Cortisol face? Adrenal fatigue? Hormone balancing elimination diets?
Phew! Balancing hormones is the latest wellness trend on Tik Tok and Instagrams. If you’ve fallen down that rabbit hole, you might have come back up scratching your head wondering why you’re suddenly taking 6 different supplements and spending half your paycheck on specialty foods at the natural grocery store.
As a dietitian who works with various hormonal conditions, including PCOS, hashimotos, and hypothalamic amenorrhea, I’m used to fielding a lot of questions about hormones and diet. But over recent years, the things my clients have been hearing about hormonal health have been wackier and wackier. Hormone balancing is a certified trend and the wellness influencers aren’t going to miss out on a chance to make a buck!
Everyone (myself included) has done that thing where you google a few vague symptoms and after reading a few articles end up convinced that you have cancer or some rare, incurable disease. With the hormone health on social media, it’s the same. Symptoms like fatigue, digestive discomfort, difficulty sleeping, and weight changes can occur with thousands of health conditions, and sometimes are just a side effect of being a human being! But when the algorithm gets you, it’s easy to come away convinced that you have a hormonal condition – and that the solution is a strict diet to balance hormones.
What are hormones?
First, let’s talk about what the heck hormones are. Hormones are chemical substances that essentially act as messengers to help coordinate bodily functions. They have a wide range of functions, including regulating metabolism, reproduction, growth and development, mood and the stress response, sexual function, and the sleep cycle. In fact, there are over 50 different hormones, and many of them multitask with roles in different systems.
Hormones and the organs that secrete them make up the endocrine system. Within the endocrine system, there multiple “pathways” of communication. For example, the HPA axis is a pathway I talk about a lot with my clients. It’s a pathway of communication between the hypothalamus, pituitary gland and adrenal gland that has roles in regulating metabolism, digestion, reproduction, temperature regulation and more. Hormones that are secreted by the hypothalamus “communicate” to the pituitary gland, which releases more hormones that “communicate” to the adrenal glands. When there is a disruption in the HPA axis, it can have an impact on all the different systems and functions the HPA axis regulates.
Hormone disorders can be caused when there is either too much or too little of certain hormones. For example, diabetes is caused by too little insulin, and PCOS is caused by too many androgrens. This hormonal imbalance can be caused by many different things, everything from tumors on endocrine glands to autoimmune conditions to malnutrition, which we’ll talk more about in this post.
Examples of hormonal conditions include:
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hyper or hypothyroidism
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diabetes
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PCOS
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cushing syndrome
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hypothalamic amenorrhea
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graves disease
The best diet to balance hormones is eating enough food.
I’ve referenced some of the wackier hormone health wellness trends in this post, but even if you’re seeing a legitimate medical doctor to manage a hormonal condition, it’s not unusual to get restrictive diet advice. Whether it’s cutting carbs, eliminating gluten, or my personal fave, the “just lose weight!”, theres a lot of pressure to restrict intake. In most cases, restrictive diet advice isn’t warranted – many times doctors, who have limited education on nutrition, are regurgitating the same misinformation you’re being fed on social media. This unhelpful and inaccurate advice can cause a lot of harm, not just to your relationship with food, but the hormonal condition itself!
That said, occasionally advice to cut something out or go on an elimination diet may be helpful. For example, there’s a lot of overlap between hashimotos and celiac disease, and when someone has undiagnosed celiac and goes on a gluten free diet, they’re definitely going to notice an improvement in their symptoms. Or if someone is integrating more physical activity and eating a little healthier in their attempt to lose weight, they might notice an improvement in blood sugar levels as a result. I’d argue that improvement is likely a result of behavior changes rather than the weight loss, but’s another post! There are endless nuances to health, so if you have benefited from an elimination diet or intentional weight loss, I am genuinely glad you found something helpful for you.
Where I get really concerned is when diet advice to “balance hormones” leads one to eat less than what their body needs*. This is where real harm is done.
*When I say less than what your body needs, I don’t necessarily mean weight loss (although than can be a side effect) or an eating disorder. Eating less than what your body needs means taking in less calories (i.e. energy) than what your body needs for all of it’s bodily functions and physical activity. Also, this amount is probably a lot more than what you think!
How undereating hurts hormonal health
One factoid I like to remind my clients is that hormones are made from amino acids (proteins) and lipids (fats). When you’re not eating enough, there’s a shortage of the building blocks needed to make hormones. This is one of the reasons why hormonal conditions are so common among people struggling with eating disorders.
Another way hormonal health is impacted by undereating is through metabolic suppression. Bodies respond to inadequate intake by lowering metabolic rate to conserve energy. Most people hear that and think lowered metabolic rate = weight gain. While that can be a side effect, I want you to think beyond the potential impact on the scale and consider what it means for your body to lower it’s metabolic rate. It means your body is slowing down on bodily functions, starting with things that are less immediately essential. Think reproduction, regulating body temperature, and building/strengthening bones.
If you’re not eating enough calories or of a specific macronutrient, it’s also unlikely you’re meeting your needs for essential vitamins and minerals. Deficiencies in nutrients like vitamin D, iodine, B12, and essential fatty acids can play a role in hormonal conditions. Please note if you have a hormonal condition, that’s not me telling you to go out and take megadoses of any of those nutrients – some supplements may be beneficial, especially if you have a deficiency, but it’s important to get guidance with that from a medical professional.
Lastly, dieting, disordered eating and restriction is a huge stressor, both physiologically and psychologically. The stress of malnutrition activates the stress response (which is regulated by hormones), and so does the psychological stress of constantly thinking and stressing about food!
Over the years it’s been really cool to see how simply supporting clients in eating enough food can have a such a huge impact on their hormonal health. I’ve had clients get their period back after years of amenorrhea in just a couple weeks after adding some fat back into their diet (it’s not always that easy but very cool when it is!). I’ve had clients who have had to constantly change their thyroid medications due to fluctuating labs finally get some stability. And I’ve had clients who have seen huge improvement in PCOS symptoms from eating enough food after years of being told to diet and lose weight.
I’ll also add that many times clients come to me suspecting a hormonal condition (or having been told they have one by an alternative provider) and following all sorts of restrictive diet advice to balance their hormones. Through our work together, we often find out that they don’t actually have a hormonal condition – they’re just undereating. Fatigue, poor digestion, hair loss, moodiness, difficulty sleeping, and skin issues can be side effects of hormonal conditions, but they’re also side effects of malnutrition!
How can I improve hormonal health with food?
That is a much more involved question than I can answer in a single blog post, as there are different hormonal conditions that can benefit from different nutrition interventions. Even for the same condition, it’s important to take an individualized approach. What’s helpful for one person may be harmful to another!
That said, the foundation of nutrition treatment for all hormonal conditions is eating enough food. That means getting enough calories (i.e. energy), carbohydrates, fats, and proteins, and eating a variety of foods to help ensure adequate intake of micronutrients. For most people, that involves a mental shift away from trying to eat as little as possible and towards adequacy (see my hierarchy of nutrition needs for more on that).
I should also add that medication is often a huge part of treating hormonal conditions. In many situations it is essential and much more effective than nutrition. People often want to treat hormonal conditions with nutrition over medication, and while that is certainly a valid decision to make, it’s worth getting curious about why. Are you feeling shame over taking a medication, like you “should” be able to manage it with food? Or is it a considered choice made after reviewing potential risks, benefits, and your own personal values and lifestyle?
If you’re struggling with a hormonal condition and looking for flexible, non-diet support to manage your symptoms, reach out! Depending on where you live, we may be able to work with you virtually. Explore our practice philosophy and services page to learn more, or check out this database for intuitive eating dietitians in your area.
