance of live cultures of beneficial bacteria. These foods include:

• Sauerkraut, kimchi, and other fermented vegetables
• Kombucha (choose low-sugar varieties)
• Miso
• Natto
• Organic plain yogurt and coconut yogurt
• Apple cider vinegar

Food is a powerful medicine for hormone balance on other fronts too. Plant compounds that resemble estrogen are called phytoestrogens. Lignans are an example of a phytoestrogen. 

Phytoestrogens modulate estrogen effects in the body and can help relieve symptoms of estrogen imbalance. Including them in the diet may be supportive when working on hormone balance, especially through perimenopause and menopause. In addition, certain bacteria in the microbiome metabolize phytoestrogens.

Foods high in phytoestrogens that provide lignan benefits include: 

• Soy
• Flaxseeds
• Sesame seeds
• Other nuts, seeds, and legumes 

Gut Health Supplements

Recommended gut health supplements will vary depending on what is going on with each person’s gut health and microbiome based on stool tests and other assessments. 

Magnesium is an example of a simple supplement that is profoundly beneficial, and magnesium deficiency is quite common throughout the population. 

Magnesium supplements, especially at higher dosages, can help relax the muscles that line the GI tract and provide a gentle laxative effect. This benefit is particularly helpful for patients who tend toward constipation. When constipated, estrogen has a chance to reabsorb and recirculate in the body. Regular bowel movements are essential for estrogen detox!

When beta glucuronidase is high on a stool test, the estobolome is out of balance and estrogen that should be exiting the body via the stool is likely recirculating. In this case, calcium d-glucarate is a beta-glucuronidase inhibitor that can be taken as a supplement. This is a helpful intervention while working on other ways to restore estrobolome balance. 

These are just a couple of examples, but there is so much we can do from a functional medicine perspective! 

Prebiotics Vs Probiotics

The truth is that each of us needs probiotics (beneficial bacteria) and prebiotics (food to feed the beneficial bacteria) for gut health. We can get these by eating high fiber and fermented foods, as well as through targeted supplements. In fact, I often recommend a combination of both to my patients. 

If you are experiencing hormone imbalances or interested in using hormone replacement therapy, consider working with a functional medicine provider. Here at The Fork, we take a complete look and always consider the role that gut health plays in your symptoms. Want to learn more? Reach out today. 

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References

1. Holscher H. D. (2017). Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut microbes, 8(2), 172–184. 
2. Leeuwendaal, N. K., Stanton, C., O'Toole, P. W., & Beresford, T. P. (2022). Fermented Foods, Health and the Gut Microbiome. Nutrients, 14(7), 1527. 
3. Rodríguez-García, C., Sánchez-Quesada, C., Toledo, E., Delgado-Rodríguez, M., & Gaforio, J. J. (2019). Naturally Lignan-Rich Foods: A Dietary Tool for Health Promotion?. Molecules (Basel, Switzerland), 24(5), 917. 
4. Cady, N., Peterson, S. R., Freedman, S. N., & Mangalam, A. K. (2020). Beyond Metabolism: The Complex Interplay Between Dietary Phytoestrogens, Gut Bacteria, and Cells of Nervous and Immune Systems. Frontiers in neurology, 11, 150. 
5. Awolade, P., Cele, N., Kerru, N., Gummidi, L., Oluwakemi, E., & Singh, P. (2020). Therapeutic significance of β-glucuronidase activity and its inhibitors: A review. European journal of medicinal chemistry, 187, 111921. 

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